6 Ways to Make a Home Safe and Comfortable for Seniors

Losing strength and balance can be common consequences of aging, and living with these changes is rarely easy. It is frustrating not to be able to do everything you once could; it can also be dangerous due to an increased likelihood of falls.

Changes in mobility can make your own home seem like a dangerous place. However, there are ways to make the home a safer place for seniors. With a few alterations and upgrades, you can live comfortably in your home again or bring aging loved ones into your home safely. Here are six ways you can bring your home up to snuff for anyone easing into old age.

Avoid Tripping Hazards

Falls are a serious hazard for older adults, often resulting in injury or even death. Fortunately, the necessary adjustments for avoiding trips are simple. Remove throw rugs from the floors as well as cords and other items that can be tripped over. Move furniture around so that there are large pathways that will be easier to navigate. Outdoors, make sure walkways are smooth and kept clear of debris. If possible, remove thresholds between rooms and into the home so an older person does not have to step over the threshold.

Eliminate Stairs

Stairs can be difficult for seniors to navigate, whether they are painful for aching joints, cause balance issues, or are just harder to climb than they used to be. If you are looking for a new residence that is senior-friendly, stay away from stairs if possible. When making changes to a home, trade the stairs for a ramp for a wheelchair. Leading up to the home, take out stairs and instead use an inclined walkway. Inside the home, be sure stairs have handrails and add nonslip tread to avoid falls. A stair lift can also be installed to help a person get up and down.

Install Better Lighting

Adequate lighting is critical for seniors, especially when their eyesight begins to worsen over time. Make sure the home is well lit in every room. Good lighting can help a person to get around their home safely and avoid tripping over objects or bumping into furniture. Put bright lights in hallways and stairs and add extra lamps. Outdoors, make sure pathways are well lit. Consider motion-sensor lights that will help keep the area bright at all times and will not need to be turned on.

Provide Easy-To-Use Appliances

One aspect of a senior-friendly home that may not be as obvious are the appliances. Appliances can become more difficult to use as eyesight declines and technology advances. Find simple, easy-to-read appliances, such as microwaves with programmed buttons. Look for appliances with an automatic shut-off, which will ensure they do not stay on if they are forgotten. Find appliances that may be easier for someone with limited mobility, like a side-by-side refrigerator and freezer. Adjust the water heater to avoid scalding injuries.

Renovate the Bathroom

The bathroom is a prime location for falls among the elderly, especially those with poor strength or balance. Several changes in the bathroom can help a person maintain their independence and reduce the risk of getting hurt. Install grab bars in the shower or next to the toilet to help with standing up and exiting or entering the shower. If a tub is being used, a bench or bar can help give support while stepping into or out of the tub. Shower chairs and nonslip mats also help prevent slipping while showering and bathing.

Make It Easy on the Hands

People with arthritis or weakness in their hands may find it difficult or painful to do simple tasks like turning on the lights or opening a door. Some relatively cost-effective changes can make these acts much easier. Change out light switches with a toggle switch and change doorknobs and faucets to levers. These alternatives can lessen the amount of force and grip strength needed. A slip and fall can be life-changing or even life-ending, for a senior. Make your home a safe and comfortable environment by making changes in layout, fixtures, and appliances. The changes are small, but the gains in safety are enormous.

What is Medicare?

Medicare is a health insurance program provided by the federal government for qualifying individuals, including people age 65 and older, those with certain disabilities, and individuals with end-stage renal disease (ESRD).

Some people may confuse Medicaid and Medicare programs. The primary difference is that Medicaid is a needs-based insurance program while Medicare isn’t. Your income isn’t a determining factor for Medicare qualification.

There are monthly premiums for certain parts of Medicare. Additionally, Medicare does have some limitations and regulations on what it’ll cover for health care costs. Read on to learn more about each part of Medicare, what’s covered, and how to enroll.

Medicare Parts

When you become eligible for Medicare, you have choices to make. First, you must decide whether you’ll enroll in Part A and B or Part A only and defer Part B. Most people choose Part A because it is premium-free. If you’re enrolled in a health savings account (HSA), you won’t be able to continue contributing to it if you enroll in Part A. Once your A and B choices are made, you can keep Original Medicare and add a supplement and Part D plan or opt for a Medicare Advantage Plan.

