Monthly Archives: July 2012

Shopping for Long-Term Care

 The average annual cost for a private nursing home room is $85,775 — and rising. Here are a few easy ways to save on long term care for your elders.

Most people don’t think twice about bargaining for a new car. But when it comes to long-term care for a relative, skimping on Mom or Grandpa strikes some as unseemly. It makes sense to wheel and deal. According to the latest John Hancock Cost of Care Survey, the average annual cost for a private room in a nursing home is $85,775 — and rising. As Kelly Greene wrote recently in the Wall Street Journal, “Long-term-care costs add up quickly — and typically, there isn’t a way to know how long you will need the services.” The best way to keep costs down, in other words, is to start out paying as little as possible. Here are a few of Greene’s tips for doing just that.

Know your options.
The types of elder-care services — and the prices — vary. Home health aides help with bathing, grooming, and other daily tasks. At assisted-living facilities, residents can live independently but have access to medical and other support services. Nursing homes offer round-the-clock, on-site care and provide more complex medical treatment than assisted-living facilities typically do. If you’re not sure what your best bet is, try the free evaluation tool at assistedlivinginfo.com.

Check average prices by area.
Both Genworth Financial and MetLife provide local costs for long-term care (go to genworth.com/costofcare or metlife.com and search for 2010 market survey). As Greene points out, if your relative lives in a different part of the country, you can compare costs to see if it makes sense to move him to a facility near you. For more on out-of-pocket costs you might incur, go to medicare.gov, where you can learn what Medicare covers.

Consider in-home services.
Ask yourself if a home health aide might be sufficient before deciding on a nursing home or an assisted-living facility. According to Genworth, the amount you’ll shell out for the first has remained roughly the same compared with last year’s cost, while the price tag for the latter two options has increased significantly.

See if they’ll throw in something free.
Most nursing homes don’t discount their rates, but you may be able to get an upgrade to a private room or additional amenities if you are paying out of pocket. An assisted-living facility might waive the move-in fee, for instance, or knock a few hundred dollars off the monthly maintenance, particularly if there isn’t a waiting list. And if you book a substantial number of hours per week with an in-home service provider, ask if you might get a few additional ones at a discount, advises Greene.

Shop around.
Mention a lower quote if you have one. Often you’ll get a better deal if you’ve done your homework and have a better offer.

Plan ahead.
While it may be too late to lower the cost of care for an elderly relative by investing in long-term-care insurance, you may want to think about doing so for yourself. In addition to traditional stand-alone insurance, there are other options. One such alternative, reports Kiplinger’s Personal Finance, is a policy that combines life insurance and long-term-care protection, like Lincoln Financial’s MoneyGuard Reserve policy. By investing over time, you build up a reserve that can be paid out in monthly chunks to cover assisted-living-facility or nursing-home costs. If you don’t use it, your heirs get a death benefit. Another choice is longevity insurance, an annuity that pays out only when you reach a certain age (usually 85) and lets you use the money for any purpose.

– Reader’s Digest

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All Calories Not Created Equal, Study Suggests

Low-Fat Eaters Burned Fewer Calories, Were More Likely to Regain Lost Weight
By
WebMD Health News

New research challenges the idea that a calorie is a calorie, suggesting that certain foods and diets may be better than others for burning calories and helping people maintain weight loss.

The study appears this week in the Journal of the American Medical Association.

Study participants who had lost weight agreed to follow low-fat, very-low-carb, and low-glycemic-index diets for a month each.

Even though they ate the same number of calories on each of the three plans, the study participants burned about 300 calories a day less on the low-fat eating plan than they did on the very-low-carbohydrate one, which was modeled after the Atkins diet.

Calories Not Equal, Researcher Says

The very-low-carb plan and the low-glycemic-index plan — which stresses a variety of high fiber and minimally processed foods — also resulted in better insulin sensitivity (necessary to process blood sugar effectively) and cholesterol levels.

This suggests that very-low-fat diets may actually slow a person’s metabolism down to a level where it is not burning calories as effectively as it could, says researcher David S. Ludwig, MD, PhD, who directs the Optimal Weight for Life program at the Harvard-affiliated Children’s Hospital in Boston.

Ludwig has long studied the low-glycemic-index diet and is one of the diet’s main proponents.

