Seniorcorp

What is Long-Term Care Insurance?

Thu, 10 Feb 2011 14:19:00 GMT

What is Long-Term Care Insurance?

Long-term care insurance is a type of insurance developed specifically to cover the costs of long-term care services, most of which are not covered by traditional health insurance or Medicare. These include services in your home such as assistance with Activities of Daily Living as well as care in a variety of facility and community settings.

There is a great deal of choice and flexibility in long-term care insurance policies. You can select a range of care options and benefits that allow you to get the services you need in the settings that suit you best. The cost of your long-term care insurance policy is based on the type and amount of services you choose to have covered, how old you are when you buy the policy, and any optional benefits you choose, such as Inflation Protection. If you are in poor health or already receiving long-term care services, you may not qualify for long-term care insurance, or you may only be able to buy a more limited amount of coverage, or buy coverage at a higher “non-standard” rate.

Long-term care insurance policies have a benefit period or lifetime benefit maximum, which is the total amount of time or total amount of dollars up to which benefits will be paid. Common benefit periods for long-term care policies are two, three, four, and five years, and lifetime or unlimited coverage. Other options between five years and lifetime/unlimited coverage are also available from many companies. Most policies translate these time periods into dollar amounts and do not actually limit the number of days for which they will pay for care – just the overall dollar amount that the policy will pay. There are fewer companies today willing to offer an unlimited/lifetime policy, although some have a “high coverage option” like a $1 million lifetime limit.

With long-term care insurance, you pay premiums in amounts you know in advance and can budget for, and the policy pays – up to its coverage limits – for the long-term care you need when you need it. Typically, premiums are waived during the time you are receiving benefits.

Coverage and Benefit Choices

Policy and Benefit Choices

The following is a summary of policy and benefit choices:

You select a daily benefit amount (for example, $100/day), which is the maximum daily amount of expenses for care the policy will pay. Most policies let you choose from $50/day to as much as $500/day. A growing number of policies specify benefits in terms of a monthly amount so that you have the flexibility to receive more care on some days (for example, when family care is not available) and less care on other days.
Often you can choose whether you want the policy to pay the same daily benefit amount for care in all settings, or whether you want the policy to pay less for care in less costly settings, such as home care. Common choices include a home care benefit of 50 percent or 75 percent of the daily nursing home benefit amount.
You choose a Maximum Lifetime Benefit or total lifetime amount you want the policy to provide. Policies typically offer a choice of lifetime dollar amounts – for example $100,000 or $300,000. The dollar amounts may correspond to a period of time. For example, a three-year policy at $100/day of benefits would provide you with a total of $109,500 for care. Some insurers also sell “Lifetime” or “Unlimited” coverage that has no dollar limit; you receive benefits as long as you continue to need long-term care and receive covered services.
You choose the type of coverage you prefer – “comprehensive” or “facility care only.” Comprehensive policies cover a wider range of care settings and services including both care at home and in various types of facilities.
Most policies today are comprehensive, but some people prefer to buy facility care only policies. These pay for care in a nursing home or assisted living facility, but not for care at home or in the community. These policies may still include hospice or respite care but only when those services are provided in a facility. Facility-care-only policies cost less than comprehensive policies, and if people prefer and have family or friends to provide care at home, they may only have the policy to reimburse them for paid care in a facility if and when they need it.
Many policies offer additional optional benefits or “riders” allowing you to customize your coverage. One important option is Inflation Protection, which helps protect you from the rising cost of care over time. It works the same way that an inflation clause on your homeowners' insurance works: As the cost of replacing your home increases, so does the amount of insurance coverage that you maintain on the home. Most people who buy long-term care insurance opt for an inflation protection rider which builds the cost in to the starting premium, so the cost of the policy doesn’t increase simply because the value of the coverage increases with inflation. But there are many different types of Inflation Protection in long-term care insurance. Be sure to find out more about Inflation Protection options in any policy you are considering.
Most policies offer benefits in a variety of settings, such as your home, an adult day care center, an assisted living community, or a nursing home.

Additional Costs Long-Term Care Insurance Sometimes Covers

Many policies may also pay for services or devices to support people living at home:

Equipment such as in-home electronic monitoring systems
Home modification, such as grab bars and ramps
Transportation to medical appointments
Training for a friend or relative to learn to provide personal care safely and appropriately

Some policies provide some payment for family members or friends to help care for you, but may do so on a limited basis, or only in relation to the costs that the family member incurs.

Many policies provide the services of a care coordinator, usually a nurse or social worker in your community. The care coordinator can meet with you and discuss your specific personal situation, and help arrange for and monitor your care. The care coordinator’s help is usually optional – you use it if you need and want it – and you are not limited to the providers that the care coordinator may recommend.

What Is a Typical Comprehensive Long-Term Care Insurance Benefit?

The majority of policies sold today are comprehensive policies. They typically cover care and services in a variety of long-term care settings:

Your home, including skilled nursing care, occupational, speech, physical and rehabilitation therapy, as well as help with personal care, such as bathing and dressing. Many policies also cover some homemaker services, such as meal preparation or housekeeping, in conjunction with the personal care services you receive.
Adult day health care centers;
Hospice care;
Respite care;
Assisted living facilities (also called residential care facilities or alternate care facilities);
Alzheimer's special care facilities; and
Nursing homes

What Does Long-Term Care Insurance not Cover?

Like all insurance, long-term care policies have exclusions. These are listed in both the Outline of Coverage you receive before you apply, as well as in the policy after you have purchased coverage. These exclusions often follow state regulations on what exclusions are allowed. Long-term care policies typically exclude the following (even if you meet all the other requirements of the policy):

Care or services provided by family member unless the family member is a regular employee of an organization that is providing the treatment, service or care; and the organization they work for receives the payment for the treatment, service or care; and the family members receives no compensation other than the normal compensation for employees in his or her job category;
Care or services for which no charge is made in the absence of insurance;
Care or services provided outside the United States of America, its territories or possessions. However, a growing number of policies now have an international care benefit that can provide care outside of the United States;
Care or services that result from war or act of war, whether declared or not;
Care or services that result from an attempt at suicide (while sane or insane) or an intentionally self-inflicted injury;
Care or services for alcoholism or drug addiction (except for an addiction to a prescription medication when administered in accordance with the advice of Your Physician);
Treatment provided in a government facility (unless otherwise required by law);
Services for which benefits are available under Medicare or other governmental program (except Medicaid), any state or federal workers' compensation, employer's liability or occupational disease law, or any motor vehicle no-fault law

Although most policies do not pay for care you receive from a family member, friend, or other individual who is not paid to provide your care, some policies provide a cash payment for each day that you receive care from anyone, even if it is a family member or friend. These policies cost more (about 25-40% more) but allow more flexibility in using your benefit dollars. Most policies provide training and support for family and friends who provide care.

Most policies require that the facility, agency or individual providing your care meet certain minimum standards with respect to quality, safety, and training. For example, a nursing home that is not licensed but operates in a state that requires licensure, would not be covered. In states that do not require long-term care facilities or programs to be licensed, the insurance policy would typically describe the staffing, safety and other features that should be present to ensure that you receive appropriate and safe care.

Long-term care policies focus on paying for the types of services and providers that someone needs when they cannot perform their Activities of Daily Living on their own or when they have a Cognitive Impairment. They do not pay for care or services unrelated to these needs, such as hospital stays or prescription medications.
However, some policies may pay for prescription drugs provided while you are in a care facility (but not at home), and some policies pay for transportation costs to help you get to medical appointments when you are physically or cognitively impaired.

Some policies provide coverage for care related to everyday household needs such as housekeeping, laundry, meals, and managing medications, so-called “instrumental activities of daily living,” but only when you receive that help as part of the help you get from a paid care provider for assistance with Activities of Daily Living. So most policies do not pay for in-home help if all you need is help with services such as housekeeping, meals, laundry, and transportation.