Here’s what each part of Medicare covers and costs:

Medicare Part AMedicare Part A is considered the hospital insurance portion of Original Medicare. It covers costs associated with hospital stays and limited stays at a nursing home, hospice care, and some costs for home health care.You don’t have to pay a monthly premium for Medicare Part A if you or your spouse paid qualifying taxes during employment. If you don’t qualify for premium-free Part A, you can pay for it. The premium amount you have to pay varies based on how long you or your spouse worked while paying qualifying Medicare taxes. For instance, if you paid taxes for less than 30 quarters, you’ll pay $499 per month based on 2022 premiums. But if you worked and paid taxes between 30 and 39 quarters, you’ll only pay a $274 monthly premium.
Medicare Part BMedicare Part B is considered the medical insurance portion of Original Medicare. It covers things like trips to the doctor’s office for a checkup or a sick visit, any outpatient care you might receive, certain medical supplies, and preventive care like an annual wellness visit.Nearly everyone pays a monthly premium for Medicare Part B. The standard amount for 2022 is $170.10. If your gross income on your tax return is high enough, you’ll be required to pay both the standard monthly premium and an Income Related Monthly Adjustment Amount (IRMAA). You’re also responsible for 20% of the costs of your health services after your annual deductible ($233 in 2022) is met.
Medicare Part CMedicare Part C, commonly referred to as Medicare Advantage, is offered by private insurance companies approved by Medicare. If you choose a Medicare Advantage Plan as an alternative to Original Medicare, it becomes your primary coverage. Think of Medicare Part C as a “Medicare bundle” because it covers everything that Part A and Part B do. Most Advantage plans include Part D prescription drug coverage. Some Medicare Advantage Plans offer additional coverage for dental and vision and even fitness memberships. For example, Medicare Part C covers in-patient hospital stays, stays in a skilled nursing facility, and home health care like Original Medicare Part A. Part C also covers outpatient care like Medicare Part B does, including doctor visits, lab tests. X-rays, outpatient surgery, and emergency services.Original Medicare Part A and Part B only cover 80% of the costs of services received. Meanwhile, Medicare Part C plans cover everything Part A and Part B cover but charge a small copayment and coinsurance for services. Most Medicare Advantage plans also have maximum out-of-pocket costs per year, and many come with a $0 monthly premium, which can make these plans more affordable. The costs of Medicare Advantage plans vary since private companies offer them, but you can expect to pay both a monthly premium and a monthly Part B premium, unless the plan is a $0 premium plan. Plan costs can vary depending on whether other benefits like Part D, dental, vision, and hearing are included.
Medicare Part DMedicare Part D refers to prescription drug coverage, so it’ll help cover the costs of medications prescribed for your health condition. Individual Medicare drug plans use a formulary developed by a pharmacy and therapeutics committee composed of pharmacists and physicians to regulate which medications they’ll cover. The United States Centers for Medicare and Medicaid (CMS) must approve the formulary. Part D plans are required to offer two medications in all categories necessary to treat your health condition. In most cases, if a name-brand medication isn’t covered, a generic will be.Medicare Part D does have costs associated with it. The costs vary based on which type of plan you choose. In general, you can expect to pay a monthly premium ― this can be deducted directly from your Social Security if you choose ― and a yearly deductible. The deductible can’t be more than $480 in 2022. You’ll pay a copayment or coinsurance percentage for each drug after your deductible is met. If you have low income and resources, you may be able to get help with Part D costs through Extra Help.
MedigapMedigap insurance is commonly known as Medicare Supplemental Insurance. As the name implies, it’s used as supplemental insurance to cover health care costs that Original Medicare does not. You can only purchase Medigap insurance if you’re enrolled in Original Medicare. It cannot be used with a Medicare Advantage Plan. Medigap insurance is offered through private insurance companies approved by Medicare.You pay a monthly premium for Medigap as well as your regular monthly Part B Medicare premium. Your Medigap premium is paid directly to the private insurance company you got your Medigap policy through while the Part B premium is paid to Social Security.Medigap insurance can help cover your deductible costs, copayments, and coinsurance under Original Medicare. For people newly eligible for Medicare on or after January 1, 2020, Medigap insurance can no longer cover the Part B deductible. If you were eligible for Medicare before January 1, 2020, you may be able to purchase Plan C or F, which will cover the Medicare Part B deductible cost. If you already have a Plan C or F, you can keep it. Medigap insurance can’t be used to cover the costs of certain health expenses, including long-term care, vision care, and eyeglass, dental care, hearing aids, or private-duty nursing care.

