The Elder Care C l i f f R e p o r t ®

WHEN LOVE IS NOT ENOUGH……….WHAT TO DO WHEN YOUR PARENTS ARE LOSING THEIR INDEPENDENCE.

As millions of us suddenly find ourselves in the role of caregiver, we are sadly unprepared for this life changing responsibility. There are about 65 mil-lion of us who provide care to an aging, blind or disabled relative and we do without any form of compensation and most of us spend 20-40 hours a week

providing the needed care. If it were not for us, the U.S health care system would be in a worst financial shape. As a nurse, a geriatric care manager and a dementia practitioner, I have traveled the journey of elder care for al-most a quarter of a century and what I have discovered is that Caregiving is the greatest art of love but LOVE is not enough.

You can’t do caregiving with just LOVE without losing yourself in the process. To be successful in caregiving, you need love, perseverance, dedication, support and professional help. Time and again, I have seen family members struggle with health challenges of their own, suffer depression, risk their marriages, decline career advance-ments, or even quit their jobs just to take

care of their loved ones. Very often, the family caregiver dies either before or shortly after the per-son that they are caring for due to stress related disorders associated with Caregiv- ing. It is for these reasons that I wrote this book. Through this book written with gentle humor and compassion, I provide real answers to urgent questions when there is no time to wait. This small, succinct and concise book will take you through a process of what to do when there is no money for care, who you should hire to help you with caregiving, how to make decisions when memory loss as started, how to talk to your parents so they would listen and how to say what and when to say it so that you can help them uphold their dignity and their independence as much as it is realistically possible. Towards the end of the book, I will give you actionable steps to devel-oping a care plan with practical solutions that you can use today and right on the spot. When Love is Not Enough The Caregiver’s Companion: What To Do When You Parents Are Losing Their Independence is NOW available in print at Home Health Care Supply Outlet 440-266-1770 located at 9165 Mentor Avenue Mentor Ohio 44060 for $6.99 or as an ebook on www.caregivinginsti-tute.org. or www.stellansong.com. for $3.99. To schedule an appointment to speak with me about your loved one, please call 440-358-1718 or call my 24 hours answer line at 440-942-9933 or you may send an email to Ohcpc@caregivinginstitute.org.

Vol. 1. Issue 1 a publication of the CAREgiving Institute founded in 2003 by Stella Nsong, RN, CMC, CDP, LTCP, Author, Speaker & Elder Care Consultant. The Elder Care Report is written and published by Stella Nsong. R.N. CMC, CDP, LTCPOne Victoria Square # 302 /Painesville Ohio 44077 Phone 440-358-1718. Fax 440-358-1716.

www.eldercarecliffreport.com. www.caregivinginstitute.org. www.stellansong.com.

Why The E l d e r C a r e Cliff Report 65 million: That is the approximate number of unpaid caregivers in Amer-ica. You most likely know one of them, they live in your city, on your street or even next door. They serve with love, courage, never ending patience and perseverance. They have mastered the art of juggling and balancing their multiple roles and re-sponsibilities. Some give 24 hours a day with days blend-ing into weeks, months and even years. Many of them have given up employment to attend to their loved ones causing their own personal financial cliff and additional financial stress. On top of the fact that they provide unpaid care, America needs them to continue working so that their will continue to help fund some of the already limited care services for the aged, blind and disabled. Today, these unpaid caregivers provide over 450 billion dollars worth of care to their elderly parents and loved ones. 450 billion is the cost of care and services that we working and tax paying people in America would have had to pay for if these dedicated, courageous, resil-ient and extremely stressed out family members where not available or willing. Guess what would have happened to Medicare and Medicaid by now if it where not for these family members whom I am going to call the invisible heros of the US health care system. On behalf of all of us who recognize your importance and appreciate your dedica-tion and your sacrifice, I Stel-la Nsong would like to use this column to raise aware-ness of the fact that without these invisible heros and without solid plan for the elder care system, America is facing a Caregiving crisis which I have decided to call the Elder Care Cliff. This is how the Elder Care Cliff Re-port came about. I invite you to follow me in these discus-sions and dialogue so togeth-er we can be ready for the year 2030 and beyond.