Finally, long-term care policies do not pay for items provided solely for your comfort or convenience, for example a television in your nursing home room or a visit to the facility's hair care salon.

Long-Term Care Insurance Costs and Receiving Benefits

What Does Long-Term Care Insurance Cost?

Policy costs vary greatly based on your age at the time of purchase, the policy, and the coverage you select. The average annual premium cost for a policy purchased in 2007 by individual buyers, across all ages of buyers and all of the types of policies was just over $2,207. Excluding 20% of individuals who elected lifetime coverage, this represents a comprehensive policy (covering both facility and at-home care) that provides an average of 4.8 years worth of benefits, with a daily benefit amount of $160. Most policies purchased in 2007 also included some form of automatic Inflation Protection. The chart below shows the average annual premium amounts paid for long-term care insurance in 2007 overall, and for specific age groups.

Age	Average Annual Premium amounts paid in 2007 – averaged for all ages and for specific age groups. (2008 LIMRA International, Inc.)
All ages	$2,207
Under age 40	$ 881
40 to 49	$1,781
50 to 59	$1,982
60 to 64	$2,249
65 to 69	$2,539
Age 70 and older	$3,026

Designing Coverage to Best Meet Your Needs

You can customize long-term care insurance coverage to match the amount you feel you can pay. Below is an example of different long-term care insurance options – all from the same program (as illustration only) – to help you see how different coverage choices can influence the monthly premium cost you would pay. To keep it simple, the illustration only changes one coverage element at a time. The price associated with some of these changes varies by age, while for some other types of changes, the savings do not vary based on your age at the time you buy.

The basic coverage design depicted in Plan A is as follows:

Comprehensive Coverage (Facility and at-home and community care)
Facility care daily benefit of $150/day
Home Health Care Benefits paid at $112/day (75% of the facility care amount).
Elimination period of 30 days
Lifetime coverage maximum equivalent to 5 years (or just under $275,000 for a policy paying $150/day)
Automatic Compound Annual Inflation Protection

Age at Purchase	Plan A	Plan B	Plan C	Plan D	Plan E
40	$90	$79	$74	$60	$24
45	$108	$95	$89	$72	$32
50	$130	$114	$107	$86	$43
55	$159	$140	$131	$106	$59
60	$195	$170	$160	$130	$83
65	$248	$216	$204	$165	$120
70	$324	$282	$267	$216	$179
75	$520	$299	$427	$347	$327

Note: The monthly premiums shown here are based on one long-term care insurance program’s rates and represents premium costs. Premiums for the exact same coverage described here from a different company will, for a variety of reasons, vary from the rates shown here. These monthly premiums are based on the Federal Long-Term Care Insurance Program (www.ltcfeds.com). You can use the premium calculator there to see how other types of coverage changes would impact the rates, or to explore sample rates for other ages.

Plans B through E show you different ways to reduce your premium costs compared to the coverage described in Plan A. You should examine how the compared to the coverage described in Plan A. You should examine how the premium changes for Plans B through Plans E based on the Plan A (base plan).

Plan B: Same as Plan A, except the elimination period is 90 days instead of 30 days.

Plan C: Same as Plan A, except the lifetime maximum is equal to 3 years, or just under $165,000

Plan D: Pays benefits at $100/day for facility care and, correspondingly, $75/day. All other elements remain the same.

Plan E: Same as Plan A, except it does not include Compound Annual Inflation Protection. Instead, each year you can elect to increase your coverage by a set amount (generally 5% of the prior years’ benefit amount) and you would pay for that additional amount at the time you elect it.

How Do You Pay Long-Term Care Insurance Premiums?

Different policies offer different payment options. With most policies, you pay premiums according to a schedule you select - monthly, quarterly, semi-annually or annually. You may be able to have the premium automatically withdrawn from your bank account, pension check, or paycheck (if you obtain coverage through your employer). Typically you pay premiums until you begin to receive benefits. Then premiums are waived as long as you continue to receive benefits.

With most policies, you pay premiums as long as you are not receiving benefits. However, with some policies you pay premiums only for a specified period – most often 10, 15, or 20 years. For example, with the 20-year option, you pay a monthly premium for 20 years and then your coverage is fully paid up. If you begin to receive benefits before the 20-year pay period is over, you stop paying premiums while you are receiving benefits. If you recover and have not yet paid in for all 20 years, you resume payments. With some policies you only pay premiums until age 65.

A few companies offer a “Single Pay” option, in which you pay for the insurance in one lump sum payment. While they are more expensive than traditional long-term care insurance, the advantage is that the single lump sum payment is the only premium required. These policies typically pay for long-term care expenses and also offer you the option to include a death benefit for your heirs. Some states do not allow single-pay policies.

When Are Long-Term Care Benefits Paid?

When benefits are paid is based on the policy’s “benefit trigger,” the length of the elimination period you choose, and sometimes when you start receiving paidcare.

Policies use objective measures to determine when you need long-term care. These are called ‘benefit triggers.’ Most policies use Activities of Daily Living and Cognitive Impairment as triggers for benefits. The policy pays benefits when you need help with two or more of the six Activities of Daily Living or when you have a Cognitive Impairment.

Benefits begin to be paid after an elimination period has elapsed. This is the number of days between when a benefit trigger occurs and when you begin to receive payment for services. An elimination period is like the deductible you have on your car insurance, except it is usually specified as a period of time rather than a dollar amount. As noted above, most policies allow you to choose the length of the elimination period, generally 30, 60 or 90 days. During the elimination period, you are responsible for the cost of any services you receive. Policies differ with regard to whether you are required to receive paid care or pay for services to satisfy an elimination period before benefits start.

Once you are eligible for benefits, most policies reimburse the costs you incur for covered services up to a pre-set limit. Some policies simply pay you a pre-set cash amount for each day that you meet the ’benefit trigger’ whether you receive paid long-term care services or not. These “cash disability” policies offer greater flexibility but are also significantly more expensive.

Buying Long-Term Care Insurance

Can Everyone Buy Long-Term Care Insurance?

No, having certain conditions means you may not qualify for long-term care insurance. However, insurance companies have different standards, so while you may be denied coverage by one company, another might accept you. You will probably not be approved to purchase a policy if:

You currently use long-term care services.
You already need help with Activities of Daily Living.
You have AIDS or AIDS Related Complex (ARC).
You have Alzheimer's disease or any form of dementia or cognitive dysfunction.
You have a progressive neurological condition such as Multiple Sclerosis or Parkinson's Disease.
You have had a stroke within the past 12 to 24 months or a history of strokes or multiple Transient Ischemic Attacks (TIAs).
You have metastatic cancer (cancer that has spread beyond its original site).

Other health conditions are evaluated in deciding whether or not you can obtain the insurance, but these are the primary conditions that can disqualify you from obtaining insurance.

Once you are accepted for coverage, your coverage cannot be cancelled for any reason other than non-payment of premium as due, or if you have received the policy's maximum benefits. If you develop one of the health conditions listed above after obtaining coverage, you would be covered for the care you need for that condition.

Consumer Protections

The following rules apply to all long-term care insurance policies:

Coverage cannot be cancelled or not renewed as long as you continue to pay premiums as they are due and you have not used up the maximum policy benefits.
You have 30 days after receiving the policy to return it for a full refund.
You have the right to designate another person to receive notice of premiums due and payments missed so you won't accidentally miss a payment.
You have up to 65 days after the date a premium payment is due to make payment. Coverage cannot be cancelled for non-payment until after the grace period and until the “third party designee” has also been notified.
If coverage lapses for non-payment because you were “disabled” at the time, you can restore your coverage within five months of the missed premium due date.
If you have a group policy through your employer or other association, you can continue that coverage, unchanged, if you leave the group but want to maintain the policy.
A spouse insured through an employer group plan may maintain coverage even after a divorce.
Your premiums are designed to remain level over the lifetime of your coverage, and are based on your age when you first buy the policy. The insurer can change rates on a group (or class) basis, but has only a limited right to do so, and the change must apply to an entire group or class. You cannot be singled out for a rate increase.
In most states, rate increases must be filed with and approved by the State Department of Insurance. Many states have adopted regulations that make it very difficult for an insurer to obtain approval for a rate increase.
You typically have the right to decrease your coverage, without underwriting, if you find in the future that the current premium costs are beyond your financial means.