What isn’t Covered by Medicare?

Original Medicare doesn’t cover certain health services and costs, including:

  • Long-term care
  • Dental care (with some exceptions)
  • Vision exams needed to prescribe glasses
  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and related exams
  • Routine foot care

How Do I Enroll in Medicare?

There are a few different ways to enroll in Medicare. Some people are enrolled in Medicare automatically, and others will have to sign up on their own. Everyone should check with Social Security three months before their expected start date to ensure everything is in order.

You’ll be enrolled automatically in Medicare if you:

  • Are already receiving Social Security benefits (at least four months prior to start)
  • Receive U.S. Railroad Retirement Board (RRB) benefits (at least four months prior to start)
  • Are under the age of 65 but have a social security disability for 24 months
  • Have amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease or ESRD

You’ll have to enroll in Medicare on your own if you:

  • Are about to turn 65
  • Are already 65 but not receiving Social Security benefits

There are also some individual circumstances that may change the timing of your enrollment. For instance, if you have employer-sponsored insurance, you may be able to wait to apply for Medicare Part B instead of being required to apply when you turn 65.

Medicare enrollment periods

The Initial Enrollment Period (IEP) for Medicare is a seven-month period beginning three months before you turn 65, the month in which you turn 65, and three months after you turn 65. For example, if you turn 65 on June 14, your IEP is from March 1 through September 30.

If you don’t sign up during your initial enrollment period, and you aren’t covered by an employer health plan or are volunteering overseas for at least 12 months, you’ll begin accruing Part B late enrollment penalties. You’ll only be able to enroll during the General Enrollment Period (GEP). The GEP runs from January 1 through March 31 each year, with coverage starting July 1st.

Medicare Advantage plans cannot start before your Part B start date, so if you don’t enroll in Part B by the end of your IEP, you’ll have to wait until the GEP for Medicare Advantage enrollment also. If you enroll in Part B during the GEP, you can join a Medicare Advantage Plan or a Medicare Drug Plan (Part D) between April 1 and June 30. Your Medigap open enrollment period starts the first month you have Part B and lasts for six months.

When does Medicare coverage start?

Your Medicare coverage start date depends on when you enroll. Remember, during the IEP, you can enroll three months before you turn 65, the month you turn 65, and three months after you turn 65.

For example:

When You EnrollWhen Coverage StartsExample: Turning 65 on May 10
The three months before you turn 65The first day of the month you turn 65May 1
The month you turn 65The first day of the month after you turn 65June 1
The month after you turn 65Two months after you sign upAugust 1
Two or three months after you turn 65Three months after you sign upOctober 1 (if you enroll in July)November 1 (if you enroll in August)

If you enroll during your IEP, you can coordinate your ancillary coverage, that is, Medigap and Medicare Part D or Medicare Advantage to start the same day as your Medicare Part A and B coverage.

If you enroll during a Special Enrollment Period, coverage generally starts the month after your sign-up.

When you’re ready to apply for Medicare, you can fill out an online application through the Social Security website or in-person at your local Social Security office.

This article was originally published by Medicare.com and republished here with permission.

The “Things” Part of Hospice

MEDICATIONS

Hospice provides medications that address symptoms related to the terminal diagnosis. All medications are prescribed by the attending physician and delivered by a courier service to the patient’s home. Medications are available to the patient 24 hours a day. The hospice nurse is responsible for ordering medications and will arrange for delivery at a time convenient to the patient/family. Let the office know if the patient is running low on any medication. 

MEDICAL EQUIPMENT

Medical supplies, walkers, wheelchairs, hospital beds, oxygen and other medical equipment that would be of service can be delivered to the patient’s home. Elite Hospice orders this equipment, which is delivered by our supplier. Equipment that is no longer needed will be retrieved by the equipment company at the request of the patient, family, or an IDG member. 

Where does Hospice Care Happen?

