How To Pay Family Members For Providing Eldercare
Robert Mauterstock

About 40 million people in the U.S. are full or part time caregivers for a member of their family. Two thirds of these caregivers are women and half of these women are working outside the home to provide for their families.
Unfortunately these caregivers often have to reduce their working hours or quit their jobs to provide the care that a family member requires. As a result they often lose seniority or a reduction in their retirement or social security benefits because of their decision to leave the workforce.
AARP has reported that these family caregivers spend an average of $7000 per year on out of pocket expenses to care for their family member. . For patients with dementia the costs exceed $10,000 per year.
​But there are alternatives for caregivers to get paid legally for providing care to an aging parent or other disabled family member. But the steps to initiate this process must be followed carefully to avoid problems with the I.R.S. or Medicaid qualification in the future.

1. First the person receiving care must be of sound mind and have the financial resources to afford the cost of this care. If that person went to a professional agency to receive care they would likely pay $25/hour or more.
2. Wages and paydays, schedules, sickdays, and respite care must be discussed between the parties realistically to avoid any misunderstandings in the future.
3. A contract between the caregiver and their family member must be drawn up that details all of the above issues just as if it were with an unrelated professional.
4. An eldercare attorney familiar with such arrangements should be consulted to review the contract to make sure it meets tax and legal requirements. If he or she recommends that FICA taxes be paid a payroll company should be hired to handle the details. Income to the caregiver must be reported as taxable income.
5. The care recipient and caregiver should host a family meeting so all family members become familiar with the situation and can accept it. There is nothing like the grumblings of a dissident sibling to destroy a good working relationship.
6. The caregiver and recipient should meet periodically to determine if the arrangement is working to the satisfaction of both parties.

If these steps are followed carefully aging parents can compensate their family caregivers legally for the time and effort they spend providing support.

Really?  Really?  
We REALLY want the Feds to be responsible for running state nursing homes or planning for our long term care?  I dont think so.  Considering the Veterans Administration (VA) and the string of debacles there.  Who will pay for your long term care?  The answer is as it should be.  YOU will.  It should be YOUR choice and hopefully you are planning for this eventual expense now.  Give me a call to discuss.

Majority of Americans think government should pay for long-term care
Lois A. Bowers
Follow @lois_bowers
A majority of Americans believe that the government should be primarily responsible for paying for the long-term care needs of older adults in the future but that the responsibility mainly will fall to the older adults themselves or to their families, according to the results of a poll released Thursday by the Pew Research Center.
Fifty-five percent of the 2,524 people polled in December said that, 30 years from now, the government should be mostly responsible for paying for long-term care, whereas 28% said the older adults themselves should be responsible for assuming those costs, and 14% said that family members should pay.
When participants were asked who likely will be most responsible for long-term care expenses in the future, however, a majority of them said the responsibility primarily will be that of the older adults themselves (36%) or their families (35%). Twenty-eight percent said the government will be mostly responsible for paying for long-term care.
Survey-takers who were black, Hispanic, aged 50 to 64 or had an annual family income of less than $30,000 were more likely to say the government should be mostly responsible for paying for long-term care than were other respondents. Participants identifying as Republicans were evenly split over whether government (40%) or older adults themselves (40%) should be mostly responsible for paying for long-term care, but two-thirds of those identifying as Democrats said that the government should be primarily responsible for paying for it.
Poll participants who were white or had an annual family income of $75,000 or more were more likely than other participants to predict that older adults themselves will be mostly responsible for paying for long-term care in the future. The outlook did not vary significantly between Republicans and Democrats.
Most people surveyed also believe that, 30 years from now, those aged 65 or more years will be less financially prepared for retirement than their counterparts are today and believe that most Americans will work into their 70s to have enough resources to retire. Most respondents also rejected the idea of reducing Social Security benefits for future retirees.
See more information on the Pew Research Center’s website.

Call me today if you are in a common law marriage and you think your estate plan is in good shape.  We need to chat.  