He says while people often lose weight on very-low-fat and very-low-carbohydrate diets, the vast majority end up gaining the weight back very quickly.

“From a metabolic perspective our study suggests that all calories are not alike,” Ludwig tells WebMD. “The quality of the calories going in is going to affect the number of calories going out.”

Different Diets, Different Outcomes

The study included 21 young adults who originally lost 10% to 15% of their body weight on a diet that included 45% carbohydrates, 30% fats, and 25% protein.

During the course of the study, the participants followed three different diets for a month each, including:

  • A low-fat diet, which included mostly whole grains, fruits, and vegetables, where 60% of daily calories came from carbohydrates, 20% from fats, and 20% from protein.
  • A low-glycemic-index diet, which included minimally processed grains, vegetables, legumes, and healthy fats, where 40% of calories came from carbohydrates, 40% from fat, and 20% from protein.
  • A very-low-carb diet, modeled after the Atkins plan, where 10% of calories came from carbohydrates, 60% from fats, and 30% from protein.

The study participants ate about 1,600 calories a day on each of the diets and the amount of calories burned was measured using state-of-the-art methods.

The testing confirms that they burned about 300 calories more a day when following the very-low-carb eating plan compared to the low-fat plan, and about 150 calories more on the low-glycemic index diet compared to the low-fat plan.

“The best diet from a metabolic perspective was the low-carbohydrate diet, but there were downsides,” Ludwig says.

Stress Hormone Levels Higher in Low-Carb Eaters

Levels of the stress hormone cortisol and C-reactive protein — an indicator of inflammation in the body — were higher during the low-carb phase of the study.

“The metabolic benefits of this diet may be undermined by more inflammation and higher cortisol, both of which can increase [heart disease and stroke] risk over time,” Ludwig says.

Nutritionist Elisabetta Politi, MPH, calls the study intriguing and deserving of further research. Politi is the nutrition director of the Duke Diet and Fitness Center in Durham, N.C.

“The idea that the type of calories people take in has a direct impact on the amount of energy they expend is certainly intriguing and worth exploring further,” she tells WebMD.

She says since the participants were only followed for the three months that they followed the highly controlled eating plans, it is not clear if one diet really is better than another for maintaining weight loss.

“It makes sense that people would be able to stick with a low-glycemic-index diet better because it is less restrictive, but that wasn’t really shown in this study,” she says.

– WebMD

The Artic Ground Squirrel and Alzheimer’s

The Arctic ground squirrel hibernates every year. During that time, their brains shrivel. They lose thousands, or even millions, of synapses, the connections between brain cells that allow
communication. But just two hours after waking up, their brains are bursting with new connections. In fact, they have extra connections, and have to shed a few over the next day or so get to normal.

How do their brains do it? And can we learn anything about reversing human brain degeneration by studying the qualities that make the Arctic ground squirrel’s so productive post-hibernation?

– Posit Science

Managing Diabetes with Exercise

By
WebMD the Magazine – Feature
Two years ago, when Jennifer Auyer’s father died at age 64 from complications related to type 2 diabetes, she faced a turning point in her own struggle with the disease.

Her father’s diabetes had led to heart disease, a quadruple bypass, a foot amputation, and vision problems, among other serious health troubles. “It was a really painful experience, for him and for all of us,” says Auyer, 40, of Nashua, N.H.

Four years ago, she, too, was diagnosed with type 2 diabetes, shortly after giving birth to her child, Grace. “If I were to pass away in 20 years, where would my daughter be?” she asks.

Deciding to “Do Differently” with Type 2

When Auyer was growing up, she never saw her father, a heavy man, exercise. She had become overweight, too. In addition to caring for Grace, she commutes to Boston to work as director of sales for a hotel company. But she eventually decided her busy life could no longer be an excuse to keep from getting into shape.

“I said, ‘I don’t want to go through what he went through.’ I was following the same path, and what am I going to do differently? I wanted to find something to help me. I was desperate.”

When she found out about a weight loss and exercise class at Joslin Diabetes Center in Boston, she signed up fast. In the course, Jacqueline Shahar, MEd, a clinical exercise physiologist at Joslin, taught her to do the best exercises for people with type 2 diabetes.

