Family Decisions: Your Parent Is Declining

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By Ryan McEniff

seniormanIt eventually happens, you and your siblings notice that your mom or dad is not acting the way they once did, maybe memory impairment has increased, or someone is still mentally sharp, but they are not stable when walking and standing. When the family is together as a whole, it provides a great time to starting talking about what the options are.

So what are the options when it’s clear that someone is steadily declining and needs help?

Your Senior Care Options

This article will go through the options most families have when looking for senior care. It will provide the pros and cons of each service and the monetary costs associated with each type of care.

Family Members

Family members are great to be able to help someone who needs a small amount of assistance. Maybe your parent can’t drive anymore but just needs to get out twice a week. Or if the family is large enough, different people can help out for a few hours per week, and all share the responsibilities of helping out.

Cost: Low/Free
Time: Medium/High
Cons: Loss of time. Often one person becomes the main caregiver sacrificing more and more of their own time than other families do and can become burnt out.

Adult Day Services

Adult day services can be an alternative to having private caregivers come in. It allows seniors, especially those with dementia, to be stimulated through physical and mental activities while a family member has time to go to work or get important errands and tasks done.

Cost: Nation average $70 per day
Time: Low
Cons: Adult day patients can often suffer from dementia, so depending on your location, it might not be a right fit for non-dementia seniors who are looking for activities a few times a week. Additionally, care is provided from 9 am to 3 pm M-F, so there needs to be someone available to drop off and pick up. So it might not be ideal for families working full time or those who work on the weekends.

Private Home Care

Private home care services can provide peace of mind knowing that there is a dedicated caregiver that is there only for your loved one. Caregivers assist with ADLs (activities of daily living) and are flexible with their hours to cater to your schedule.

Cost: $20-30 per hour all private pay (no insurance coverage available)
Time: None/Low
Cons: It is expensive. Many families cannot afford the services. Additionally, families and seniors can be very nervous letting caregivers into their home.

Assisted Living Facilities (ALF)

Assisted living facilities provide an active social environment for senior who wish to interact with people their age. The services provide a private or shared room, meal services and transportation services. Additionally, many assisted living facilities have included a dementia unit, which, as the name implies, is for residents who have developed dementia and needs to be in a secure unit with dedicated and trained staff.

seniorwoman2Cost: $3,300 per month depending on location (no insurance coverage available)
Time: Low
Cons: Expensive. What you are paying for are room, food, and transportation. The personal care hours included are minimal, usually 2-5 hours per week. So if your family member ends up needing more care than that, it will be required to get additional attention, usually from a private home care company that will be an out of pocket expense. Finally, assisted living facilities are private pay, and once the money runs out, then you will be asked to leave.

Nursing Home

Nursing homes help people who need more complicated care that they cannot get at an assisted living or through private home care services. Many are new, provide outstanding care, good food, and activities. Nursing homes have a stigma attached to them of places you go to die or once there, no one visits you, but for many places, it is just not true.

Cost: $6,500-7,000 per month depending on location.
Time: Low
Cons: Expensive & Spend downs. Stigmas are a problem. Quality can range drastically, and some nursing homes will try and only accept spend down patients first.

Pro-tip: Nursing homes are not automatically paid for by Medicare or Medicaid, spending down is required (which is when the patients assets are “spent down” with a seven-year look back before Medicaid pays for the services). So if mom or dad is a resident at an assisted living or using private home care, my suggestion is to start looking for at nursing homes when you have over $50,000 left. Reason being, higher end nursing homes will be more accommodating to private pay customers than those that have no money and will be coming to them on Medicaid.

– The author of this guest post is Ryan McEniff, owner of Minute Women Home Care, in Lexington, Massachusetts.

Dangerous Decisions – Why Doctors Order So Many Tests

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By Dr. Michael Wald

doctorDoctors admit to performing tests because some patients insist on testing when they have chronic symptoms. Other causes include:

Staying out of trouble and surviving in medical practice – doctors are performing tests to help offset malpractice cases.