Hospice is a type of care, not a place. Hospice can happen wherever a patient calls home. This could be in a Skilled Nursing Home (SNF), an Assisted Living Facility (ALF), Independent Living Facility (IL), their home – such as a house or an apartment, even a hotel or homeless shelter. 

Hospice Care in a skilled nursing facility is quite similar to home hospice care. Hospice manages all care related to the patient’s terminal diagnosis. In many cases, the staff of the nursing facility acts as the primary caregiver (a role that must be filled by family, friends, or in-home staff when hospice is given at home — see our section on The Caregiver’s Role). Elite Hospice collaborates with each facility in which our patients reside to develop a coordinated Plan of Care, which ensures that all caretakers are working together to meet the patient and family’s needs, wishes, and goals.

It is important that the entire team, staff, and volunteers communicate effectively with facility staff when visiting a patient. 

THE MEDICARE / MEDICAID HOSPICE BENEFIT

The following levels of care are available under this benefit. 

Routine Home Care

This is the most frequently used level of care. Under a Routine Level of Care, the Hospice Team is available on a scheduled basis and is available for consultation or to make a visit 24 hours a day. Visit frequency is determined by the IDG in response to the patient’s needs and is documented in the Plan of Care.

General Inpatient Care

Short-term inpatient care may be used during times when a patient and/or family has an immediate and apparent need. This level of care is most often needed for pain control or acute symptom management and can only be provided in a Skilled Nursing Facility or hospital that is contracted with Elite Hospice. Once symptoms are well-managed, the patient will be returned to the routine level of care, in the current setting, or at home. 

How do patients pay for Hospice?

Most of Elite Hospice’s patients utilize a Medicare or Medicaid benefit. This usually covers 100% of the cost of Hospice. Some patients use private or commercial insurance. These patients often have a co-pay. Because we receive money from the federal government for Hospice services we have to follow their guidelines. Hospice is required to pay for the “people” and the “stuff” as shown above for our patients when it is related to the terminal diagnosis or to comfort. We are also responsible for moving patients to different levels of care if their symptoms require it. 

Inpatient Respite Care

Inpatient respite care is available to home patients in order to give the caregiver relief and is limited to five consecutive days. This level of care is provided in a skilled nursing facility. 

Continuous Home Care

Continuous care is provided when symptoms need acute management in order to prevent hospitalization. Under the continuous care benefit, a minimum period of eight hours of care is provided during a 24-hour day. Nursing care by either a Registered Nurse (RN) or Licensed Practical Nurse (LPN) must be provided for more than half of this period of care.

Signs and Symptoms of Approaching Death

When diagnosed with a life=threatening illness, a person begins a new journey in life. Each journey is unique, and we all handle death in our own way. As time progresses toward a person’s death, that person will undergo some changes. The person will prepare physically, emotionally, mentally, and spiritually. Few things about death and dying are predictable- nobody knows when it will happen, how it will happen, who will be present, or what feelings it will bring up. A patient and family must be prepared to work through this process as it unfolds, discovering the patient’s own unique journey. The wishes of the patient should be followed whenever possible.

Physical Symptoms

On the physical level, the body begins the final process of shitting down. Usually, these are an orderly and undramatic progressive series of physical changes, which are not medical emergencies. These physical changes are normal and may occur quickly or over a period of time.

Coolness and Mottling (blotches of discoloration of the skin)

The person’s hands, arms, feet, then legs may be increasingly cool to the touch and the color of the skin may change. The underside of the body may become darker and the skin becomes mottled. This is a normal indication that the circulation of blood is decreasing to the body’s extremities and being reserved for the most vital organs. Keep the person warm with a blanket, but do not use an electric blanket or heating pad.

Sleeping

The person may spend an increasing amount of time sleeping, appear to be uncommunicative or unresponsive, and at times, difficult to arouse. This normal change is due in part to changes in the metabolism of the body. Sit with them; hold his or her hand. Speak softly and naturally. Speak to him/her directly as you normally would, even though there may be no response. Never assume the person cannot hear; hearing is the last sense to be lost.

Disorientation

The person may seem to be confused about the time, place, and identity of people surrounding him/her, including those close and familiar. This is also due in part to metabolic and oxygen supply changes. Identify yourself by name before you speak. Speak softly, clearly, and truthfully when you need to communicate something important to the patient’s comfort such as “it is time to take your medication” and explain the reason for the communication such as “so you won’t begin to hurt”.

