Category: Aging

We all Cherish Choice and Autonomy

Every July Americans come together and revel in our freedoms. The freedom to make choices and pursue our own path is celebrated as a fundamental right.

Unfortunately, as we age people lose sight of the fact that we retain our civil rights, and often take away choice and self-determination of older Americans in the name of safety or concern. This is commonly called ageism and is a subtle prejudice we must avoid personally and call out in others when we see it.

It is true that many older Americans need support as they age but this should be done via honest conversation with the elder using a respectful attitude as we explain their options. Yet even today well-intentioned relatives and caregivers are stripping away older and disabled Idahoan’s civil and legal rights, self-esteem, and quality of life by pursuing guardianship with the motivation to keep their older loved ones safe.

Although we applaud the motivation, the Idaho Commission on Aging advocates for older and disabled adults by urging concerned caregivers to consider the multitude of alternatives to guardianship for as long as possible.

What are alternatives to guardianship? Some examples include:

• Representative payee
• Durable powers of attorney
• Health care surrogacy
• Living wills
• Trusts
• Community advocacy systems
• Joint checking accounts
• Case management

Power of attorney – A power of attorney is a legal document. The document grants one person, generally called an agent, sometimes known as an attorney in fact, the authority to act on behalf of the person appointing them. The person appointing the agent is called the grantor. To create a power of attorney, an adult must be able to understand they are appointing the agent and understand the kinds of authority they are giving the agent. The scope of the agent’s authority is limited by the terms of the document and by state laws. A grantor with capacity can revoke or modify the appointment of an agent in a power of attorney. Revocation of a power of attorney should be in writing, signed by the grantor, with a copy delivered to the agent and anyone who is likely to be dealing with the agent. In some states, the revocation needs to be recorded in the public records like a deed. A power of attorney is a private agreement and is not subject to automatic oversight by the Courts.

Health care surrogate – A health care surrogate is a person who makes health care decisions for a person, when the person lacks capacity to make health care decisions. This person may also be called a health care agent or proxy. In every state, a person with capacity can appoint a health care surrogate in a durable power of attorney that incudes health care authority. Many states have a short form for naming a health care surrogate. A person has capacity to appoint a health care surrogate if they understand what a health care decision is and can name a person they trust to make health care decisions. If a person does not appoint someone, 45 state statutes give guidance on who can make health care decisions. Generally, statutes turn to the nearest relatives to make health care decisions. Health care decision-making is the only area of decision-making where the law creates a default agent when a person does not name an agent in writing.

The authority of a health care surrogate to make health care decisions does not start until the person loses capacity, or knowingly defers to the agent. The determination of loss of capacity is made by the person’s health care providers. The criteria and documentation for the loss of capacity is based on state law. The scope of the authority is defined in the document and by state law. If the person has capacity, the person can revoke or modify the appointment of a surrogate. Many states have a very low standard of capacity for revocation of an advance directive. Aside from leaving directions on who can make health care decisions, many people leave directions about the health care they want or do not want in the form of an advance directive or living will directive. When making health care decisions for another person, it is helpful to understand their health care values, goals of care, and specific wishes.

Social Security Representative Payee – A Social Security Representative Payee (rep payee) receives the benefits for a beneficiary who has been determined unable to manage money by the Social Security Administration (SSA). Rep payee is specific to Social Security benefits, including Social Security Disability and Supplemental Security Income (SSI). VA pensions and some private pensions have separate payee systems. Social Security will place the benefits in payee status if SSA has reason to believe that the beneficiary is unable to manage benefits. The evidence is either a verification from a physician who has seen the person recently, or evidence in a disability case of serious mental illness or substance abuse. The beneficiary can file voluntarily if they are unable to manage their benefits. The process is entirely administrative. Social Security does not recognize any other agents. Guardians and agents under powers of attorney must apply to Social Security to be recognized as a representative payee.

