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The Continuing Retirement Community—the not so easy convenience of one-stop retirement

August 28, 2009 By Leave a Comment
The Man Fut Tong Nursing Home in Singapore was...
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by Rose Broyles

Continuing retirement communities are meant to make the transition easier for seniors who want to keep their independence, yet have the safety and security of knowing that if they need help in the future it is readily available.  It’s a one-stop-shop. You move there and live the rest of your days there.

Most of the time, only those with a sufficient amount of assets can move into these type of communities. After all, we all know how expensive long-term care can be. However, even those who can afford to move to these type of communities aren’t guaranteed 100% worry-free care.

The Stages

  • Mom and Dad decide that the house too big, the children and grand-children live too far and they want something different so they move to ABC Retirement Community.

  • They live in a single-story bungalow half the size of their former house. It is equipped with emergency cords to pull, weekly housekeeping, their own garage, and golf down the way. There is a huge dining hall where they can enjoy all of their meals in the company of friends and other neighbors. They also have the option of staying home and dining in.  In the community center, there are a calendar of events and classes that they can take: salsa, yoga for seniors, arts and crafts, chess, news and events discussion.

  • Mom or Dad start to find it difficult to get things done. They become forgetful, start having “accidents” and have problems toileting. They might start to wander off, or Mom breaks her hip and is unable to leave the house. They move to assisted living so that the caregivers there can keep a closer watch on Mom. Dad doesn’t really need to be there, but he doesn’t want to be separated from her. For about the same cost or a little more for what they were paying for the single-story house, they are now both living in a 1-bedroom condo on-campus.

  • Mom starts to get worse and it is determined that she has been diagnosed with Parkinson’s and Alzheimers.  The staff determines that she needs to be moved into the locked Alzheimer’s wing on the other side of the building for her safety and for the residents. Dad can go visit her still but they will no longer be in the same room. They still have activities for them to do together in her part of the wing. Dad can also do his own activities on his side.

  • Mom is no longer able to walk and is not eating, so she moves to skilled nursing on the other side of campus where she is given IV fluids to sustain her health. Dad is left behind in assisted living. With the assistance of staff, he takes the campus shuttle to go visit her every couple of days because he is having a hard time getting around as much.

Now this is a fictional scenario, but one typical of what it would be like to live in a  continuing retirement community. Mom and Dad may live the rest of their days in the house they started off with when moving there, or any of the above-mentioned events can occur. However, instead of a dramatic and costly move, everything was paid in advance to prepare for the possible scenarios. Residents pay a down payment and as more services are needed, they just simply pay the higher fee instead of starting all over again.

Downfalls of transition

Given what I described above, you would think that things run smoothly. Unfortunately, (and this depends on how big the community is) things aren’t so cut and dry. For instance, Josie’s mother-in-law lives in one of these communities. The campus is  very large like that of a small university. There is a gate guard in front, apartments, assisted living, single-story houses, a hospital and community center with golf nearby. It’s a place a younger person wouldn’t mind living in. But that is where the downfall is: the size.

Her mother-in-law recently started wandering off and becoming forgetful. She lives by herself in the house she shared with her husband who passed away 3 years ago. With limited staff and I’m assuming what would be a costly move, there is no way that a community of that size can keep an eye on all of their independent residents. How could they determine when it was time for those residents to transition to the next step? Realistically, they can’t and that’s the problem. So what do you do? You can hire an independent geriatric manager to handle all of their affairs. You can hire someone to do a wellness check or pay extra for the facility. If money is a problem then you will have to make sure to keep an eye on things. What was the point of them moving then if you end up having to handle everything anyway? I know it can be frustrating, but unless the community is extremely well staffed and organized, it’s a fact of life.  Hopefully, you and your parents discuss plans for different transitions in life and you’ll be ready to spring into action once something happens no matter if they are at home or at a retirement community.

For more information, read our free-guide to housing located on the menu on the right to find out more about different housing options.

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Scabies, more than just an annoying itch

August 26, 2009 By Leave a Comment
A microscopic mite Lorryia formosa.
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by Rose Broyles

A few weeks ago, Josie went to visit her mother-in-law in the Bay Area. Betty had this terrible rash on her skin. It was so scaly and inflamed that it caused some worry. So, Josie took her into the on-campus doctor at the retirement community she lives in. The doctor suspected scabies. This was odd, because how on earth could she have gotten scabies? She lives in her own home and not in an institutional setting where she is sharing space with others.

What is Scabies?

Scabies is an itchy skin condition caused by an infestation of  mites called Sarcoptes scabiei. They are 8-legged parasites naked to the human eye,  that burrow into the skin  to produce intense itching.

Causes of Scabies

Scabies mites can only live about a day off the body, so in order for an infestation to occur there must be close skin-to-skin contact. It is almost impossible to get scabies by shaking someone’s hand or sharing coats or sharing a blanket that had mites in it. Many times scabies is contracted  through sexual contact. Hugging someone might be a possible cause.

Scabies can be misdiagnosed because  the beginning symptoms may resemble other skin conditions: pimples, light rash, etc. In some cases, no symptoms are present until weeks later. If left untreated, the person may develop a secondary bacterial infection especially if they are scratching so much that they break skin.

Symptoms of Scabies

The person affected can feel no symptoms for a couple of months before they start to feel the itch. At first, the itch might be more or less of a nuisance. However, as time goes by, the itching gets worse and to a point where it becomes difficult to sleep. What sets it apart from other skin conditions such as eczema is that it is so bad there is never a break. With eczema, symptoms may come and go; with scabies, the symptoms seem to get worse.