The following article is from Canada.  The law is different in Virginia, to a point.  But please, check out the article and consider how your common law marriage may impact your estate plan.
For common-law couples, estate planning is full of pitfalls. Here's how to avoid some of themJason Heath: Couples who are common-law can have a unique set of financial planning challenges that differ from their longtime, first-marriage counterpart


Jason HeathApril 16, 2019
6:30 AM EDT
Last Updated
April 16, 2019
6:30 AM EDT

Statistics show that more Canadians are divorcing, remarrying and living common-law than in the past. Couples in second marriages or who are common-law can have a unique set of financial planning challenges that differ from their longtime, first-marriage counterparts. Perhaps the most difficult issue is the one that nobody likes to talk about — estate planning.
Polls suggest about half of Canadians have no will. Talking about dying and proactively planning for it can be difficult, but it is easier for married couples who started with nothing and built their nest egg together.
Common-law couples and those who remarry may manage their financial affairs separately. They may bring uneven assets or incomes into their relationship. They may have uneven expenses for their children, an uneven number of children, or ongoing support obligations for a former spouse.
​Here are some of the most common estate planning mistakes made by these couples and how to avoid them.
Joint ownership of real estate
It is not uncommon for common-law spouses and couples in second marriages to hold real estate as tenants in common, particularly if they have children from other relationships. This differs from the typical joint ownership structure called joint tenancy, whereby a survivor becomes the sole owner of an asset upon the death of the other owner. As tenants in common, both parties can own a separate interest in a home, the ownership of which can be transferred by an individual to whomever they wish.
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As an example, a couple might each own half of a home as tenants in common, and both might leave their 50 per cent share to their children in their wills. Upon the death of the first partner, their children might end up as co-owners of a home with their step-parent. In the absence of a provision in a will, this could present an awkward situation for the survivor and the children of the deceased.
One solution may be to include a clause in a will permitting a surviving partner to stay in the home for a predetermined time afterwards, so they are not forced to sell their home and move while mourning a loss. It is important to include conditions in a will about who is responsible for the ongoing expenses in the interim, and how the value is to be determined if the survivor decides to purchase half of the home from the children of the deceased.
One valuation option may be to obtain two independent appraisals, with the purchase price being the midpoint of the two. A notional real estate commission based on the customary rate in the province of residence could also potentially be included in this calculation.
Leaving too much or too little to the survivor
The Goldilocks principle often applies to estate planning for couples who each have their own children. They must find the right mix of beneficiary designations so that neither too much, nor too little, but just the right amount of inheritance is left to all parties. This really is more art than science, as the only allocations that may be somewhat predetermined relate to potential family law requirements and minimum inheritances that may apply between spouses in certain provinces.
There are real and perceived risks of leaving everything to a surviving spouse or common-law partner who is a step-parent to your children. In the absence of establishing a trust in your will, or preparing mutual wills, there may be nothing stopping a survivor from gifting assets during their life or upon their death in such a way that you may not have anticipated. They may even get into a new relationship after your death that significantly changes how their assets are ultimately expended or distributed.
There is also the risk of how your children could perceive your partner if they inherit everything, at the expense of your kids, even if your children may someday inherit from them.
At the other extreme, if you do not provide sufficiently for your partner in your will, they could be in an unfortunate financial position as a result of your death. If a couple has one partner with less assets as retirement approaches, they may feel compelled to work longer than they would otherwise if they had more confidence in their financial security in the event the other partner died. Or they may compromise their spending in retirement in order to preserve their assets, to the detriment of a mutually happy retirement.
As a result, it can be vitally important to think about and talk about how assets will be distributed upon death in order to find a happy medium.
Leaving the wrong assets to the survivor
Certain types of assets can pass more efficiently to a surviving spouse or common-law partner than to children. Registered Retirement Savings Plan (RRSPs) and Registered Retirement Income Funds (RRIFs) can be transferred on a tax-deferred basis to a spouse or common-law partner upon death. If these accounts are instead payable to children, they become fully taxable upon death, unless an account is left to a financially dependent child or grandchild who lived with the deceased and whose income was below certain thresholds.
Tax Free Savings Accounts (TFSAs) can also be transferred into a surviving spouse or common-law partner’s TFSA without affecting their TFSA room, creating more tax-free investment opportunities for them. A TFSA left to a non-spouse beneficiary is no longer tax-free for the beneficiaries.
RRSPs, RRIFs and TFSAs should not necessarily be left to a surviving partner simply to save tax. However, considering which assets to leave to whom when there is a desire and a choice is an important estate planning exercise.
This is hardly an exhaustive discussion of the estate planning challenges or opportunities for those in a second marriage or common-law relationship. It is important to appreciate the unique circumstances facing these couples. Avoiding talking about or not planning for death will not make us immortal. And not addressing these issues while you are alive can lead to problems for those you love most after you are gone.
Jason Heath is a fee-only, advice-only Certified Financial Planner (CFP) at Objective Financial Partners Inc. in Toronto, Ontario. He does not sell any financial products whatsoever.