Strength and Interval Training for Diabetes

For example, Auyer is now a believer in resistance training and works out with elastic bands to improve muscle strength. This form of strength training helps patients use glucose more efficiently, Shahar says. “If we can get them to do some resistance training, they’re going to be able to increase their muscle mass so they’re actually burning more glucose.”

Other payoffs come, too. “They increase their metabolism and they lose weight,” Shahar says. Resistance training also helps people with diabetes improve their cardiovascular health, lower blood pressure, and reduce abdominal fat. It benefits posture and helps strengthen muscles to prevent injuries.

In another big step, Auyer began interval training, which involves repeatedly mixing bouts of high-intensity aerobic activity with less intense work — the segments are called “intervals.” For example, you can pedal fast on a bike for 30 seconds, then go at a slower speed for 90 seconds. Altering the speed and intensity of the workout challenges the muscles, helping burn more calories, boost fitness, and improve insulin sensitivity, according to Shahar. “That’s actually my favorite,” Auyer says of interval training. “It keeps everything fast-paced and fresh.”

At home, long stretches of treadmill walking bored her. But now, she’ll walk on the treadmill for 10 minutes, then run for another few minutes. “Then I’ll jump off and do the resistance bands for a few minutes, then squats or side steps, then maybe I’ll jump back on the treadmill for 10 minutes,” Auyer says. “The next thing you know, an hour has gone by, and I feel so invigorated.”

Exercise and Blood Glucose Levels

Shahar advises Auyer and other diabetes patients to exercise at least three or four times a week. Blood glucose levels can keep dropping up to 48 hours after exercising, she says. “I always use this analogy in people with diabetes: Their muscles are kind of sleeping, so they’re not burning glucose or calories. But if they exercise, they keep their muscles awake all the time. They keep burning calories, they lose weight, they make the glucose work more efficiently in their body.”

Auyer is delighted with her improved blood glucose levels. “Almost immediately, I noticed a change in my morning blood sugars, which are always really high,” she says. But after she started exercising, “they were dropping from an average of about 140 to 110. I was so excited one day — I had one under 100.”

She exercises in class once a week to make sure she’s doing it right, then repeats the routines at home. She aims to lose weight gradually — she has about 80 pounds to go — and hopes to eventually run a 5-kilometer race.

Grace is already following by example, playing with the resistance bands when her mom exercises in her playroom. “Kind of funny — she’s 4 years old and she wants to exercise, too. Honestly, growing up, I didn’t have that,” Auyer says. “One of my goals, besides making myself healthy, is to really instill that in my daughter so that she doesn’t have to go through what I’m going through.

“I’m setting her up for potentially having diabetes as well because of the history in my family,” Auyer says. “Hopefully, that won’t be her curse, but if we can cut it now — get her to see that this is what Mommy does, we exercise — then it’s not so foreign.”

Like every working mom, Auyer sometimes gets off her exercise routine for a few days. But she gets back on track by reminding herself why she started. “For me, that reason was my father. This is what he would want and this is important,” she says. “That’s the motivation to keep going.”

Starting an Exercise Program

Ready to get fit? Shahar offers these tips for getting started.

  • Talk with your doctor. People with heart problems might need a stress test, while those with hypertension should make sure their blood pressure is stable. If you have retinal problems, ask your eye doctor if you should avoid certain exercises that increase pressure on the retina, Shahar says. If you have orthopaedic problems, such as knee pain, back problems, or foot issues, an exercise physiologist can teach you appropriate exercises, including using a stationary recumbent bike.
  • Check your blood sugar before and after exercise. “No. 1: It’s a motivation tool. When you exercise and see your blood glucose improve, you’ll probably do more because it’s going in the right direction,” Shahar says. In time, your doctor might be able to reduce your insulin or oral diabetes medication. But you should also be checking to make sure your blood sugar isn’t too high or too low.
  • Keep snacks on hand for low blood sugar. Be prepared. Bring fast-acting snacks to the gym or along on your outdoor workout in case your blood sugar drops too low while you’re exercising.
  • Wear a diabetes ID. Wear a bracelet or necklace or carry something that identifies you as having diabetes. List an emergency contact, and indicate whether you take insulin.
  • Wear comfortable shoes. Good shoes will help you avoid foot problems, which can be more serious when you have diabetes.

Find more articles, browse back issues, and read the current issue of “WebMD the Magazine.”

