About Beth Adams

Director, Ann Arbor Meals on Wheels and Housing Bureau for Seniors University of Michigan Health System

Winter Snow, Ice, and Bitter Cold

I think most of us have, at one time or another, dealt with the headache of snow removal from our walkways and driveways (or at the very least, around our cars).  Snow removal is not for the faint of heart or those who have heart problems, especially when temperatures become frigid.  During the latest big snow storm and negative temperatures and wind chills, I saw several of our neighbors (including my spouse) working together to remove snow from sidewalks, and even a portion of the street!

While our block has mainly young couples and those in our 40s/50s, that’s not the case in many areas throughout the County.  There are many neighborhoods, where residents may not be physically able to shovel the snow off the sidewalks. Exposure to the cold puts additional strain on the heart and seniors and those with chronic medical conditions are at an increased risk.

Seniors may also be unable to afford to have a service do it for them. If you’re able, please consider offering your elderly or disabled neighbor help with snow removal, especially if you’ve noticed that it doesn’t get done within 24 hours of the end of a storm.  This is especially important since many cities and towns, including Ann Arbor, Chelsea, Dexter, Manchester, Saline, and Ypsilanti have snow removal ordinances which will penalize homeowners with fines.

Snow removal also helps the volunteers at Meals on Wheels deliver food to frail, homebound persons in our communities.  At Ann Arbor Meals on Wheels, several customers often call to cancel meal delivery following a winter storm because they’re unable to remove the snow and are concerned for the safety of our volunteers.  Helping your neighbors by removing snow from their driveways and walkways can mean the difference in whether they eat that day.

Why is this so critical?  The inability to continue with typical maintenance, heavy chores, and yard work are often what lead an older homeowner to consider moving.  At the Housing Bureau for Seniors, we can recommend our HomeShare and our Housing & Caregiver Counseling programs for those looking to transition from one living situation to another.  But if affordable assistance can be brought in, why move?

Be neighborly! Check on your elderly and disabled neighbors, and if you can help in some small way, please do so.

November is National Family Caregiver’s Month!

“National Family Caregivers Month is a time to reflect on the compassion and dedication that family caregivers embody every day…..I encourage all Americans to pay tribute to those who provide for the health and well-being of their family members, friends, and neighbors.”    –  President, Barack Obama

Every year, family caregivers provide $375-450 billion worth of uncompensated care for their loved ones.  Yes, you read right – Billion.  That’s almost twice as much as what is spent on formal home care and on nursing home services combined.

Consider the following:

  • Over 65 million caregivers (29% of the US adult population) provide care for someone who is an older adult, chronically ill or has a disability.
  • About 19%, or 43.5 million, provide care for someone over the age of 50.
  • Over 55% of caregivers are employed and more than 37% share households with children or grandchildren under the age of 18.
  • Roughly 66% of caregivers are female.
  • 34% care for two people.
  • While the average age of caregivers is 48, 51% of caregivers are between the ages of 18-49.
  • Of those providing care for someone 65 or older, the average age of caregivers is 63, and 1/3 of those are in poor health themselves.
  • For those caring for a parent, the total aggregate lost wages, pensions and social security benefits is nearly $3 trillion

The Housing Bureau for Seniors’ Housing & Caregiver Counseling program:

  • Assists caregivers and seniors who need assistance with decision-making around housing options and long-term care services to support aging in place.
  • Provides tools to evaluate the older adult’s functional, in-home supports and housing needs.
  • Prepares the caregiver with tools to evaluate and analyze housing options, long-term care options and financial resources.
  • Evaluates the older adults’ financial resources, housing and home safety and caregiving and social supports.
  • Identifies contributing factors that will impact how in-home supports and needed housing will be paid for and how they will be accessed.
  • Maintains information on senior-specific housing options in Washtenaw County.

If you are a caregiver and need assistance, please call us at 734-998-9339 or email housingbureauseniors@umich.edu.

Every year since 1997, Presidents have issued an annual proclamation.  Here are highlights from this year’s Presidential Proclamation:

Family members, friends, and neighbors devote countless hours to providing care to their relatives or loved ones.  During National Family Caregivers Month, we recognize and thank the humble heroes who do so much to keep our families and communities strong.

Across America, daughters and sons balance the work of caring for aging parents with the demands of their careers and raising their own children. Spouses and partners become caregivers to the ones they love even as they navigate their own health challenges.

Mothers and fathers resume care for children returning home as wounded warriors. Friends and relatives form networks to support loved ones with disabilities. All of them give selflessly to bring comfort, social engagement, and stability to those they love.

Family caregivers have an immeasurable impact on the lives of those they assist, but their hours are long and their work is hard. Many put their own lives on hold to lift up someone close to them.

National Family Caregivers Month is a time to reflect on the compassion and dedication that family caregivers embody every day…..I encourage all Americans to pay tribute to those who provide for the health and well-being of their family members, friends, and neighbors.

