Preparing and Planning for the

Aging� Gracefully

As life expectancy is going up, we will see several seniors over the age of 90 or even 100 years. Planning for this group, majority of whom are not working actively and not financially productive is a big challenge. We need to address the followings:

LIST OF THINGS TO CONSIDER

• Healthcare issues, including record keeping, “Advanced Directives” and Comfort Care Palliative/ Hospice Care.
• Financial issues.
• Activities of Daily Living.
• Use of Technology, including “Medical Alert Systems.”
• Falls prevention.
• Decision about “Aging at Home” versus “Independent/Assisted Living.”

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• List if things to CONSIDER:

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• Know about Skilled Nursing Care, Rehab. Care, Nursing homes.
• Know about Memory Care, Palliative care &Hospice Care.
• Housing options: Assisted Living and Independent Living, and Cluster Homes.
• Legal issues including “Estate Planning.”
• Funeral Planning.
• Documents needed after Death. ( see attached list)
• Legacy

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Healthcare

• Health insurances: Medicare, Medicaid, Private insurance. Learn about deductible, co-pay.
• Personal Medical Records. Electronic records on smartphones. Several Apps. available
• Medications. Learn about adverse reactions. Organizing using “Pill boxes” and “Pillpack.com.” This prevents forgetting and avoid double dosing.
• Completing “Advances Directives” and updating periodically. Appoint “Healthcare Power of Attorney.”
• Understanding “Palliative Care” and “Hospice Care.”
• “Euthanasia” and “Physicians’ Assisted Suicide.”
• Remember terms like “Vegetative state”, CPR, DNR, Endotracheal tubes, PEG.

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Useful Technologies

• Several available for both Seniors as well as for Caregivers.
• Computer programs for poor eye sights and impaired hearing. Affordable internet services both for education and entertainments.
• Interactions and Communications: Smartphones helpful in several different ways. Keeping in touch with friends and families, social media, texting.
• Video Phones calls like Facetime ,Skype and also Virtual zoom presentations
• Safety and Security: Several “Medical Alert Systems” are available. Also GPS tracking. New Apple watch has “Fall Detection.”
• Assistive Technology Devices (ATD). �-- Stairlifts.�-- Power wheelchairs and Scooters.�-- Bed and Chair “Fallguard” protect from falls. Also transfer accessories like slings and sliding boards.

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• Records Keeping- besides Medical Records�Ideally best kept electronically on a computer and updated regularly. Keep your spouse and children informed and let them know the password.
• Contact information of the following people:�-- Your Attorney and Accountant.�-- Your Banker and Investment Broker.�-- Your Physicians-include all.�-- Insurance agents of all insurances.�-- Utilities companies, Electric, Gas and Water.�-- Yard worker and Landscaping companies.�-- At least four close friends.�-- Home security companies.
• Financial and Estate Planning documents.
• Title of your House and Rental properties.
• Copies of “Advanced Directives.”

SOME DEFINITIONS :

• ADVANCE DIRECTIVES/ADVANCE CARE PLANS. Has two parts i.e. Living will and health care power of attorney.
• WITH HOLDING OR REFUSING “Life-Support treatment” or “Life-Sustaining treatment” or “Life-Prolonging treatment”.
• WITHDRAWING LIFE-SUPPORT TREATMENT i.e. Pulling the plug.
• CPR (Cardio-pulmonary resuscitation). Has two parts i,.e. Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS)/

MORE DEFINITIONS:

• DNR (Do Not Resuscitate)
• POST (Physician Order for Scope of Treatment. It addresses more than DNR. It addresses comfort level, IVs/ Nutrition and antibiotics.
• PERSISTENT VEGETATIVE STATE : It is eye open permanent unconsciousness.
• BRAIN DEATH.

Comfort Care: I. Palliative Care.� II. Hospice Care.

• Palliative Care: It is a compassionate comfort care that provides relief from the symptoms and physical and mental stress of a serious or life-limiting illness. It is available at any stage of patient's illness. It is appropriate for illnesses causing long-term pain and discomfort. Palliative care can be pursued at diagnosis, during curative treatment and follow-up, and at the end of life. Palliative care Physicians work along with the regular Physician and is covered by health insurance.

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Hospice Care

• Hospice Care: is compassionate comfort care (as opposed to curative care) for people facing a terminal illness with a prognosis of six months or less, based on their physician’s estimate if the disease runs its course as expected. It can be offered at home or there are specialty hospitals or special wards just for Hospice patients. It is also covered by health insurances.

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Activities of Daily Living ( ADL)

• Basic ADLs consist of self-care tasks that include
• Bathing and showering
• Personal hygiene and grooming (including brushing/combing/styling hair)
• Dressing
• Toilet hygiene (getting to the toilet, cleaning oneself, and getting back up)
• Functional mobility, often referred to as "transferring", as measured by the ability to walk, get in and out of bed, and get into and out of a chair; the broader definition (moving from one place to another while performing activities) is useful for people with different physical abilities who are still able to get around independently.
• Self-feeding (not including cooking or chewing and swallowing)
• Basic ADLs include the things many people do when they get up in the morning and get ready to go out of the house: get out of bed, go to the toilet, bathe, dress, groom, and eat.

