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Plan for Memory Care Now, Before it is Needed – Greensboro, NC

Joseph Coupal - Friday, April 29, 2016

Long-term care insurance distributors and educators, recommend preemptive action against the impact of Alzheimer’s disease and other forms of dementia. “Cognitive decline is a big and growing reason Americans need long-term care,” says Denise Gott, CEO, “and the best time to plan for it is before symptoms arise.”

“Think of it this way,” she explains. “If you’re worried about your house burning down, you wouldn’t wait for smoke and flames before getting fire insurance or removing fire hazards.”

When it comes to Alzheimer’s, most Americans fail to appreciate its danger and avail themselves of sensible precautions. Here are three guidelines:

1. Recognize the size of the problem. The Alzheimer’s Association reports that one in three seniors dies with Alzheimer’s disease or another form of dementia. Five million Americans are living with Alzheimer’s, and the number is expected to triple as millions of Baby Boomers enter their retirement years.

Alzheimer’s is a progressive and fatal disease. Over time, more and more longer-living Americans may lose the ability to care for themselves. Millions will need long-term care.

And they may need it for an extended period. Many dementia victims require LTC for seven to ten years or more, while others typically need care for about three years.

2. Determine whether insurance is the right option. Medicare does not cover many services that are needed by people living with dementia.

Medicaid does provide substantial help, but only for those lacking the financial means to help themselves. If you fall into this category, public assistance may be your best bet.

Otherwise, providing care is up to you. If you’re very wealthy, you may choose to self-insure. If you’re not rich but doing OK, private insurance may be your best option. An LTC policy lets productive family members keep on with their jobs and lives. Nobody has to become default caregiver, a role usually filled by a wife, daughter, or other female relative.

3. If LTC insurance makes sense for you, consult with a dementia-aware advisor. LTC agents are state-certified, but there’s no legal requirement they know anything about dementia. So it’s up to you to pick one who does.

Ask questions such as, “How many years of care should my policy cover?” and “What mental or physical disabilities trigger benefits?”

For more information on Alzheimer’s and memory care, contact Spring Arbor.

Massachusetts News Wire

Keeping the Brain Healthy – Richmond, VA

Joseph Coupal - Monday, April 25, 2016

Losing cognitive functions are a normal part of aging.

An 80-year-old may not remember as sharply as a 20-year-old, but doctors have some advice on how to keep the brain sharp and boast mental capabilities.

From exercise and diet to stress reduction, here are some ways to keep your brain young and functioning well.


Studies have shown that physical activity and exercise are associated with less cognitive decline as you age.

A recent observational study published in the American Academy of Neurology asked a group of individuals to describe their physical activity. The people in this group took a brain MRI and did cognitive testing throughout the years.

“Essentially people who recorded doing moderate to heavy physical activity actually had better cognitive performance than people who recorded doing light or no activity,” said Dr. Clinton Wright, one of the doctors who conducted the study.

Observational studies don’t prove causation, but they do support the idea.

“We know that when we exercise, blood pressure and blood flow increase everywhere in the body including the brain and we know that more blood means more energy and oxygen.”

That makes our brain perform better and also helps make the rest of our body perform better.

Exercise helps increase the number of small blood vessels that bring blood to the brain and build the connection between the nerve cell and the brain, so those are important ways to keep your brain healthy.

It is also important to keep vascular risk factors checked and well treated. People who smoke, have hypertension, diabetes or high cholesterol have shown more mental decline.

Those things damage the brain, just like they damage the heart and the kidneys. That damage to the brain has cognitive consequences.

Keep your brain active

You have to think of your brain like it’s a muscle. Exercise it.

Mental activity is the single-biggest predictor of staying sharp as you get older.

For example, if you retired at 55 and watch television all day, your brain at 60 will be like an active person’s brain at 80.

Keeping your brain active helps older people handle new challenges. Many elderly people must deal with technological difficulties like online banking and bill paying, managing medications through a website and viewing public transportation information.

Doctors advise everyone to get enough sleep, avoid stress and eat a healthy diet. These factors strongly correlate with good brain function as one ages.

“If you can do all that stuff, that’s great.” “Do as much of it as possible, it’s better than not doing it at all.”

It is also important to treat depression through antidepressant medication, stress reduction and psychotherapy.

Depression is common in older people. It’s also very treatable.

The takeaway: What’s good for the heart is often good for the brain.

For more information, contact Spring Arbor.


