A Patient Advocate's View

How to get families to talk about estate planning issues

  • 162f4b4f0a8e1d7bf61355795d29a751Carol Marak, Aging Advocate, Editor at, and Columnist. She earned a B.S. in Social Services and a Certificate in the Fundamentals of Gerontology from the University of California Davis, School of Gerontology. Carol is an active member of the American Society on Aging. She publishes aging-related news in the Huffington Post,, Lifehack, ASAging, Love to Know, BlogHer, and SheKnows,, and

    ​Sharing my personal experience and challenges about my family members’ estates and advance directives is the most efficient way to start the conversation. It illustrates that it’s a real issue. I try to de-stigmatize the topic by taking a matter-of-fact approach and providing practical tips, as I did in my book “Juggling Life, Work, and Caregiving. Amy Goyer, Amy Goyer Consultant.

  • Ask: if they’ve had to make life altering decisions for one who is unable to make decisions himself? Who would so this for you; would he know how to based on your expressed wishes? It’s the greatest love letter written to one’s family. Don’t require your family to handle your affairs without any guidance. Let them know how to conclude the legacy story of your life. Rhonda Caudell, Endless Legacy.
  • Use stories: When folks don’t know how to begin sharing a situation on TV or what happened to a neighbor/co-worker, that exposes vulnerability. It sets up the question that enables the conversation. Everyone loves a good plight-story: how others did it, or what they encountered. Tragedy or Triumph, we weigh them. Stories both teach and compel us to turn inward toward our planning. Nancy Ruffner, Navigate NC.

Offer education

  • Most consumers, don’t understand “The Modern Estate Plan” as the threshold for estate taxes is more than $10M for a couple. We need to explain better “property or estate erosion” due to potential healthcare costs which have no minimum threshold. Effectively, this stealth estate tax needs to be addressed, and most advisors fail to help clients understand the impact of healthcare in retirement and LTC planning. Mike Padawer, INERTIA Advisor Services.
  • It’s important to educate clients about all the consequences if they neglect having an estate plan. A primary goal is to avoid probate court. Estate planning enables the client to consider who is most appropriate to handle medical and financial decisions should they become incapacitated. We also provide advice on techniques that can be used to benefit a client’s intended beneficiaries. Ron Webb, Peck Ritchey, LLC.
  • Use TV shows, movies, articles in the paper and experiences of friends and relations to bring up the subject. Play the “what if” game–what if you were hit by a bus and broke your right arm and couldn’t write a check–how would your bills be paid? What if you were in a coma–what would you want me to do to care for you? Let’s all fill out our forms together. Donna Schempp, Family Caregiver Alliance.
  • Let’s face it. Money and death are not the easiest discussions and deserves the greatest level of sensitivity. Depending upon the person, it may be simpler to provide a few books or resources to review. Other times, you can refer them to a specialist or send them documents to fill out directly. Sites like have updated materials to make it easier. Michelle Jeong at LifeAssist.


Use assessments and tools

  • I use an assessment form that asks multiple choice questions. The answers tell me if a person is prepared, or needs assistance to make them or needs help from another person to make decisions for them. I deliver support via personal interviews, in family group settings, and in larger audiences. Caryn Isaacs,
  • I discuss EOL issues through The Conversation Project’s free tools. ( TCP’s Starter Kit is an easy, painless way to open the door about EOL. It is the step before setting up advance directives and thinking about medical interventions and talking with a lawyer. The approach makes you think about what is important to you at the end of life in broad terms. Laurie Miller, AppleCareandCompanion.
  • It is part of our care management assessment process and ongoing work with every client. Community education is also important to create awareness and conversation. So far this year, our owner Elder Law Attorney Linda Chamberlain has talked about “Creating an Exit Strategy” and “The Legal Docs You Must Have” in monthly workshops. Shannon Martin, Aging Wisely

April 6, 2016 Posted by | Uncategorized | Leave a comment

Preparing for the unthinkable.