Top 10 signs that America is not ready for the eldercare cliff…..see if you agree!

• By the year 2030, the youngest baby boomers will turn 85. • 1 of 2 people aged 85 and older will suffer from Alzheimer’s disease. • Alzheimer’s disease is the most expensive disease

facing America today. • There will not be enough people to care for the 85 years and older —the fastest growing segment of the population. • Today, there are about 5 people to provide care for an older adult but by the 2030, the research is showing that there will be only 3.6 persons and by 2050, there will be only about 2.9 persons available to care for an older adult. • The family caregiv-ers hold the US health care system with the 450 billion dollars of free care that they provide each year. • The family caregiv-er now dies either before or shortly after the care recipi-ent. • 75 of the family members who are employed are clinically depressed and yet untreated. See the sky rocketing cost of the em-ployer’s health plan. • It cost an employ-er an average of 2300 per year per employee for loss of productivity associated with Caregiving. • America depends on the taxes of these em-ployed caregivers so it can continue to fund the pub-lic and community services which are already limited and will be drastically re-duced under the highly needed health care reform.

THE ELDER CARE CLIFF REPORT OFFERS POSSI-BLE SOLUTIONS The Eldercare Cliff Report is a print and on line communication platform bringing up to the minute discussions, cutting edge ideas, solutions, innova-tion, research and education about America’s Caregiving crisis. This report will dis-cuss what caregivers, em-ployers and policy makers need to do, research, explore and collaborate so we can survive and thrive in 2030 and beyond. To contribute to the report or to begin a dis-cussion please call me at 440-358-1718 or email to Ohcpc@caregivinginstitute.org of follow me on face book, twitter and linkedin. You may also visit me on line at www.theeldercarecliffre-port.com. or www.stellan-song.com.

Where is Stella Nsong, R.N. TODAY?Seminars, workshops, quick help sessions and support group schedules. To register for any of these seminars, please call 440-358-1718.

Date: Thursday March 21st, 2013.-Topic: How to Get the Government to Pay Family caregiversLocation: ‘S’ Generation Center Inc. 7750 Plaza Blvd Mentor Ohio 44060 440-942-9933 Time: 7:00pm to 8:30pm.

Date: Monday April 29th, 2013. Topic: Where to find money to pay for respite care. Location: John Henrys Salon8484 Mayfield Rd Chesterland Ohio 44026 440-688-4150. Time: 630pm to 8pm. ***********************Date: Wednesday May 15th, 2013.Topic: ASK anything Caregiv-ing. This is an OPEN and FREE telephone consultation day. If you get the voice mail then all lines are busy. Leave a message and your call will be returned in 2 hours or less.

Location: Telephone to 440-358-1718.

Building the bridge to transform America’s Elder Care Cliff through Education, Innovation & Collaborative Initiatives

As a token of my appre-ciation for your interest in this report, I wish to

extend to you a gift called The Eldercare Survival Tool Kit. Enjoy it, share

some of the gift certificates within the kit or regift it to

a dear friend or relative. The valued is just over $997.00. See page 4 for

details.

What’s Inside? Stella 100….Questions, Answers, Advice to enhance inde-pendent living 100 years and beyond. Page 2. It’s a matter of time…Life Resource Planning: what we must do to secure a good retirement….Page 2. Where is Stella today? Page 1-These are places that I am go-ing to be appearing as in speaking engagements and support groups and or seminars. Delaying nurse home placement: CAREgiving Institute’s REBIRTH demonstration study a success. Page 2. New service offer employer support when Caregiving be-comes a work place issue. …page 3. Incontinence is not a disease……page 3. Caring 4 Caregivers……the GIFT of a support group. page 4.

(in cooperation with Healthy Referral Newspaper, www.healthyreferral.com 347-6-UR-WELL)

Save the Date!National Healthcare Decisions Day Is April 16th

Please join Geriat-ric Care Manager and Americans across the coun-try in reminding family members and friends to make their fu-ture healthcare decisions known. Everyone should share their wish-es and complete their advance directive, be-cause...DECI-SIONS MATTER. Huummmmm, it could be a book signing day for me…………got to think about that a little more. Na-tional Healthcare Decisions Day and get free infor-mation at www.nhdd.org.