Someone seeking to be appointed as a rep payee should contact Social Security with the name and identifying information for the beneficiary, the reason the person needs a payee, and name and contact information of a physician who has recently seen the person and may include a proposed payee. Social Security then sends notice to the beneficiary, and a verification form to the physician. The beneficiary has a right to object to the need for a payee, or to the proposed payee. Upon finding of need for a rep payee, Social Security does a basic background check on the proposed payee. The payments must be directly deposited into a separate account, titled “payee as representative payee” for the benefit of the named beneficiary. Most payees file a very basic annual accounting. Representative Payee status can be terminated, at request of the beneficiary, with proof that the beneficiary has regained the ability to manage benefits. If the payee resigns or becomes unable to serve, benefits are held until a replacement payee can be appointed. There is a shortage of reliable volunteer payees and a need for representative payees. All payees are volunteers, with an exception for narrowly defined non-profits who are allowed to receive a limited fee from the benefits. In some states, inpatient residential settings, such as nursing homes, are allowed by state law or regulation to serve as representative payees.

Bank accounts – A common way to manage another person’s finances is to authorize an agent to sign on to that person’s bank accounts. There are two ways to do this: 1) add a person authorized to transact business on the account; or 2) make the bank account a joint account. A joint account creates a presumption of ownership in the account assets and may create inheritance rights. Joint accounts are very helpful for married or committed couples. For more distant family members or friends, joint accounts should be used with great caution. Rather than create a joint account, the bank can authorize someone to sign on the account without creating an ownership interest in the account.

This is commonly accomplished by the bank recognizing the authority granted under a power of attorney. In many states, the banks may insist on a state standard form, or a bank approved power of attorney form. Banks can also authorize signers on accounts without creating an ownership interest; many business accounts are structured this way. Direct deposit and automatic payment for All Social Security benefits and virtually all retirement benefits are paid by direct deposit. Direct deposit eliminates the need to make deposits and prevents lost or stolen checks. Nearly all reoccurring bills can be set up on automatic payment. The combination of direct deposit and automatic payments can help to assure that necessary bills are paid when a person is unable to attend to finances. These arrangements should be monitored to assure that all income is properly received, and automatic payments are correct. Increasingly, financial institutions and utility providers are willing to send copies of invoices and statements to a third party, or to arrange online access for accounts oversight.

This information was supported by a contract with the National Center on Law & Elder Rights, contract number HHSP233201650076A, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201

Additional resources to help concerned family and caregivers support their older relatives without the civil death of full guardianship are:

A Guide to Managing Other’s Money

Supported decision making

A Guide from AARP

Thank you for standing up for life, liberty, and the pursuit of happiness for older Idahoans! Visit the ICOA website for additional information and services to help older Idahoan’s age with safety and dignity.

www.aging.idaho.gov

Resources:

• Visit to the National Center on Elder Abuse website to increase your knowledge about elder abuse.
• Learn how you can decrease loneliness in older Idahoans with the Let’s End Loneliness Campaign in Idaho.
• Visit the ICOA website to learn about programs to keep vulnerable Idahoans safe.

Age My Way 2022

Older adults play vital, positive roles in our communities – as family members, friends, mentors, volunteers, civic leaders, members of the workforce, and more. Just as every person is unique, so too is how they age and how they choose to do it – and there is no “right” way. That’s why the theme for Older Americans Month (OAM) 2022 is Age My Way.

Every May, the Administration for Community Living (ACL) leads the celebration of OAM. This year’s theme focuses on how older adults can age in their communities, living independently for as long as possible and participating in ways they choose.

While Age My Way will look different for each person, here are common things everyone can consider:

• Planning:Think about what you will need and want in the future, from home and community-based services to community activities that interest you.
• Engagement: Remain involved and contribute to your community through work, volunteer, and/or civic participation opportunities.
• Access: Make home improvements and modifications, use assistive technologies, and customize supports to help you better age in place.
• Connection: Maintain social activities and relationships to combat social isolation and stay connected to your community.

Idaho includes a growing number of older Americans who contribute their strength, wisdom, and experience to our community.

Communities benefit when people of all ages, abilities, and backgrounds are welcomed, included, and supported.

The Idaho Commission on Aging (ICOA) recognizes our need to create a community that provides the services and supports older Americans need to thrive and live independently for as long as possible.

Idaho can work to build an even better community for our older residents by:

• Planning programs that encourage independence.
• Ensuring activities are responsive to individual needs and preferences.
• Increasing access to services that support aging in place.

This year, the Idaho Commission on Aging is excited to celebrate OAM with our partners in the aging community. Visit the ICOA website for more information on aging resources to help.

