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Continued Care for Seniors – an often difficult and complex decision.

Lately I’ve had multiple discussions with patients about how to determine what kind of care they need to plan for as they age.  For some, considering moving to a continued care residential care facility (CCRC) is a good option.  Still others would like to remain in their homes as they age, hopefully being able to do so for the rest of their lives.  The two most common questions I hear are:  “How do I decide which option is best for me (and for my spous  e/partner)?”  and “When is the right time to either move into a CCRC or have in-home healthcare begin?”  The first question is perhaps the most difficult to answer, there are many factors that play into the decision process such as: finances (do the individuals have a long-term care policy, enough personal wealth to pay for care out of pocket, or is Medicare the only option?)  How connected and involved are one or both people to their communit  y/neighborhood?  How close are family and are they willin  g/able to help out, and for how long?  What resources are there in the community that are available to help should the person choose to remain in their home?  There are many more things to consider, these are the main concerns that I like to discuss with patients when we talk about making these decisions. 

Gathering as much information about the costs and availability of both CCRC’s and in-home health care are one of the first steps toward making a decision.  Then, I suggest that each person make a pro and con checklist, list as many of the reasons for and against each option.  Visiting the CCRC facilities that are available both in their community or nearby and near family if moving closer is an option is another good idea.  What might look good on a website may not be the best fit when seen in person. 

When considering in-home health care, some things to consider are: cost, who pays for the care – the seniors themselves, family?  Who will provide the care – a private individual or an agency?  If using a private individual or an agency, what is their reputation?  Will the family provide some, or all of the care?  If so, what happens i  f/when the senior needs more skilled care than the family can provide? 

Planning ahead when possible will make any transition much easier.  Some may not have the option of such preparation and planning; a sudden fall or illness could make the choices more limited and the decision a more obvious one.  But for seniors that are in good health, at least talking about the available choices with each other and their families might make a decision easier and the right choice for them more obvious. 

On another note, June 15 was World Elder Abuse Awareness Day, so I thought I should include the following information that I found on the Right At Home website about how to spot the warning signs of Elder abuse and the different types of Elder abuse.  Click here for the rest of the article: 


World Elder Abuse Awareness Day is June 15 

The National Council on Aging (NCOA) estimates that 1 in 10 people over the age of 60 have experienced elder abuse. More than half of reported cases of elder abuse are carried out by a family member, typically an adult child or spouse. 

Much about elder abuse is secretive, however, and accurate research can be hard to come by. The NCOA found that one study estimated that only 1 in 14 cases of elder abuse are actually reported to authorities. It’s so important to shed light on the realities of elder abuse in order to encourage more seniors to speak up about abuse, and with World Elder Abuse Awareness Day coming up on June 15, it’s a good time to start the conversation. 

How to Spot the Warning Signs of Elder Abuse 

In order to be able to report elder abuse, you need to know the warning signs, which can vary depending on the type of abuse being perpetrated. The NCOA has broken it into five categories of abuse: 

Physical Abuse:  When an older adult is being physically abused, there will be physical signs present on their body, such as bruising, pressure marks, broken bones, abrasions and even burn marks. 

Emotional Abuse:  Signs of emotional abuse are harder to spot, but not impossible; if your loved one is withdrawing from regular activities without explanation, experiencing depression or a strain in their personal relationships, or having frequent arguments with caregivers, it might be a sign that they are being emotionally abused. 

Financial Abuse:  Financial abuse is all too common, unfortunately, costing older Americans an estimated $36.5 billion per year. The abuse can be personal, with family members or spouses stealing from bank accounts, but it can also include different types of fraud, including Social Security and Medicare scams. 

Neglect:  If an older person is being neglected, they are not being provided the quality of care they need in order to feel healthy and thrive. This can include not providing physical or medical care, which can result in bedsores; not providing meals, leading to malnourishment; or not providing general daily care services, which can result in poor hygiene. 

Verbal Abuse:  Verbal abuse is a form of psychological abuse that makes a person feel diminished or unworthy. Belittling comments and threats can be used by the abuser to establish power and control over the abused, who may not even realize the extent of the damage being done to them. 

The NCOA cites research that shows that elderly people who have experienced abuse have a 300 percent higher risk of death than their peers who are not mistreated. So while it might seem like meddling to report a situation in which you suspect an elderly person is being abused, it can literally be the difference between life and death. 

To your long and vibrant health, 

Dr. Susan Azar, ND 


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