Carol Marak

by Carol Marak

There is a geriatric population explosion in the United States, and policies for improving care and quality of life for the elderly have come to the forefront. Last year, Medicare modified payments to cover counseling sessions for providers and patients when discussing end-of-life issues. The topic is a sensitive one; having these discussions may lower health care spending. Since 25 percent of Medicare payments apply to the last year of life, these conversations could limit treatment. According to a 2010 Health Services Research study, 63 percent of beneficiaries receive hospital care in the last few months of life.

Public and private hospitals lack the services needed to educate patients regarding palliative care. The new Medicare ruling allows voluntary advance care planning during patients’ annual checkups. The provision aims to forego aggressive life-sustaining treatment and help beneficiaries deal with complex decisions when approaching death.

The National Institutes of Health notes that doctors are trained to maintain health and fight illness and, thus, receive insufficient guidance on how to communicate with dying patients. And since our society is death-averse, it is not surprising that physicians find it difficult to engage in “terminal state” consultations. For them, death is a medical failure. However, advocates of Medicare’s ruling recognize that good communication can dispel fears, minimize pain and suffering, and enable patients and their families to experience a peaceful death.

A few members of the Aging Council offer advice to initiate end-of-life conversations:

Scot Cheben,, encourages doctors and patients to have ongoing group conversations that include a trained gerontologist or social worker.

Kathy Birkett,, sees doctors ideally positioned to have an end-of-life dialogue. Doctors don’t have to know everything but need to get the process started and then help patients complete the journey.

Caryn Isaacs,, remembers a client who refused to change his “destructive” habits until he began dialysis. The patient thought one or two treatments would be the cure. The patient soon learned from his doctor that if he wanted to live longer, he would need to make substantial lifestyle changes. It led to advance directive discussions.

Evan Farr,, says that because physicians fight illness, they need practical educational tools to address fundamental issues concerning death and dying.

Connie Chow,, thinks Medicare support is a step in the right direction. An excellent book is Being Mortal: Medicine and What Matters in the End. Written by Atul Gawande, a surgeon and public health researcher, it illustrates doctors’ reluctance to stop treatment even in terminal cases and their avoidance of discussions about likely outcomes.


Carol Marak is the editor at She earned a Certificate in the Fundamentals of Gerontology from the University of California, Davis. Contact Carol at