Th e Stella 100 column is for questions, answers, options and recommendations for everything Caregiving. Use this column to ask Caregiving questions and look for

the answers to your questions in the next issue. For faster response, please call 440-358-1718 or for immediate assis-

tance call my 24 hours answer line at 440-942-9933.

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Stella 100!“Questions, Answers, Options to enhance independent living 100 years and beyond. ” by Stella Nsong, RN

Stella Nsong is a certi� ed geriatric care manager and a certi� ed dementia practitioner. She has been a nurse for than twenty years and has worked in almost every branch of health care. Over � � een years ago, she became a business owner and has owned, founded, turned around, licensed and managed private duty agencies, Med-icaid/Medicare certi� ed agencies, adult day centers, home medical equipment companies and assisted living facilities. A widely renowned speaker and caregiver’s coach, she has authored three books on eldercare and she is also a coauthor of the gratitude project. She is the president of the CAREgiving In-stitute a 501 3 c organization (located in Painesville Ohio) whose mission is the transform America’s Caregiving crisis by providing options and resources for today’ and tomorrow’s elderly. Stella is also the writer and publisher of the Elder Care Cli� Report. In 1990, she won the gold medal for practical nursing in the state of Georgia. In 2010, she was nominated business woman of the year in Chesterland Ohio. In 2012, she was nominated for the Plati-num award in Care Management as well as the Professional of Note in Geriatric Medicine. Her books bring much needed basic information to the everyday caregiver to make it easier to carry out their Caregiving responsibilities without losing themselves in the process. She is available to help families and employers with consultation, seminars and Caregiving advice.

Question: My husband is 87 years old. He has a new problem. He can’t quite make it to the bathroom so when he stands up to go to the bathroom, there is a trickle of urine from the bedroom to the bathroom. Two weeks ago, he slipped on his own urine and fell and has been in the hospital since. Th e doctor says he has urinary incontinence and an enlarged prostate. Surgery would be too hard on his body so he will have to wear diapers. I have to decide if he should come home or go to a nursing home because I can’t take care of him at home by myself. What kind of help can you give him?

ANSWER: 20 million people in this country suf-fer from urinary incontinence. Leaking urine or losing blad-der control can aff ect people of all ages and both genders. In-continence is not a disease. It is a symptom of an underlying problem. We can help you in 4 diff erent ways; provide advice on what to look for when getting incontinent supplies, help you fi nd a reimbursement grant to defray some of your cost of care, give you 1 free hour of a geriatric care management service, locate in home for around the clock care for under $10.00 an hour and help you with a home safety evaluation. THE BEST INCONTINENT PRODUCT EVER: Th ere is a brand of disposable undergarment/diaper and in-continent supplies called TRANQUILITY. For my 20 plus years as an elder care consultant it is the only brand that I can guarantee that it does not smell when wet, it controls bacte-rial growth, reduces the chances of a urinary infections, each undergarment holds almost half a gallon of urine, does not leak and it is convenient for a caregiver like you because you do not need to change it frequently and your husband can get better sleep through out the night. Best of all, it is less expen-sive than 90% of all other brands including the generic store brands. You can get TRANQUILITY at Home Health Care Supply Outlet 440-266-1770 located across the street from Su-per Kmart on Mentor avenue. For hands on help, I would recommend the AS-SISTED LIVING AT HOME service off ered by Nightingale Home Support & Care. It is around the clock care for under $10.00 per hour. Th eir number is 440-942-9933. I would also recommend that you call my offi ce for an appointment with a geriatric care manager and we can help you locate grants, plan for long term care and help you become a less stressed out caregiver so that when he comes home, you can have some help and be able to take time off for respite. If you are able, fol-low me on twitter or like me on face book to get a free copy of my soon to be released book ON RESPITE CARE & WHERE TO FIND MONEY FOR CARE. You may also send me an

