Having a pet in the house has a number of benefits to our overall physical and emotional health. But I’ve heard many friends and clients question whether it would be better to remove a pet from their aging parents’ homes to prevent injuries or to eliminate the added responsibility of caring for an animal.

Carolyn Rosenblatt of AgingParents.com wrote recently for Forbes about the problems pets can present in the home of an elderly person.  If your parent has a large dog or a cat that is old and can’t see or hear a human coming to get out of the way, there is the risk that your parent could trip and fall sustaining serious injuries. And if your parent suffers from dementia, there is concern for the pet that it won’t get fed or taken outside for walks.

But whatever the risks, it is likely they can and should be mitigated to preserve the parent-pet bond.

According to research in the Journal of the American Geriatrics Society, caring for a pet serves as a buffer against isolation and loneliness. And further studies suggest that petting a dog for a few minutes a day can relieve stress, lower a person’s blood pressure, and alleviate depression. Pets also aid elders in their socialization with others, serving as a conversation starter.

If the pet is unruly, offer to pay for training, Rosenblatt suggests, or shop together for a collar or harness that provides more control. If your parent is frail, find someone to walk to dog to prevent falls or suggest that your parent’s home care worker go along on walks to monitor your parent’s safety.

Whatever the risks, it is probably more beneficial to your parent’s health to protect that owner-pet bond. Safety is a family issue, but don’t forget that Fido or Fluffy is family, too.

James D. Perry

Open the newspaper and on any given day you can find a cautionary tale of an elderly person losing thousands of dollars to his or her caretaker, a scam artist, or some final friend.

The sad fact is that the elderly make easy targets of financial abuse, and you may be their first line of defense against scammers. If you have a parent over the age of 70, you should have a conversation with him or her about what would happen if they could no longer manage money.

Approach your parent respectfully, asking permission to talk about the subject. Your parent is likely to feel vulnerable – relinquishing money means relinquishing control.

You’ll want your parent to sign a durable power of attorney. And, if your parent is already showing signs of mental impairment, you need to act fast. A durable power of attorney must be signed and notarized while your parent is still competent.

If possible, you should include the whole family in the conversation and decision-making. Put all agreements in writing so that there is no argument or second-guessing.

If you already are in charge of your parent’s bank accounts, try not to micromanage. If possible, keep just enough for monthly expenses in a joint checking account and protect the rest in another account. Pay the bills together or help your parent set up automatic bill-pay to prevent forgotten bills.

The change in power can be a tough, emotional transition, but you don’t want to put off protecting your loved ones.

James D. Perry

It is estimated that by the year 2020, 12 million elderly Americans will be in need of long-term care.  Many of them will have to rely on their adult children as caregivers.

This imposes a heavy emotional and financial burden, even on happy and willing caregivers, and financial assistance for long-term care is sparse.

Medicare generally does not pay for long-term care, which assists people with daily living activities such as cleaning, meal preparation, dressing, bathing, using the bathroom.  Medicaid may pay for some long-term care services, but its eligibility is limited to people with low incomes and limited assets.  Private long-term care insurance can be pricey, especially if you wait until you are over the age of 50 to begin paying premiums.

The new Community Living Assistance Services and Supports (CLASS) Act is an attempt to close the gap between people too rich for government assistance, but not rich enough to afford they care they need.  It goes into effect January 1, 2011 and enrollment is expected to begin in 2013.

The government program acts like long-term care insurance – you pay premiums for five years (working at least three of those years) and it will provide cash to pay for care when you need it for as long as you need care.  No tax dollars are to be used to support the program.

The CLASS Act is not meant to cover the full cost of 24-hour in-home care or a nursing home, but to supplement your personal contribution.  The Congressional Budget Office has assumed a cash benefit of $75 a day, but the Department of Health and Human Services has until October 2012 to hammer out the rules.  But, to put this in perspective, the national average cost last year of an assisted living facility was $37, 572; $75 a day would pay almost three-quarters of that expense.

The best thing to do is to plan now as if long-term care, for yourself or for your aging parents, is a financial inevitability.

James D. Perry

A living will – called an advance directive for health care here in California – is an important part of your estate-planning arsenal. In the event of an accident or life-threatening incapacitation, an advance directive dictates your medical care and treatment preferences. This is especially helpful to family members and care providers because where there is uncertainty and disagreement, the court may have to step in.

