Although my mother in law is not a baby boomer, we had to remove her keys so that she would not put others in danger behind the wheel. She was not happy about it either.

Traffic fatalities are down across the country, older drivers still account for a “disproportionately high share” of the casualties. That was one of the findings of a recent report by The Road Information Program and the American Association of State and Highway Transportation Officials. The issue is a significant one as the Baby Boom generation enters its golden years.

Consider this: One in every five drivers will be 65 or older by the year 2025. As it is, a large amount of fatalities in crashes involve drivers age 65 or older.

The report’s recommendations included improving lighting and street signs to improve visibility, widening lanes where needed and adding rumble strips. The report also suggested training and education for older drivers.

How this plays out will be worth watching because mobility remains a significant challenge as people age.

If you have a loved one or work for someone who should not be driving, be proactive and help save lives.
http://www.MartaPerrone.com

Faced with soaring health care costs and shrinking Medicare and Medicaid financing, nursing home operators are closing some facilities and embracing an emerging model of care that allows many elderly patients to remain in their homes and still receive the medical and social services available in institutions. The rapid expansion of this new type of care comes at a time when health care experts argue that for many aged patients, the nursing home model is no longer financially viable or medically justified.

In the newer model, a team of doctors, social workers, physical and occupational therapists and other specialists provides managed care for individual patients at home, at adult day-care centers and in visits to specialists. Studies suggest that it can be less expensive than traditional nursing homes while providing better medical outcomes.

The number of such programs has expanded rapidly, growing from 42 programs in 22 states in 2007 to 84 in 29 states today. In New York City, a program run by a division of CenterLight Health System, formerly known as the Beth Abraham Family of Health Services, has over 2,500 participants at 12 sites in the metropolitan area.

“It used to be that if you needed some kind of long-term care, the only way you could get that service was in a nursing home, with 24-hour nursing care,” said Jason A. Helgerson, the Medicaid director for New York State. “That meant we were institutionalizing service for people, many of whom didn’t need 24-hour nursing care. If a person can get a service like home health care or Meals on Wheels, they can stay in an apartment and thrive in that environment, and it’s a lower cost to taxpayers.” The recent influx of adult day-care centers and other managed care plans for the frail elderly is being driven by financial constraints as President Obama and Congressional leaders seek hundreds of billions of dollars in savings in Medicare and Medicaid. Nursing homes, which tend to rely heavily on Medicare and Medicaid dollars, are facing enormous financial pressure — Mr. Obama’s proposed budget includes a $56 billion Medicare cut over 10 years achieved by restricting payments to nursing homes and other long-term care providers.

Nationally, the number of nursing homes has declined by nearly 350 in the past six years, according to the American Health Care Association. In New York, the number of nursing homes declined to 634 this January from 649 in October 2007, and the number of beds to 116,514 from 119,691.

Over the next three years, New York State plans to shift 70,000 to 80,000 people who need more than 120 days of Medicaid-reimbursed long-term care services and are not in nursing homes into managed care models, Mr. Helgerson said.

The move away from nursing homes was highlighted on Thursday when Cardinal Timothy M. Dolan announced that the Archdiocese of New York, one of the state’s largest providers of nursing home care, is selling two of its seven nursing homes and opening or planning to open seven new adult day-care centers over the next three years.

“Seniors and others who have chronic health needs should not have to give up their homes and independence just to get the medical care and other attention they need to live safely and comfortably,” Cardinal Dolan said in a statement before he opened a 250-patient program at Saint Vincent de Paul Catholic Healthcare Center in the South Bronx.

These new adult day-care centers, known around the nation by the acronym PACE — Program of All-Inclusive Care for the Elderly — provide almost all the services a nursing home might, including periodic examinations by doctors and nurses, daytime social activities like sing-alongs and lectures, physical and occupational therapy and two or three daily meals. All the participants are considered eligible for nursing homes because they cannot perform two or more essential activities on their own like bathing, dressing and going to the toilet. But they get to sleep in their own beds at night, often with a home health care aide or relative nearby.

The nonprofit groups that operate them receive a fixed monthly fee for each participant and manage their entire care, including visits to specialists, hospitalizations, home care and even placement in a nursing home. Because Medicare and Medicaid pay set fees instead of paying for specific procedures, center operators are motivated to provide preventive care to avoid costly hospitalizations or nursing home care.


Most elderly people want to live out their lives at home, a desire evident in interviews in the PACE center the archdiocese opened in 2009 in Harlem, which has a staff of three doctors and is visited regularly by a dentist, a podiatrist and a psychiatrist.

“My spirits would drop if I went to a nursing home,” she said. “I love the fact that I can go home at night. There’s no place like home. I can sit down, look at the TV and go to bed when I want.”

Dr. Fredrick T. Sherman, the Harlem PACE medical director, said that a 2009 study showed that PACE programs reduce lengths of stays in hospitals and delay assignments to nursing homes.

The archdiocese, whose new centers will serve a total of 1,500 people, receives an average of $4,000 a month from Medicaid for each participant and $3,300 from Medicare. By comparison, said Scott LaRue, the chief executive of ArchCare, the archdiocesan health care network, a month of nursing home care can cost the government $9,000.

Ultimately, the archdiocese hopes that half of its elderly clients will be served in community settings rather than in nursing homes, which currently serve about 90 percent of the archdiocese’s clients. For-profit companies have not yet moved into the managed care market, in part because of uncertainties about reimbursement formulas and the risks of taking on a nursing home population.

The PACE population tends to be younger than that at nursing homes, which raises the question of whether many PACE clients would really need nursing homes without PACE. Dr. Sherman replies to such skepticism by saying that his clients “need that level of service — the question is where they’re going to get it.”