Diverse communities are strong communities. Ensuring that older adults remain involved and included in our communities for as long as possible benefits everyone. Please join the Idaho Commission on Aging in strengthening our community.

For more information, visit the official OAM website, follow ACL on Twitter and Facebook, and join the conversation using #OlderAmericansMonth.

Millions of older adults are likely eligible for, but not enrolled in, benefits that can help them save money on health care, prescriptions, food, and more. Public benefit programs, such as the Supplemental Nutrition Assistance Program (SNAP), Medicaid, Medicare Savings Programs, and Part D Low-Income Subsidy, help these individuals save thousands of dollars each year by helping with the costs of food, health care, and prescriptions.

However, barriers to enrollment in these programs, i.e., knowledge of programs and how to apply, affect many eligible individuals from not receiving benefits that they need. That is why every April, the National Council on Aging (NCOA), along with its partner network, promotes Boost Your Budget® Week, a targeted campaign that aims to educate older adults about enrolling in public and private benefits that can save them money.

During the weeklong campaign, the aging and disability service network partners work to educate low-income Medicare beneficiaries and their caregivers about benefits available to improve health outcomes and economic security. Those participating in promoting the campaign are also encouraged to connect older adults with online and community resources for benefits screening and application assistance.

What is Boost Your Budget® Week?

Boost Your Budget® Week takes place each year during the second full week of April. This year, the campaign will run from April 11-15, 2022.

What can the aging and disability network partners do to promote Boost Your Budget® Week?

For any community, state, or private organization wanting to promote and be a part of the campaign, some of the things that you can do include:

• Share information about benefits as part of a food drive, health fair, or tax assistance event
• Run ads in local newspapers or on social media
• Invite media, legislators, and the public to tour your facility and learn about the importance of benefits for your community
• Posting information about the campaign on your website
• Educate your stakeholders (i.e., staff and clients) during meetings/presentations about Boost Your Budget® Week

What can YOU do to promote Boost Your Budget® Week?

Even if you do not work for an organization whose customers and clients are older adults, you can still do your part to spread the campaign message! Some activities that anyone can do to promote Boost Your Budget® Week can be:

• Share resources from NCOA’s toolkit about the campaign on your social media
• Let older adults in your family and social circle know about the campaign, and, if appropriate, let them know where they can find resources
• Craft a press release and send it to your local newspaper about the campaign

For further information and resources needed to start planning your Boost Your Budget® Week events, please visit the official Boost Your Budget® Week website.

Your efforts can be life changing for low-income seniors or people living with disabilities. Visit the ICOA website to learn more about the MIPPA/MSP programs.

According to Feeding America, one in six seniors are considered food insecure. This means about 57,000 seniors in Idaho may be dealing with the issue of food insecurity, which can create negative impact on their health.

In addition to causing a few extra wrinkles and unexpected aches and pains, getting older also impacts metabolism and the body’s ability to absorb nutrients. Because the way the body processes food changes as we age, nutrition becomes vitally important. For older adults, eating the right foods can not only improve health, but also protect against preventable diseases and even enhance quality of life. As with most health-related issues, the first step towards developing better nutrition is awareness.

‘Hippocrates, a famous Greek physician, stated in 440 BC “Let food be thy medicine and let thy medicine be food”. We have finally come to fruition with that fact, 2,383 years after his death.

Each March, the Administration for Community Living (ACL) leads the celebration of the Senior Nutrition Program and the Idaho Commission on Aging promotes its anniversary by celebrating the program’s rich history and tremendous value across the nation with Area Agencies on Aging and meal providers.

The purpose of the nutrition program is to:

• (1) to reduce hunger, food insecurity, and malnutrition;
• (2) to promote socialization of older individuals; and
• (3) to promote the health and well-being by assisting such individuals to gain access to nutrition and other disease prevention and health promotion services to delay the onset of adverse health conditions resulting from poor nutritional health or sedentary behavior.

ACL funds senior nutrition services, including home-delivered and congregate meals. For more resources follow ACL on Facebook and Twitter and join the conversation via #SNP50.

For more information on Congregate Meal Sites and Home-Delivered Meals, please contact your local Area Agency on Aging.