The law in Virginia is a bit different, but the issues are similar in England, it looks like, from this article.  If you are named as an executor in a will of a friend of loved one, and need help, CALL ME.  I will be happy to assist you in Virginia.




The nightmare of being executor to a will: Inheritance feuds are on the rise, so how do you handle unruly relatives (and can you just resign)?By Samantha Hirst For This Is Money
Published: 02:46 EDT, 16 April 2019 | Updated: 05:16 EDT, 16 April 2019
Inheritance feuds: How do you navigate them as executor to a will
You might feel gratified to be asked by a friend or relative to be their executor, and sort out their will.  It's only after they are gone that the trouble can start.
Feuds over inheritance are on the rise,  according to official court figures, a trend lawyers put down to rising property prices and the intricacies of modern family life. 
Samantha Hirst, a solicitor at Ridley & Hall and a specialist in will disputes, explains how executors can get embroiled in family drama and how best to avoid this - and, if necessary, fight back. 
Being appointed as an executor is a great honour. The person who made the will trusted you implicitly to carry out their final wishes.
However, it is often under-estimated how much responsibility the position holds, and for some executors they can feel like they have been handed a poisoned chalice - many find the role stressful and upsetting.
Executors come in all different shapes and sizes, from family members and friends to accountants and solicitors, and each estate is unique. But there are some challenges that come up time and again, so how might you deal with them? 
Hounded over the will: What are beneficiaries entitled to know?You may be in a situation where you are struggling to manage the beneficiaries’ demands and expectations.
They might be regularly contacting you for updates or want you to send them various documents in relation to the estate.
Communication is key in these circumstances, and it is important to find the right balance between making sure the beneficiaries don’t feel left in the dark, but also knowing that you are not duty bound to pander to their every request.
It is quite common for beneficiaries to want to see the will, but it is at your discretion whether you disclose it to them.

+2

Samantha Hirst: As an executor, you are not duty bound to pander to every request
It is common practice to show a copy to residuary beneficiaries - those who are given the remainder of the estate once all the debts, legacies and other expenses have been paid.
The will would not usually be seen by anyone who is not named on it.
However, once you have been awarded probate, the stage at which executors gain control over an estate after someone dies, the will becomes a public document. Anyone can request a copy by doing a standing search.
Only residuary beneficiaries are entitled to see a copy of the estate accounts, which is a full summary of all the finances associated with a will, including the executors' expenses.
There are some exceptions to this rule, such as parents and guardians of minor beneficiaries, or beneficiaries and creditors who cannot be paid because there is not enough money to do so.
If a legitimate request to see the accounts has been made then you should disclose these within a reasonable time period.
Sometimes beneficiaries want to see more detailed documents like the deceased’s bank statements or pension documentation.
Strictly speaking a beneficiary has no entitlement as of right to such documentation – it is at your discretion whether to disclose any requested information.
If you do receive a request for information or documents, you should usually consider the following in deciding whether to allow it:
1) The nature of the beneficiary’s interest
2) The information the beneficiary is requesting
3) The reasons for the request for information
4) Whether the information may be confidential (for example, it's relevant to one beneficiary but not another)
5) The cost to the estate of providing the information.
If beneficiaries feel as though vital information is being withheld from them, they can make an application to the Probate Registry for an inventory and account. If this type of application has been made then you should seek legal advice. 
A feud breaks out: What if the will is challenged?There are several ways people can challenge a will. The two most common are bringing a claim under the Inheritance (Provision for Family and Dependants) Act 1975, where someone feels they haven't been provided for properly, or challenging the validity of the will.
If someone is challenging the validity of a will then they may apply for a 'caveat' to be placed on the estate which will prevent you from taking out a grant of probate if you have not already done so.
Heath v Heath A conflict of interest may arise as it did in this recent case.
Timothy Heath was an executor and beneficiary of his late mother’s estate, Rachel Heath. In her last will Rachel left her substantial estate to her three sons equally.
Tim brought a claim under the Inheritance Act and said he deserved more because he had looked after his mum for many years.
Tim’s two brothers made a claim against him to have him removed as executor. The brothers were successful and an independent solicitor was appointed.
Although this decision was unusual, the court thought there was a conflict of interest because Tim was responsible for administering an estate in accordance with his late mother’s will which he didn’t agree with.

