In part 1 of this series on the disposal of adult diapers, I discussed what materials—and how much of those materials—are ending up in the landfill via used adult disposable diapers. In this post, I want to examine the disposal and potential compostability of these used diapers, pads, underpads, liners and other incontinence products.

For most incontinence product users, the process of disposing of adult diapers is the same as it is for those disposing of children’s diapers; most national waste management companies allow consumers to simply put used diapers into the waste stream along with other garbage (check with your local waste management company to be sure they do not have some special requirements). Given the numbers I mentioned in my last post, that’s a lot of dirty diapers. However, if there is one bit of good news here, it is this: viruses contained in human feces have not yet shown any danger to waste collection workers based on current collection methods.

These diapers are thrown away for one major reason: it is ?the norm.? To date, there are no truly compostable diapers available on the market, although the technology to make such diapers does exist. In my opinion, the technology can—and will—only work if government regulation requires diaper manufacturers to produce such products. Why? Simply put, even if all of the non-compostable products (e.g., petrochemical plastics, glue, tapes, etc.) in adult diapers were replaced by compostable materials, waste management companies would have to be assured that each and every diaper entering the waste stream was completely compostable, and free of non-biodegradable materials. Moreover, the process for full compostablility will only work if there is 100% compliance by all manufacturers to produce a diaper that is 100% compostable. Otherwise it will be nearly impossible for waste management companies to process this stream of dirty diapers.

As consumers, all that we can do for now is to encourage our federal, state and local governments to recognize the amount of non-compostable trash being generated by the users of adult disposable diapers and to propose proactive solutions. The industry knows of the technology to completely eliminate this issue. However, as I’ve stated before, I am no expert on this matter and welcome all comments from readers, informed individuals and bona fide experts.

Next time I’ll tackle how incontinent product users can help the environment, reduce the carbon footprint left by disposable diapers, and save money at the same time.

Your Partner in Comfort,

Gary

Reverse mortgages understandably have their fair share of both advocates and critics. A financial tool to help seniors pay for home improvements, stay in their home, and increase their standard of living, the downside of reverse mortgages is that the cost can be high. I recently met with a family who asked me to help them talk with their aging parent about moving. The senior and her adult children shared with me their concerns about why they thought it was a good time for her to move. The mom—let’s call her Susan—recognized she needed some help with preparing meals and housekeeping, but really wanted to stay at home. The challenge was finding the money and the services to help Susan stay home for as long as possible, and in a way that would meet her daily needs and give her family some peace of mind, knowing that she would be safe. This gave us the opportunity to talk about reverse mortgages.

First, to be eligible, you must be over sixty-two years of age, own your home, and be living in it as your primary residence. The amount you are eligible for depends on your age, interest rates and the value of your home. Most reverse mortgages are set up so the home owner can receive monthly payments.

Advantages

• The reverse mortgage can be set up as a monthly payment, line of credit or a lump sum—whatever works best for the senior.
• No matter how the reverse mortgage is set up, the home owner does not make any monthly payments.
• No monthly payment is due from the home owner unless he or she dies, moves or sells the home. At that time the loan is due in full, plus interest and fees.
• The home owner can receive monthly income from a reverse mortgage as long as he or she lives in the home as a primary residence. A home owner could potentially continue to receive monthly payments even after the loan balance is higher than the amount that the house is worth.
• Neither the home owner nor his or her heirs will ever owe more than the home is worth, no matter how many payments are received or how high the interest rates become.
• It’s fairly easy to qualify for this loan since credit scores and income are not part of the qualification process.

Disadvantages

• The closing costs are high. The senior must pay origination fees that are about double what they are for conventional mortgages and mortgage insurance. The interest rates are adjustable.
• For seniors who depend on Medicaid or other state or federal programs, it’s important to consider if reverse mortgage payments will affect their eligibility.
• The senior is required to attend counseling by an independent HUD counselor prior to receiving a reverse mortgage. These are complex loans and this is a measure of consumer protection.

Possible Alternatives

• A line of equity may be an alternative. There are fewer fees, and the money is available on an as-needed basis, but it requires monthly payments.
• Refinancing the home with a conventional mortgage may save mortgage insurance fees that a reverse mortgage would require. However, this too requires monthly payments.