Things to Consider Before Buying Long-Term Care Insurance

Don't buy out of fear or emotion.
Don't buy more insurance than you think you may need. You may have enough income to pay a portion of your care costs and may need only a small policy for the remainder. You may have family willing and able to supplement your care needs.
Don't buy too little insurance. That will only delay the use of your own assets or income to pay for care. Think about how you feel about having care costs that won't be covered. While you can usually decrease how much coverage you have, it is more difficult to increase coverage, especially if your health has declined.
Look carefully at the policy you are considering. There is no “one-size-fits-all” policy.
Does the policy pay only for room and board in a facility? If so, plan for other expenses, such as supplies, medications, linens, and other things that may not be covered.
It costs less to buy coverage when you are younger. The average age of someone buying long-term care insurance today is about 60. For those who purchase policies offered at work, the average age at which they buy is about 50.
Make sure that buying the long-term care insurance policy is a sound financial decision and affordable for you.
Look at different options and talk with a professional before making a decision.

Where to Buy Long-Term Care Insurance

Most people buy long-term care insurance directly from an insurance agent, financial planner or broker. States regulate which companies can sell long-term care insurance and the products that they can sell. There are over 100 companies offering long-term care insurance nationally, however about 15 to 20 insurers sell most of the policies on the market today. The best way to find out which insurance companies offer this type of coverage in your state is to contact your state's Department of Insurance [offsite].

Another option for some people is to buy long-term care insurance offered through their employer. Many private and public employers, including the Federal government and a growing number of state governments, offer group long-term care programs as a voluntary benefit. Employers do not typically contribute to the premium cost (as they do with health insurance), but they often negotiate a favorable group rate.

If you are currently employed, it may be easier to qualify for long-term care insurance through your employer than purchasing a policy on your own. Check with your benefit or pensions office to see if your employer offers long-term care insurance.

The U.S. Office of Personnel Management has additional information about the Federal Long Term Care Insurance Program [offsite]. Check the map below to see if your state has a program to offer long-term care insurance to public employees, public retirees, and their families.

A Partnership Program is a collaboration or “partnership” among a state government, the private insurance companies selling long-term care insurance in that state, and state residents who buy long-term care Partnership policies. The purpose of the Partnership program is to make the purchase of shorter term more comprehensive long-term care insurance meaningful by linking these special policies (called Partnership qualified or PQ policies) with Medicaid for those who continue to require care.

Partnership qualified policies must meet special requirements that can differ somewhat from state to state. Most states require Partnership policies to offer comprehensive benefits (cover institutional and home services), be Tax Qualified, provide certain specific consumer protections, and include state specific provisions for inflation protection. Often the only difference between a partnership qualified policy and other long-term care insurance policies sold in a state is the amount and type of inflation protection required by the state.

Partnership policies must be certified by the State as meeting the specific requirements for the Partnership Program. State insurance departments are responsible for ensuring that individuals who sell Partnership policies are trained and understand how these policies relate to public and private coverage options.

How Do Partnership Policies Work?

A Partnership qualified policy provides you, as the purchaser, with the right to apply for Medicaid under modified eligibility rules that include a special feature called an ‘asset disregard’. This allows you to keep assets that would otherwise not be allowed if you need to apply, and qualify, for Medicaid in order to receive additional long-term care services. The amount of assets Medicaid will disregard is equal to the amount of the benefits you actually receive under your long term care Partnership qualified policy. Since these policies must include inflation protection, the amount of the benefits you receive can be higher than the amount of insurance protection you originally purchased. If you have a Partnership-qualified long term care insurance policy and receive $100,000 in benefits, you can apply for Medicaid and, if eligible, retain $100,000 worth of assets over and above the State’s Medicaid asset threshold. In most states the asset threshold is $2,000 for a single person. Asset thresholds for married couples are typically more generous.

The following is an example of how a Partnership Qualified policy works. Let's say John, a single man, purchases a Partnership policy with a value of $100,000. Some years later he receives benefits under that policy up to the policy’s lifetime maximum coverage (adjusted for inflation) equaling $150,000. John eventually requires more long-term care services, and applies for Medicaid. If John's policy was not a Partnership-qualified policy, in order to qualify for Medicaid, he would be entitled to keep only $2,000 in assets. He would have to spend down any assets over and above this amount. However, because John bought a Partnership-qualified policy, if he needs to apply for Medicaid and is deemed eligible, he can keep $152,000 in assets and the State will not recover those funds after his death. However, any assets John has over and above the $152,000 would have to be spent in order for him to be eligible for Medicaid. He would also have to satisfy the income, general eligibility and functional eligibility requirements for Medicaid before he can qualify.

Partnership programs help both individuals and the state. For individuals, it allows them to get and pay for services they need without having to spend all of their assets. For the state, it can decrease the amount of Medicaid dollars used for long-term care services.

Some Important Considerations for Consumers

It is important to know if the long-term care insurance policy you buy is a Partnership qualified policy or not, since they can be the same as non-Partnership policies. A Partnership qualified policy is one that is certified by the State, and it must include the level of inflation protection coverage set by the State. Only if you have a Partnership policy will you be eligible for an asset disregard if and when you apply for Medicaid.
Policies issued prior to a state Partnership Program’s effective date will not be considered Partnership-qualified; however there are circumstances under which you may be able to exchange a policy you previously purchased for one that is Partnership qualified.
It is important to buy your Partnership qualified policy from an agent who is specially trained to sell that type of coverage. States with Partnership Programs have additional educational requirements for agents who wish to sell Partnership policies.
It is important to note that eligibility for Medicaid is not automatic. You must still apply and meet the income, functional and general eligibility requirements of the Medicaid program in your state. The long-term care services provided by Medicaid vary by state and may not be the same as the services you are eligible to receive under your private Partnership long-term care insurance policy (for example, many state Medicaid programs do not pay for room and board costs in an Assisted Living Facility even if you are also receiving personal care).
States that have Partnership programs are automatically considered to have “reciprocity” with each other and to honor the asset disregard you earned under a Partnership policy you purchased in a different state. However, States can “opt out” of this requirement at any time.

Which States Have Partnership Programs?

The map below shows which states have implemented Partnership programs and are offering long-term care Partnership policies as of June 1, 2009. There are numerous other states in the process of implementing these programs. We will update this map with those states when they have fully implemented programs. If you want more information on your State’s program including which insurance agents are selling Partnership policies, or if you want to find out if your State is planning to offer a Partnership program, contact your State’s Department of Insurance.

About Alzheimer's disease

Thu, 10 Feb 2011 14:17:00 GMT

Misplacing car keys. Not remembering a familiar name. Some people do become more forgetful as they get older. That's a normal part of aging. Alzheimer's disease is not.