A caveat remains in place for six months but there are steps you can take to remove it.
It is important as the executor that you take a neutral stance in any claims been brought.
If someone has put you on notice they are going to bring any sort of claim against the estate then the estate administration process should be put on hold.
If someone has issued proceedings against the estate you will be named as one of the defendants in your capacity as executor.
However, this still means you should continue to take a neutral stance and preserve the estate to the best of your ability.
If you don’t, you can run the risk of a costs order being made against you personally.
It can get complicated if you are an executor and a beneficiary. This situation is quite common. If a claim is being brought then you will have two hats to wear – your neutral executor hat and your beneficiary hat.
Only in your capacity as a beneficiary are you entitled to defend any claims that have been brought, and in this situation you should seek legal advice. 
Badgered over your decisions: How do you keep beneficiaries at bay?It’s tough being an executor – you will have to make several difficult decisions during the administration process which don’t always go down very well with some of the beneficiaries.
You may want to take the beneficiaries' views into account but it is not compulsory that they sign off every decision.
What is important is that you can justify you are acting in the best interests of the estate at all times.
STEVE WEBB ANSWERS YO       The most common dispute that can arise is selling the family home, especially if someone is living in it, or one of the beneficiaries wants to buy the others out.
There are all sorts of arguments that can crop up, such as payments of notional rent and accusations of selling the property at an undervalue.
If the beneficiaries feel as though you have not been administering the estate appropriately, they may bring a claim against you personally, not the estate, and try to remove you as executor.
One example of this could be if the beneficiaries feel you sold the property in the estate at an undervalue, or failed to dispose of wasting assets before they lost value – this is known as 'devastavit' which means mismanagement of the estate.
Get legal advice if these types of accusations are being made against you. 
Threats to oust an executor: How easily can they get rid of you?If a beneficiary believes that the estate is not being properly administered then it is possible for them to apply to the court to substitute or remove you as an executor.
Most applications to remove or substitute an executor are made under section 50 of the Administration of Justice Act 1985.
This usually deals with the removal of executors after probate is granted, but applications can be made beforehand.
Generally speaking, it is difficult to remove an executor. The court will only consider it if it is in the interest of the proper administration of the estate, which will depend on the circumstances of each case. 
If an application has been made to remove you as executor, again, take legal advice. 
Executor's expenses are disputed: What are you allowed to spend money on?In the recent case of Mussell v Patience, the court ruled that an executor who receives and pays for legal advice during the administration of an estate only needs to show that the estate’s money has been spent on ‘proper estate business’.
In this case the judge said that an executor is entitled to pay expenses from the estate provided he can show:
1) That the sum concerned was indeed spent, and
2) That it was spent in the fair execution of the estate administration.
As an executor, you should be able to show this by giving a receipt or invoice that is related to the estate’s administration. However, the receipt or invoice need not provide a detailed breakdown of the total charged.
If you are caught up in litigation, a lot of executors are badly advised that their legal costs will come out of the estate - this is not guaranteed. 
Executors and trustees can apply for a Beddoe Order, which if successful means your own costs, and those of the other side if you are ordered to pay them too, will be covered by the estate.  
The task becomes overwhelming: Can you resign as executor? If you find out you are an executor and do not want to take on the role then before the grant of probate has been taken out you can ‘renounce’ by signing a deed of renunciation. 
Once this deed has been signed you have effectively stepped down and given up all your executor responsibilities.
If you have ‘intermeddled’ with the estate – such as dealt with aspects of the administration, like selling the deceased’s house before the grant of probate has been taken out - then you would not be able to renounce because you would be seen as already actively taking on the executor role.
As a general rule, if you are an executor and have already taken out the grant of probate then you would not be able to renounce. 
You can apply to revoke a grant of probate but these applications are usually made because the will was invalid or that the grant of probate was improperly obtained.

Sad article today.  Poses some good questions.  If you have an elderly relative or friend in a nursing home, you might want to check on them about this issue.  Just something to think about.  

https://khn.org/news/suicide-seniors-long-term-care-nursing-homes/

I cant stand scammers.  And those who scam seniors, especially at risk seniors?  Ugh...

