The Community Choices Act will be designed to “expand home care and community-based care and to better inform seniors and their caregivers about the options.”  The idea is to stop the use of nursing homes as a stop gap method when the nursing home isn’t needed.  Basically, they intend to educate Tennessee citizens on community options such as assisted living, adult day care, and other elder organizations.

According to an article in the Shelbyville Times-Gazette, there are 42 states that have a plan in place similar to this one.  They report that the key components to Tennessee’s plan are:

“Create consumer-directed care options, including the ability to hire non-traditional providers like family members, friends and neighbors with accountability for taxpayer funds;

Broaden residential care choices in the community beyond nursing facilities with new options such as companion care, family care homes and improved access to assisted care living facilities;

Streamline the member’s eligibility process for faster service delivery and the enrollment process for new providers;

Maintain a single point of entry for people who are not on TennCare today and need access to long-term care services through Medicaid or other available programs;

Use existing Medicaid funds to serve more people in cost-effective home and community settings;

Designate one entity to coordinate all of the care a TennCare member needs including medical, behavioral and long-term care;

Implement active transition and diversion programs for people who can be safely and effectively cared for at home or in another community setting outside the nursing home; and

Install an electronic visit verification system to monitor home care quality.”

LTCD: What are the emotions your clients deal with when they are the main caregiver in a sandwich situation?

SMITH: There are many emotions involved in situations like this and sometimes they overlap and are hard to sort through.  Some typical emotions are:

1.  Both grief and sadness that the loved one can no longer stay at home by themselves or that the loved one is aging.

2.  Guilt that they [the caregivers] can’t do everything themselves or the thought they’re no doing enough.

3.  Anger is one that pops up a lot in these situations.  Anger that they [the caregiver] have to take care of their loved one in the first place and then back to guilt for feeling the anger.  There can also be anger at siblings who second guess things (especially those who live far off and criticize from afar).  Anger at medical staff at hospitals, nursing homes or day care facilities who can’t  do anything to help heal the aging parent.  There can even be anger at God.

4.  Sometimes they [the caregivers] feel that they are being manipulated by the aging parent and that can cause anger as well.

5.  Then there can be the swirl of mental and physical tiredness matched with a feeling of being both overwhelmed and helpless.  These feelings can make it difficult to set aside time to deal with the other emotions [mentioned before] that are adding weight to these feelings.

LTCD:  How do you advise your clients to work with the emotions they feel?

SMITH:  They shouldn’t be afraid to talk them [the emotions and feelings] out with siblings, friends, or co-workers.  They might be surprised to find colleagues that are dealing with similar situations.  Also, they need to get plenty of exercise to make sure they are keeping themselves healthy and decreasing their stress levels. 

One of the best ways to deal with their care-giving situation is to journal.  It’s a great way to get some of these feelings “named.”  Or draw if they’d rather do that.  Journaling about better days in the past with their loved ones can also help relieve the helplessness that they now feel.

LTCD.  What can a client do when they struggle with emotions in the short term versus the long term?

SMITH:  Back to exercise to release stress, talk to hospital/nursing home social workers, attend support groups with others doing the same thing, and if there isn’t a support group, start one.  Like I said earlier, once they start talking about some of these issues, they will be surprised to hear of others with similar situations.

LTCD:  Any other general advice for taking care of yourself emotionally when you are stretched thin on caring for others?

SMITH:  Be realistic about what is possible and what is not.  And always the general advice when dealing with any stressful situation: pay attention to yourself first.  That means: eat right, exercise, get enough sleep, pray, meditate, practice mindfulness and prioritize.  Remember what’s important, what you can let slide and what you can hire to have done. 

Also, a few good articles on the web can be found at:

Learning to Handle Stress

11 Easy Ways to Handle Stress

Thank you Susan for giving us some ideas on how to take care of ourselves in a long term caregiver situation!

Anyone who has additional questions on this blog can feel free to post a comment or email me and I can forward them to Susan.

A great video from US News and World Report discusses this very issue.  It covers how being caught as the long term caregiver in a sandwich situation can cause “depression and loneliness” for the caregiver.  It also has some interesting statistics:

*  FMLA covers 12 weeks of UNPAID leave to take care of family members, but it only covers immediate family.

*  Businesses lose $34 Billion in employees taking off to care for a sick relative.

*  Some large businesses are putting into place help for eldercare, but this isn’t enough.