As a potential consumer of any financial tool, be cautious and seek out accurate information before making a decision. If you are looking for information on reverse mortgages, I suggest you talk with a HUD counselor or someone impartial. Reverse mortgage officers may be prone to selling only the advantages since they get paid when you take out a reverse mortgage. Real estate agents may be prone to selling only the disadvantages of them, as they get paid when you sell your home. Your best bet is to find an impartial advisor such as a financial planner (whose brokerage doesn’t sell reverse mortgages), an elder law attorney or a certified reverse mortgage counselor, all of whom will be able to share practical information to help you make your decision.

Here are a few links of interest to help you get started:

Reverse Mortgage Calculator

Find a HUD Counselor

Find a HUD-Approved Reverse Mortgage Lender

Affordability is a key ingredient in any successful long-term care plan. That is why the premium cost is often the most important factor to consumers who are considering the purchase of LTCI.

“Will My Premiums Ever Increase?”

One of the most common questions I hear is: “Will my premiums ever increase?” The answer is this: there are a couple of scenarios in which LTCI premiums could increase. I will try to explain one in this article and follow up with the second in a future article.

The first scenario involves a choice the policyholder makes regarding inflation protection. Most LTCI policies have automatic inflation protection built into the policy design from the beginning; in such cases the premium is designed to stay level for the life of the policyholder. The benefits increase each year, but the premium remains the same.

Inflation Protection: What You Need to Know

Some insurance carriers offer a different kind of inflation in which the policyholder starts out with no automatic inflation protection; instead, benefit increases would be offered every three years or so. These increases can usually be accepted or declined by the policyholder. This means that your premium would increase every three years for the rest of your life or until you start receiving policy benefits.

The problem with this inflation protection choice is that the policyholder is three years older when each offer of extra benefits is made. The cost of the added benefits is based on the later age, not on the age of the policyholder at the inception of the policy. This can result in a significant increase in premiums in later years. Some consumers simply drop these policies after a while, as they just can?t afford to continue paying premiums that are so much higher than the cost of the original premium.

Long-term Effects of Premium Increases

Group policies often offer this kind of inflation protection to stay competitive with individual LTCI policies. Before finalizing their decision, it is very important for consumers to understand the long-term effects that these premium increases can have. Unfortunately, I see many policyholders who did not understand the ramifications of this kind of inflation protection when they purchased their policy. They sometimes find themselves locked into a policy that is constantly increasing in price and have few options for switching to a more affordable LTCI product due to their age and/or health circumstances.

It is true that automatic inflation protection increases that are built into the premium cost from the inception of the policy will initially be more expensive than a periodic increase offer. But in my opinion, in most circumstances, it is better to lock in your inflation protection costs at an early age, and know that your premiums will remain stable, than take the chance on an ever-increasing premium that may eventually be too much to afford.

Until next time…Duane

Read more about long-term care insurance (LTCI).

I believe activities are crucial to well-being. In the past ten years, research has shown that activities play a large part in preventing the progression of dementia. We also know that socializing prevents loneliness, despair and suicidal thoughts.

For several years I led recreational activities on weekends at a geri-psych hospital. The activities that took place on any particular weekend greatly depended on the patients in the unit at that time. All of the patients there had dementia and behavior disorders that precluded their being able to remain at home until the behavior had been extinguished. Most patients were on the unit between three to four weeks, while the doctors changed their drugs or the dosages. Some were more alert; others were more physically functional. Some returned home; others returned to a nursing home or entered a long-term care facility for the first time after discharge.

There are many activities that are appropriate for people with dementia. The only guideline is to not degrade them by having them do children’s activities. Instead, show your respect by engaging them in pastimes that are similar to children’s activities but suitable for an adult, retaining whatever qualities that make the activity fun. Here are some suggestions for caregivers who have a dementia patient at home.

Puzzles & Games

Try:

• Easy crosswords and word searches that use large type.
• Jigsaw puzzles with very large pieces. The images shouldn’t be child-oriented; try scenery or pictures of animals instead. Floor puzzles are good because they typically have large pieces, and there aren’t too many, which can be discouraging. Work on these on a table so you don’t have to struggle getting off the floor!
• Old favorites like dominoes, card games such as “Go Fish” or “Old Maid” and board games like Candyland and Pollyanna.
• Reminiscing, a board game available through SeniorStore.com, which prompts memories of assorted events and fads from 1939 on.