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Cognitive Impairment

ou forget things more often.

• You Our brain, like rest of the body, changes as we grow older. Many people notice gradual increasing forgetfulness as we age. It may take longer to think of a word or to recall a person’s name. But consistent or increasing concern about your mental performance may suggest mild cognitive impairment (MCI). Cognitive issues may go beyond what is expected and indicate possible MCI if you experience any or all of the following:
• forget important events such as appYOOUROOOorget things more often.
• You forget important events such as appointments or social engagements.
• You lose your train of thought or the thread of conversations, books or movies.
• You feel increasingly overwhelmed by making decisions, planning steps to accomplish a task or understanding instructions. tment social engagements.
• You lose your train of thought or the thread of conversations, books or movies.
• You feel increasingly overwhelmed by making decisions, planning steps to accomplish a task or understanding instructions.

Mild Cognitive Impairment (MCI)

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• You forget things more often.
• You forget important events such as appointments or social engagements.
• You lose your train of thought or the thread of conversations, books or movies.
• You feel increasingly overwhelmed by making decisions, planning steps to accomplish a task or understanding instructions.

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Cognitive Impairment (contd)

• You start to have trouble finding your way around familiar environments.
• You become more impulsive or show increasingly poor judgment.
• Your family and friends notice any of these changes.

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If you have MCI, you may also experience:

• Depression
• Irritability and aggression
• Anxiety
• Apathy

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Falls are the leading cause of injuries to Seniors.

• Falls are the leading cause of fatal and non-fatal injuries for older Americans. Falls threaten seniors’ safety and independence and generate enormous economic and personal costs.

According to the U.S. Centers for Disease Control and Prevention:

• • One in four Americans aged 65+ falls each year.
• • Every 11 seconds, an older adult is treated in the emergency room for a fall; every 19 minutes, an older adult die from a fall.
• • Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions among older adults.

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“Falls” contd.

• Falls result in more than 2.8 million injuries treated in emergency departments annually, including over 800,000 hospitalizations and more than 27,000 deaths.
• • In 2015, the total cost of fall injuries was $50 billion. Medicare and Medicaid shouldered 75% of these costs.
• • The financial toll for older adult falls is expected to increase as the population ages and may reach $67.7 billion by 2020.
• Falls, with or without injury, also carry a heavy quality of life impact. A growing number of older adults fear falling and, as a result, limit their activities and social engagements. This can result in further physical decline, depression, social isolation, and feelings of helplessness.

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Medical Alert Systems

• Medical alert systems act as vital life-saving tools. In the case of an accident, fall, or sudden illness at home, these systems are particularly valuable. Help can be alerted, and assistance on the way, in less than one minute.
• The four key benefits of a medical alert system include:
• Help When You Need It: Medical alert systems are monitored 24 hours a day, seven days a week. They will alert ambulance, police, or fire personnel within moments..
• Ease of Use. These systems are specifically designed to be easy to use. They are typically worn on the wrist or around the neck,and open a two-way communication channel with the push of a button.. There is no need to reach for a phone, remember numbers to dial or even press more than one button.
• Peace of Mind: According to a study published in Age and Aging. Knowing that help is available if something happens can offer great peace of mind, both for seniors and for their families.

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Medical Alert Systems

• Medical alert systems are far more than just a communication device. For seniors, they are a link to the help they may need when they need it most. With the confidence gained from knowing help is available, and possibly some extra support services offered through the systems, many seniors are able to remain in their own homes longer.

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Documents needed after Death?

• Copies or originals of the following documents will be needed:
• Account Statements - Including bank accounts, brokerage accounts, and retirement accounts (IRAs, 401(k)s and annuities) for at least a few months prior to death.
• Life Insurance Policies - Note that for some older policies the insurance company will require the return of the original policy.
• Beneficiary Designations - For life insurance, retirement accounts, payable on death accounts and transfer on death accounts.
• Deeds for Real Estate - There is a common misconception that the original deed is needed, but a copy is fine.
• Automobile and Boat Titles - The original titles will be required to transfer legal title.
• Stock and Bond Certificates - For stocks or bonds held in certificate form, the original certificate will be required to transfer legal title.
• BillsCopies of the following bills will be needed:
• Utility Bills
• Cell Phone Bills
• Credit Card Bills
• Mortgages and Personal Loans - including lines of credit
• Real Estate Tax Bills
• Storage Unit Bills
• Medical Bills and Funeral Bill

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Documents needed after Death

• Estate Planning Documents
• If the decedent had an estate plan, then copies or originals of the following documents will be needed:
• Last Will and Testament and Codicil(s) - The originalwill and codicils will be required because if an original cannot be found, then it is presumed the decedent destroyed them.
• Revocable Living Trust and Amendment(s) - Usually a copy of the trust or amendment is all that is required.
• Tax Returns
• Copies of the following tax returns will be needed:
• Income Tax Returns - federal and state for the past three years
• Gift Tax Returns - federal and state
• Death Certificates
• Multiple, original death certificates will be required to settle the decedent's final affairs. Order minimum of ten.
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Additional References:

• Aging_well_guideFidelity
• www.aplaceformom.com
• www.aarp.org

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