Check out this story...

Senior's Weakness for Scams May Be Warning Sign of Dementia
By The Associated Press

• April 15, 2019

WASHINGTON — Does an older friend or relative have a hard time hanging up on telemarketers? Or get excited about a "You've won a prize" voicemail? New research suggests seniors who aren't on guard against scams also might be at risk for eventually developing Alzheimer's disease.
Elder fraud is a huge problem, and Monday's study doesn't mean that people who fall prey to a con artist have some sort of dementia brewing.
But scientists know that long before the memory problems of Alzheimer's become obvious, people experience more subtle changes in their thinking and judgment. Neuropsychologist Patricia Boyle of Rush University's Alzheimer's disease center wondered if one of the warning signs might be the type of judgment missteps that can leave someone susceptible to scams.
"When a con artist approaches an older person, they're looking for a social vulnerability — someone who is open to having a conversation with a complete stranger," said Boyle. Then the older person must interpret that stranger's intentions and emotions, with little else to go on, in deciding whether to believe what they're peddling, she explained.
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Boyle turned to data from the Financial Industry Regulatory Authority, which operates a fraud "risk meter," to determine behaviors that could signal scam vulnerability — things such as answering the phone when you don't recognize the number, listening to telemarketers, finding it difficult to end unsolicited calls, being open to potentially risky investments and not realizing that seniors often face financial exploitation.
Boyle studied 935 seniors, mostly in their 70s and 80s, with no known brain problems who were enrolled in a long-running memory and aging project in Chicago. They took a scam awareness questionnaire and then took yearly brain tests for an average of six years.
During the study, 151 seniors were diagnosed with Alzheimer's and another 255 with mild cognitive impairment, sometimes a precursor for Alzheimer's. The participants who'd had what Boyle calls low scam awareness at the study's start were more likely to have developed each of those conditions than seniors who were more aware of scam vulnerability.
For a closer look, the 264 participants who died during the study underwent brain autopsies. Sure enough, the lower the scam awareness at the study's start, the more people had a buildup of sticky plaque in their brains that is a hallmark of Alzheimer's, Boyle reported in Annals of Internal Medicine.
The study can't prove a link between low scam awareness and impending decline in thinking and memory, cautioned Dr. Jason Karlawish of the University of Pennsylvania in an accompanying editorial.
Karlawish described one of his own patients who confessed to a grandson, "I think I've been had" by a lottery scam that persuaded him to pay taxes up-front so he could receive his purported winnings. It was just too hard to hang up on the polite caller. Three years later, that patient shows no sign of cognitive impairment, said Karlawish, who said he's flummoxed by how the clever crooks managed to rob the man.
Still, the study results "should be a call to action to health care systems, the financial services industry and their regulators," Karlawish wrote, urging further research into what he called "notable findings."
The possible scam link isn't surprising, agreed Alzheimer's Association vice president Beth Kallmyer, who also said it needs more research. In fact, she said seniors may be reluctant to report fraud for fear family members might suspect they were sucked in because of health problems.
Dementia concerns or not, she advises seniors simply to not answer unsolicited calls or emails from people they don't recognize, making it harder for them to be targeted.
Previous research has suggested that seniors can begin to have trouble managing their finances even with aging's normal cognitive slowing.
And the rise in elder fraud has reached such a level that investment firms now are supposed to ask customers for the contact information of a "trusted person" they can alert if they suspect a case of financial exploitation. Just last week, federal agents broke up a Medicare scam that sold unneeded orthopedic braces to hundreds of thousands of seniors. And every tax season the government warns people not to fall for phone calls from IRS impostors — that agency won't call for payment.
"As older people start making mistakes in financial, health care and other types of complex decisions, we do need to raise awareness and start asking, 'Do they need some help?'" Boyle said. "It doesn't necessarily mean someone is going to go on to develop dementia. But we should become more aware."
___

Utah's Silver Alert program will help find dementia patients who wander from caregiversBy Emily Ashcraft @emilyjaneen3
Published: April 5, 2019 11:34 am Updated: April 10, 2019 5:45 p.m.