Photo & Scrapbooking Activities

• Sort photos by topic, subject, type or date. Mix them up after you finish so they can be sorted in a different way next time.
• Assemble a photo collage. Pasting can be fun.
• Make a scrapbook, pasting photos onto the pages and writing notes about the memory beside the photo. You can also use a photo album with plastic sleeves.
• Label old family photos so you’ll have that information later on.
• Reminisce about the focus of the photo.

Housework

• Rake leaves.
• Fold towels.
• Clean windows.
• Cut coupons.

Gardening Activities

• Pull weeds.
• Plant annuals in spring and bulbs in the fall.
• Transplant small plants into larger pots. Have the patient paint pots ahead of time and use these for gifts.

Seasonal Decorating

• String cranberries or popcorn.
• Make door wreaths and window decorations.
• Put up decorations and take them down.

Activities Involving Humor

• Watch or listen to comedy TV shows, movies and old radio shows like “Who’s on first” (Abbott and Costello) and “I Love Lucy.”
• Start a humor notebook or scrapbook.
• Laugh over funny family memories (like the time Mom put frozen rolls on the Thanksgiving table).

Sorting & Organizing Activities

Sort or organize:

• Nails, screws and other hardware.
• Nail polish and lipsticks, sorting by color, brand or on a scale of 1–10, in order of preference.
• Buttons, using muffin tins to sort by color, size or style.
• Coins, according to date, value or place of origin.
• The pantry, arranging cans and jars by size, brand or contents.
• The silverware drawer, rearranging the order of the forks, spoons and knives.
• Playing cards into decks that match, or into suits within a deck, or by numbers. Tupperware by size or color.
• M&Ms, using muffin tins to sort them by color. Choose one color to eat!

Cooking & Activities in the Kitchen

• Make salads, ice cream, Jell-O, pudding (try a hand mixer), no-bake cookies and pies, popcorn balls and other simple recipes.
• Wash fresh produce and put it into bags.
• Grind nuts to use for baking.
• Peel vegetables.
• Copy recipes from magazines onto cards.
• Make a grocery list of items needed for recipes.
• Sort recipes and find pictures to illustrate them.
• Empty the dishwasher (use melamine or plastic dinnerware).
• Set the table.
• Fold or roll silverware into napkins.
• Assemble shish-kabobs with fruit or vegetables (use wooden ones with blunt ends).
• Shell nuts or peas.

Reading Activities

Read out loud or simply look through books and magazines that can lead to discussions. Try:

• Reminisce Magazine.
• Picture books like Bradley Trevor Greive’s The Blue Day Book and Shel Silverstein’s A Light in the Attic and The Giving Tree.
• Old copies of Look or Life magazines.
• The Bible or Bible stories.
• Short story collections, such as Chicken Soup for the Soul.
• Steven Kellogg’sThe Day Jimmy’s Boa ate the Wash and Jimmy’s Boa Bounces Back.
• When I am an Old Woman I Shall Wear Purple, edited by Sandra Martz.
• Dr. Seuss’ You’re Only Old Once: A Book for Obsolete Children.
• John Wagner’s Maxine: Yelling it Like It Is: A Fine Whine with the Queen of Attitude.
• Judith Viorst’s Forever Fifty and Other Negotiations and Suddenly Sixty and Other Shocks of Later Life.

Reminiscing with Memory Books

You can find blank memory books in the baby section of a bookstore. These usually pose questions that will prompt discussion. Here are a few suggestions:

• Grandmother’s Memories: To Her Grandchild by Candy Paul, illustrated by Thomas Kinkade.
• Grandfather Remembers: Memories for my Grandchild by Judith Levy.
• Grandmother’s Scrapbook illustrated by Judy Pelikan.
• Grandmother Remembers Songbook: Heirloom Songs for My Grandchild by Judith Levy and Judy Pelikan.

The list above is not all-inclusive. Hopefully it will give you some ideas for getting started. Think about the kind of activities the patient has always enjoyed. Those are probably the best ones to start with. I’ll close with a few more ideas.

If the care recipient enjoys building things, try assembling model kits of airplanes or cars. A simpler activity could be making strings of paper clips, using different colors and sizes. Patients who have an artistic side may enjoy painting or coloring in one of Dover’s many stained glass coloring books. Musically inclined patients might enjoy singing along to patriotic songs, hymns and old favorites, or playing rhythm band instruments. Did the patient used to enjoy sewing or mending? Offer some pants that need hemming or items of clothing that need buttons sewn on. Remember: people with dementia can still derive enjoyment from activities they have always enjoyed. Give it a try!