April 4, 2016 Posted by | Uncategorized | Leave a comment

Understanding What Makes Americans Dissatisfied With Their Health Care System

Health Affairs
March 2016
Understanding What Makes Americans Dissatisfied With Their Health Care System: An International Comparison
By Joachim O. Hero, Robert J. Blendon, Alan M. Zaslavsky and Andrea L. Campbell
For decades, public satisfaction with the health care system has been lower in the United States than in other high-income countries. To better understand the distinctive nature of US health system satisfaction, we compared the determinants of satisfaction with the health system in the United States to those in seventeen other high-income countries by applying regression decomposition methods to survey data collected in the period 2011–13. We found that concerns related to “accessing most-preferred care” (the extent to which people feel that they can access their top preferences at a time of need) were more important to satisfaction in the United States than in other high-income countries, while the reverse was true for satisfaction with recent interactions with the health system. Differences among US socioeconomic groups in survey responses regarding access to most-preferred care suggest that wide variation in insurance coverage and generosity may play a role in these differences. While reductions in the uninsured population and the movement toward minimum health plan standards could help address some concerns about access to preferred care, our results raise the possibility of public backlash as market forces push plans toward more restricted access and higher cost sharing.
From the Introduction
For at least the past twenty-five years, Americans have been consistently less satisfied than residents of other high-income countries with their own nation’s health system.
In some ways, Americans’ low levels of satisfaction with their health system seem to defy expectations. For example, system satisfaction in European countries has been found to be strongly correlated with per capita expenditures.4 However, this is not the case in the United States, where per capita expenditures are high compared to those in Europe.
In our study we applied, across countries, a measure of relative importance that combined the strength of the relationship between each factor and system satisfaction with the amount that the factor varied. We focused on domains of opinion in which we most expected the United States to differ from other countries, given its unique culture and health care system. These include access barriers, satisfaction with the last health care experience, and the newly defined construct of access to most-preferred care.
From the Study Results
We found that security in accessing most-preferred care was more important in explaining overall satisfaction in the United States than in other countries, whereas satisfaction with recent health care experiences was less important. In particular, confidence in accessing the best care available explained more variance in ratings of system satisfaction in the United States than did satisfaction with a recent hospital or doctor visit — which in most countries was the most important predictor of overall satisfaction.
From the Discussion
For years the Commonwealth Fund has fielded international surveys that use mostly objective measures of patient experience. The surveys have found that the United States underperforms its peers along many dimensions of cost, access, and quality and that Americans are more in favor of major system reform than are people in other countries. In spite of these findings, researchers using the Commonwealth Fund data did not find the desire for system change in the United States to be very sensitive to performance on these measures, even measures of affordability — which leaves the determinants of desire for system change within the United States mostly unexplained. Using a different data source and more subjective measures of personal care and satisfaction, we have taken a new look at potential drivers of satisfaction in the United States and have offered evidence on the ways in which that country differs from its peers.
Comparing results for the United States and international averages, we found that access-related concerns played an outsize role in determining system satisfaction in the United States and that confidence in accessing one’s most-preferred care mattered in particular to Americans. Conversely, satisfaction with recent health care experiences, which tended to be the most consequential to system satisfaction abroad, mattered less in the United States.
One possible explanation for the dominance of access-related beliefs over experiences with care in the United States is the structure of the health insurance system. In other high-income countries, where access to health care is more uniform and minimum standards guarantee that most people receive health care of a certain quality, access to one’s top choices may be perceived as less pressing, and recent individual experiences in the health system become more salient. The wide range of insurance coverage in the United States creates more significant gaps in the kinds of care that individuals can obtain, compared to those in other high-income countries.
This explanation is consistent with research that shows deep concerns in the United States over insurance-related economic security. Wider variation in and less certainty about coverage in the United States compared to other countries may therefore explain the greater importance of access to most-preferred care and the diminished importance of recent health care experiences.
These expectations are not a matter of simply having insurance; they are also related to the type of insurance held. The patchwork of public and private sources of insurance and the wide variation in insurance generosity in the private market create large differences in the comprehensiveness of coverage among the insured. It is perhaps because of this that access to most-preferred care remained the top predictor of system satisfaction, even among Americans with insurance.
From the Policy Implications
Our research found that the concept of access to most-preferred care is particularly salient to Americans’ satisfaction with the US health care system. This research also underscores the important role that variation in insurance coverage and type in the United States may play in system satisfaction, in part through that variation’s role in giving people security about being able to exercise health care preferences when needed. Therefore, reductions in the uninsured population resulting from the ACA may marginally improve system satisfaction.
Overall gains could be limited, however, since the reductions affect only a small segment of the population, and the types of insurance that people are acquiring tend to be less generous and more restrictive than what has been available through employers. Broader improvements in satisfaction will likely require addressing the concerns of the insured as well as those of the uninsured, and the importance of Americans’ access to their top preferences indicates that this may involve issues of network adequacy and treatment availability.
From the Conclusion
Our findings raise particularly troubling questions about the implications of health care equity as it relates to variation in the types of health insurance that Americans can obtain. Changes in insurance that threaten to widen the gaps in access to and perceived quality of care between more and less privileged Americans may serve to increase the number of people who feel that their health care preferences are out of reach.
Comment by Don McCanne
Even though we spend more on health care than any other high-income nation, we are less satisfied with our health care system. This study indicates that the leading reason (that happens to be unique to the United States) is the concern we have about uncertainties in being able to access our most preferred care, that is, the extent to which people feel that they can access their top health care preferences at a time of need.
Wide gaps in insurance coverage, high out-of-pocket expenses, and fragmentation in insurance and delivery systems seem to be the major factors contributing to this uncertainty.
Current trends are to further restrict access through narrower networks, and to impose ever higher cost sharing, especially through higher deductibles, while perpetuating the fragmentation of our financing system. That can only increase uncertainties about our ability to access our preferred care.
Let’s hope that the inevitable backlash will send the message that we are ready for a more equitable and effective system – an improved Medicare for all with free choice of care for everyone. Americans need to be assured that the financing system does not create barriers that impair access to their top health care preferences at a time of need.