Please join our free educational webinars on March 8th and on March 23rd. For additional nutrition information please visit the ICOA website and follow us on Twitter and Facebook.

See how the healthcare system benefits if seniors eat a nutritious meal at a congregate meal site.

A 2018 study reports that 22% of all adults in the US – nearly 60 million — said they often or always felt lonely or socially isolated (Kaiser Family Foundation) and 45% of seniors (65 and older) feel lonely on a regular basis (HRSA).

Along with the emotional response to feeling lonely comes many health risks that include increased risk of dementia, stroke, and coronary heart disease (CDC). There is no doubt we are a lonely bunch and alleviating loneliness is a public health concern. Over the past two years we have all become masters of zoom, and all things virtual. However, it may be time to set aside our phones, tablets, and computers for an old-fashioned way of alleviating the loneliness – the handwritten note.

Letter writing is tied to our hearts through our inherent drive for social bonds (Janine Ilsley, LMSW). In May of 2020 the United States Postal Service published research stating 65% of people agreed that receiving mail lifted their spirits, with just under 67% stating they have sent or would send mail to family or friends. Many studies have been conducted on the benefits of both the person composing the handwritten sentiments, as well as those receiving the letter.

Letter writing is tied to our hearts through our inherent drive for social bonds.  Studies prove letters bring us closer together.  The letter recipient will feel special and appreciate the thoughtful effort invested into physically writing, addressing, and mailing a letter.  This sends the message to the recipient that they are important to the sender (Janine Ilsley, LMSW).

When we think about an idea or concept, we can get stuck looking at it one way, but when we actually put pen to paper, a different part of our brain begins to examine the idea, opening new doors.  The repetitive nature of writing gives us the option to focus on what we are writing and the physicality of the act of writing, working on different aspects of our brain. (Erin Miers, Psy.D.). When reading books from the past we often hear of letters from past love saved in a box, or letters from family someone holds dear and rereads when they feel a need for comfort.  There is something about a handwritten note that touches our heart in a way lacking in today’s fast-paced world of electronic communication. 

So, pick up your favorite pen and share your heart with your grandma far away, or your neighbor down the street and always remember the words of Soraya Diase Coffelt, “Letter writing can be seen as a gift because someone has taken his/her time to write and think and express love.”

Write a Letter to Lift Loneliness! If you want to bring joy to someone you don’t even know consider writing a letter to a resident of a local nursing home or assisted living center.  Simply address the letter to “Any Resident”.  Staff will forward it to a resident that has few visitors or correspondence, and it is guaranteed it will make their day!

End Loneliness Campaign

The End Loneliness Campaign supports volunteers, professionals, elected officials, and concerned citizens to end loneliness in Idaho. This campaign is modeled after the End Loneliness UK campaign that has had decades of success in multiple countries around the world. Find the free “Let’s End Loneliness” training course on the Commission on Aging’s website.

Caring for someone with Alzheimer’s and other dementias can be a rewarding experience, it can also be demanding and challenging.  Caregivers for people with Alzheimer’s and other dementias are two and half times more likely than caregivers with other conditions to need help with emotional or mental challenges and nearly four time as likely to assist with behavioral issues (Alz Association, 2018). 

About one in three Alzheimer’s caregivers report their health has gotten worse due to care responsibilities, compared with one out of five caregivers or older adults (National Alliance for Caregiving, 2017).

Luckily help is available within the local area where the caregiver or the person with Dementia are living.

Caregivers usually do not know what they are seeking when calling an agency, so The Idaho Commission on Aging in partnership with six Area Agencies on Aging staff can aid caregivers to explore a spectrum of issues so the caregiving family can make informed decisions in their situation. There are 6 AAAs located throughout the state and each are experts on resources available in their communities.

Area Agencies on Aging (AAAs) are trusted sources of information and assistance, where older adults can turn to find specialized information, supports and service options in their area.  AAAs also play a crucial information and referral role, connecting families with local providers who can help them create a caregiving plan, address specific challenges, or identify support services.

In addition to Information and Assistance, each local AAA also offers support groups, Powerful Tools for Caregiver workshops, and respite.

The Commission on Aging’s website has free education and training resources found on the Idaho Commission for Aging’s website.  Further, the Idaho Chapter of Alzheimer’s offers “Know the 10 Signs” and “Understanding Alzheimer’s and Dementia” and many other webinars.  Look out the January schedule of educational webinars here.