SALT LAKE CITY — Rich Dixon got out of the shower one morning to find his wife, Patricia, was gone.
After reaching out to police and the fire department, she was found attempting to get into a home that was not hers. She had walked around barefoot and across a busy street looking for what she thought was home.
After that, Dixon added multiple locks to his doors so his wife couldn't leave alone, and would no longer even take a shower without being aware of exactly what she was doing. Dixon cared for his wife for seven years while she progressed through stages of dementia.
"It’s just very, very frightening. What do you do? I mean you go out and look but sometimes they wander great distances," Dixon said.
Utah is creating a Silver Alert program to help find endangered seniors and those with dementia who have wandered away from home. Created by HB215, which passed unanimously in the House and Senate during the recently completed legislative session and was signed by the governor, the program will go into effect later this year.
Local Silver Alerts will work through a reverse 911 call. Cellphones can be registered with the local 911 dispatch center.
Utah's aging population is growing significantly. There are more than 33,000 Utahns diagnosed with Alzheimer's disease, but national statistics suggest that accounts for only half, according to Jeremy Cunningham, director of public policy for the Utah chapter of the Alzheimer's Association.
Cunningham said 60 percent of adults with Alzheimer's will walk away from caregivers at some point. Between now and 2025, about 21,300 adults will wander in Utah. And he noted that Alzheimer's patients often wander farther — 2 to 5 miles — than the national average because of the rural nature of much of the Beehive State.
Trina Anderson, memory care director at Sheridan at South Jordan, an assisted living facility that also offers adult day care, likes the the idea of the program.
"I think (the Silver Alert program) is really cool," Anderson said, adding "I hope I never have to use it."
Anderson said the care facility conducts drills and practices procedures if a patient is lost, but the facility hasn't had a resident wander away.
The facility is proactive in its work with seniors with dementia, trying to keep them engaged, both physically and mentally, so they are less likely to wander.
"We create the environment where they’re thriving and enjoying life again, and then they don’t want to wander because … they’re enjoying the moments," Anderson said.
One resident likes to swim, so they take him swimming on Wednesdays, she said. They go on field trips and get out of the bus to do activities most Mondays.
"If we get out they get to feel like a normal person again, they have purpose and feel a sense of belonging," Anderson said.
But the center also takes measures to ensure residents don't walk away unnoticed. Each has a bracelet that will alert the staff if the resident gets close to an exit, giving them 15 seconds to intervene before the door opens. They can also see each resident's location from their phones.
Cunningham said 39 states have a program like the Silver Alert, but Utah's is unique because it will include a geographical aspect, reaching out first through local alerts and contacting local officials and media. This differs from Utah's Amber Alert program, which sends push alerts to the entire state.
Later, if there is evidence the senior has used a car or other transportation, the alert will expand and use messaging boards on freeways and interstates.
The program will also allow law enforcement to send an alert if they have found a senior and are attempting to contact their family or caregiver.
The Alzheimer's Association reached out to Rep. Lee Perry, R-Perry, who sponsored HB215 to create the Silver Alert system. Perry said before there wasn't much a small police department could do when looking for an adult who had wandered, especially if they had access to a car or public transportation.
"I want law enforcement to have the tools they need to work out from the area they were last seen in," Perry said.
Perry said a few years ago a man got keys to a car and drove off. After a three-day search in Box Elder county, police found he had died in the car in nearby Cache County. He said the Silver Alert system could have helped find the man sooner.
The odds of finding a person are much higher when everyone is looking, Perry said, and not just police and family members. He said using the Utah Department of Transportation's overhead signs can get people in the area to start talking about and looking for a missing person.
Detective Greg Wilking, of the Salt Lake City Police Department, said the department sees on average about one instance a month where police are called to locate a senior with dementia
"I like anything that we can get that information out there quickly because time is always of the essence," Wilking said.
He did express concerns the system would not reach as many people because more people are using cellphones and online landlines are automatically registered.
As part of the bill, the Alzheimer's Association is providing training throughout the next year for police and first responder agencies.
2 comments on this story Dixon, who lost his wife to dementia, notes the new Silver Alert program fits in well with highlighting the importance of community involvement to help a caregiver. He remembers being able to call members of the Relief Society from his Latter-day Saint congregation when he needed help, and both his children and her children were available as well. He sees the Silver Alert program as bringing another level of support.
"I think (the program) would give them reassurance that other people were concerned and other people were willing to keep their eyes open and be looking," Dixon said.


­

This was deleted at the request of the original author.  Sorry.