March 10, 2016 Posted by | Uncategorized | Leave a comment

How Caregivers Can Save Time and Reduce Stress

I was quoted in this article:

January 5, 2016 Posted by | Uncategorized | Leave a comment

WHCOA: 5 months later, Experts report in

Carol Marak Headshot

Experts know that older adults rely on good health to remain independent and productive but by the measure of medical diagnoses, baby boomers are sicker than their predecessors. The NCOA confirms 92 percent of older adults over 65 live with one chronic condition, more than two-thirds (77 percent) have at least two, and about 15 percent have at least six long-term ailments. The sickest account for more than $324 billion spent on traditional Medicare.

Knowing the massive numbers of sick people, financing long-term care might be unsustainable. But why didn’t the conference tackle the problem of paying for long-term care since it’s the most unstable factor eating into our retirement security? A new federal brief found that half of Americans who reach age 65 will experience severe functional needs and will pay $138,000 out of pocket for care.

The White House has access to such figures — so, why was it missed?

But that wasn’t the only one. There were a lot overlooked. Topics like the future of aging, transforming nursing homes, dementia support, and tapping the vast knowledge of older adults — all ignored. And since expert panels who could give meaningful answers to the critical issues were not included, asked prominent aging leaders to share their perspectives of what SHOULD have been discussed:

In your experience of reading about (or participating in live webinars during) the White House Conference on Aging, name one aging opportunity the conference missed?

More focus placed on retirement security, prevention of elder financial exploitation including abuse, and long-term services and supports. Evan Farr, Farr Law Firm — Strengthening Social Security and finding ways to protect pensions and Medicare not covered nearly enough. Also, the agenda overlooks our diversified older population (including ethnic, non-white, and LGBT elders).

WHCOA missed creating solutions not just revealing problems for caregivers trying to meet needs of aging carees. Kathy Birkett, Senior Care Corner — Can we give tax incentives for adult caregivers working while caregiving? How can spouses pay for items not covered by Medicare-homecare, training, co-pay, dental care, hearing aids? It would also have been helpful to have a real forum for caregivers to voice their concerns during WHCOA.

The main complaint I hear from patients is not getting to see a doctor. Caryn Isaacs, Get Health Help — The change from doctors to Physician assistants and nurses doing doctors work, the changing role of the physician to a paper pusher. I asked this question at a conference and was told that the plan was to phase out doctors.

Caregiver health and well-being isn’t covered sufficiently and that mirrors society in general. Anthony Cirillo, The Aging Experience — Family caregivers in the workforce is another important issue that needs to be discussed. A recent report looking at hospital chief experience officers and their role found a glaring lack of initiatives and priorities focused on caregiver burnout.

We need to combat Ageism. Michelle Jeong, Reminder Rosie — We need to combat Ageism directly to tap into the wisdom and experience of those over 65.

Respite for caregivers. Nancy Wurtzel, Dating Dementia — I’d like to have heard more concrete details about how to provide respite for caregivers. Respite care is discussed, but the reality is that there are not enough free or affordable programs for those of advanced age or those living with Alzheimer’s. This has to change as we are facing a rapidly aging population and it will take people and money to make this happen.

A look at senior living community regulations and how they hinder/help could be beneficial. Michelle Seitzer, — It seemed to be quite comprehensive in its scope. But perhaps a look at senior living community regulations and how they hinder/help could be beneficial, particularly as the new generation of senior living residents is already changing what these communities look like and what services they provide.