Incontinence

The person may lose control of bladder and/or bowels as the muscles in that area begin to relax. Discuss with the hospice nurse what can be done to protect the bed and keep the patient clean and comfortable.

Congestion

You may hear gurgling sounds coming from the person’s throat or chest as though marbles were rolling around inside. These sounds may become very loud. This normal change is due to the decrease of fluid intake and inability to cough up normal secretions. Suctioning usually only increases the secretions and causes sharp discomfort. Gently turn the person’s head to the side to allow gravity to drain secretions. You may also gently wipe the mouth with a moist cloth. The sound of the congestion does not indicate the onset of severe or new pain.

Restlessness

The person may make restless and repetitive motions such as pulling at the bed linen or clothing. This often happens and is due, in part, to the decrease in oxygen circulation to the brain and to metabolism changes. Do not interfere with or try to restrain such motions. Talk to the Elite Hospice team about methods to assist in relaxing the person.

Urine Decrease

The person’s urine output normally decreases and may become tea-colored, referred to as concentrated urine. This is due to the decreased fluid intake as well as decrease in circulation through the Kidneys.

Fluid and Food Decrease

The person may have a decrease in appetite and thirst, wanting little or no food or fluid. The body will naturally begin to conserve energy for other functions that would otherwise be used in digestion. Swallowing and normal reflexes can become sluggish and nourishment by mouth can carry the risk of choking. Do not try to force food or drink into the person. Doing this only makes the person much more uncomfortable. Although it can be difficult to disassociate food with love, refusal of offered nourishment is a choice that needs to be honored. Small chips of ice, frozen Gatorade, or juice might be refreshing in the mouth. If the person is able to swallow, fluids may be given in small amounts by syringe (ask hospice nurse for guidance). You can try raising the head of the bed to make swallowing easier. Elite Hospice can provide glycerin swabs to help keep the mouth and lips moist and comfortable.

Breathing Pattern Change 

The person’s breathing pattern may change becoming more labored, irregular, or noisy. The person may breathe deeply and then pause for a long time – 10 seconds to a minute – before breathing resumes. This is called apnea and causes the person no discomfort. These patterns are very common and indicate decrease in circulation in the internal organs. You may want to elevate the head or turn the person on his/her side. 18 

Emotional/Spiritual/Mental Symptoms

In addition to physical/medical symptoms, the process of dying includes the spirit beginning the final process of release from the body, its immediate environment, and all emotional attachments. This release tends to follow its own priorities, including the resolution of unfinished business, reconciliation, affirmation of close relationships, and accepting permission from family members to let go. Support and encourage this transition. 

Withdrawal

The person may seem unresponsive, withdrawn, or in a comatose-like state. This indicates preparation for release, a detaching from surroundings and relationships, and a beginning of letting go. Since hearing remains until the end, speak to the patient in your normal tone of voice, identify yourself by name when you speak, hold his/her hand, and say whatever you need to say that will help the person “let go.” 

Vision-Like Experiences

The person may speak to or claim to have spoken to persons who have already died. He/she may see or have seen places or things not presently accessible or visible to you. This doesn’t indicate a hallucination or drug reaction. This person is beginning to detach from this life and is being prepared for the transition. You may hear the hospice team refer to this process as “celestializing.” Affirm his or her experiences—just because you cannot see or hear these things does not mean they are not real to the patient. If they frighten the patient, explain to him/her that these visions are normal and common. The Chaplain may be a good resource in this situation. 

Decreased Socialization

Your loved one may want to be alone or with only a few people. This is a sign of preparation for release and an affirmation of whom the support is most needed in order to make the appropriate transition. If you are not part of this “inner circle” at the end, it does not mean you are not loved or important. It means you have already fulfilled your task with him/her, and it is time for you to say goodbye. If you are part of the final “inner circle” of support, the person needs your affirmation, support, and permission. 

A Need for Permission

Giving permission to your loved one to let go without making him/her feel guilty for leaving or trying to keep him/her with you to meet your own needs can be difficult. Despite prolonged discomfort, a dying person may hold on to be sure that those who are going to be left behind will be all right. Therefore, your ability to release the dying person from this concern assure him/her that it is all right to let go whenever he/she is ready is one of the greatest gifts you have to give your loved one at this time. 