Alzheimer's disease affects approximately 5.3 million people in the U.S. Over time, Alzheimer's disease gradually destroys a person's memory and ability to learn and carry out daily activities such as talking, eating, and going to the bathroom. As the disease progresses, individuals may also experience changes in personality and behavior. Unfortunately, there are no cures for Alzheimer's disease and there is no way to predict how fast someone will progress through the stages of the disease.⁹

However, early Alzheimer's diagnosis and treatment can slow the progression of Alzheimer's symptoms. If you or someone you are caring for is suffering from Alzheimer's disease, you may want to talk with the doctor about an Alzheimer's medication called Namenda^® (memantine HCl)*. It works in an entirely different way than all of the other Alzheimer's therapies on the market and has been shown in clinical trials to safely and effectively treat moderate to severe Alzheimer's disease.1,

New "Generation Alzheimer's" Report Calls Alzheimer's Defining Disease Of The Baby Boomers

Thu, 10 Feb 2011 14:15:00 GMT

Starting this year, more than 10,000 baby boomers a day will turn 65. As these baby boomers age, one of out of eight of them will develop Alzheimer's - a devastating, costly, heartbreaking disease. Increasingly for these Baby Boomers, it will no longer be their grandparents and parents who have Alzheimer's - it will be them.

"Alzheimer's is a tragic epidemic that has no survivors. Not a single one," said Harry Johns, president and CEO of the Alzheimer's Association. "It is as much a thief as a killer. Alzheimer's will darken the long-awaited retirement years of the one out of eight baby boomers who will develop it. Those who will care for these loved ones will witness, day by day, the progressive and relentless realities of this fatal disease. But we can still change that if we act now."

According to the new Alzheimer's Association report, Generation Alzheimer's, it is expected that 10 million baby boomers will either die with or from Alzheimer's, the only one of the top 10 causes of death in America without a way to prevent, cure or even slow its progression. But, while Alzheimer's kills, it does so only after taking everything away, slowly stripping an individual's autonomy and independence. Even beyond the cruel impact Alzheimer's has on the individuals with the disease, Generation Alzheimer's also details the negative cascading effects the disease places on millions of caregivers. Caregivers and families go through the agony of losing a loved one twice: first to the ravaging effects of the disease and then, ultimately, to actual death.

"Most people survive an average of four to six years after a diagnosis of Alzheimer's disease, but many can live as long as 20 years with the disease. As the disease progresses, the person with dementia requires more and more assistance with everyday tasks like bathing, dressing, eating and household activities," said Beth Kallmyer, senior director of constituent relations for the Alzheimer's Association. "This long duration often places increasingly intensive care demands on 11 million family members and friends who provide unpaid care, and it negatively affects their health, employment, income and financial security."

The report also offers very personal glimpses into the lives of families who are in the throes of caring for a loved one with Alzheimer's disease, including a son who struggles to change the diapers of the mother who changed his as an infant, and a husband who watches his wife's fascination with the "lady in the mirror," not realizing the lady in the mirror is her.

In addition to the human toll, over the next 40 years Alzheimer's will cost the nation $20 trillion, enough to pay off the national debt and still send a $20,000 check to every man, woman and child in America. And while every 70 seconds someone in America develops Alzheimer's disease today, by 2050 someone will develop the disease every 33 seconds - unless the federal government commits to changing the Alzheimer trajectory.

"Alzheimer's - with its broad ranging impact on individuals, families, Medicare and Medicaid - has the power to bring the country to its financial knees," said Robert J. Egge, vice president of public policy of the Alzheimer's Association. "But when the federal government has been focused, committed and willing to put the necessary resources to work to confront a disease that poses a real public health threat to the nation - there has been great success. In order to see the day where Alzheimer's is no longer a death sentence, we need to see that type of commitment with Alzheimer's."

The full text of the Alzheimer's Association's Generation Alzheimer's report can be viewed here.

Source:
Alzheimer's Association

End-Of-Life Decisions Delayed If Patient's Wishes Not Shared With Family

Thu, 10 Feb 2011 14:14:00 GMT

Family caregivers who had not discussed life support measures with critically ill patients took nearly two weeks longer to decide to forego further medical intervention than those who had prior conversations about the issues, according to researchers from the University of Pittsburgh School of Medicine and the Graduate School of Public Health. They share their findings in a poster presentation at the Society of Critical Care Medicine congress this week in San Diego.

Also, a patient's loved ones were more confident about acting as surrogate decision-makers when they perceived their communication with intensive care physicians to be of high quality, said senior investigator Douglas B. White, M.D., MAS., associate professor and director of the Program on Ethics and Decision-Making in Critical Illness, Department of Critical Care Medicine.

"This is the first evidence to suggest that how a doctor guides family members through the foreign territory of critical illness may influence their ability to act as a surrogate," he noted. "Teaching doctors to be better communicators may be an important step in improving end-of-life decisions for patients. The study also reinforces the value of patients, families and friends having prior conversations about the end of life so that they can feel comfortable with their decisions about medical care."

For the study, conducted at four intensive care units at the University of California San Francisco Medical Center between 2005 and 2008, the researchers surveyed 230 caregivers who were making decisions on behalf of incapacitated patients on ventilators with greater than a 50 percent chance of dying from their illnesses.

They found caregivers who hadn't had a prior conversation with patients about treatment preferences were less confident about making decisions and it took them 40 percent longer - 33 days versus 21 days - to decide to discontinue life support.

"This prolongation of the dying process may not be in the best interest of patients and it places an enormous burden on the health care system," Dr. White said. "Health care reform will provide incentives for formal advance care planning between physicians and patients, such as the completion of advance directives and living wills. Our findings indicate that informal conversations between patients and their families may be very important for both patient-centered decisions and the family's comfort with the huge responsibility of being a surrogate."

The research team included Alyssa Majesko, M.D., of UPMC, and S. Hong and Lisa Weissfeld, Ph.D., of the University of Pittsburgh Graduate School of Public Health. The project was funded by the National Institutes of Health.

Source:
Anita Srikameswaran

An Extra 5 Years Of Life An Unexpected Benefit Of Osteoporosis Treatment

Thu, 10 Feb 2011 14:14:00 GMT

Australian clinical researchers have noted an extraordinary and unexpected benefit of osteoporosis treatment - that people taking bisphosphonates are not only surviving well, better than people without osteoporosis, they appear to be gaining an extra five years of life.

Associate Professor Jacqueline Center and Professor John Eisman, from Sydney's Garvan Institute of Medical Research, based their findings on data from the long running Dubbo Osteoporosis Epidemiology Study*.

Out of a total cohort of around 2,000, a sub-group of 121 people were treated with bisphosphonates for an average of 3 years. When compared with other sub-groups taking other forms of treatment, such as Vitamin D (with or without calcium) or hormone therapy, the longer life associated with bisphosphonate treatment was marked and clear.

These findings are published in the Journal of Clinical Endocrinology and Metabolism, now online.

"While the results seemed surprisingly good, they are borne out by the data - within the limitations of any study - and appear to apply to men as well as women," said Associate Professor Center.

"When we first looked at the figures, we thought that there had to be a fallacy, that we were missing something. One of the most obvious things might be that these are people who seek medical attention, so may be healthier and live longer. So we compared the bisphosphonate group with people taking Vitamin D and calcium or women on hormone therapy."

"The comparison against these other groups of similarly health-aware people simply confirmed that our results were not skewed by that factor."

"In a group of women with osteoporotic fractures over the age of 75, you would expect 50% to die over a period of five years. Among women in that age group who took bisphosphonates, the death rate dropped to 10%."

"Similarly, in a group of younger women, where you would expect 20-25% to die over 5 years, there were no deaths."

"The data were consistent with about a 5 year survival advantage for people on bisphosphonates."

The authors are intrigued by their findings. "We speculate that it may have something to do with the fact that bone acts as a repository for toxic heavy metals such as lead and cadmium," said Professor Eisman.

"So when people get older, they lose bone. When this happens, these toxic materials are released back into the body and may adversely affect health."

"By preventing bone loss, bisphosphonates prevent some of this toxic metal release. While we know that this is the case, we don't yet have evidence that this produces the survival benefit."

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Osteoporosis is a serious and disabling condition that affects around 2 million Australians. Someone is admitted to hospital with an osteoporotic fracture every 5-6 minutes, averaging 262 hospitalisations each day. It has already been shown by Garvan and others that osteoporotic fractures increase a person's risk of dying, even after relatively minor fractures if that person is elderly.