An advance directive for heath care can fail its essential purpose, though, if it is ambiguous about treatment options and does not provide enough detailed guidance.

A recent MSNBC article highlighted this problem in the story of Bunny Olenick, an 87-year-old from Boston who became incapacitated by a severe stroke. She had a living will and a medical power of attorney, but her sons were left with questions about assisted breathing devices and feeding tubes and the quality of life she would sustain because of them.

She had stated that she didn’t want to be intubated or hooked up to a respirator, but did that preclude temporary nasogastric tubes for nutrition or a short-term oxygen mask?

Bunny’s sons were able to take advantage of palliative care counseling, which helped them navigate her legal documents and the preferences she had shared with them prior to her stroke.

However, had the sons gotten into a disagreement about Bunny’s wishes, they might have ended up petitioning a judge to appoint a medical proxy. The legal process is costly and ultimately may prolong an incapacitated individual’s life or suffering where he or she would not want it.

No one really likes to ponder their own death, but appropriate advanced planning can save you and your family pain and confusion in a time better spent saying goodbye.

James D. Perry

An Alameda Superior Court judge decided this month not every felony conviction will disqualify you from helping the elderly or disabled.

Gov. Arnold Schwarzenegger originally wanted to ban everyone with a felony record from working in the In-Home Supportive Services program (IHSS). As the law stands, workers are barred from the program for 10 years if they have been convicted of child abuse, elder abuse, or defrauding MediCal or any patient.

Outside those restrictions, though, Judge David Hunter says in-home patients can employ anyone they want.

IHSS helps pay for in-home care to 430,000 low-income elderly and disabled Californians. It allows patients to remain in their homes under the care of individuals of their choosing, as approved by the state, to render help with daily tasks, such as bathing, house cleaning, meal preparation, laundry, grocery shopping, personal care services, accompaniment to medical appointments, and protective supervision for the mentally impaired.

The state argues that its interest is protecting Californians and preventing fraud.

One of the plaintiffs to the suit is a Sacramento woman who provides in-home care for her 90-year-old-mother. She was initially disqualified under the governor’s plan because of a 1976 conviction for felony grand theft.

The program costs about $5.5 billion annually, half of which is paid for by the federal government, 35% by the state, and 15% by individual counties.

“We are following the court order, but we do not believe convicted felons should be eligible to care for elderly and disabled Californians in their homes,” said Lizelda Lopez, spokeswoman for the Department of Social Services.

The state could appeal the ruling, and Ms. Lopez says the Department is already reviewing it.

This is tricky ground. The state has a legitimate interest in protecting its citizens and taxpayer dollars, but how long should it punish people for their crimes at the expense of the elderly and disabled?

James D. Perry

I recently came across a truly heart-warming story about a neighborhood initiative in the Washington, D.C. area.

Harry Rosenberg and his wife, Barbara Filner, along with nine of their neighbors started an aging-in-place “village” in their Bethesda, Maryland community to help their elderly neighbors with basic services such as transportation and home maintenance, helping them to stay in their homes longer as they aged.

Their first request for assistance came in November 2008: they helped an 81-year-old widow take out her trash and drover her to the doctor. The organization has a budget of $4,000 collected solely through donations. It charges no dues and has about 65 “friends” who volunteer, receive help, or are otherwise are associated.

And while it doesn’t receive many requests for assistance Harry and Barbara say it is still a viable presence in the community hosting neighborhood walks and restaurant outings. There are now six similar “villages” in the city itself, two in the Virginia suburbs, and eight others in the planning stages in the Maryland suburbs.

The first such aging-in-place community on record was called an “intentional community” in Boston’s Beacon Hill neighborhood to which members paid dues to provide collective services. The idea spread and “intentional communities” popped up in California, Illinois, Colorado, Florida, Hawaii, New York, and other states, and the first international intentional community was in Australia.

Retirement communities are expensive and aren’t always the best option. Not every older adult needs the care of trained staff but could use, perhaps, the helpful hand of neighbor every now and then. If you are interested in learning more about aging-in-place initiatives or starting one in your community you can learn more at http://www.aginginplaceinitiative.org/.

James D. Perry