How to Choose the Best Assisted Living Facility - Greensboro, NC

Joseph Coupal - Thursday, April 21, 2016

The most important thing you can do is plan ahead

If you have concerns about the ability of an aging parent or relative to live independently, you may want to investigate assisted living—and sooner rather than later. The best time to look is six months to a year before your parent will need to make the move. If you wait until your parent is being discharged from a hospital or rehab center, you'll have fewer choices. And, as an investigation we conducted a few years ago clearly showed, finding a good, safe, and affordable facility can be problematic due to states hodgepodge system of licensing, inspection, and staff training standards of varying strictness.

Assisted-living facilities are residential units that sometimes include a kitchen, housekeeping, meals, transportation to doctors and activities, and various levels of personal assistance.

More than 900,000 Americans now live in about 39,500 assisted-living facilities, according to estimates, but there is no federal oversight of the industry. Each state sets its own definition of assisted living and decides what licensing procedures and inspections are required. One result is that there are more than 26 designations used to refer to what is commonly known as assisted living, including "residential care," "board and care," "adult home," and "retirement residence."

The following game plan will help you find the best facility for an aging relative.

Is assisted living appropriate?

Your first step is to make an honest appraisal of whether your relative can continue to live at home. If he or she needs only a minimum of help and dislikes the idea of moving, home care might be a better choice. But for gregarious people who are beginning to experience a decline in function, assisted living might be a good option.

For help assessing your relative's physical, mental, and financial situation, consider consulting a geriatric-care manager, who should be knowledgeable about the assisted-living options in your area, including the facilities' financial strength. You can search for one on the National Association of Professional Geriatric Care Managers website, at  You can also get recommendations from family doctors or local senior centers.

Several websites provide information on nearby facilities.  SnapforSeniors senior housing locator seems to be comprehensive, and it has some good information on long-term-care and funding options, too. does not require you to enter personal information on the site, and it doesn't make referrals, which prevents lots of annoying phone calls later.

Once you have a list of facilities, make an appointment to visit them with your parent or relative. You can find a checklist of things to look for and questions to ask.

Your first tour will probably be led by the director of marketing. You will see the common areas and available apartments. Notice if the facility's décor suits your parent's taste, but don't let that be the deciding factor. Nice chandeliers and fancy furniture don't provide good care. Of course, the place should be clean and well lit. Look for safety features like grab bars on all the walls, including the hallways, and nonslip flooring materials, especially in the bathrooms. Try to have a meal while you're there to check out the food.

Watch for red flags

Observe the interaction between staff members and residents. Is it cheerful and respectful? Do staff members seem genuinely interested in the residents? If you see few residents in the common areas or participating in activities, it might signal that the facility is not full, which could bode ill for its financial stability.

Get a copy of the admissions contract and the residence rules. If you sense reluctance by administrators to part with such information at this early stage, consider it a red flag. The facility's contract outlines fees, services provided, and residents' rights, and explains who will handle medications, when reassessments of a resident's condition take place, and when a resident might be asked to leave because he or she needs more services than the facility provides.

The contract should also specify whether a resident is allowed to return to the same unit after a hospital stay. Nursing homes are required to hold a room for Medicaid patients, but many assisted-living facilities are not. Make sure that yours will.

Return unannounced several times to your top two or three choices. Visit at different times of day, especially around mealtimes and the early evening to see how they are managed at busy and quiet times.

Ask to speak with the residence administrator. Even if it means coming back for another appointment, this is important. He or she is the person who sets the mood and philosophy of the whole place.When you meet, ask to review the facility's licensing or certification inspection report. This should be readily available to the general public and will outline any complaints or black marks the residence has received during inspections. Ask how any problems were corrected.

Also ask about who will draw up the care plan for your relative and how much input he or she and the family will have. Find out how the facility will accommodate your relative's current and future needs. For example, someone with diet-controlled diabetes might eventually need insulin. How will the facility handle that? Find out how many employees are assigned to each resident. And look for a facility that has a licensed nurse on duty or on call at all times. Ask about the staff's training in such areas as safety, emergency care, first aid, mental health, residents' rights, and medication administration.

Add up the costs carefully

When you've narrowed the field to one, review the fees. Note the costs for any extra services your relative will need, policies regarding the return of a deposit or down payment, costs involved during hospitalizations, and the possibility of unexpected rate increases. Most costs for assisted living have to be paid out-of-pocket.

Make sure you take into account the possibility of added costs if your relative needs more assistance than the level covered in the base rate. For example, if more help is needed with what are known as instrumental activities of daily living, such as medication management.

Contact your state's long-term-care ombudsman, who acts as an independent resident advocate. He or she will have a record of complaints lodged against a facility and how they were handled. You can find your state's contact information through the National Long-Term Care Ombudsman Resource Center,, or by calling 202-332-2275.