"Osteoporosis is a big societal burden and remains a poorly understood and severely undertreated disease in Australia," said Eisman.

"Only about 30% of women and 10% of men with osteoporosis receive treatment, which is unacceptable when you consider that people could be helped, and death could be delayed by several years. There is good evidence - even without this study - that treating osteoporosis reduces fractures and reduces mortality."

"While osteoporosis is clearly under-recognised and under-treated, the findings of this study are important to better understanding the benefits of these treatments and may directly influence doctors' practice. It was unexpected and remarkable to find that not only osteoporosis but also life expectancy appear to be improved for people taking bisphosphonates," said Dr Christine Bennett, Chair of the Bupa Health Foundation Steering Committee and Bupa Australia's Chief Medical Officer.

"Bupa Health Foundation is proud to have supported this valuable research since 2005 and we see its findings as a major breakthrough that can now guide doctors' treatment decisions for these very vulnerable older people."

Like any pharmaceutical product, bisphosphonates may have unpredictable side effects in a small minority of people and should only be used for their approved purpose.

*Dubbo Osteoporosis Epidemiology Study

The Dubbo Osteoporosis Epidemiology Study is an ongoing population-based study that started in 1989 in Dubbo, a city with a population of 32,000 in regional New South Wales. The study cohort is women (1223) and men (898) over the age of 60. Approximately 60% of eligible people were recruited into the study.

Acknowledgements And Disclosure Summary

This work was supported by the National Health and Medical Research Council Australia, The Bupa Health Foundation, the Ernst Heine Foundation, and untied grants from Amgen, Merck Sharp & Dohme, Sanofi- Aventis, Servier and Novartis. There was no financial compensation paid to any of the participants in the study. The study sponsors had no role in the study design, nor the collection, analysis and interpretation of the data.

Associate Professor Center has been supported by and/or has given educational talks for Eli Lilly, Merck Sharp and Dohme, Novartis and Sanofi-Aventis. Professor Eisman has consulted for and/or received research funding from Amgen, deCode, Eli Lilly, Merck Sharp and Dohme, Novartis, Sanofi-Aventis and Servier. The other authors on the paper have nothing to disclose.

Source:
Garvan Institute of Medical Research
Bupa Health Foundation

Improvements In Memory In Older Adults Following Moderate Aerobic Exercise

Thu, 10 Feb 2011 14:12:00 GMT

A new study shows that one year of moderate physical exercise can increase the size of the brain's hippocampus in older adults, leading to an improvement in spatial memory.

The project - conducted by researchers at the University of Pittsburgh, University of Illinois, Rice University, and Ohio State University - is considered the first study of its kind focusing on older adults who are already experiencing atrophy of the hippocampus, the brain structure involved in all forms of memory formation. The study, funded through the National Institute on Aging, appears in the Jan. 31 Proceedings of the National Academy of Sciences (PNAS).

The scientists recruited 120 sedentary older people without dementia and randomly placed them in one of two groups - those who began an exercise regimen of walking around a track for 40 minutes a day, three days a week, or those limited to stretching and toning exercises. Magnetic resonance images were collected before the intervention, after six months, and at the end of the one-year study.

The aerobic exercise group demonstrated an increase in volume of the left and right hippocampus of 2.12 percent and 1.97 percent, respectively. The same regions of the brain in those who did stretching exercises decreased in volume by 1.40 and 1.43 percent, respectively.

Spatial memory tests were conducted for all participants at the three intervals. Those in the aerobic exercise group showed improved memory function, when measured against their performance at the start of the study, an improvement associated with the increased size of the hippocampus. The authors also examined several biomarkers associated with brain health, including brain-derived neurotrophic factor (BDNF), a small molecule that is involved in learning and memory. They found that the increases in hippocampal size were associated with increased amounts of BDNF.

"We think of the atrophy of the hippocampus in later life as almost inevitable," said Kirk Erickson, professor of psychology at the University of Pittsburgh and the paper's lead author. "But we've shown that even moderate exercise for one year can increase the size of that structure. The brain at that stage remains modifiable."

"The results of our study are particularly interesting in that they suggest that even modest amounts of exercise by sedentary older adults can lead to substantial improvements in memory and brain health," said Art Kramer, director of the Beckman Institute at the University of Illinois and the senior author.

"Such improvements have important implications for the health of our citizens and the expanding population of older adults worldwide."

Source: University of Illinois at Urbana-Champaign

Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Lifting Weights Can Help Seniors Stay Independent Longer

Thu, 10 Feb 2011 14:11:00 GMT

Adults who begin lifting weights early in life may benefit from decreased age-related muscle loss and live independently longer, according to a report published this month by the American College of Sports Medicine.

The report, titled "Influence of Resistance Exercise on Lean Body Mass in Aging Adults: A Meta-Analysis," was published in Medicine & Science in Sports & Exercise®, the official scientific journal of the American College of Sports Medicine. A research team with the University of Michigan compiled data from 49 studies to assemble this report. They found that older adults gain an average of 2.42 pounds of lean body mass, primarily muscle, after strength training for approximately 20 weeks.

This 2.42-pound increase counteracts the 0.4 pounds of muscle lost each year by sedentary adults over age 50. The findings suggest that aging individuals should consider beginning a strength training regimen as early as possible to maximize results and delay sarcopenia, an age-related muscle deterioration that can lead to mobility disability and loss of independence for seniors.

"The findings of this analysis are significant, given the millions of U.S. adults affected by sarcopenia," said Mark Peterson, Ph.D., lead author of the study. "Because we have identified a robust link between resistance exercise and lean body mass, future generations of seniors who incorporate this modality may be less affected by age-related muscle loss and better able to preserve independence and quality of life."

In addition to beginning a strength training program early in life, researchers also recommend adults consider the volume, or number of sets, of their program. The analysis suggests progression models, with gradual changes in volume and load, are appropriate to accommodate long-term growth in muscle mass.

"Our report is the first comprehensive meta-analysis to confirm a significant association between strength training volume and lean body mass increases in aging men and women," said Dr. Peterson. "These findings suggest that, while effective for getting started, a single set of resistance exercises and/or fixed-volume programs may no longer be sufficient for individuals looking to achieve long-term changes in lean body mass."

Researchers screened more than 5,000 references for this analysis, and 49 studies with 81 cohorts were selected for inclusion based on several criteria. The selected studies had an average participant age of at least 50 years, incorporated supervised, whole-body resistance training programs, and lasted at least eight weeks in duration.

ACSM and the Physical Activity Guidelines for Americans recommend that adults get at least 150 minutes of moderately intense physical activity each week. For more information on exercise for older adults, see the ACSM Position Stand on "Exercise and Physical Activity for Older Adults."

Source: American College of Sports Medicine

Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Alzheimer's Scan Might Help Spot Disease

Thu, 10 Feb 2011 14:11:00 GMT

RIDAY, Jan. 21 (HealthDay News) -- An advisory panel's recommendation that the U.S. Food and Drug Administration approve a new chemical that can highlight the telltale signs of Alzheimer's in brain scans may one day help doctors diagnose the neurodegenerative disease, experts said Friday.

On Thursday, the panel voted 16 to 0 to recommend approval of the imaging agent, known as Amyvid, with one critical caveat: Manufacturer Eli Lilly and Co. must demonstrate that standards for interpreting brain scans that show amyloid plaques illuminated by Amyvid can be made consistent enough to routinely guarantee an accurate diagnosis.

Amyvid (florbetapir) is injected into patients who then undergo a PET scan; a negative result can help rule out Alzheimer's, according to Lilly.

Experts agreed that the test could become a critical part of spotting Alzheimer's before symptoms have taken hold, but they noted that the clinical reality of that is far from imminent.

