Recently retirees in Colorado Springs, CO received a mailing allegedly from the State of Colorado talking about their recent application for Unemployment Benefits.  Few of the recipients were even working at their age and none of them had applied for unemployment compensation.  The letter went on to explain that if they had not applied to go online and fill out a form to alert the department of a possible fraud.

The link took the person receiving the bogus letter to a website that showed a legitimate Colorado State form that is exactly like the real online form for reporting fraud.  Page two of the form, however, was designed by the scammers to be formatted the same and to ask for social security numbers and bank account information into which the unemployment compensation would have been deposited.

There is no assumption that this scam was limited to Colorado, but it is a prime example of taking advantage of the feeling of responsibility seniors often take for keeping things right and preventing fraud.

Isolation Creates Opportunity

Today, particularly with Covid restrictions, seniors are more and more isolated.  Social isolation is a leading factor contributing to elder financial abuse.

Much of the contact seniors have is by electronic means, whether by telephone, email or Internet.  It sets the stage for the unscrupulous to invade the space without much filtering that might be available with more live interaction with family members or friends.  This is exacerbated when a senior may have any degree of diminished cognitive capacity.  Newfound “friends” can more easily approach seniors with investment schemes and flattery that puts a lifetime of savings at risk.  This situation is potentially made worse when the senior is widowed or divorced.

Perhaps, surprisingly, unsolicited phone calls or emails are not the most dangerous – though they are still frequently used by scammers.  With seniors being more engaged in an online life, scammers have found more success with social media approaches or pop-up messages on websites.

Anyone who promises a high return with little risk is generally not telling the truth.  This is even more evident if it is important to “act fast”.  Acting fast reduces the opportunity for consultation with those who may be more skeptical of the “opportunity”.

One key way to prevent the vulnerable from being exploited is to increase contact.  Frequent phone calls or, better, video chats, go a long way toward preventing strangers with bad intentions from insinuating themselves into your loved one’s lives.

Financial abuse can happen any time during a person’s life.  Scammers, however, find their best opportunities when seniors are most vulnerable.  They often pick up clues to their opening by reading social media or online obituaries.  They even get involved in the lives of seniors by invading senior social and support groups.

Warning Signs

Counseling your senior to avoid being scammed is as simple as listening.  Be on the alert for situations where your senior talks about a new friend who suddenly appears in his or her life.  Listen closely for hints that the new “friend” tries to keep other family members from learning of the friendship or encourages a distancing from family.

More worrisome is a situation where you learn of new acquaintances who are “helping” the senior and, to do so, need financial information and passwords to accounts.

Be on the lookout for indications that your senior wants to suddenly make unexplained changes in estate planning documents or beneficiary designations.  Do not be dissuaded by sounding self-interested if these changes involve your prospective inheritance.

Preventative Measures

One of the best ways to prevent scammers from attacking an elder is to “train” the elder to make distinctions between legitimate senior advisors and new “friends” and scammers.

1. It is never too late to learn. A good project for those who have the time is to learn all they can about finances and investments.  There are many good websites that do this but stick with the known providers of information.  The more marginal sites are where scammers lurk.
2. Encourage conversations with family and friends or professional advisors about any prospective decisions.
3. Learn how to do a website search to investigate “opportunities” that are offered. For those who are not as comfortable with the Internet they should be encouraged to seek help from a family member or friend to thoroughly understand as much as they can about the offer and offeror.  They should be reminded to never invest money unless they fully understand the risks and legitimacy of the individual and company involved.
4. If you think your loved one has been defrauded, do not allow them to be too embarrassed to seek help and file an official complaint. Complaints can be filed with the SEC, the Financial Industry Regulatory Authority (FINRA) or your state securities regulators.

Education, communication and caution are the best ways to avoid senior financial abuse.  Be proactive.