Finally, have the contract reviewed by an attorney before you sign it. You can find one in your area who specializes in elder-care issues on the website of the National Academy of Elder Law Attorneys, at

For more information on assisted living, contact Spring Arbor.

Consumer Reports

A Grandchild for One Day Keeps Dementia Away - Richmond, VA

Joseph Coupal - Friday, April 15, 2016

Beyond adding joy to grandparent’s lives babysitting grandchildren has now been shown to increase cognitive functions and reduce the risk of dementia and Alzheimer’s according to a new study published by the journal of the North American Menopause Society (Source). The study which followed 120 grandparents found grandmothers who babysat one day per week scored higher on a range of cognitive tests. One caveat, filed under “everything in moderation” found that grandmother’s that babysat five or more days per week performed lower on cognitive tests.

There is a wide body of research that shows regular social interaction helps seniors stay mentally healthier. Many grandparents report increased levels of life satisfaction from minding grandchildren stemming from feeling needed and increased life purpose to more importantly giving and receiving love.

For more information on memory care, contact Spring Arbor.



Alzheimer's Caregivers Make Huge Sacrifices – Greensboro, NC

Joseph Coupal - Tuesday, April 12, 2016

Primary care physicians with patients who support loved ones with Alzheimer’s disease should be aware of both the financial and health-related tolls involved with taking on such responsibilities, as a new report has indicated that Alzheimer’s caregivers are 28% more likely to eat less or go hungry, and one-fifth sacrifice their own medical care.

The 2016 Alzheimer’s Disease Facts and Figures report states that nearly 50% of those who provide dementia-related care for friends or family members with Alzheimer’s disease cut back on their own expenses to take on the cost. That often means spending less on their own food, transportation and medical care, and can sometimes lead them to quit their job or reduce their own hours to make time to provide the necessary care.

“The devastating emotional and physical effects of caring for a person with Alzheimer’s disease have been well studied,” Beth Kallmyer, MSW, vice president of constituent services for the Alzheimer’s Association, said. However, this new report shows, for the first time, the enormous personal and financial sacrifices that millions of care contributors make every day. These sacrifices jeopardize the financial security of individuals and families, as well as their access to basic needs and health care.”

According to the report, 5.4 million Americans have Alzheimer’s disease, with nearly 16 million family members and friends of patients acting as caregivers, providing either financial, physical or emotional support. On average, these contributors spent more than $5,000 of their own money per year to care for loved ones with Alzheimer’s disease, the report said.

In addition, two out of three caregivers incorrectly believe, or are not sure, that Medicare will help them cover the cost of a nursing home. According to the report, only 3% of adults in the United States have long-term care insurance, which may help cover the costs. The report also states that one-third of caregivers reported having to reduce their hours at work or quit their job, leading to an average loss of income of approximately $15,000 compared to the previous year. Also, 11% reported reducing their spending on their children’s education in order to care for loved ones with Alzheimer’s disease.

Along with the report, the Alzheimer’s Association released a series of recommendations for caregivers, including:

  • using retirement planning as a time to think about how best to prepare for the need for long-term or dementia-related care;
  • conducting a personal financial resource inventory, reviewing savings, insurance, benefits and available assistance;
  • looking into local long-term care services; and,
  • contacting the local Agency on Aging to determine what community services and support programs are available.

“Our findings show that very few people are prepared for the cost of caring for someone with Alzheimer’s, which is the sixth-leading cause of death in the United States and is expected to nearly triple in prevalence by 2050,” Kallmyer said. “It is imperative for our health care system and the financial security of millions of Americans that we help people understand the full costs associated with Alzheimer’s disease, and more importantly, that we provide practical steps to mitigate these costs.”

The full 2016 Alzheimer’s Disease Facts and Figures report is available at

For more information on Alzheimer’s care, contact Spring Arbor.


Activities and Lifestyle Can Affect Risk of Dementia and Alzheimer’s – Richmond, VA

Joseph Coupal - Friday, April 01, 2016

The biggest risk factors for Alzheimer’s disease are aging and genetic predisposition. That is, all of our risks go up as we get older, and those with certain genetic variants are also at heightened risk. But aside from these factors that we can’t control, there are some things that we do in the way of activities and lifestyle, which seem to affect our risk, both for better and for worse. Research has found that different factors are linked to Alzheimer’s disease, depending on how they influence our neurology, metabolisms, immune systems and cardiovascular systems. The caveat is that while they may not affect whether plaques and tangles accumulate in our brains, they may at least affect the speed with which they do, the age at which they do and our ability to cope with them.