"It may well be that amyloid imaging will join colonoscopy, mammography, etc. as mid-life surveillance tests, and that anti-amyloid interventions are most effective in the pre-symptomatic stages of Alzheimer's disease," said Dr. Sam Gandy, the Mount Sinai Chair in Alzheimer's Disease Research in New York City. However, this possibility is years away, he added.

The value for research is clear, Gandy said. "Either a spinal fluid amyloid test or an amyloid scan will help weed out non-Alzheimer's dementias in clinical trials of anti-amyloid agents. The clinical value in the short-term is less obvious."

Current medications are most effective in the early stages of Alzheimer's, and amyloid scans might identify those patients for doctors who don't have access to neuropsychological testing, Gandy said.

"A confirmed diagnosis would enable planning for the future while patients are at an early enough stage to still participate in the discussion," he said. "In the symptomatic patient, the amyloid scan would portend the onset of dementia within the next five years."

However, because there is no cure for Alzheimer's disease yet, the test might be one that is not considered worth its cost, Gandy said.

Gandy noted that the "300-pound gorilla in the room" is whether Medicare/Medicaid will reimburse such a test, even if the FDA follows its expert panel's advice and approves Amyvid. (While the FDA doesn't have to follow a panel's advice, it usually does.) "Medicare may decide that the added value does not merit reimbursement without a meaningful intervention," he said.

Also, Grandy said he doesn't expect approval until there are methods in place to train doctors in how to read these scans.

Another expert, David Loewenstein, a professor of psychiatry and behavioral sciences and neurology at the University of Miami Miller School of Medicine, said that the approval of Amyvid "will allow physicians to come to an earlier diagnosis of Alzheimer's."

What is needed is consistency for evaluating scans using the agent, he said, so that physicians "can apply a single standard and there won't be gaps between hospitals because of different readers using different methods."

Loewenstein thinks use of this new diagnostic tool will help in several ways. First, it will help researchers find effective treatments by diagnosing the disease early, although having the plaques does not always mean the patient has Alzheimer's. Second, it will identify people who can take part in clinical trials of new Alzheimer's drugs.

"There is a whole new line of drugs being formulated that will help treat the earliest stages of the disease," Loewenstein said. "We need to know who are the appropriate people with the mildest cognitive problems to get into clinical trials."

In addition, the test has value even before treatments are available in terms of helping patients prepare for the course of the disease, Loewenstein noted. "I think many people would like an early diagnosis," he said.

More information

For more information on Alzheimer's disease, visit the Alzheimer's Association.

AHRQ News And Numbers: Approximately Five Percent Of Seniors Report One Or More Cognitive Disorders

Thu, 10 Feb 2011 14:08:00 GMT

Slightly over over 5 percent of the nearly 39 million Americans age 65 and older in 2007 reported one or more cognitive disorders, such as senility or dementia, according to the latest News and Numbers from the Agency for Healthcare Research and Quality.

Seniors age 85 and older were the most likely to have reported one or more cognitive disorders (18.4 percent), compared to seniors ages 75 to 84 (6 percent) and seniors ages 65 to 74 (1.1 percent).

AHRQ found that for elderly Americans age 65 and older in 2007:

- Seniors with less than a high school education were more likely to have reported one or more cognitive disorders than seniors that were high school graduates (8.6 percent and 4.9 percent, respectively) or seniors with more than a high school education (2.7 percent ).

- Nearly 8 percent of poor seniors reported one or more cognitive disorders compared to 4.1 percent of middle and high income seniors reporting such a condition.

- Nearly 11 percent of seniors who had both Medicare and another type of supplemental public insurance reported one or more cognitive disorders, compared to 5 percent of seniors with Medicare only and 4.1 percent of seniors with Medicare and supplemental private insurance.

- Average annual health care expense for seniors reporting one or more cognitive disorders totaled $15,549 a year, compared to $9,019 for seniors not reporting any cognitive disorders.

AHRQ, which is part of the U.S. Department of Health and Human Services, improves the quality, safety, efficiency, and effectiveness of health care for all Americans. The data in this AHRQ News and Numbers summary are taken from the Medical Expenditure Panel Survey (MEPS), a detailed source of information on the health services used by Americans, the frequency with which they are used, the cost of those services, and how they are paid. For more information, go to: Person Characteristics of the Elderly Reporting One or More Cognitive Disorders, 2007 .

Source:
AHRQ News and Numbers

Alzheimer's Scan Might Help Spot Disease

Thu, 10 Feb 2011 03:23:00 GMT

By Steven Reinberg
HealthDay Reporter by Steven Reinberg
healthday Reporter – Fri Jan 21, 11:48 pm ET

FRIDAY, Jan. 21 (HealthDay News) -- An advisory panel's recommendation that the U.S. Food and Drug Administration approve a new chemical that can highlight the telltale signs of Alzheimer's in brain scans may one day help doctors diagnose the neurodegenerative disease, experts said Friday.

Amyvid (florbetapir) is injected into patients who then undergo a PET scan; a negative result can help rule out Alzheimer's, according to Lilly.

Experts agreed that the test could become a critical part of spotting Alzheimer's before symptoms have taken hold, but they noted that the clinical reality of that is far from imminent.

Current medications are most effective in the early stages of Alzheimer's, and amyloid scans might identify those patients for doctors who don't have access to neuropsychological testing, Gandy said.

However, because there is no cure for Alzheimer's disease yet, the test might be one that is not considered worth its cost, Gandy said.

Also, Grandy said he doesn't expect approval until there are methods in place to train doctors in how to read these scans.

More information

For more information on Alzheimer's disease, visit the Alzheimer's Association.

Reverse Mortgages: Get the Facts Before Cashing in on Your Home’s Equity

Thu, 10 Feb 2011 03:21:00 GMT

If you’re 62 or older – and looking for money to finance a home improvement, pay off your current mortgage, supplement your retirement income, or pay for healthcare expenses – you may be considering a reverse mortgage. It’s a product that allows you to convert part of the equity in your home into cash without having to sell your home or pay additional monthly bills.

The Federal Trade Commission (FTC), the nation’s consumer protection agency, wants you to understand how reverse mortgages work, the types of reverse mortgages available, and how to get the best deal.

In a “regular” mortgage, you make monthly payments to the lender. In a “reverse” mortgage, you receive money from the lender, and generally don’t have to pay it back for as long as you live in your home. The loan is repaid when you die, sell your home, or when your home is no longer your primary residence. The proceeds of a reverse mortgage generally are tax-free, and many reverse mortgages have no income restrictions.

Types of Reverse Mortgages

There are three types of reverse mortgages:

single-purpose reverse mortgages, offered by some state and local government agencies and nonprofit organizations
federally-insured reverse mortgages, known as Home Equity Conversion Mortgages (HECMs) and backed by the U. S. Department of Housing and Urban Development (HUD)
proprietary reverse mortgages, private loans that are backed by the companies that develop them

Single-purpose reverse mortgages are the least expensive option. They are not available everywhere and can be used for only one purpose, which is specified by the government or nonprofit lender. For example, the lender might say the loan may be used only to pay for home repairs, improvements, or property taxes. Most homeowners with low or moderate income can qualify for these loans.

HECMs and proprietary reverse mortgages are more expensive than traditional home loans, and the up-front costs can be high. That’s important to consider, especially if you plan to stay in your home for just a short time or borrow a small amount. HECM loans are widely available, have no income or medical requirements, and can be used for any purpose.

Before applying for a HECM, you must meet with a counselor from an independent government-approved housing counseling agency. Some lenders offering proprietary reverse mortgages also require counseling. The counselor is required to explain the loan’s costs and financial implications, and possible alternatives to a HECM, like government and nonprofit programs or a single-purpose or proprietary reverse mortgage. The counselor also should be able to help you compare the costs of different types of reverse mortgages and tell you how different payment options, fees, and other costs affect the total cost of the loan over time. To find a counselor, visit www.hud.gov/offices/hsg/sfh/hecm/hecmlist.cfm or call 1-800-569-4287. Most counseling agencies charge around $125 for their services. The fee can be paid from the loan proceeds, but you cannot be turned away if you can’t afford the fee.