Tracking a senior’s blood pressure between medical appointments is a simple way to get an early read on issues that should not wait until your loved one can see a doctor again.  Getting an accurate read is key to knowing if you have a problem or an insignificant blip.  Having commonly available home blood pressure equipment allows for easy and frequent tracking.

And, taking blood pressure at home is often more accurate.  Seemingly minor issues can impact BP measurement resulting in an artificially inflated blood pressure reading by anywhere from two to 40 mmHg in a clinical environment.  It is called “white coat syndrome”.

There are other, seemingly innocuous, things than can impact a BP reading.  For Example, if the person whose blood pressure is being measured talks during the measurement or if his or her feet aren’t flat on the floor, there is a chance that blood pressure measurement will give a falsely high reading.  Measurements should be taken when a patient is relaxed and sitting upright with both feet flat on the floor.

When measuring blood pressure use these guidelines to help ensure your loved one receives accurate readings:

• Allow the person being measured to sit and rest for 5 minutes before the test.
• Drinking coffee or smoking should be avoided for 30 minutes before the reading is taken.
• Avoid clothing being between the cuff and the arm.
• Have the person being measured use the restroom beforehand.

As you undertake the responsibility of checking your loved one’s blood pressure at home, it is important that you work with his or her physician to select a quality device and learn how to use it properly. BP monitors can be bought at durable medical equipment stores and pharmacies, but they typically are not covered by Medicare.

In some cases, your loved one may qualify for Ambulatory Blood Pressure Monitoring (ABPM).  As of July 2019 ABPM is a covered Medicare benefit.

ABPM is a non-invasive diagnostic test that uses a device to track blood pressure over 24-hour cycles, allowing a doctor to assess a patient’s blood pressure during routine daily living, instead of when they are sitting nervously on an examination table.  ABPM may measure blood pressure more accurately and lead to the diagnosis of high blood pressure in patients who would not otherwise have been identified as having the condition.

All too often, older patients get released from the hospital and are fully eligible for help at home but refuse it.  The reasons for this vary, but often it gets down to privacy or pride.  Seniors see their homes as sanctums.  They don’t want strangers invading their privacy. They think they’ve been getting along just fine and have unrealistic expectations of what recovering from a hospitalization will entail.

Occasionally, there are situations at home where the home is in disrepair or maybe a hoarding habit that the older adult does not want anyone to know about.  Sometimes the patient’s cognition is compromised, and he doesn’t understand his needs or limitations. Or cost might be a concern.

According to a report from the United Hospital Fund, as many as 28 percent of patients offered home health care after a hospital stay decline the offer of help.  There are a lot of misperceptions about what home health care is.

Many seniors and caregivers confuse home health care with “home care” delivered by aides who help people shower or get dressed or who cook, clean and serve as a companion. The two types of services are not the same: Home health care is delivered by medical professionals; home care is not. Nor is home care covered by Medicare, for the most part.

Typically, these services last four to six weeks after a hospitalization, with a nurse visiting several times a week. Some patients receive them for much longer.  Home health care services are available under Medicare to older adults who are homebound and need intermittent skilled care from a nurse, a physical therapist or a speech therapist, among other medical providers.

Refusing home health care after a hospitalization puts patients at risk of a difficult, incomplete or slower-than-anticipated recovery. Without these services, older adults’ odds of being readmitted to the hospital within 30- or 60-days double, according to The American Journal of Managed Care.

Given that 118,000,000 people in the US have a “smart speaker” the next part of this paragraph is probably be rendered unnecessary, but it is important to set up the conversation.  Amazon Echo is a voice-activated and controlled smart speaker that uses a virtual assistant called Alexa, to perform a variety of tasks. These tasks can be simple, such as playing music or making lists, or more advanced, such as controlling your smart home’s thermostat or turning off your lights.