Here are the things studies suggest may actually affect our risk of Alzheimer’s down the road.


Food has long been thought to be linked to brain health. It’s not totally clear whether specific foods can reduce a person’s risk of Alzheimer’s, but overall diet may have an effect. For instance fish was linked to reduced risk for Alzheimer’s, but only for those with a strong genetic predisposition. On the other hand, some researchers say there’s no really convincing evidence that any one food alone can affect anyone’s risk across the board.

But again, one’s whole diet may have an effect, at least on how and when symptoms onset, over the years. In fact, the central aim of the MIND diet, ranked high by U.S. News and World Reports in ease of follow-ability and healthiness, is to reduce one’s risk of dementia. A study showed that people who followed the diet most closely over about 4.5 years cut their risk of dementia by over 50%. Those who followed it even moderately were at a 35% reduced risk.

According to the diet, the foods to eat in abundance are: Green leafy vegetables; any other types of vegetable; nuts; berries, and in particular blueberries; beans; whole grains; fish; poultry; olive oil; and a little wine. And those to avoid: Red meats, butter and stick margarine, cheese, pastries and other sweets, and fried or fast food.

Diet as a whole may reduce one’s symptoms of dementia or delay onset, but it’s unlikely that eating fish or blueberries alone, if you’re not doing other things as well, will do much at all.


The connection between exercise and brain health is quite strong, and the research keeps confirming it. Exercise increases blood flow and oxygen to the brain, which may underlie the connection. It also seems to help generate new neurons, particularly in the brain’s hippocampus, the area that governs learning and memory, and which is known to lose volume with age–and in Alzheimer’s disease. Some studies have found that in people with genetic risk for the disease, exercise may help preserve the volume of the hippocampus over time. Others have suggested that exercise may delay the onset or reduce the risk of the disease later in life. Though researchers are loath to say it will unequivocally reduce a person’s risk, it certainly seems like a good candidate in preventing Alzheimer’s disease in general.

Heart Health

And what may really explain the link between exercise and dementia is the undeniable connection between the heart and the brain–so that what’s good for the one is good for the other, and what hurts the one hurts the other. Smoking, for instance, is linked to heart attack and to dementia–so are being overweight, obese, sedentary, having high blood pressure and having diabetes. So doing right by your heart in all the ways we know about–food, lifestyle choices and exercise–will do well for your brain as well.

In other words, exercise–and, in some sense, most of these lifestyle factors–may boil down the cardiovascular connection. There’s even been some evidence that coffee is linked to reduced dementia risk, but it may just be its connection to cardiovascular health, which it’s been shown to have in recent years.

Education/mental activity

We often hear that crosswords and Sudoku can stave off dementia, but there’s been mixed evidence about how activities like these really affect risk. A recent study reported that Alzheimer’s in people who had at least a high school education has declined over the years, relative to those who had less education, suggesting that education may have some protective effect.

Another new study finds that people who were educated, stayed mentally active in middle age and who had higher genetic risk for Alzheimer’s had less amyloid plaque buildup in their brains

It’s best if mental stimulation is a lifelong endeavor, rather than a late-in-life one, since at that point it may be too little too late. The key thing to keep in mind with these sorts of activities is that they invariably originate from exposure and lifestyle choices early in life so that late life cognitive and social activities are invariably reflections of life-long activities. Presumably these activities can stimulate the development of new and enriched brain connectivity, which in turn might protect a person from becoming demented by increasing the amount of reserve that the brain possesses.

In other words, people with more education or richer intellectual lives may be able to better withstand the effects of Alzheimer’s, since they have more reserves to use when the disease hits.

Mental health

For reasons that aren’t totally understood, mental health issues like depression and chronic stress have been linked to Alzheimer’s disease in some studies. It’s not totally clear which came first, the chicken or the egg. It could be that depression and stress are actually very early symptoms of the disease–or it could be that either one alone actually raises the risk for dementia, because of the ways in which they change or inflame the brain. Or perhaps experiencing mental health issues just makes a person less resilient, just like mental activity makes a person more so. But taking care of your mental health, whether or not it’s linked to dementia, is always important.

So these are some of the ways in which lifestyle can affect risk. Some research has suggested that incorporating healthy lifestyle factors and reducing the bad ones could reduce the risk of dementia by up to two-thirds. Whether it would be that much is unclear, but doing the good things we know to do will very likely help. We may not know by how much they’ll help, but at this point, we do know that they do.

For more information, contact Spring Arbor.