How much you can borrow with a HECM or proprietary reverse mortgage depends on several factors, including your age, the type of reverse mortgage you select, the appraised value of your home, and current interest rates. In general, the older you are, the more equity you have in your home, and the less you owe on it, the more money you can get.

The HECM lets you choose among several payment options. You can select:

a “term” option – fixed monthly cash advances for a specific time.
a “tenure” option – fixed monthly cash advances for as long as you live in your home.
a line of credit that lets you draw down the loan proceeds at any time in amounts you choose until you have used up the line of credit.
a combination of monthly payments and a line of credit.

You can change your payment option any time for about $20.

HECMs generally provide bigger loan advances at a lower total cost compared with proprietary loans. But if you own a higher-valued home, you may get a bigger loan advance from a proprietary reverse mortgage. So if your home has a higher appraised value and you have a small mortgage, you may qualify for more funds.

Loan Features

Reverse mortgage loan advances are not taxable, and generally don’t affect your Social Security or Medicare benefits. You retain the title to your home, and you don’t have to make monthly repayments. The loan must be repaid when the last surviving borrower dies, sells the home, or no longer lives in the home as a principal residence.

In the HECM program, a borrower can live in a nursing home or other medical facility for up to 12 consecutive months before the loan must be repaid.

If you’re considering a reverse mortgage, be aware that:

Lenders generally charge an origination fee, a mortgage insurance premium (for federally-insured HECMs), and other closing costs for a reverse mortgage. Lenders also may charge servicing fees during the term of the mortgage. The lender sometimes sets these fees and costs, although origination fees for HECM reverse mortgages currently are dictated by law.
The amount you owe on a reverse mortgage grows over time. Interest is charged on the outstanding balance and added to the amount you owe each month. That means your total debt increases as the loan funds are advanced to you and interest on the loan accrues.
Although some reverse mortgages have fixed rates, most have variable rates that are tied to a financial index: they are likely to change with market conditions.
Reverse mortgages can use up all or some of the equity in your home, and leave fewer assets for you and your heirs. Most reverse mortgages have a “nonrecourse” clause, which prevents you or your estate from owing more than the value of your home when the loan is repaid.
Because you retain title to your home, you are responsible for property taxes, insurance, utilities, fuel, maintenance, and other expenses. If you don’t pay property taxes, carry homeowner’s insurance, or maintain the condition of your home, your loan may become due and payable.
Interest on reverse mortgages is not deductible on income tax returns until the loan is paid off in part or whole.

Getting a Good Deal

If you’re considering a reverse mortgage, shop around. Compare your options and the terms various lenders offer. Learn as much as you can about reverse mortgages before you talk to a counselor or lender. That can help inform the questions you ask that could lead to a better deal.

If you want to make a home repair or improvement – or you need help paying your property taxes – find out if you qualify for any low-cost single-purpose loans in your area. Area Agencies on Aging (AAAs) generally know about these programs. To find the nearest agency, visit www.eldercare.gov or call 1-800-677-1116. Ask about “loan or grant programs for home repairs or improvements,” or “property tax deferral” or “property tax postponement” programs, and how to apply.
All HECM lenders must follow HUD rules. And while the mortgage insurance premium is the same from lender to lender, most loan costs, including the origination fee, interest rate, closing costs, and servicing fees vary among lenders.
If you live in a higher-valued home, you may be able to borrow more with a proprietary reverse mortgage, but the more you borrow, the higher your costs. The best way to see key differences between a HECM and a proprietary loan is to do a side-by-side comparison of costs and benefits. Many HECM counselors and lenders can give you this important information.
No matter what type of reverse mortgage you’re considering, understand all the conditions that could make the loan due and payable. Ask a counselor or lender to explain the Total Annual Loan Cost (TALC) rates: they show the projected annual average cost of a reverse mortgage, including all the itemized costs.

Be Wary of Sales Pitches

Some sellers may offer you goods or services, like home improvement services, and then suggest that a reverse mortgage would be an easy way to pay for them. If you decide you need what’s being offered, shop around before deciding on any particular seller. Keep in mind that the total cost of the product or service is the price the seller quotes plus the costs – and fees – tied to getting the reverse mortgage.

Some who offer reverse mortgages may pressure you to buy other financial products, like an annuity or long term care insurance. Resist that pressure. You don’t have to buy any products or services to get a reverse mortgage (except to maintain the adequate homeowners or hazard insurance that HUD and other lenders require). In fact, in some situations, it’s illegal to require you to buy other products to get a reverse mortgage.

The bottom line: If you don’t understand the cost or features of a reverse mortgage or any other product offered to you – or if there is pressure or urgency to complete the deal – walk away and take your business elsewhere. Consider seeking the advice of a family member, friend, or someone else you trust.

Your Right to Cancel

With most reverse mortgages, you have at least three business days after closing to cancel the deal for any reason, without penalty. To cancel, you must notify the lender in writing. Send your letter by certified mail, and ask for a return receipt. That will allow you to document what the lender received and when. Keep copies of your correspondence and any enclosures. After you cancel, the lender has 20 days to return any money you’ve paid up to then for the financing.

Reporting Possible Fraud

If you suspect that someone involved in the transaction may be violating the law, let the counselor, lender, or loan servicer know. Then, file a complaint with:

the Federal Trade Commission (FTC). You can do that online at ftc.gov or by phone at 1-877-FTC-HELP (1-877-382-4357).
your state Attorney General’s office or state banking regulatory agency.

Whether a reverse mortgage is right for you is a big question. Consider all your options. You may qualify for less costly alternatives. The following organizations have more information:

Reverse Mortgage Education Project
AARP Foundation
601 E Street, NW
Washington, DC 20049
www.aarp.org/revmort
1-800-209-8085

U. S. Department of Housing and Urban Development (HUD)
451 7th Street, SW
Washington, DC 20410
www.hud.gov/offices/hsg/sfh/hecm/rmtopten.cfm
1-800-CALL-FHA (1-800-225-5342)

Federal Trade Commission
Consumer Response Center
600 Pennsylvania Avenue, NW
Washington, DC 20580
www.ftc.gov/bcp/menus/consumer/credit.shtm — Click on “Mortgages & Your Home”
1-877-FTC-HELP (1-877-382-4357)

The FTC works to prevent fraudulent, deceptive and unfair business practices in the marketplace and to provide information to help consumers spot, stop and avoid them. To file a complaint or get free information on consumer issues, visit ftc.gov or call toll-free, 1-877-FTC-HELP (1-877-382-4357); TTY: 1-866-653-4261. Watch a video, How to File a Complaint, at ftc.gov/video to learn more. The FTC enters consumer complaints into the Consumer Sentinel Network, a secure online database and investigative tool used by hundreds of civil and criminal law enforcement agencies in the U.S. and abroad.

VeteransAid.org Aid & Attendance Pension

Thu, 10 Feb 2011 03:18:00 GMT

THE AID & ATTENDANCE PENSION

The Aid and Attendance (A&A) Pension provides benefits for veterans and surviving spouses who require the regular attendance of another person to assist in eating, bathing, dressing and undressing or taking care of the needs of nature. It also includes individuals who are blind or a patient in a nursing home because of mental or physical incapacity. Assisted care in an assisting living facility also qualifies.

To qualify for A&A it needs to be established by your physician that you require daily assistance by others to dress, undress, bathing, cooking, eating, taking on or off of prosthetics, leave home etc. You DO NOT have to require assistance with all of these. There simply needs to be adequate medical evidence that you cannot function completely on your own.

The A&A Pension can provide up to $1,632 per month to a veteran, $1,055 per month to a surviving spouse, or $1,949 per month to a couple*.