The opportunity to advance LGBT senior rights was one topic sorely overlooked. David Mordehi, Advise and Protect — Great strides were made this year in marriage equality laws; however, with Congress not funding the conference on aging in 2015, many believe the opportunity to advance LGBT senior rights was one topic sorely overlooked. Unless addressed, this populace of elders will continue to suffer discrimination when it comes to housing and healthcare.

The glaring need: to increase the frequency of the conference Nancy Ruffner, Navigate NC — It needs to rise in the frequency due to the swelling of our aging demographic and include more topics. Sure, we further engagement with watch parties and online access. We may even connect the consumer to visionary and to spur action. The rub for me and many is: one day, in 10 years time, and four topics?

Society’s stigma against aging and caregiving. Connie Chow, DailyCaring — Caregivers are isolated and feel alone in their struggles. How can they get support unless they can speak openly about their experiences and needs? Today, one in eight Americans are caregivers, so why isn’t caring for seniors discussed and supported like caring for children is?

Endorsing penalty-free and tax-free withdrawals from qualified accounts to pay for long-term care or LTC insurance. Stephen Forman, Long Term Care Associates, Inc. — This year’s WHCOA generated nearly 20 large-scale initiatives on topics ranging from aging-in-place to fall prevention. And while the White House took steps to encourage better retirement planning (via the 401(k), myRA and TSP programs), it stopped just short of that missed opportunity.

Comment Here:

December 16, 2015 Posted by | Uncategorized | Leave a comment

Please help me to continue to offer mentorship.


Mentors Martha & Matt

I met Martha Stevens when I was just starting out in my career, as a healthcare practice management consultant. Martha was surprised when I told her recently that I always told people that she was a role model and mentor to me. She has always been there for me with advice, referrals and friendship. After 30 years, I was finally able to pay her back by being there for her when her husband began demonstrating the signs of Alzheimer’s disease.  Matty passed peacefully this summer after returning from a Florida vacation. With the help of Laura Giunta of Senior Helper’s Martha had wonderful home health attendants to make sure that Matty was able to stay comfortable at home.

For the past year, I have been listed on the Alliance for Professional Health Advocates as a mentor.   Take a look at some of the other mentors and the reviews they have received.

It has been my pleasure to take calls from people who are interested in becoming Professional Patient Advocates. I’ve followed up with advice, references and referrals. The only thing I’ve asked is that if I’ve helped you to advance your plans in becoming a Patient Advocate that you write a review for me either on my LinkedIn profile or on the APHA mentor page.

Now, I am in jeopardy of having my listing removed from APHA because I am not getting the feedback that is required to keep this program going. All I ask is that you post a sentence of two to this easy to fill out form. Your contact information will not be shared with anyone unless you give permission.

Please take a moment to help me to keep this service active. The review should be of my coaching/mentoring service if I have helped you to increase your business, not for my Patient Advocate services.

Here is the link where you can post a review.

Thank you, Caryn Isaacs

August 25, 2015 Posted by | Uncategorized | Leave a comment

Maintaining a healthy weight.

Dean  Witherspoon  Dean Witherspoon just posted a new white paper — Small Steps or Giant Leaps: What Works Best for Health Behavior Change?
In it he talks about the difference between lasting weight loss experienced by people who lose weight quickly, but put it all back on and those who are able to lose it quickly and then keep it off. He mentions the “Biggest Losers” diet as one in which the people are not able to maintain the weight loss because the program is too strenuous. In comparison, he shows that people who try to make just small changes, like taking the stairs instead of the elevator, will not be able to maintain their weight loss program because the rewards are just too small for the person to feel incentivized. That last one describes me.
I came to realize that most of my clients who suffer from diabetes, heart disease, COPD and cancer have all been overweight. Knowing what to do and how to do it were not enough to help these people to lose weight. Several of my clients in nursing homes have finally lost weight only because their meals are prepared for them by a dietician and there is no way for them to get other foods.
Rather than wait to take that drastic step, I am starting the Nuvo Ultimate Fat Loss Diet TODAY! This is a four stage program in which you lose weight rapidly while learning to maintain the weight at the same time. It is doctor and nutritionist supervised. It has many of the successful aspects of the programs that Dean talks about, including eating real food, not the shakes and bars that have been my (unsuccessful) go to plan for over twenty years.