Jill Gilbert, our CEO, just finished up her tenth article for McKnight?s Long-term Care News, the eldercare industry?s leading magazine. In her monthly articles, Jill tries to raise awareness and spotlight new and innovative ideas in the eldercare industry by highlighting facilities and people who are outstanding at some aspect of serving the senior population. The articles just keep getting better with discussions on food/menu choices, building a solid care team, Green House projects, Kiwanis International clubs and much more. Not only do all of us at Gilbert Guide like to point out excellence and quality care, but also we hope that by doing so we inspire and set higher standards for eldercare providers across the country.

Our very own Expert Columnist, Kay Paggi, was recently interviewed in a Dallas Morning News article discussing the role of geriatric care managers and what they can offer families, especially when they are at their wit’s end. As Kay pointed out, “I’m the person you call when you have more questions than answers about your mother’s or father’s care.” Many Americans are unaware of the importance of geriatric care managers—some don't even know they exist! However this will definitely change in the coming years. As Dr. Harvey Gilbert pointed out in a recent post on America’s aging population, the number of people in the over-65 group is rapidly escalating; from 35 million in 2000, the group is estimated to grow to 55 million by 2020 and 72 million by 2030. And these are exactly the people who will benefit from the services a geriatric care manager can offer.

And that’s just a little of what’s been going on…

The Gilbert Guide Team

Alzheimer’s disease is a brain dysfunction. It is just one of several types of progressive memory loss that falls under the label of dementia. The occurrence of Alzheimer’s disease is increasing at a very rapid rate. Generalized memory loss, which is so commonly seen in older patients, was once considered a natural phenomenon of aging. But is Alzheimer’s a natural part of the aging process or is it related to lifelong adverse lifestyle issues that can be altered?

Lifestyle May Play a Part

Many wellness and medical professionals believe that Alzheimer’s is, at least in part, due to unhealthy lifestyle choices; in particular, a combination of nutritional inadequacies, a sedentary lifestyle and a high stress level. These factors can result in a condition called metabolic syndrome. Metabolic syndrome is related to body-wide inflammation, insulin resistance and its resultant disease states: visceral obesity, diabetes, hypertension and cardiovascular disease, among others. Many experts believe that the inflammation is associated with solid plaques of a substance called amyloid in the brain tissue, and research shows that there is a link between Alzheimer’s disease and these amyloid plaques. Alzheimer’s manifests itself in the brain much later in life than the other metabolic syndrome-related diseases. The causes of Alzheimer’s are much more complex than what is being described here, but much of the difficulty lies in treating problems that took a lifetime to develop. Regardless of whether the link between lifestyle and Alzheimer’s can be proven, the disease is appearing in a very large percentage of our aging population, and there is currently no other explanation of its origin.

How Early Can it Be Detected?

The disease state is present in the body for many years prior to becoming a recognizable disease. Thus, if the condition can be detected early, and prevented, it is a significant accomplishment. However, research has not shown that Alzheimer’s can be prevented. This is partly due to not having a reliable method of objectively identifying the abnormality in the brains of these patients early on, and therefore being unable to study these patients prior to the disease developing years later. Consequently, we are left with putting band-aids on the problem after it is too late.

We know that from the first sign of mental deterioration, there can be years of slow and steadily progressive (sometimes intermittent) dysfunction or, in some cases, a very rapidly progressive form. The period from symptom onset can be several years, and can be very destructive to patients and their families if the person does not meet the criteria for a diagnosis of dementia by mental status exams alone. Without objective evidence such as scans and blood tests to confirm the diagnosis, there can be a great deal of emotional pain during this waiting process. Without a definitive diagnosis, treatment will be delayed. And even when there is a diagnosis, the type of dementia present isn’t clear.

Because of the magnitude of the problem, the government and the insurance world have been less than enthusiastic about paying for diagnostic testing. Part of this reluctance is due to the prior lack of effective treatment for the disease; this in turn is partly due to physicians’ waiting until the disease is advanced before diagnosing a patient with Alzheimer’s.