Eligibility must be proven by filing the proper Veterans Application for Pension or Compensation. (Form 21-534 surviving spouse) (Form 21-526 Veteran.) This application will require a copy of DD-214 (see below for more information) or separation papers, Medical Evaluation from a physician, current medical issues, net worth limitations, and net income, along with out-of-pocket Medical Expenses.

A DD-214 is issued to military members upon separation from active service. DD-214s were issued to separated service members beginning in the 1950's. The term "DD-214" is often used generically to mean "separation papers" or "discharge papers", no matter what form number was used to document active duty military service. If the VA has a copy of a DD-214, it is usually because the veteran attached a copy (or sometimes, the original) to his or her application for disability or education benefits. If you've lost your original DD-214 or a copy and you are receiving (or applied for in the past) disability or education benefits from the VA, they may have a copy (or the original, if you gave it to them) on file. At the very least, if you are currently receiving benefits (or did in the past), they should be able to provide a Statement of Service, which can be used instead of a "DD-214".

To request a copy of a DD-214 visit www.vetrec.archives.gov.

For more general information about the Aid & Attendance Pension, please see our FAQ Section.

Aging With Dignity: Five Wishes

Thu, 10 Feb 2011 03:17:00 GMT

Five Wishes lets your family and doctors know:

Who you want to make health care decisions for you when you can't make them.
The kind of medical treatment you want or don't want.
How comfortable you want to be.
How you want people to treat you.
What you want your loved ones to know.

Five Wishes is changing the way America talks about and plans for care at the end of life. More than 14 million copies of Five Wishes are in circulation across the nation, distributed by more than 23,000 organizations. Five Wishes meets the legal requirements in 42 states and is useful in all 50.

Five Wishes has become America’s most popular living will because it is written in everyday language and helps start and structure important conversations about care in times of serious illness.

Five Wishes was introduced in 1997 and originally distributed with support from a grant by The Robert Wood Johnson Foundation, the nation's largest philanthropy devoted exclusively to health and health care. With assistance from the United Health Foundation, Five Wishes is now available in 26 languages.

Alzheimer's Treatments

Thu, 10 Feb 2011 03:14:00 GMT

Currently, there is no cure for Alzheimer's. But drug and non-drug treatments may help with both cognitive and behavioral symptoms.

Researchers are looking for new treatments to alter the course of the disease and improve the quality of life for people with dementia.

In this section:

What is Alzheimer's

Thu, 10 Feb 2011 03:09:00 GMT

alz.org offers valuable information about Alzehimers.

Alzheimer's is a brain disease that causes problems with memory, thinking and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks.

The basics
Symptoms
Changes in the brain

Plaques & tangles
Research

The basics

Alzheimer's is the most common form of dementia, a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. Alzheimer's disease accounts for 50 to 70 percent of dementia cases.
Learn more: What We Know Today and Related Dementias.

	Alzheimer's is not the only cause of memory loss. Many people have trouble with memory — this does NOT mean they have Alzheimer's. In fact, most do not. There are many different causes of memory loss. If you or a loved one is experiencing symptoms, it is best to visit a doctor so the cause can be determined. Learn more: Visiting Your Doctor

Alzheimer's is not a normal part of aging, although the greatest known risk factor is increasing age, and the majority of people with Alzheimer's are 65 and older. But Alzheimer's is not just a disease of old age. Up to 5 percent of people with the disease have early-onset Alzheimer's (also known as younger-onset), which often appears when someone is in their 40s or 50s.
Learn more: Risk Factors
Alzheimer's worsens over time. Alzheimer's is a progressive disease, where symptoms gradually worsen over a number of years. In its early stages, memory loss is mild, but with late-stage Alzheimer's, individuals lose the ability to carry on a conversation and respond to their environment. Alzheimer's is the sixth leading cause of death in the United States. Those with Alzheimer's live an average of eight years after their symptoms become noticeable to others, but survival can range from three to 20 years, depending on age and other health conditions.
Learn more: 10 Warning Signs and Stages of Alzheimer's Disease.
Alzheimer's has no current cure, but treatments for symptoms are available and research continues. Although current Alzheimer treatments cannot stop Alzheimer's from progressing, they can temporarily slow the worsening of symptoms and improve quality of life for those with Alzheimer's and their caregivers. Today, there is a worldwide effort under way to find better ways to treat the disease, delay its onset, and prevent it from developing.
Learn more: Standard Treatments, Treatment Horizon, Prevention and Clinical Trials.

Help is available

If you or a loved one has been diagnosed with Alzheimer's, you are not alone. The Alzheimer's Association is the trusted resource for reliable information, education, referral and support to millions of people affected by the disease.

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Symptoms

The most common early symptom of Alzheimer's is difficulty remembering newly learned information.

Just like the rest of our bodies, our brains change as we age . Most of us eventually notice some slowed thinking and occasional problems with remembering certain things. However, serious memory loss, confusion and other major changes in the way our minds work may be a sign that brain cells are failing.

The most common early symptom of Alzheimer's is difficulty remembering newly learned information because Alzheimer changes typically begin in the part of the brain that affects learning. As Alzheimer's advances through the brain it leads to increasingly severe symptoms, including disorientation, mood and behavior changes; deepening confusion about events, time and place; unfounded suspicions about family, friends and professional caregivers; more serious memory loss and behavior changes; and difficulty speaking, swallowing and walking.

There are many conditions can disrupt memory and mental function. Anyone experiencing significant memory problems should see a doctor as soon as possible. If you need assistance finding a doctor with experience evaluating memory problems, your local Alzheimer's Association chapter can help. Early diagnosis and intervention methods are improving dramatically, and treatment options and sources of support can improve quality of life.

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Importance of Early Diagnosis

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Alzheimer's and the brain

Microscopic changes in the brain begin long before the first signs of memory loss.

The brain has 100 billion nerve cells (neurons). Each nerve cell connects with many others to form communication networks. Groups of nerve cells have special jobs. Some are involved in thinking, learning and remembering. Others help us see, hear and smell.

To do their work, brain cells operate like tiny factories. They receive supplies, generate energy, construct equipment and get rid of waste. Cells also process and store information and communicate with other cells. Keeping everything running requires coordination as well as large amounts of fuel and oxygen.

Scientists believe Alzheimer's disease prevents parts of a cell's factory from running well. They are not sure where the trouble starts. But just like a real factory, backups and breakdowns in one system cause problems in other areas. As damage spreads, cells lose their ability to do their jobs and, eventually die, causing irreversible changes in the brain.

Learn more: Brain Tour

The role of plaques and tangles

Plaques and tangles tend to spread through the cortex as Alzheimer's progresses.

Take the Brain Tour

Two abnormal structures called plaques and tangles are prime suspects in damaging and killing nerve cells.

Plaques are deposits of a protein fragment called beta-amyloid (BAY-tuh AM-uh-loyd) that build up in the spaces between nerve cells.

Tangles are twisted fibers of another protein called tau (rhymes with “wow”) that build up inside cells.

Though most people develop some plaques and tangles as they age, those with Alzheimer's tend to develop far more. They also tend to develop them in a predictable pattern, beginning in areas important for memory before spreading to other regions.

Scientists do not know exactly what role plaques and tangles play in Alzheimer's disease. Most experts believe they somehow play a critical role in blocking communication among nerve cells and disrupting processes that cells need to survive.

It's the destruction and death of nerve cells that causes memory failure, personality changes, problems carrying out daily activities and other symptoms of Alzheimer's disease.

Research and progress

Today, Alzheimer's is at the forefront of biomedical research.

Ninety percent of what we know about Alzheimer's has been discovered in the last 15 years. Some of the most remarkable progress has shed light on how Alzheimer's affects the brain. The hope is this better understanding will lead to new treatments. Many potential approaches are currently under investigation worldwide.

Learn more: Alz.org Research Center