Th e Society for Human Resource Management has described Caregiving as the silent productivity killer. Th e Metlife study of Em-ployer Costs for Working Caregivers estimated that U.S employers lose approx-imately 11.4 to 29 billion dollars each year as a result of employee Caregiving that interferes with work re-sponsibilities. Today, loss of productivity cost an employ-er approximately $2500 per year per Caregiver employee . Approximately 29% of the U.S population is involved in providing care for a chron-ically ill, disabled or aged family member or loved one. Half of all caregivers for persons aged 50 and over are employed full time and almost 75% of them have had to change jobs or

stop working because of the demands of family Caregiv-ing. Most of these Caregiver employees have symptoms of true clinically depression that goes untreated. Ac-cording to the University of Pittsburgh eldercare in the workplace study, the pop-ulation of people over 65% is expected to increase at a rate of 2.3% but the number of family members available to care for them will only increase at a rate of 0.8%. Th ese trends result in the demand for workplace elder care programs that do more than provide the employees with FMLA benefi ts, phone numbers and lots of complex and confusing literature from social service organizations. Employees who are caregiv-ers need real help and small businesses need to keep

their talent, watch the bottom line and contain their group health insurance cost. Employers suff er increased healthcare benefi t utilization because oft en, their caregiver employees end up more sick than the person for whom they are caring for. With the rising cost of insurance and the demands of the health care reform, employers with Caregiving employees face a huge challenge because 20% of these employees will quit their jobs to provide care full time. Th e cost of insuring these employees and then replacing them when they quit poses a fi nancial strain on an employer.

Th e CAREgiving Institute extend grants for the development of workplace Elder Care Programs to lake county businesses who qualify.

Th e CAREgiving Institute has a new program designed to support the employer and the caregiver employee. It is a collaborative initiative between 4 organizations to raise awareness for the need for eff ective workplace elder care pro-grams that can accomplish a 4 pronged goal; fi rst to educate the Caregiver employee about the IMPORTANCE of long term care planning. Second, to design a back up Caregiv-ing system to help the employee especially when there is a sudden need for care. Th irdly, to help the Caregiver employ-ee to develop an individualized work life balance, self care and wellness program. Lastly to help the employer lower the

cost of employee retention, absenteeism and health care benefi t utilization as it relates to caregiving.

Each employee will have access to services which will include level of care assess-ments, care plan develop-ment, back up care, adult day care, in home care, assistance with the legal aspects of Caregiving, stress management, relaxation and wellness, as well as support groups and access to hands-on and on-line caregiver training and education.

Th e program will be cus-tomized to fi t the organi-zations that qualify based on the size of the Caregiver employee group and shift s that the employees work. Th is program is a worksite

Grants available to lake county businesses……when Caregiving become a work place issue.

program so employees do not have to travel or loose time from work. Th e appli-cation process is quick and simple. Some organizations may need to cost share or contribute in kind commu-nity services to support the program at the end of the grant period.

Employers and or em-ployees who are interested in a workplace elder care program should contact the CAREgiving Institute by either calling 440-358-1718 or send an email to Ohcpc@caregivinginstitute.org.

REBIRTH Demonstration Study a Success……….Shows How to Delay the Need for Assisted Living & Medicaid Enrollment Columbus Ohio Jan. 2013. Deeply frustrated with the complexity and fragmentation of our

health care and long term care ser-vices and support systems, nurse entrepreneur Stella Nsong decided to dedicate her expertise and time to help find one possible solution to Ohio’s ailing Med-icaid system. Her interest sparked when she came across several older adults who were losing their independence and

needing long term care placement simply because their family caregivers and or guardians did not have enough information or knowledge on how to keep them safe and independent in their homes. It was painful to see a frail widow loose her home because she lost her ability to walk while she was at the rehabilitation facility receiving the therapy that was supposed to help her regain her strength and her independence. Today, Ohio spends 85% of its budget on 15% of its population which is made up of the aged, the blind and the disabled. Every month, Ohio enrolls almost 2000 individuals into its Medicaid system. What would happen if the State of Ohio had a system that could delay or reduce the need for Medicaid enrollment by 100 older adults each month. Imagine if this delay could happen effectively and safely for 12 months for each older adult over the next decade. By the 2030, when the oldest baby boomer will be turning 85, Ohio could possibly have its Medicaid budget well under control.