How PET Scans Work

What are our options, and what do we know about the diagnostic accuracy of our clinical observations with or without brain imaging? We know that in the patient who has fairly advanced symptoms, PET scanning (a nuclear scan of brain function) can increase the accuracy of the diagnosis from 75% to 90%. It is optimal to scan the patient before he or she develops a more advanced form of dementia, because a doctor cannot make a diagnosis by mental status checking alone at that very early point in time. Ninety percent accuracy in this preclinical setting can be extremely helpful, both in making and ruling out a diagnosis as well as finding additional signs related to other dementia or non-dementia causes.

The other advantage of PET scanning is that it allows the physician to differentiate Alzheimer’s from fronto-temporal dementia and vascular dementia. The approach to treating these forms of dementia is quite different from the treatment of Alzheimer’s, so making an accurate diagnosis early on is very beneficial. Experts recommend PET scanning at the earliest possible time in the mental aging process. The downside of this procedure is that it must be paid for out of pocket, as it is not typically covered by insurance.

Chances are, you’ve heard of reverse mortgages. But do you really know how they work? There are many professionals on both sides of the fence. One side will try to sell you on the upsides of reverse mortgages, and the other will warn you of the downsides. Let me tell you this, objectively: reverse mortgages can be a good solution for a certain type of consumer, but they are complicated. Understand how they work before you decide on this option.

Understand the Cost of the Benefits

As we have all learned over time, sometimes things that seem too good to be true are just that. Obtaining a reverse mortgage is an important financial decision; they are very expensive products and should be used only when they’re appropriate for the situation. It’s essential that you understand the actual price and implications, not just the upfront ones. Reverse mortgages can be beneficial and worth the costs, but consider the disadvantages before making your decision. Remember: a mortgage salesperson is not a financial planner and does not have a fiduciary responsibility to your best interests. Get objective advice beyond the required counseling meeting!

You’ve probably heard plenty about the benefits of reverse mortgages. They can:

• Stop your monthly mortgage payments
• Offer access to some of your equity without monthly payments
• Provide flexibility in your use of the funds:
  • Credit line for emergencies
  • Additional monthly stream of income
  • Lump sum distributions
  • Or a combination of any of the above
• Give access to tax-free money (as is the case in all equity loans)
• Qualify you easily (qualification is based on the property, not income)
• Allow you to stay in your home
• Offer independence and freedom of choice

Exercise Caution

Of course, all of these benefits sound great! But is a reverse mortgage the panacea? Is it the best solution to meeting life objectives if you have limited funds (equity-rich, cash-poor) and increased income needs? Yes, these types of loans can do all this, but make sure you thoroughly understand the high cost and terms, compared to other financial alternatives, before proceeding. Remember: if it sounds too good to be true…

I want to clarify here: I do think that reverse mortgages can be a great product, especially for older seniors who need to facilitate costly care needs such as aging in place endeavors or meeting the future needs of a healthy spouse when the other person’s health costs become significant. In fact, reverse mortgages are a part of my tool chest as a financial planner for the elderly. Sometimes it is the best alternative. I am thrilled that the product is evolving quickly and getting significantly better with time. I don’t deny that equity-rich, cash-poor retirees might want to consider leveraging their equity to enhance their lives, but as hassle-free as the reverse mortgage industry tries to make it sound, the cost and financial implications on the future unfortunately get downplayed in light of the benefits—especially for retirees younger than seventy-five. Age is a significant factor in this equation.

What are the Total Annual Loan Costs?

Compare annual percentage rates (APR), not interest rates. To understand how a reverse mortgage really works, think about your current circumstances and how they might change in the future. Consider these factors:

• Even though you’re not writing a check for closing costs, monthly payments, monthly service fees and mortgage insurance, it doesn’t mean you’re not paying for it! Those costs are merely added to the loan balance. You pay compounded interest on all of it, quickly accelerating the loan balance due in the future!
• You may have to pay off a valuable lower rate existing mortgage. Note the reverse mortgage rate is variable and can rise. You will also pay for mortgage insurance and additional service fees. What is the real cost of the money?
• There are other products that are significantly cheaper than reverse mortgages, and possibly other deferred loans that can help you finance home improvements. Deferral on tax payments can also help reduce your present expenses.
• If you reduce your equity quickly, as this product does, what happens if you need those funds in the future to finance expensive elder care? Your reverse mortgage agent may tell you that you can always refinance the reverse mortgage at that time, but front-end fees are very high—usually about 4–8% of the entire loan.
• One of the benefits of reverse mortgages is that you don’t have to repay the loan as long as you live in the home. But if your health care needs change—for example, you have a stroke or develop Alzheimer’s—and must go to a nursing home, you could lose that benefit. If you are out of the house for more than one year, you must then repay the loan.
• You lose your tax interest deduction until the year it is paid off.
• The loan balance grows quickly due to the compounding. Will your heirs be shocked and disappointed when they find out the loan balance that has built up? Perhaps you should discuss reverse mortgages with them before entering into an agreement. They might be able to facilitate other options.
• Is this the best tool to gain liquidity to purchase other things, such as long-term care insurance, annuities and additional real estate?
• Does the property qualify (based on the value and present condition of the home) without your needing to make large repairs?
• Does the net amount you get warrant the front-end fees?