References:
Alzheimer’s Association. (2018) Alzheimer’s disease facts and figures. Alzheimer’s Dementia 2018;14(3).  Available at alz.org
National Alliance for Caregiving in Partnership with Alzheimer’s Association. Dementia caregiving in the U.S Bethesda, MD: National Alliance for Caregiving: 2017.

My favorite definition of loneliness comes from Britannica:   A distressing experience that occurs when a person’s social relationships are perceived by that person to be less in quantity, and especially in quality, than desired.

It is common when people think of loneliness to think of the emotional response to a situation.  We’ve all felt lonely at some point in our lives, often in a room full of people.  Sometimes we don’t even recognize it as loneliness, we just realize we are not connected to anyone around us.

But, did you know that loneliness is much more than an emotional state?  It is a health epidemic costing Medicare 6.7 billion dollars a year? (AARP)

Loneliness is equivalent to smoking 15 cigarettes a day, being obese and having a sedentary lifestyle. (Julianne Holt-Lundstad) 

Nearly 40 percent of seniors feel some level of loneliness on a regular basis. (UCSF) and there is no doubt the holidays can be a difficult time for this generation stressed by the pressure of holiday expectations and the sadness of holiday memories.

What can we do to help those we care about?

Listen

---

That may seem simple, but when you have heard a story many times, make sure to listen again.  Especially about holiday memories.  If your loved one is hard of hearing or is developing dementia prepare ahead of time on how to best communicate.

Focus on the true meaning of the season

---

If they are no longer able to prepare the traditional holiday spread, or able to shop for gifts, make modifications. 

Simplify the meal

---

One month after my mother had major surgery my family went from a full holiday meal on Christmas afternoon to a simple morning brunch.  Each adult child arrived at my parent’s home with the food prepared and set it on the table immediately.  This made for a quick and easy meal that emphasized family time and created little work for any one person.  It has worked so well we’ve continued and made it our new tradition.  My parents still feel involved because it is in their home, but they do not have the pressure of preparing the meal. You can also leave them the leftovers!

Simplify the gift giving

---

Ask older people in your life to give you the gift of their memories.  In writing if they are able, or verbally, and you can record them.  Another idea is to let them know that spending time together is the greatest gift. This year I am giving my mother a few 300 large format piece puzzles (available on Amazon for less than $10.00) with a certificate for puzzle day. When she turns in a certificate my daughter and I will show up with a few snacks and visit while we complete the puzzle.

Holidays are unfortunately a trigger for loneliness; however, our goal is to ensure the older people in our lives feel noticed and included not only during the holiday season, but each and every day.

Join the campaign and visit the ICOA website “Stay Educated” page to increase your knowledge about loneliness by taking our six module course, browse the tools and resources, and reach out to your local Area Agency on Aging to get involved.

Being a family caregiver isn’t uncommon, in fact, more than 53 million people provide a broad range of assistance to support the health, quality of life, and independence of someone close to them, but it is crucial. In fact, millions of older adults and people with disabilities would not be able to live in the community without that support and replacing it with paid services would cost an estimated $470 billion each year.

Providing support is rewarding, but it can be challenging when family caregivers do not have training or support, needed for the growing complexities of care, or opportunities for rest and protecting their own well-being. At the Idaho Commission on Aging, we believe that caring shouldn’t hurt.

The Idaho Commission on Aging’s core duty is planning a network of services that help older Idahoans to live safe, healthy, and self-directed lives in their communities of choice. One of the most important services is the Idaho Family Caregiver Support Program offering:

• Information Services
• Help accessing services and supports
• Support groups, training, and counseling
• Respite, or a short break from caring
• Supplemental Services for individuals aged 60 years or older

This month ICOA encourages all Idahoans to recognize and thank family caregivers. If you are a family caregiver celebrate the important job you perform, but don’t forget to also prioritize the interests and passions that enrich your life and recognize the essential component of self-care.

Visit the ICOA Website for Caregiver information

Contact your local Area Agency on Aging for programs and services

For free education on healthy caregiving topics visit the Idaho Commission on Aging’s Caregiving Education webpage.