Health Care Reform: What does it Mean for Seniors?

On Thursday, September 13th the Housing Bureau for Seniors held our annual meeting where Dr. Aaron David Cooke gave a presentation on this topic. Here is a synopsis of his presentation.

Dr. Cooke is an Assistant Professor of Internal Medicine at the University of Michigan Health System. His presentation does not necessarily represent the views or opinions of the University of Michigan Health System.

 

What is in the Bill: 

Expanded patient protections

  • Eliminates pre-existing conditions clauses after 2014
  • No lifetime limits on care
  • New appeals process
  • Patient’s Bill of Rights

Cost Controls

  • Limit insurance overhead spending to no more than 15%
  • Insurance plans must justify 10%+ premium increases
  • Reduce Medicaid/Medicare fraud
  • Change payment model – quality, rather than quantity
  • Promote preventive care

Medicaid

  • Eligibility expanded to cover those at or below 133% of poverty (monthly income for 1 individual up from $931 to $1238, for 2 persons from $1261/month to $1677/month)

Medicare

  • Annual health maintenance visit
  • Preventive services covered (and no co-pays, co-insurance or deductibles on these services) including colon cancer screening, mammograms, osteoporosis screening, cholesterol testing, blood pressure screening, more immunizations, dietary counseling for high-risk patients and smoking cessation
  • Closure of the “Donut Hole”
  • o By 2020, once patients have spent over $2830 on medications, they will have a 50% brand-name discount and a 25% co-pay.  Once patients reach the catastrophic range of over $6440, they will have a 5% copay
  • o Over the next 8 years, there will be increasing coverage for generic drugs

What is NOT in the Bill:

  • Death panels
  • Euthanasia
  • Setting maximum, lifetime limits on care
  • Health care rationing (limit health care procedures based on age)
  • Outlawing private insurance
  • Jail time for refusing to buy health insurance
  • Free health care for illegal immigrants

During this political season there’s been a lot of talk about the “Ryan Plan” and how it differs from the Affordable Care Act. Here’s a side-by-side comparison of the major provisions:

Provision

Affordable Care Act (ACA)

“Ryan Plan”

Individual Mandate Implements Eliminates
Insurance Exchanges and Premium Support Implements Eliminates
Medicare Eligibility Age Remains 65 Age begins to rise in 2022 until reaches 67 years old in 2033. In 2022 closes Medicare enrollment for persons turning 65, who will then receive $8,000/yr towards private health insurance
Medicare Prescription Drug Plan Donut Hole Eliminates by 2020 Revert to pre-ACA, individuals pay 100% of annual medication costs between $2830-6440
Services Covered Retains current structure, adding preventive care benefits Minimum coverage standards; otherwise determined by individual insurance plans
Spending Growth Caps Limits spending increases to GDP growth + 5%If spending exceeds cap, payment advisory board recommends cuts, but not in benefits or coverage Limits spending increases to GDP growth + 5%Premium support payments are subject to a hard cap
Cost Control Mechanisms Reduce payments to providers, limit insurance overhead, pay-for-performance, best research practices, independent advisory board Assumes that free market competition will reduce costs
Medicaid Changes States encouraged to increase eligibility to 133% of povertyMaintains current federally-determined payment/benefit structureMaintains asset protection for community-residing spouse Eliminates expansion to 133% of povertyConvert Medicaid to fixed block grants, indexed for inflation but do not keep pace with costs. States set eligibility and benefits.Assets of both spouses considered for Medicaid coverage of nursing home payments; some seniors may lose nursing home care coverage

Want to know more? Check out these Web sites!

Where One Program Ends, Another Begins

Most of the time, our clients come to us and receive help from just one specific program. But sometimes, a clients’ housing needs are beyond the scope of what one program can handle. Thankfully, we are able offer multiple solutions to help older adults find and maintain appropriate and affordable housing.

What follows is an account of one client who received assistance this past year.

Post-Foreclosure Assistance – The story starts

The Housing Bureau for Seniors’ Post-Foreclosure Assistance Program sent Jim, a 70-year-old male, an outreach letter offering our services.

Jim’s home was foreclosed on and he knew he would need to vacate the property, but did not know when and did not have a plan as to where he would live. He had lived in his home for many years and always paid the mortgage on time.

What changed? Jim’s his wife died and he retired from his job to take care of his own serious health issues. As a result, his household income was drastically reduced. Now, Jim was faced with finding a way to live solely Social Security. He started using credit cards and before he knew it, his debt reached $50,000.

Although Jim had two adult children living nearby with their families, both were struggling financially and he could not ask them for help, or even admit that he was losing his home – the home in which they had grown up. He was overwhelmed and frightened about his financial and housing situation and could not bring himself to reach out for help immediately. He put the letter aside for possible future reference.