Unfortunately, the pushers of this product often prey on the poor, seizing their home equity in exchange for a pricey promise or dream. The reverse mortgage can impact the aging home owner’s future ability to qualify for other benefits like supplemental social security, Medicaid, and other low-income government loans and services. As a buyer or borrower, be aware before entering into this type of financial arrangement. Frequently the benefits are presented in such a way that they blur the borrower’s understanding of the significant costs and the ramifications. Everything has a cost. Just know your choices and the total price before committing.

Receiving “The News”

A person faced with a new diagnosis that is life-limiting is generally overwhelmed. Everything has changed, and nothing will ever be the same. All of the grief stages can come into play: denial, anger, bargaining, depression and ultimately, acceptance. The person might wonder, Why me? Why now? Can I beat this? The situation can become overwhelming when coupled with confusing medical jargon about palliative care and hospice care. Let’s start by clarifying the care options that are available.

Palliative care for life-limiting disease naturally follows curative treatments. Treatments can include chemotherapy, radiation, blood transfusions, dialysis, physical therapy and more. The goal is to achieve the highest quality of life for the patient while trying to control or eradiate the disease process. This is a time for hope and challenge for the patient and family. It is generally only when all treatment options fail or have been exhausted that the physician may suggest comfort care, which is also known as hospice care.

Similarities & Differences

Hospice care and palliative care both provide compassionate care for patients facing life-threatening illnesses. Both share a team-oriented approach to medical care: pain management, symptom management, and emotional and spiritual support that are patient-specific. Both share a common core belief as well: that every patient deserves the very best care possible, and that each of us has the right to die with dignity and respect, pain-free. In fact, the word palliate refers to giving comfort (but not cure). The differences between the two disciplines are subtle. While all hospice care is palliative or comfort care, not all palliative care is considered hospice care. Confused?

Let’s look at it another way. The focus of hospice is on caring, when curing is no longer an option. To be eligible for hospice care, two physicians (the primary physician and the hospice physician) must certify the patient’s prognosis to be six months or less, should the disease run its natural course. The hospice philosophy embraces death as a natural part of life, and encourages a patient’s desire for dignity, respect, and autonomy over his or her own care. Aggressive symptom management and pain control support this philosophy.

Most hospice care is provided in the patient’s own home. Some care is also provided in nursing homes, residential care facilities and hospice facilities. Services are provided regardless of religion, race, age or illness. The patient care goals are centered on quality of life as opposed to quantity of life. Hospice care is covered under the Medicare Hospice Benefit, Medicaid, most private insurance plans, HMOs, and other managed care plans. All charges related to the terminal diagnosis, such as medications, durable medical equipment (e.g., a hospital bed), and nursing and supportive services, are paid by the benefit. Hospice care, therefore, is both a philosophy and a method of health care financing for terminally ill patients and families.

Palliative care is very similar to hospice care, but with a broader population. It is not time-restricted—indeed, it can last for years—and no specific therapy is excluded if it can improve the patient’s quality of life. Palliative care helps meet the needs of patients and families who are not yet eligible for hospice services as well as those who still want to pursue more aggressive treatments not covered under the hospice reimbursement system. Payment for palliative services is generally paid by the patient’s insurance, Medicare or Medicaid (but not under the hospice benefit). Goals of care focus on improving quality of life and helping support patients and families during and after these treatments. Whereas palliative care is appropriate from terminal diagnosis on, when prognosis is uncertain, hospice care focuses on supporting patients with a life expectancy of months, not years. From that standpoint, palliative care should naturally follow curative care, and then evolve into hospice care as the disease process progresses.