Without PACE, he said, “they’re going to end up in nursing homes.”

Source: http://www.nytimes.com/2012/02/24/nyregion/managed-care-keeps-the-frail-out-of-nursing-homes.html?pagewanted=2&_r=2&nl=nyregion&emc=ura1

After so many years of working as a domestic agency, many of my clients would request a caregiver for their parents or themselves. When my mother-in-law recently had a stroke, it became a personal matter. Most elderly people that suffer a set-back are first sent to the hospital and must remain there for at least 3 consecutive days to qualify for transfer to a rehab center. It is never pleasant to be in a hospital, but a Rehab center (which in this case was more like a Nursing Home) is worse.  Just walking through the halls, all you see is very old people practically waiting to pass on. Many seem incoherent as they stare into the oblivion.  Between that visual and the smell, I could not imagine my mother-in-law or anyone that I cared about deeply remaining there another day.  I insisted on bringing a qualified caregiver from Los Angeles back East and bringing her home immediately.   

Choosing someone for the job meant finding a woman with the nurturing qualities along with necessary experience to handle this kind of job. It was also very important to find someone with the right personality and kindness to fill the job. Fortunately, among several candidate, I found one that had no problem re-locating.  We flew off together and prepared for mom's arrival with the following list:

1) Organize the home for someone to live/in.  In this case, a 1-bedroom apartment, we had to reconfigure the living space to accommodate a bed and get a television in for her use.  This made me realize how important it is to have 2 bedrooms as you get older, even if you don't need them now, you will later.

2) Put the caregiver on the auto insurance policy as additionally-named insured. Drive with her in the car to be sure she is comfortable and can handle the car easily. Teach her the various routes needed to go to the store, doctor, beauty salon, etc.

3) Place the caregiver on payroll. Not only is this the legal thing to do, but with most long term insurance policies, they will require proof that you have a caregiver in order to distribute funds. 

4) Prepare a list of duties for the job - since my mother-in-law is ambulatory, most of the work involves shopping, cooking, driving, activities and light cleaning. I created a list of what she needed to accomplish daily so that everything would run smoothly. I also made a list of weekly meals.  Elderly people left on their own have a tendency to not eat regularly. One of the many benefits of having a caregiver is that someone is there to ensure that your loved one is eating properly.

5)  Arrange for relief for the caregiver - this meant either finding someone that would work 1 day per week or asking the family members to all contribute their time by visiting one full Sunday per month.  Fortunately, there is enough family to fill this task and all were agreeable to doing so.

After one week of helping the caregiver and my mother-in-law get acclimated, I flew home relieved and so did everyone  knowing that mom was in good hands.

http://www.MartaPerrone.com

Latinos make up 15% of the total labor force in the United States.  Their share of selected occupations and industries are 22% in Hotel and Food Services and 17% in Private Service (Home and Health Services).  Many Latinos got slammed by the recession which wiped out about 2 million construction jobs. As the economic recovery improves, Latinos are scoring more gains than most other demographic groups. They are the only demographic group that whose employment numbers have returned to pre-recession levels. The reasons experts say that Latinos are faring better than other groups is thaty are willing to take low-wage, temporary jobs. They believe that part time work can lead to full time employment - which in many cases in the private service industry is true. They also tend to be more mobile and willing to do what it takes to get the job, even if it means moving from one county to another. However, due to the decrease of jobs, less Latinos have moved to the U.S. and more have moved back home. 

Latinos are the fastest growing segment of the U.S. population and especially visible in California Texas and Florida as well as Iowa, Nebraska and Ohio.  Not only the economy but also immigration issues have affected the Latino's decision to remain in the U.S.  The administration has increased deportations of undocumented immigrants.  Their biggest concern is "jobs".

My professional development classes are primarily filled with Latino women, and the emphasis is to provide them with the tools they need to prepare themselves as presentable, qualified, trained household professionals. Just ask yourself this one question: "If there are only 10 jobs and 50 applicants, who will be the ones chosen to work?" 

http://www.Martaperrone.com

_If you hire a Housekeeper, you now have an employee and must pay household employment taxes.  Here is some sound advice from Kathy Webb of Home Work Solutions, Inc. - a leading household tax company.

Do you have a regular person who comes to your home to provide housekeeping, maid or cleaning services? Do you know that this individual is probably your employee under common law and the Internal Revenue Code? Any individual whom you employ to provide services in your home whom you pay directly AND whose total payments in the calendar year meets the IRS household employment threshold ($1700 in 2011 and $1800 in 2012) must receive a W-2 from the employer (family) and the employer must pay the payroll taxes.

Household employment taxes - known as the "nanny taxes" - include:

• Social Security & Medicare Taxes (13.3% of Gross Wages - employer may collect 5.65% from the employee via deductions.)
• State Unemployment Taxes where required.
• Federal Unemployment Tax (FUTA) where required.

The employer is legally obligated to pay (remit) both employee and employer portions of Social Security and Medicare taxes. Should the employer fail to collect this tax from the employee via periodic payroll deductions, the employer remains responsible to remit or pay the tax to the IRS. The household employee CANNOT remit their share of Social Security and Medicare tax independent of the employer.

Many families try to classify their weekly (bi-weekly, monthly) cleaning ladies as independent contractors. In the vast majority of circumstances, this is a total legal fiction. This usually only works if the worker is properly incorporated, bonded and licensed in the trade and maintains "corporate formalities."

If you wish to avoid this obligation, we recommend that you engage a cleaning service. The service will decide who to send to your home to do the cleaning, and you will avoid any payroll tax obligations. When you hire a service, you make your payments to Cleaning Services Inc. or Cleaning Services LLC - and not to Mary Jones.

http://www.MartaPerrone.com