While going through his personal papers to organize for a move, he saw the letter from HBS and gave us a call. He scheduled an appointment for the next day to assess his situation and discuss possible options. The Post-Foreclosure Assistance Coordinator confirmed with the Sheriff that the foreclosure and sale of the home had already occurred. We advised Jim that the 6-month redemption period was ending and he would soon get a notice informing him of a court date for the eviction process to begin.

We worked with Jim to develop a budget to determine what housing options he could afford. Jim shared that he was paying over $900 per month through a credit counseling agency to settle his credit card debt. He was left with approximately $1500 per month for mortgage/rent, utilities, food, car expenses, health care, insurance and all of his other needs. One option we discussed with Jim was bankruptcy and provided him a list of attorneys so he could explore this option with an expert.

We also discussed housing options – senior subsidized housing (including expected waiting lists), low-income housing for all ages, market rate housing options, HomeShare, downsizing and the moving process. Jim decided that, because he had little time with which to work and did not know if his income situation might improve as a result of bankruptcy and discharge of some of his large debts, that he would apply for the Housing Bureau’s HomeShare program where the rent would be affordable even with his present income.

The Home Share coordinator did an assessment and began the process of checking backgrounds and looking for a good match. Meanwhile, Jim received his court notice. The Post-Foreclosure Assistance Coordinator accompanied him to court, discussing what he might expect from the court proceeding and what would be asked of him in terms of participation and negotiation with attorneys representing the mortgage holder. During the court hearing, an agreement was made to vacate the home within 30 days. The next day the client met with a possible HomeShare match and agreed to accept this living arrangement.

Jim expressed gratitude and relief that he did not have to go through this experience alone.

With the stress of dealing with the legal issues and court behind him, he was able to focus on downsizing and moving. He was able to talk to his family about his situation and the decisions he had made, enlisting their support in helping with his move. Within 2 weeks he was completely moved in to his new home.

As a result of counseling he had received from HBS, he had asked for “Cash for Keys” from his bank. Because Jim left his home in good condition and removed all of his possessions he received a check for $800 from his lender which paid for his move.

At the close of his case, Jim was settling into his new home and was feeling relief that this struggle was over, pride in his ability to handle the situation, and even optimism about regaining control over his finances and sticking to a plan to successfully and happily live within his means.

He is now focusing on spending as much time as possible with his grandchildren.

HomeShare – The story continues

Jim came to HomeShare as a referral from the Housing Bureau’s Post-Foreclosure Relocation Assistance Program. Jim had lived in the home with his wife home for over 30 years. Jim’s wife was the house bookkeeper and after her passing he found himself in a challenging situation with significant credit card debt costing $930 each month. Jim tried to keep afloat but was unable to. His home slipped into foreclosure and was sold at Sheriff’s sale leaving him little time to find new, appropriate and affordable housing with a damaged credit history and no rental history. Jim found himself having to make many big decisions, such as filing bankruptcy and where to move from his home with under 6 weeks to do so.

Jim applied for the HomeShare program and was approved for participation. We explored many referrals for Jim. After narrowing down the options based upon compatibility of what Jim was looking for, and what our homeowners were looking for, we referred Jim to Bob.

Bob is 61-year-old disabled veteran who lives alone in a modular home on the west side of Ann Arbor. Bob has participated in HomeShare previously. Bob was once again interested as a way to help increase his financial security and to obtain some household assistance with tasks he has trouble with. When Bob re-presented to the program he was anxious due to an increase in his lot rent and the high cost of utilities. Also, Bob has limited cooking skills and as a result, he would eat out often, or pick up prepared foods which is costly.

The HomeShare program introduced Jim and Bob and they had an immediate connection, both men served in the military and have a love of sports. After discussing the option of living together in detail and after several days of contemplation, both gentlemen decided to move forward with sharing Bob’s home. The HomeShare program helped to negotiate the details of the shared housing contract. Jim paid Bob $300 per month as a financial contribution including his portion of utilities. Jim was responsible for making home cooked meals at least 3 times per week. In addition Jim was also charged with helping with the weekly housekeeping.

The extra income helped Bob to keep afloat with increasing lot rent and utility costs. It improved his quality of life as he gained companionship, help with housekeeping, and home cooked meals which are important to him.

With this HomeShare situation, Jim was able to move into a safe and secure housing where he stayed for over 9 months. During this time, Jim was able to save money and he decided to move forward with bankruptcy – which he completed.

With his savings and a positive landlord reference from Bob, Jim was able to move into an independent apartment where he can continue to rebuild his life and maintain appropriate, and affordable housing. And, of course, spend more time with his grandchildren.

A Little Known Component of the Affordable Care Act

One thing goes without saying: a lot of emotions surround the recent Supreme Court decision to uphold the Affordable Care Act.