Saying Goodbye

When the person is ready to die, then it is time to say goodbye. Saying goodbye is the final gift of love to the patient, for it achieves closure and makes the final release possible. Family members may find it helpful to lie in bed with the person and hold him/her or to take his/her hand and say everything they need to say. It may be as simple as saying “I love you.” It may include recounting favorite memories, places, and activities you shared. It may include saying, “I’m sorry for whatever I contributed to any tensions or difficulties in our relationship.” It may also include saying “Thank you for…” Tears are a normal and natural part of saying goodbye. Tears do not need to be hidden from the patient or apologized for. Tears are an expression of love and may assist in “letting go.” 

Elite Hospice Social Workers and Chaplains can be available to provide additional support during this time. It may also be helpful to seek a spiritual advisor with whom the patient has a relationship to come and provide reassurance and support during the last days. In addition, some volunteers specialize in what is called “11th hour support,” and are there to serve the patient and family may have throughout the dying process.

How will you know when death has occurred?

Signs of death include no breathing, no heartbeat, release of bowel and bladder matter, no movement of arms and legs, fixed eyes, no blinking, relaxed jaw, and slightly open mouth.

If you are with the patient at the time of his/her death: 

  • Call Elite Hospice — there is no need to call the coroner or police.
  • DO NOT CALL 911.
  • Turn off any electrical equipment attached to the patient’s body, but leave any tubes or attachment devices in place.
  • Follow any religious observances that were requested by the patient. 
  • Call any friends or family members who may wish to spend some private time with the patient before the body is taken by the mortuary. 
  • When the family is ready, the nurse will call the mortuary.

Death comes to us all and most of us will experience numerous deaths of loved ones. Each one will affect us in different ways. After the patient’s death, be sure to express your needs with the Elite Team and your family and friends. Find some alone time to reflect if you need to. This will be a period when you start the grieving process, which is necessary in healing. The Elite Hospice team will be there to assist during this process.

Five Tips to Help Your Loved Ones Pare Down Their Belongings

As your loved ones enter their golden years, their home becomes their sanctuary. But if they’ve kept all the tokens of love over the years, their home is probably too cluttered for them to navigate safely. This can be a health hazard, both physically (tripping and falling over things) or mentally (hoarding).

Here are some tips to declutter your loved ones’ homes and help them lessen their belongings so that they can remain safe and happy in their living spaces.

Put Safety First

Your elderly loved ones have spent decades with their belongings- especially if they’ve remained in the same home- and they have created an emotional attachment to many of the items in the house. Although each item may have a special place in their hearts, the more items in the house, the more dangerous navigating between the clutter becomes. Help them see the safety benefits of organizing and decluttering so that they will change their attitude about the decluttering process.

Find Support

Sometimes extreme clutter means that your loved one has developed a hoarding problem. Healing a hoarding issue takes time and patience, so we recommend you find a good support system for you, your loved one, and the rest of the family. Love, support, and patience are key in decluttering the house. Whether your loved one has a hoarding problem or not, groups like the IOCDF (International OCD Foundation) offer great suggestions and tips for those struggling with clutter.

Take It Slow

Always remember to start small. You don’t want to overwhelm your loved ones by renting a dumpster for a weekend and completely gutting their house. Be satisfied with baby steps in the right direction. Try starting with one room- or even a cupboard- so that your loved one can work through the process of decluttering with you. Remember: Patience is always important in these situations.

Put it in a Box

Persuade your loved one to handle an object only once. Allow him or her time to look at the object and make a conscious decision about whether to keep it or not. The more the object is handled, the harder it is to make a decision. Make three piles (or have three boxes) in each room: one for keeping, one for throwing away, or one for donating. If your loved one can’t decide whether to throw it away, put the item in a box for up to six months. Then, he or she can revisit the item and decide what to do with it.

Share heirlooms with those who want them

To help your loved ones in the process of decluttering, gather the family together and distribute any cherished heirlooms. Your loved ones will feel secure knowing that the item isn’t going to waste, and you will get to keep something special.

 The process to declutter your parents’ home can be long and difficult. But if you remember to keep safety at the top of your priority list, find a good support system, go slowly and steadily, put everything in a box, and keep the heirlooms, the level of stress and hardship will be minimized.