This is how the REBIRTH study came about. REBIRTH stands for Restoring El-der Bio-Medical Independence, Restoring Transformational Health. It is a 12-18 months demonstration study program conducted by the CAREgiving Institute, part of the Inde-pendent Living Community of the Woodlands at Eastland in Columbus Ohio. The study has demonstrated how a comprehensive enhanced care management model designed by Stella Nsong (utilizing available community generated solutions and resources, health promotion/ educational activities, informal/family caregiver support, recre-ational day time services and intermittent home health aide services) will help older Ohioans realize three significant benefits: · Lower the level of care thereby delaying the need for institutional or assisted living placement for 12 months.· Delay the need for Medicaid funded services and nursing home admissions for at least 12 months.· Help the older Ohioan enjoy MORE LIFE out of days than DAYS OUT OF LIFE through finding peace, purpose, hope and happiness in their later years.

WHO WOULD BENEFITS FROM the R.E.B.I.R.T.H study? Older Ohioans between the ages of 62 and 85 who meet the following criteria:· Do not require 24 hours supervision or care· Are not eligible for Medicaid and are currently not engaged in Medicaid plan-ning techniques in an attempt to divest themselves of their assets to qualify for Medicaid in the future. .· Require assistance with no more than 4 Activities of Daily Living.· Have been hospitalized at least once in the last two years· Have been placed on 1-4 new medications in the last two years· Have been at risk for institutional or assisted living placement in the last two years.

REBIRTH a success: 9 participants have stayed out of Assisted Living successfully & happily. · During the course of the study, the participants experienced a gradual and continuous reduction in their level of care (through participating in the wellness programs, engaging in therapy, utilizing less medications and keep mentally stimulated) therefore preserving more of their assets that otherwise would have been spent on a higher level of care.· Assets have been preserved as much as possible through the utilization of community based care solutions and other available benefit programs such as the VA aide and attendance pension plan. .· All have enhanced and maintain independence to their highest functional abil-ity and one has been able to regain his driving privileges. As a matter of fact, this participant drives himself to dialysis three days a week and has mastered his care and symptom

management. Before enrolling in REBIRTH, one of the participants was at the emergency 2-4 times a month for falls and urinary track infections. Since her enrollment in the REBIRTH study, she has not been admitted to the hospital and has been to the emergency once for a swollen leg and once for a fall in the last 15 months. ·All the participants have access to the comprehensive care management system and up to date wellness, physical, emotional, mental and psychological health check up and follow up services.

REBIRTH is very cost effective. Fee for the participation in the program ranges from $1690 to $1945.00 per month based on need. The fees covers room and board, all utilities, cable TV, activities, use of the laundry facility, transportation to medical appointments, breakfast and dinner meals and comprehensive care management services. Physician services and all required therapies are billed under Medicare or private insurances. Personal care, some medication management, medication reminders and home making are provided by home health agencies of the participant’s choice. Participants are required to pay for their medications, extra food outside of the break fast and dinner meals, snacks, toiletries, laundry detergent, extra laundry services, and any other specialized services that are not covered under the program.

THE FUTURE OF REBIRTH. The final results of the study are being compiled and will be made available upon request. So far, nine participants (all who needed level 3 assisted living or nursing home placement) have been able to remain independent, active and well. One participant is doing so well that he is able to regain his car keys, has a very active social life and has offered to become a volunteer for the program. The CAREgiving Institute intends to seek federal funding and sponsorship to expand the program and conduct further research for keeping older Ohioans active and well and out of long term care facilities while helping the Medicaid bottom line. Through the CAREgiving Institute, REBIRTH is facilitated by Stella Nsong, RN, Dr. William Roberts of Doctor’s House Call, Anta Mcknight, RN, CNP, Dr. Esther Hampton, Shari Baker, RD and Chaplin F. Bernard Harris Jr. For more information call 614-866-2080 or email to rebirth@caregivinginsti-tute.org. or visit us on the internet at www.caregivinginstitute.org.