Another part of the plan is using EFT, Emotional Freedom Technique to help you through the stressful times, and reduce the chance of emotional binging. I found a great EFT video that you can tap along with, from the Mercola people.
Wish me well. I plan to post my weight loss and other experiences here, so look for the before and after pictures by the end of summer. Yes, this is one of the things a successful diet starts with, letting people support you.

July 21, 2015 Posted by | Uncategorized | Leave a comment

Misconceptions on Aging Report: America Has a Major Misconception on Aging

Forty-four senior care industry experts discuss the financial and emotional toll on an unrealistic aging population and offer pro-active solutions.

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Misconception on Aging

Misconception on Aging

We are facing a catastrophic shift downward in the standard of living for the majority of people in the United States. Social security won’t save us. Our kids won’t house us. And, our savings won’t cover us.

St. Louis, Missouri (PRWEB) April 28, 2015 has published the Misconception on Aging report that delves into the reality problem Americans have regarding aging and long-term care needs. While 70% of the population will need long-term care services as they age, 63% of Americans do NOT believe they will need such care.

In the report, Carol Marak of interviewed 44 senior industry experts, from organizations such as the American Health Care Association and The Scan Foundation. The experts discuss why there exists such an unrealistic perception of the care that will be needed and the consequences of a nation unprepared.

The report discusses the perception gap – between the care individuals will need versus the care individuals believe they will utilize. Dr. Bill Thomas, who the Wall Street Journal dubbed one of the Top 10 Americans shaping aging, suggested “human beings have a very limited ability to accurately predict or even really imagine the needs of their future self. It is especially true when that future contains scary possibilities and lies decades in the future.”

It also addresses the consequences that people face if not prepared for long-term care. Rhonda Harper, Founder and CEO of Penrose Senior Care Auditors, states “We are facing a catastrophic shift downward in the standard of living for the majority of people in the United States. Social security won’t save us. Our kids won’t house us. And, our savings won’t cover us. We risk state-institutionalization on a massive scale.”

The experts shared potential solutions to educate the growing aging population on closing the perception gap and to better prepare for their future care needs. When asked how he would improve the public’s perception, Dr. Bruce Chernof, CEO of The Scan Foundation, states “Working families need better tools to plan and pay for their future care needs, and this can only happen when there is a groundswell of public support and dialogue.”

Mr. Tom Burke, Senior Director of the American Health Care Association had this advice for consumers, “Start the conversation about the future with aging parents now so everyone can agree on a course of action before the unthinkable happens.“

The comprehensive Misconception on Aging report, with Key Findings and Full Text answers from all 44 experts, can be found online at

About is dedicated to informing consumers about the realities and options within the senior care industry. brings together established experts in the senior industry to discuss the pivotal issues the country faces as the demand increases for quality senior living and health care for the growing aging population.

Caryn is listed at here

July 6, 2015 Posted by | Uncategorized | Leave a comment

Celebrating 5th Annual Private Professional Patient Advocates Week

Patient Advocacy is getting their own Prime Time TV show on ABC!

The Advocate was inspired by the real story of former talent agent Byrdie Lifson-Pompan, who teamed with Valerie Ulene, a medical doctor and a health education specialist, to launch a healthcare consulting company, It centers on Francis “Frankie” Reese, a tough, resourceful, type-A businesswoman at the top of her game who has a medical scare and experiences firsthand the hazards of our healthcare system. Shocking her friends and family, she leaves her career behind, becoming instead a brilliant and relentless advocate for anyone caught in the chaotic and ever-changing maze that is modern medicine.

I am a member of the Association of Professional Health Advocates.