The point of this article, however, is specifically about how the Alexa technology can be helpful to assisting Seniors in their daily lives.  We will get into specifics about how in a minute, but to start, lets talk about the “why”.  Certainly, people of any age can and do use Alexa, but older adults will find voice-activated management particularly useful.  Here are a few examples:

Hands-free Tasks.  Easily the best benefits of Amazon Echo for seniors is that it allows many actions to be initiated hands-free.  With over 50 million adults suffering from arthritis, making tasks from writing to dialing less painful.  A couple of examples include:

• Playing music. A simple voice command can ask Alexa to play a type of music or a specific title or a specific artist.
• Make phone calls. No need to even know where the cell phone is.  Alexa will dial by a simple voice command, “Alexa…Call Jane”, for example.  Or “Alexa…Call 888-123-4567.”

Tasks Requiring Vision.  Alexa can be a significant help with seniors with vision problems.  With Alexa they can listen to the news, hear weather forecasts – even hear their glucose readings without using a meter (with a CGM unit).

• Read the news. Let Alexa pick your news source or designate it specifically yourself.
• Hear the weather. From simple questions like the temperature to a seven-day forecast – locally or for any city in the world.
• Tell the time. “Alexa, what time is it.”
• Make lists. As things occur to you (grocery items, things to talk to the doctor about, to do list) Alexa will add them to lists that can be read from a cell phone at a later time and checked off as they are accomplished.

Basic Tasks.  Alexa can greatly assist seniors with mobility issues.  With Alexa they can run all sorts of systems with only their voice.

• Adjust the thermostat.
• Turn lights on or off, or to dim. Newer Alexa devices (Echo Flex) will turn on lights based on motion detection.  All Alexa devices can be set to turn lights on or off at specific times.
• Lock doors. With “smart locks” all it takes is a voice command.
• Medication reminders. Tell Alexa to remind you to take medicine at a specific time every day.  One instruction will repeat the reminder every day.
• Tell Alexa when to take the bread out of the oven.  The instruction can be by time of day or number of minutes ahead.

Emergency Tasks.  An older person’s home is dramatically safer when they can summon help from anywhere in their home by simply using a voice command.  They can call 911 or pre-programmed family phone numbers.  And, because Alexa uses common language, the senior does not need to remember any difficult protocols to use the system.

Caregiving can be an all-consuming, and occasionally a thankless task.  Those for whom you care are inherently net takers, though not usually intentionally selfish.  In the end, however, the caregiver gives more and gets less.  In many cases that makes the caregiver attempt to provide more than the capacity he or she may have physically or emotionally.

Capacity Match.  While it may seem obvious that one cannot give more than one has, many caregivers do not acknowledge personal limitations and attempt, not always successfully, to exceed that capacity.  Sometimes that insistence on going it alone with unrealistic goals ends in a poor experience for the caregiver and the cared-for alike.  Acknowledging capacity limitations and planning around them will create a calmer situation for all concerned.

Illusion of Control.  Caregivers sometimes start their journey believing they are in control of the situation.  Soon reality checks in.  Caregivers take pride in believing they can make things happen but soon learn that they control less than they first thought.  Understanding the limits of what the caregiver controls is an essential coping skill.

Expectations of Others.  Once capacity and control limitations are acknowledged, caregivers are free to recalibrate expectations about responsibilities and outcomes.  The problem can arise when non-contributing family members do not acknowledge the caregiver’s limitations and criticize the performance.  Understanding and defending against unrealistic expectations of family members is another essential coping skill necessary for the committed caregiver.

Establishing Boundaries.  When caregivers attempt to accomplish any or all of the above to retain control and sanity, there will be pushback and occasionally hostility.  This, however, is an acceptable price to pay for establishing personal boundaries rather than becoming a “prisoner of the impossible.”  Despite the anxiety, by firmly defending personal boundaries, the caregiver can establish an important coping mechanism.