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A Cheaper Alternative for Respite Care-Walk-In Senior Care ONLY

$4.95 to $7.00/hour Since the downturn of the economy, costs for health care have been on the rise. According to a 2011 market survey of long-term care costs, the national average daily rate for a private room in a nursing home rose 4.4% last year from $229 in 2010 to $239 in 2011. Similarly, the national average monthly base rate in an assisted living community rose 5.6% from $3,293 in 2010 to $3,477 in 2011.

These rising costs are frightening to many young caregiv-ers who are trying to find the best way to care for their loved one. If your loved one is suffering from dementia or other chronic diseases such as chronic hyperten-sion, physical disabil-ity, cardiovascular dis-ease, diabetes, mental illness and develop-mental disability, you may want to look into

an adult day care program like the WALK-In SENIOR CARE at the “S” Generation Center. While the costs of adult day care rose along with other health care costs, it still remained the lowest annual rate in 2011 when compared with the annual costs of nursing homes, assisted living communities, and home care. Though daily fees for adult day services vary depending upon the services provided, the national average rate for adult day centers is $61 per day (includes 8-10 hours on average) compared to an average rate for home health aids of $19 per hour. Walk-in Senior Care at ‘S” Generation Center range in cost from $4.95 to $7.00 per hour. The National Adult Day Services Association describes adult day centers in this way:

“Adult day service centers provide a coordinated program of professional and compassionate services for adults in a community-based group setting. Services are designed to provide social and some health services to adults who need supervised care in a safe place outside the home during the day. They also afford caregivers respite from the demanding responsibilities of caregiving.” The adult day service is a growing industry with over 4,600 adult day centers across the United States and more than 260,000 participants. They provide aging and chronically ill adults with a small loving community. The average capacity of an adult day care center is for-ty adults with a recipient to staff ratio of 6:1. Participation at the Walk-In Senior Care ranges from 7 to 13 people a day with a care recipient to staff ration of 3:1. Walk-In Senior Care is for those family caregivers wishing to keep loved ones who are in chronic care in their own community, at home, and among friends and family for as long as possible. Caring for a loved one can present emotional, physical, and financial tolls that are often too difficult to manage 24/7. Walk-In Senior Care can provide family caregivers a few hours of rest and rejuvenation while your loved one spends their day engaging in social and therapeutic activities. The Walk-In Senior Care center has a bright activity room that is easily accessible for those with wheelchairs and walkers. A caring staff presides over the activities which include restorative therapy, music, board games, crafts, painting, meals and socialization. The center is open from 6am to 6pm Monday to Friday and 8am to 6pm on Saturdays by request. It is sometimes difficult to leave your loved one at a facility that is new to them but give your loved one a chance to try for a few days as it will take several visits for a new setting and routine to feel comfortable and allow yourself to relax knowing that your loved one is being cared for. There are grants for those who qualify. Stop in and tell us your Caregiving story and we will immediately create a customized care program that will take your stress away. STOP IN OR CALL NOW 440-942-9933. WE CAN START TODAY!.

Elder Care Survival Tool Kit! Value over $997.00!As a token of my appreciation for your interest in this report,I wish to extend to you a gift called The Eldercare Survival Tool Kit.

Enjoy it, share some of the gift certificates within the kit or regift it to a dear friend or relative. The valued is just over$997.00. To

schedule an appointment to speak with me about your loved one, please call 440-358-1718 or call my 24 hours answer line at

440-942-9933 or you may send an email to Ohcpc@caregivinginstitute.org.

Save the Date!and Help Save Your Family with Vital

Powerful Hidden Information

National Healthcare Decisions

Day Is April 16th

Please join Geriatric Care Manager and Americans across the country in reminding family members and friends to make their future healthcare decisions known. Everyone should share their wishes and complete their advance directive, because...DECISIONS MATTER. Huummmmm, it could be a book signing day for me…………got to think about that a little more. National Healthcare Decisions Day

and get free information at www.nhdd.org.

$50.00 per person WAIVED for the first 111 that pre-register by_______________