I am also listed as a mentor on their site.

Here is a press release from Trish Torrey, author and founder of APHA.

pppawheaderThe Fifth Annual Private Professional Patient Advocates Week – is this week – March 16 to 22 -and I’m here to share tales of the growth of our profession.

Can it be that patient advocacy as a profession is now so “old” ?  Granted, there were a handful of advocates practicing long before we began to quantify and qualify the profession.  The year 2009, with the launch of NAHAC and APHA / AdvoConnection, marked the beginning of the growth that would make us a recognized profession across North America.

Some background:

From the 30-ish people who joined AdvoConnection in 2009 – for free! – with a belief that this might be an interesting alliance full of possibilities… to the almost 550 members of APHA today, and dozens more who aren’t yet on our current radar…  yes, growing.

So, as I did last year, I thought I’d share a profile of our membership and achievements:

  • We hail from 38 states and 2 Canadian provinces, with more members from California than any other state or province.)
  • We are international, with members from Australia, Russia, South Africa, Spain and the UK.
  • We represent advocates who have been performing advocacy services for 30+ years, those who are just exploring the opportunity to perform advocacy services as a business, and everywhere in between.
  • Our APHA members provide at least 40 unique services to their clients.
  • About half our membership is signed up to use our APHA Forum where we discuss every topic imaginable (the other half could participate, too, but they’ve never signed up.)
  • We have held 50 teleconferences with experts to help members build their practices.
  • The Alliance and AdvoConnection have been mentioned in the likes of O Magazine, Health Magazine, Forbes, CBS TV, CNN and others.  Its members have benefited from dozens of local press mentions.

March 18, 2015 Posted by | Uncategorized | Leave a comment

Plans for 2015

Beverly&Caryn   I haven’t posted here for the last few months, but if you follow us on Facebook or LinkedIn, then you know we’ve been busy with some very difficult situations for our clients. Many of you will know the clients I am talking about, so here are some updates.

Client A is a 66 year old man with chronic progressive health conditions including arthritis, gout, diabetes type II, depression and Obsessive Compulsive Disorder. We have been to all kinds of specialists, hospitals, rehab facilities and mental health providers without any improvement. Currently, we placed him in an assisted living facility with a full-time aide, while we attempt to find a residence that is more appropriate to someone of his age.

Client B is a 94 year old man suffering from Osteomyelitis caused by a non-healing heel wound. We were able to keep him in an independent living environment with private care for the past six months. At this time he is in a rehabilitation facility after which he will be transferred to Long Term Care in the same facility. He is happy to be alive and we will continue to help to keep him that way.

Client C is an 89 year old author, playwright and concert accordionist. We have tried to find her a cat to replace her long time pet. After fostering and returning over a dozen cats, she recently adopted a teacup yorkie. We are in the process of training the dog with the help of a behaviorist.

Client D is an 84 year old man whose family member helped herself to the man’s life savings. With the help of Iris Bikel, attorney the man is now home from the nursing home he waited in while Medicaid was approved. Unfortunately, the Long Term Managed Care plan we chose didn’t work out. No one was watching that he took his medications or ate properly. With the help of Ilene Griensky, Elder Care Consultant, we are looking forward to changing the MLTCP and have recently changed the home care agency.

Client E is someone we have known for a few years. A few months back his POA asked me to help to place him in a skilled nursing facility so that Medicaid would pay for his care. This didn’t sound right to me, as I didn’t see the need for skilled care. The POA somehow got the patient accepted by a nursing facility, but as private pay since his irrevocable trust was only set up a couple of years ago. Just before Christmas we had a call from the client asking why he had to stay in a nursing home. This is one story we will tell you about in more detail when we have everything settled, but happily we helped him to go back to the assisted living facility where he was living before.

We are thankful that all our regular clients are healthy and we continue to enjoy their company. We also have several new clients starting in 2015. We look forward to the challenges we will face together.

January 4, 2015 Posted by | Uncategorized | Leave a comment