Treatment

Unfortunately, there are no over-the-counter drugs as what is available for lice. However, if you get a prescription from a doctor it’s easy to cure the problem.

  1. Permethrin (Elimite) cream. These creams are left on overnight, then washed off. This application is usually repeated in one week. Permethrin is approved for use in people 2 months of age and older
  2. Ivermectin, an oral medication, is an antiparasitic medication that has also been shown to be effective, it is not FDA-approved for this use. The CDC recommends taking this drug at a dosage of 200 micrograms per kilogram body weight as a single dose, followed by a repeat dose two weeks later. It is typically used only when topical medications have failed or when the patient cannot tolerate them.
  3. Crotamiton lotion 10% and cream 10% (Eurax, Crotan) is a another drug that has been approved for the treatment of scabies in adults but not children. It is not as effective as other methods.
  4. Antihistamines, such as diphenhydramine (Benadryl), can be useful in helping provide relief from itching. Maybe try Calamine lotion (the kind used for chicken pox)
  5. Wash linens and bedclothes in hot water. Because mites don’t live long away from the body, it is not necessary to dry-clean the whole wardrobe, spray furniture and rugs, and so forth.
  6. Treat sexual contacts or relevant family members who may have been affected
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Filed Under: Disease info, General Tagged With: , , ,

Medicare’s Coverage Gap: Seniors and families feeling a big bite in costs

August 24, 2009 By Leave a Comment
Pharmacy Rx symbol
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by Rose Broyles

This is the predicament we are currently in. In fact, I just had to make a call to my dad’s doctor today to see if there is a lower cost alternative to Advair, the drug my dad needs to control the symptoms of his COPD and asthma. But before I get into all of that, what exactly am I talking about?

What is the Medicare Coverage Gap?

There was a story showcased on CBS Evening News regarding the Medicare Coverage Gap or “Doughnut Hole” back in 2006. Unfortunately, nothing has changed to alleviate the problem of Medicare Coverage Gaps.



Watch CBS Videos Online

While the debate rages on in this country about how much the government needs to get involved in healthcare, people like my dad are seeing their only means of living depleted by high prescription costs. You see, my dad reached the threshold for the amount that Medicare will pay for his medicines. He does have Secure Horizons but they have already paid out their share and so Dad is responsible for the rest of his. At least, this is what the representative told me on the phone. Health insurance is so confusing!

Regardless, what was $30.00 for Advair is now $200.00. This price is for one medicine! Don’t forget, we also have all of Mom’s prescriptions, some of which cost around the same price without additional help from insurance.

Options to Consider

While I wait for Dad’s doc to get back to me on other generic alternatives, I’m trying to find other ways for us to afford these medications until January when everything resets and Medicare covers everything again. Medicare Interactive has a list of suggestions to follow if you fall into the “doughnut hole” . You can read more about the details of each, but I will summarize the suggestions below.

  1. Ask your doctor
  2. If you have extra help, find out about a mail order option.
  3. Request that your loved one’s  plan put your drug in a lower “cost tier” . This will require a formal request from the primary care doctor. Ask them to put your loved one’s plan and ask for an “exception” to the formulary.
  4. Some pharmacies and hospitals will waive copays for people with low incomes
  5. Some states offer pharmaceutical assistance programs that help their members pay the out-of-pocket costs of a Medicare private drug plan.
  6. Some charities may pay a portion or the full cost of your Medicare prescription copays.
  7. Catastrophic coverage.
  8. Some pharmaceutical companies have Patient Assistance Programs (PAPs) that offer low-cost or free drugs to people with low incomes.
  9. Lower price at the pharmacy.
  10. Prescription drug discount programs. You can try a place like http://www.needymeds.org/drugcard/index.shtml to see if you can get big discounts on prescriptions.

***I’m going to add another suggestion here which we in fact, are going to try if his doctor can’t give us a good generic that’s affordable. We’re going to ask him if it would be ok for us to order from Canada and get a prescription. Canada follows a very strict quality control of medicines in the same way that the FDA does for us.

Therefore, their drugs are of high quality and safe to use. Advair is on sale for $249 for a 3 discus pack as opposed to around the same price at CVS for one.

This is also the actual brand name. So, this sounds like a great deal. There are of course, a ton of other drugs available of up to 80% cheaper than the drugs you will find here. Now, not to say that we couldn’t just drive across the border to Mexico to get prescriptions (I know some people who do) but I feel more comfortable ordering from Canada because of their stringent standards.  Now be careful of just ordering from any online pharmacy that claims to be Canadian. You have to make sure they are the real deal. Since we are partnered with Canada Pharmacy.com and will be ordering from them ourselves, they are verified by pharmacychecker.com and certified by the Canadian International Pharmacy Association . The seal itself isn’t a guarantor of authenticity so you should directly go to CIPA’s website and manually enter the pharmacy name in their search box.

So, as another challenge presents itself to us, Dad has to forgo this important medication for a couple of days while we figure things out. What happens though to the millions of other seniors who do not have family to help them? This is where I feel people should put their politics aside and at least, regardless if we have a nationalized healthcare system or not, consider the most vulnerable of our nation–seniors and children. They should be attended to, if not everyone else. This is a prime example of why our healthcare system needs serious reform.

**Update: Later today we got a call from Dad’s doctor’s office. Tomorrow we will have to pick up samples! So there you have it, it was option 1 from above! This is only a temporary fix so I still have to see what else we can do. It looks like we will end up getting some meds through Canada.


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