By the way, did you know that women are the highest number of the caregivers?  According to a video by  Mary Jane Mullatta, the average caregiver is a 46 year old, employed, married woman.  She discusses this in her video that provides tips to Sandwich Generation caregivers.  The visual quality isn’t that great, but if you listen, she has some good ideas to pass along.

Another video with Susan Cunningham, author of Unwrapping the Sandwich Generation,  says that it “only takes 6 months of caregiving before the caregiver starts to have their own health issues”.  With this in mind, all the videos talk about some ideas of what you can do to help yourself as the sandwich caregiver.  Some include:

1.  Create a network of friends who can help you – carpooling for kids, friend who can pick up your parents at the adult day care facilities, etc.

2.  Ask for help from all members of the family – your children can help with their grandparents and it is great for children to learn from intergenerational interaction!

3.  Check into your local government and non-profit organizations to see what they can offer to you, your aging relative or your children.

Finally, if you feel you’re alone: don’t!  Listen to another story about sandwich generation caregiver, Susan Colley Monk

California, Connecticut, Indiana and New York all offer Partnership for Long-term Care Insurance policies but yesterday New York State Health Department announced its plans to sink $1.75 million into an advertising campaign for their partnership.  This campaign will emphasize that purchasing long term care insurance will help “New Yorkers financially prepare for the possibility of long-term care” and will help protect “some or all of their assets or resources.”

The idea is to purchase LTC Insurance from an approved insurer and if you ever need to use the benefits, you can also apply for the New York State Medicaid Extended Coverage which allows you to protect some or all of your assets. 

Right now, plans to spread the word in NY include TV, radio, magazine ads and a direct mail piece.  Their direct mail piece grabs readers’ attention by stating that  “New York State has a 20% tax credit on premiums paid for tax-qualified, long term care insurance.”

The target age is 40 to 65 (the sandwich generation).  In other words, they are attempting to kill two birds with one stone as the sandwich generation can purchase these policies for themselves before they need it and they can also look into it for their parents.

More information on the NY Partnership for Long-term Care can be found at their website.

I heard from a friend (we’ll call him “Bob” for the purpose of this story) today that he was at a cocktail party this past weekend and found himself discussing his search for long term care insurance – and no one else knew what it was.  He and his wife are in the sandwich generation, worrying about both their parents and their children.  They were talking to two other couples in the same predicament: one couple has a daughter in college and a mother who is homebound with in-home care; the other couple has a child in college and another in medical school and their parents are still well.  Neither couple had heard of long term care insurance. 

I find this astounding.  From what “Bob” told me, these are well educated people who can afford the premiums without a blink.  Now, “Bob” admitted that he and his wife haven’t settled on long term care policies for themselves yet, but they have been researching the subject.  It may be that the sole reason “Bob” is ahead of the curve on this subject is because he has been paying for his own mother’s care for the past few years.  This has most likely opened his eyes to the realization that the quality of care that he would like, and that he is giving to his mother, costs around $120,000 per year.

So this begs the question of what is it going to take for the rest of the sandwich generation to look into their own long term care insurance policies?  How much does long term care insurance need to be in the news before everyone is talking about their policy like they talked about their mortgage interest rate last year?

Here’s what we need to do…bring up long term care insurance at your next cocktail party and email me as to your story of what happens when you talk about it!

Adult Day Care is increasingly becoming an alternative for the Sandwich Generation who aren’t ready to have their parents in a nursing or retirement home, but don’t have the resources to stay home with them.  Day Care supporters also allude that it is a better alternative because it is safer and more varied in activities.

Currently, Adult Day Care is said to serve more than 400,000 seniors.  Not all attend daily, but that number is expected to grow between 5% and 15% a year according to the WSJ article.  With costs averaging $61 per day (approximately $42 per day more than an in-home health care professional) this isn’t a cheap long term care option which is why more and more insurers are looking at this as an opportunity.

Last year, MetLife began to include adult day care in its annual report.  The WSJ article quotes Kathy O’Brien with MetLife as saying that this type of care “is becoming increasingly recognized within the long-term care community for the array of services available.”

I was interested in learning more about the Adult Day Care industry and found the National Adult Day Services Association.  They are a pretty good resource and have been around for more than 20 years.  The National Adult Day Services Association touts themselves as “the leading voice of the rapidly growing adult day services (ADS) industry and the national focal point for ADS providers.”

I wonder: is this the wave of change for LTC which will eventually drive costs down and become increasingly recognized by insurers and government or will it go back to a luxury for only those who can afford it?