Looking to the Future

The hospice benefit is written for comfort care only, and is intended for patients with terminal illnesses who have exhausted all curative and therapeutic treatments. In that sense, it can be abrupt and frightening, and generally results in very late hospice referrals from physicians. The challenge for hospices is to find a way to transition from one discipline to another. Patients should have a safe place to explore care options while still receiving palliative treatments—without pressure to enroll in the hospice program later on. This is an important step in patient continuity of care, and one that warrants further attention.

Currently, hospice and palliative care are separate disciplines. Helping patients and families deal with terminal diagnoses and navigating the various palliative therapies available is the goal of both. Finding a way to blend the two would help alleviate the confusion many patients and families experience and help motivate physicians to discuss end-of-life care options earlier in the disease trajectory.

Celebrating Life!

Audrey Wuerl

At seminars, I’m often asked to talk with seniors about the process of selling a home. The most common question I get is: what do I need to do to get my home ready to sell? I usually tell the person who’s asking that I’d be glad to visit the home and make some suggestions. The response I almost always get: “Oh no! I would need to get my house in order before you came over.”

We all think we have more stuff, or a messier house, than everyone else. Despite many a real estate agent’s reassurances, seniors often start to make all sorts of changes to their homes before they invite a real estate agent over for suggestions on preparing their home for sale. Those changes are often not the right ones to help maximize the sale price of the home or help it to sell more quickly. Before you make changes to your home, invite a senior real estate agent over to talk with you about your goals for your move, and the kinds of changes you can make to your home to help you accomplish those goals.

Once the real estate agent understands what is most important to you, he or she can help you develop a list of things to do (or not do) to your home to get it ready for market. Your real estate agent is not going to use a fix-it-yourself, make-a-million-dollars-with-simple-improvements, flip-it, home-improvement cable television show as a guide. Instead, a real estate agent will guide you with real-time local information to help you make sound decisions. Working with a real estate agent early on can keep you from making unnecessary changes to your home, and save you a lot of money in the long run!

4 Ways a Senior Real Estate Specialist Can Save You Money

Let’s be honest. The point in working with any professional is to get the job done better than you can do it on your own. Sure, you could do it, but you probably don’t have unlimited time, resources and the in-depth knowledge of the industry that a professional senior real estate specialist does. Ask yourself: what can this person do for me that I can’t do on my own? Hiring a real estate agent will help you get more return on your investment. A senior real estate specialist can:

1. Help you decide what to fix. Talk with your agent about what should be fixed. In general, the rule is: if it’s broken, fix it. In today’s market you’re going to have a lot of competition to sell your home. If you have broken items you’ve just lived with (we all do!), get them fixed. Even if the rest of your home is in reasonably good repair, little things like a leaky faucet, a window that doesn’t open, and a broken garage door opener are all excuses for buyers to lower the amount they’re willing to offer. You can actually save a lot of money by making these small repairs before you sell.
2. Help you decide what to replace. Before you replace that living room carpet or those kitchen appliances, talk with a real estate agent and get suggestions on what will make your home more marketable. If the potential buyer for your home is a first time home buyer or young family, the type of flooring you put in the kitchen may be different than if you live in a luxury condominium that might appeal to a young executive. Spending a lot of money on unnecessary high-end flooring for your home may be just as costly as putting in an inexpensive floor in a luxury home. Talk with a local real estate agent about what your competition has, and how you can minimize the cost of improvements without sacrificing the marketability of your home.
3. Prevent your spending money on things that break. Getting your home ready for the market is a lot of work, and in some cases, can cost you money. Talk with your agent about a home warranty. Many of the home warranties available today cover the home owner from the date the home is listed until it is under contact with the new buyer. That means if you have a mechanical failure, you won’t be trying to figure out how to pay to get it fixed while your home is on the market. Instead you can put in a claim to the home warranty and get it fixed with minimal out-of-pocket cost. A home warranty is also a nice additional selling point for your home—especially when you need to stand out from all the other homes on the market!
4. Suggest loan alternatives to buyers that will save you money. With lending guidelines getting tighter for borrowers, home buyers are using first-time home buyer programs that charge fees to the seller. For example, there are two nonprofit programs for first-time home buyers, Nehemiah and Genesis. Both offer essentially the same benefit to the buyer, but one charges the seller a $295 fee, and the other does not. Your real estate agent will help you understand these loan programs and work with the buyer’s loan officer to see if the fees can be reduced.