Dementia Travel Safety

Having dementia does not mean that it’s necessary to stop participating in meaningful activities such as travel; it just requires planning to ensure safety, comfort and enjoyment for everyone.
Whether taking a short trip to see friends and family or traveling a far distance for vacation, it’s important to weigh the costs and benefits of travel for a person with dementia, based on needs, abilities and preferences. If travel is not appropriate, talk to family and friends about scheduling another time for them to visit the person.
General travel guidelines

  • Changes in environment can trigger wandering. Be sure to enroll in MedicAlert® + Alzheimer’s Association Safe Return®, a 24-hour nationwide emergency response service for individuals with dementia that wander or who have a medical emergency. The enrollment phone number is 1.888.572.8566. Those already enrolled should notify MedicAlert + Safe Return of travel plans.
  • Stick with the familiar. Travel to known destinations that involve as few changes in daily routine as possible. Try to visit places that were familiar before the onset of dementia.
  • Evaluate options for the best mode of travel. Based on needs, abilities, safety and preferences, decide what would provide the most comfort and the least anxiety.
  • Avoid planning a trip where emergency health services and pharmacies to refill prescriptions are not easily accessible.
  • Keep travel simple and manageable: Plan a short trip and avoid multiple stops.
  • Avoid elaborate sightseeing trips or complicated tours, which may cause anxiety and confusion.
  • If you will be staying in a hotel, inform the staff ahead of time of your specific needs so they can be prepared to assist you.
  • Have a backup plan in case your trip needs to change unexpectedly. This may mean purchasing traveler’s insurance if you have booked flights or hotels.
  • Create an itinerary that includes details about each destination. Give copies to family members or friends you will be visiting, or to emergency contacts at home. Keep a copy of your itinerary with you at all times.
  • Travel during the time of day that is best. For example, if the late afternoon increases agitation, avoid traveling at this time.
  • Have a bag of essentials with you at all times that includes medications, your travel itinerary, a comfortable change of clothes, water, snacks and activities.
  • Remember to pack necessary medications, up-to-date medical information, a list of emergency contacts and photocopies of important legal documents.
  • Allow plenty of time for rest. Don’t over-schedule.
  • Learn if there are services available at your destination by contacting the local Alzheimer’s Association for your destination area.
  • If traveling involves too many risks for the person with dementia, call the Alzheimer’s Association to help you find an alternative plan that allows the person to remain at home.

Visiting with family or friends
Be sure to prepare friends or family members for the visit by explaining dementia and the changes it may have caused. Go over any special needs, and explain that the visit may be short or that you may need to change activities on short notice. Some additional considerations:

  • Request in advance any necessary preparations, such as having certain foods in the refrigerator and bedroom space set up. If it would be helpful, ask your hosts to label important areas, like the bathroom and bedroom, with signs.
  • Stay as close to normal routine as possible. For example, bathing and eating times should be on a similar schedule to what they are at home. Eating in familiar settings, such as a dining room table, may be less confusing than eating at a crowded restaurant.
  • Be realistic about abilities and limitations. Allow for extra time when scheduling activities.

Special considerations for air travel
Airports are full of things that will require attention. At times, so much activity can be distracting, overwhelming or difficult to understand. Here are a few things to keep in mind if you’re traveling by plane:

  • Avoid scheduling flights that require tight connections. Ask about airport escort services that can help you get from place to place.
  • Inform the airline and airport medical service department ahead of time of your specific needs to ensure they can be prepared to assist you. When requesting assistance, most airlines ask for at least 48 hours advance notice.
  • Do not hesitate to remind airport employees and in-flight crew members of your needs.
  • Even if walking is not difficult, consider requesting a wheelchair so that an airport employee is assigned to help you get from place to place in the airport.
  • If you’re traveling with someone who has dementia
  • It’s important to remember several things to ensure a positive, calm traveling experience:
  • Avoid very loud restaurants and places with a lot of people if the person is overly tired.
  • Learn to recognize warning signs of anxiety and agitation.
  • Do not move too quickly or appear too hurried.
  • Do not overload the person with many directions or too much information.
  • If behavior becomes difficult, do not attempt physical restraint or to lead the person away. It may be better to step away or out of reach and monitor the person or call for help.
  • Don’t take it personally. Speak calmly and do not become drawn into an argument.

– Alzheimer’s Association