Getting Help.  While these ideas may help a caregiver to keep composure and mental health in dealing with the pressures of giving care to a loved one, sometimes the most straight-forward answer is to simply ask for help.  Fortunately, professional home care is readily available.  Whether respite care for a few hours or days or regularly scheduled help, it can stretch the primary caregiver’s abilities much further than if he or she attempts to go it alone.  It is important to acknowledge the importance of a pressure valve.

Help notwithstanding, the coping strategies described above cannot be turned on and off.   They must be practiced and sustained.  The caregiver can expect blowback and little appreciation, but must remain resolute.  It is not easy, but it is important.

When you consider the challenges of growing older, a variety of unhappy situations can come to mind.  Loneliness as we have less exposure to family and friends is one.  Less activity may lead to feeling less self-worth.  A life of responsibility becoming one of “freedom” turns out not to be the panacea that it sounded like during the years that life felt hectic.  Aging sometimes isn’t all that fun.

Relief from these and other deficits of aging can be resolved fairly simply in the form of a dog. Cat lovers will forgive this, but dogs more frequently respond when they are spoken to.  Cats, on the other hand, sometimes fit better in your lap – if they are in the mood.  (Lizards and hamsters are not part of this analysis.)

Responsibility for a pet refocuses and replaces many of the deficits created by aging.  While not great conversationalists, dogs are great listeners.  Caring for them provides a sense of purpose and appreciation is expressed unabashedly. Simply having another living thing that relies on us can make us feel an increased sense of purpose and responsibility.

The simple act of walking with your dog will reduce stress and anxiety.  While it might be merely a distraction, this process has the effect of centering attention around life’s uncomplicated pleasures.  Animals keep us aware of immediate needs and wants, thereby reducing the opportunity to feel depressed.

The presence of an animal in an elder household has been scientifically proven to encourage positive thinking and elevate the speed of recovery when the patient is sick.  The almost universal adoption of a pet therapy program in hospitals is testimony to that thesis.  Social support in the form of four legs and an active tail is a proven antidote to anxiety and loneliness.

Certain breeds of dogs are more in tune with a senior lifestyle.  There are many adoption programs that can match a senior’s personality and environment with the perfect pet.

It has been said, “Dogs are not our whole life, but they make our lives whole.”

Pressure ulcers, more commonly called “bed sores”, represent a preventable and treatable issue for seniors, but caregivers must be vigilant to monitor for the potential of this malady.  Further, these wounds can happen in places other than beds.  They can appear and worsen very quickly so consistent and close inspections are important.  Repositioning of those receiving care and consistent skin maintenance are critical.

Continue reading “Pressure Ulcers (Bed Sores) Represent Real Risk for Seniors” →

Even as the vaccine is now available to an increasing number of seniors, logical protections are still in place that have kept seniors isolated over the past year.  The psychological distress that has been a by-product of isolation due to necessary social distancing must be addressed proactively.  This concern may have taken a backseat to the other, more obvious, threats that have been part of this crisis.

Continue reading “UNINTENDED CONSEQUENCES: Depression During Covid” →

In a previous column we talked about the challenges of being a long-distance caregiver. The subject matter dealt with knowing as much as possible when the caregiver is not local.

One key component that should be added to the list of things a long-distance caregiver needs to have is a “Need to Know Kit”. This is a book that contains critical information about the cared-for individual which may be helpful in the case of an emergency. Caregivers can rely on a single source of information that the cared-for may not be able to produce or remember at a critical juncture.

Continue reading “Your ‘Need-to-Know’ Book” →

Caregiving in-person can be physically exhausting.  Caregiving long distance can be mentally tortuous.

When you are responsible for a loved one (or feel you should be) and you cannot see first-hand what the situation is, it can be very stressful. You may call and your Dad does not answer.  You know he “should be there”, but he is not answering the phone. He could have fallen and injured himself – or he could be enjoying a cookout with the neighbors. Or he just forgot to plug in his cellphone. You can only allow yourself so many police wellness-checks before your welcome is worn out at the local constabulary.

Continue reading “Long Distance Caregiving” →