But, regardless of how you feel, what you believe or where you fall on the political spectrum, the Act does one thing that, I believe, most Americans support. Even though most, including aging professionals, don’t even know it exists!

Congress passed The Elder Justice Act (EJA) with its’ funding tied up in passage of the Affordable Care Act. The EJA provides federal resources to assist and support State and community efforts. The goal? To prevent, detect, treat, understand, intervene in and, where appropriate, prosecute elder abuse, neglect and exploitation.

All older adults have the right to be free of abuse, neglect and exploitation. Elder abuse is the mistreatment or neglect of an elderly person 65 and older or dependent adults 18-64 years of age who are physically, developmentally or emotionally disabled. Elder abuse includes neglect by caregivers, self-neglect, physical abuse, sexual abuse, emotional/psychological or verbal abuse and financial exploitation.

Elder abuse crosses all socio-economic, cultural and geographic boundaries and can occur anywhere by anyone.

Here are just a few provisions of the EJA (taken directly from the “other sources” listed below:

• Elevate elder justice issues to a national attention. Creation of (1) Offices of Elder Justice at the Departments of Health and Human Services and Justice to serve programmatic, grant-making, policy and technical assistance functions relating to elder justice, (2) a public-private and a Coordinating Council to coordinate activities of all relevant federal agencies, States, communities and private and not-for-profit entities and (3) a consistent funding stream and national coordination for Adult Protective Services (APS).

• Developing forensic capacity. There is scant data to assist in the detection of elder abuse, neglect and exploitation. Creating new forensic expertise (similar to that in child abuse) will promote detection and increase expertise. New programs will train health professionals in both forensic pathology and geriatrics.

• Victim assistance, “safe havens” and support for at-risk elders. Elder victims’ needs, which are rarely addressed, will be better met by supporting creation of “safe havens” for seniors who are not safe where they live and development of programs focusing on the special needs of at-risk elders and older victims.

• Increasing Security, Collaboration and Consumer Information in Long-Term Care.
o Improving prompt reporting of crimes in long-term care settings
o Creating a national program of criminal background checks for persons seeking employment in nursing homes and other long‐term care facilities.
o Enhancing long-term care staffing
o Promoting accountability through a new federal law to prosecute abuse and neglect in nursing homes

• Training. Training to combat elder abuse, neglect and exploitation is supported both within individual disciplines and in multi-disciplinary (such as public health-social service-law enforcement) settings.

• Increasing prosecution. Technical, investigative, coordination and victim assistance resources will be provided to law enforcement to support elder justice cases. Preventive efforts will be enhanced by supporting community policing efforts to protect at-risk elders.

Want to know more?
National Health Policy Forum
Elder Justice Coalition
American Psychological Association
American Bar Association

Would You Know What to Do?

A few months ago my mom was visiting from out-of-state. She had been asking me for advice about a family member who was in a bit of crisis about their housing and finances when her phone rang. It was the family member we were talking about.

Mom put her phone speaker on, and I was able to counsel this relative about housing options, applying for early Social Security and encouraged them to act now (this relative had been indecisive for several years). Several months later, my mom informed me this relative had applied for Social Security and put in their application for a subsidized housing facility with a year+ long waiting list.

Most families don’t have a gerontologist in the family. But, seniors and their families living in Washtenaw County are fortunate. The Housing Bureau for Seniors (HBS) has an array of services to assist seniors to find and maintain appropriate living arrangements. For families in similar situations as we had, our Housing and Care Counseling program is for you.

Thanks to an Ann Arbor Area Community Foundation grant, family caregivers who live in or have an older family member living in Washtenaw County have a resource to support and enable them to make informed decisions regarding housing and long-term care needs.

Approximately 19% of the adult U.S. population (43.5 million) provides unpaid care for an adult family member or friend over the age of 50. Over 55% of these caregivers are employed and more than 37% share households with children or grandchildren under the age of 18.

Seventy-seven percent (77%) of caregivers report needing more information or support with issues including:
• Long-term care needs (such as supportive housing and in-home supports);
• Keeping loved ones safe at home; and
• Choosing home care agencies.

The Housing Bureau for Seniors assists caregivers and seniors who need assistance with decision-making around housing options and long-term care services to support aging in place. Specifically, we:
• Provide tools to evaluate the older adult’s functional, in-home supports and housing needs;
• Prepare the caregiver with tools to evaluate and analyze housing options, long-term care options and financial resources;
• Evaluate the older adults’ financial resources, housing and home safety and caregiving and social supports;
• Identify contributing factors that will impact how in-home supports and needed housing will be paid for and how they will be accessed; and
• Determine if there are adequate financial resources and if there are private or public options to maximize resources.

If you’re a caregiver and have questions about an aging family member, give us a call! We can be reached at (734) 998-9339 or housingbureauseniors@umich.edu.