Public Health
Hospitals Look To Nursing Homes To Help Stop Drug-Resistant Infections
April 2, 20195:00 AM ET

Anna Gorman


Hospitals and nursing homes in California and Illinois are testing a surprisingly simple strategy to stop the dangerous, antibiotic-resistant superbugs that kill thousands of people each year: washing patients with a special soap.
The efforts — funded with roughly $8 million from the federal government's Centers for Disease Control and Prevention — are taking place at 50 facilities in those two states.
This novel collaboration recognizes that superbugs don't remain isolated in one hospital or nursing home but move quickly through a community, said Dr. John Jernigan, who directs the CDC's office on health care-acquired infection research.
"No health care facility is an island," Jernigan says. "We all are in this complicated network."
At least 2 million people in the U.S. become infected with some type of antibiotic-resistant bacteria each year, and about 23,000 die from those infections, according to the CDC.
People in hospitals are vulnerable to these bugs, and people in nursing homes are particularly vulnerable. Up to 15 percent of hospital patients and 65 percent of nursing home residents harbor drug-resistant organisms, though not all of them will develop an infection, says Dr. Susan Huang, who specializes in infectious diseases at the University of California, Irvine.
"Superbugs are scary and they are unabated," Huang says. "They don't go away."
Some of the most common bacteria in health care facilities are methicillin-resistant Staphylococcus aureus, or MRSA, and carbapenem-resistant Enterobacteriaceae, or CRE, often called "nightmare bacteria." E.Coli and Klebsiella pneumoniae are two common germs that can fall into this category when they become resistant to last-resort antibiotics known as carbapenems. CRE bacteria cause an estimated 600 deaths each year, according to the CDC.


CRE have "basically spread widely" among health care facilities in the Chicago region, says Dr. Michael Lin, an infectious-diseases specialist at Rush University Medical Center, who is heading the CDC-funded effort there. "If MRSA is a superbug, this is the extreme — the super superbug."
Containing the dangerous bacteria has been a challenge for hospitals and nursing homes. As part of the CDC effort, doctors and health care workers in Chicago and Southern California are using the antimicrobial soap chlorhexidine, which has been shown to reduce infections when patients bathe with it.
The Centers for Disease Control and Prevention funds the project in California, based in Orange County, in which 36 hospitals and nursing homes are using an antiseptic wash, along with an iodine-based nose swab, on patients to stop the spread of deadly superbugs.
Heidi de Marco/KHN Though hospital intensive care units frequently rely on chlorhexidine in preventing infections, it is used less commonly for bathing in nursing homes. Chlorhexidine also is sold over the counter; the FDA noted in 2017 it has caused rare but severe allergic reactions.
In Chicago, researchers are working with 14 nursing homes and long-term acute care hospitals, where staff are screening people for the CRE bacteria at admission and bathing them daily with chlorhexidine.
The Chicago project, which started in 2017 and ends in September, includes a campaign to promote hand-washing and increased communication among hospitals about which patients carry the drug-resistant organisms.
The infection-control protocol was new to many nursing homes, which don't have the same resources as hospitals, Lin says.
In fact, three-quarters of nursing homes in the U.S. received citations for infection-control problems over a four-year period, according to a Kaiser Health News analysis, and the facilities with repeat citations almost never were fined. Nursing home residents often are sent back to hospitals because of infections.
In California, health officials are closely watching the CRE bacteria, which are less prevalent there than elsewhere in the country, and they are trying to prevent CRE from taking hold, says Dr. Matthew Zahn, medical director of epidemiology at the Orange County Health Care Agency
"We don't have an infinite amount of time," Zahn says. "Taking a chance to try to make a difference in CRE's trajectory now is really important."
The CDC-funded project in California is based in Orange County, where 36 hospitals and nursing homes are using the antiseptic wash along with an iodine-based nose swab. The goal is to prevent new people from getting drug-resistant bacteria and keep the ones who already have the bacteria on their skin or elsewhere from developing infections, says Huang, who is leading the project.
Heidi de Marco/KHN Licensed vocational nurse Joana Bartolome swabs Shinkle's nose with an antibacterial, iodine-based solution at Anaheim's Coventry Court Health Center. Studies find patients can harbor drug-resistant strains in the nose that haven't yet made them sick.
Heidi de Marco/KHN Huang kicked off the project by studying how patients move among different hospitals and nursing homes in Orange County — she discovered they do so far more than previously thought. That prompted a key question, she says: "What can we do to not just protect our patients but to protect them when they start to move all over the place?"