Financial reasons – Most doctors do not report that this is a motivation. This of course does not mean that money making is not part of their decision to perform tests. In my opinion, however, financial gain is not a prominent reason by the individual health care provider, but might be on the part of their employer (i.e., the hospital and/or HMO/PPO who drives testing criteria). It is my belief that many practitioners are ignorant to the harm that many procedures/practitioners can inflict upon their patients (such as too many x-rays, mammograms and CT scans, or medication prescriptions). I believe that most medical physicians actually believe that they are doing the right thing for their patients in terms of medications and medical tests and have not thoroughly thought out the negatives. They are simply “doing what they are told” and do not often think creatively or “out of the box”.

It should be noted, according to the New York Times article, that some studies have estimated that up to 30% of the care delivered to patients in the United States is unnecessary, and sometimes even harmful. Patients are receiving too much care. This belief, according to many doctors, underscores the issue of too much care, increasing chances of complications including unnecessary deaths, side effects and other issues associated with unnecessary interventions (i.e., x-rays and CT scans that may contribute to cancer incidence).

Surveys show that doctors feel pressure to over-treat patients based on inadequate time allowed to consult with their patients, fear of being sued or being perceived as not doing enough and ordering tests for minor issues. The problem here in my opinion is that patients insist on more attention within a disease care system (and not a health care system) – this philosophical and practical difference often leads to trouble.

doctorA survey of doctors said that they, “believe that the current quality measures and clinical guidelines endorsed by healthcare experts and insurers has a way to reign in excesses, where, in fact, has the opposite affect. The guidelines might, for example, require patients with high blood pressure and diabetes to have specific blood tests every three months…” What this statement is saying is that the insurance companies often dictate practice guidelines to doctors that may lead to overtreatment, medical complications and unnecessary medical care. One must also keep in mind that the medical treatments for these and other conditions that are tested, due to medical policy, on a regular basis, may lead for many people only to the “standard medical management” (which may be dangerous) when so many safe and natural alternatives are available.

“Guidelines in general set a bar for not enough care” – Some doctors claim that more testing should be done, but studies have shown that the more medical care delivered the greater the number of complications. According to the New England Journal of Medicine, 80% of procedures and practices in medicine are wrong! According to other studies, most diagnoses are wrong; if this is true, than 100% of the medications prescribed for these wrong diagnoses are incorrect.

“Moreover, a majority of doctors surveyed acknowledge being curious about how their colleagues practice; and well over half ask to see a report and the researchers offered on how practices in their own communities differed from others”. I find this statement unbelievable. Doctors should know something about other areas of medicine. This is a problem in the basic medical education that is compartmentalized, meaning that different doctors studying different types of medical care are often undereducated in other areas of medicine. This underscores a major criticism of holistic doctors and practitioners that have knowledge in medicine, natural medicine and all areas of the body. Remember the old saying, “One can be too close to the tree so as not to see the forest.” This statement is true of medicine and is a major limiting factor preventing wellness care delivery to the public.

What this article completely ignores is the fact there is almost a total absence of tests and procedures, which are meant to prevent the major causes of death and disability in this country. Furthermore, these tests, otherwise known as bio-markers and nutritional tests, when considered in a holistic fashion, can go a long way towards prevention saving literally billion so of dollars and millions of lives; and improving quality of life. No one is claiming that holistic care, when done right is inexpensive, but in the long run people undoubtedly live higher quality lives and may even be living longer as a result of a reduction in chronic degenerative incidence.

– Dr. Michael Wald, aka The Blood Detective, is the director of nutritional services at Integrated Medicine of Mount Kisco, located in Westchester New York. He has appeared on ABC World News Tonight with Diane Sawyer, Channel 11 PIX, Channel 12 News, CNN, The Food Network and other media outlets. Dr. Wald earned the name Blood Detective for his reputation to find problems that are often missed by other doctors. He earned an MD degree, is a doctor of chiropractic and a certified dietician-nutritionist. He is also double-board certified in nutrition. He has published over a dozen books with three additional titles due for release late 2013 including: Frankenfoods – Genetically Modified Foods: Controversies, Lies & Your Health and Gluten-A-Holic: How to Live Gluten Free and the Blood Detective’s Longevity Secrets. Dr. Wald can be reached at: or or by calling: 914-242-8844.