Her previous research showed that patients who were carriers of MRSA bacteria on their skin or in their nose, for example, who, for six months, used chlorhexidine for bathing and as a mouthwash, and swabbed their noses with a nasal antibiotic were able to reduce their risk of developing a MRSA infection by 30 percent. But all the patients in that study, published in February in the New England Journal of Medicine, already had been discharged from hospitals.
Now the goal is to target patients still in hospitals or nursing homes and extend the work to CRE. The traditional hospitals participating in the new project are focusing on patients in intensive care units and those who already carry drug-resistant bacteria, while the nursing homes and the long-term acute care hospitals perform the cleaning — also called "decolonizing" — on every resident.
One recent morning at Coventry Court Health Center, a nursing home in Anaheim, Calif., 94-year-old Neva Shinkle sat patiently in her wheelchair. Licensed vocational nurse Joana Bartolome swabbed her nose and asked if she remembered what it did.
"It kills germs," Shinkle responded.
"That's right. It protects you from infection."
In a nearby room, senior project coordinator Raveena Singh from UCI talked with Caridad Coca, 71, who had recently arrived at the facility. She explained that Coca would bathe with the chlorhexidine rather than regular soap. "If you have some kind of open wound or cut, it helps protect you from getting an infection," Singh said. "And we are not just protecting you, one person. We protect everybody in the nursing home."
Coca said she had a cousin who had spent months in the hospital after getting MRSA. "Luckily, I've never had it," she said.
Coventry Court administrator Shaun Dahl says he was eager to participate because people were arriving at the nursing home carrying MRSA or other bugs. "They were sick there and they are sick here," Dahl says.
Results from the Chicago project are pending. Preliminary results of the Orange County project, which ends in May, show that it seems to be working, Huang says. After 18 months, researchers saw a 25 percent decline in drug-resistant organisms in nursing home residents, 34 percent in patients of long-term acute care hospitals and 9 percent in traditional hospital patients. The most dramatic drops were in CRE, though the number of patients with that type of bacteria was smaller.
The preliminary data also show a promising ripple effect in facilities that aren't part of the effort, a sign that the project may be starting to make a difference in the county, says Zahn of the Orange County Health Care Agency.
"In our community, we have seen an increase in antimicrobial-resistant infections," he says. "This offers an opportunity to intervene and bend the curve in the right direction."

From the Washington Post....

​More seniors ‘aging in place’ mean fewer homes on the market to buy

Freddie Mac’s researchers estimate that the "aging-in-place" trend accounts for approximately 1.6 million houses held back from the market through 2018 by homeowners born between 1931 and 1959. 
By Michele Lerner
April 9Looking for someone to blame for the years of low inventory that have pushed housing prices higher and made it harder for millennials to become homeowners? While builders share some of the responsibility, recent research by Freddie Mac finds that people between the ages of 67 and 85 who stay in their homes longer and “age in place” also play a role.
Fewer Americans ages 67 to 85 are leaving their homes than their predecessors. Homeownership rates dropped 3.6 percent among people born between 1931 and 1941 when they reached 67 compared to 11.6 percent among those born before 1930 when they reached that age.
[Design for living: Modifications can remove the obstacles to aging in place]
Freddie Mac’s researchers estimate that the “aging in place” trend accounts for about 1.6 million houses held back from the market through 2018 by homeowners born between 1931 and 1959. Those 1.6 million houses equal about a typical one-year supply of new construction or more than half of the current estimated shortfall of 2.5 million housing units.
Seniors keep their homes longer for several reasons, according to the researchers, including better health and higher levels of education than previous generations. In addition, improvements in health care and technology that make aging in place easier help today’s seniors keep their homes longer and are likely to continue the pattern in the future.
Researchers found that older Americans prefer to remain where they are because they’re satisfied with their homes, their communities and their quality of life.
In addition, the researchers estimate that the number of homes retained by seniors will increase in the future as the baby boomer generation ages. Because there will be more seniors and anticipated improvements in health care and technology, that will make it even easier for them to stay in their homes.
The solution for the housing shortage, according to the study, is to reduce the barriers that slow housing production in an acknowledgment of increased demand.