NorthStar Care and Guidance, LLC


Here to help you manage the "1000 points of light" of elder and psychiatric care. 

August 2009
In This Issue
STUCK! (not)
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Welcome to the first edition of NorthStar Care and Guidance's newsletter. In trying to decide what to name the newsletter, we thought to avoid the obvious choice of "The North Star". We considered a variety of options such as The Pole Star, Ursus Minor, etc... However, a little bit of research revealed a profound and illustrious history of the name North Star. The great American abolitionist Frederick Douglass named his newspaper North Star that he published from Rochester, NY. The reason he named it that was that fugitive slaves on the underground railroad used the North Star as a guide in the trek to freedom from slavery.  We desire to be a dependable source of direction to help in the struggle in caring for the elderly and mentally ill. The North Star, both the star and the publication are apt metaphors. Decision made.

We hope to spotlight issues of concern to our readers. With the recession, clearly money's a big issue. In this issue, we explore the difficulty in selling homes and its impact of trapping seniors in their homes due to their liquidity being locked up in the home. Other future financial will issues include paying for prescriptions during the "donut hole", paying for home care and on and on. I hope you will find this useful.And, of course, matters are not always financial. We'll see to those, as well. Feel free to offer your suggestions
as we're all ears.

So, that's it. Welcome to North Star!

-Mark (Zilberman, LCSW)

STUCK! (not)

  In the 11/21/08 edition of the New York Times Jack Healy wrote an article1s entitled "Unable to Sell Homes, Elderly Forgo Move To Assisted Living." In it he cites the impact of the severely depressed housing market as an obstacle to accessing the funds seniors need to change residence. Its true that for most, the home is the largest asset. Its well known that dipping into this piggy bank has been a primary catalyst in the current downturn. Unfortunately, you can't access this resource when you're out of it lest you sell. He goes on to cite the various reasons why our parents and grandparents want to shed their castles (too large, have become dangerous given their declining functioning, etc...). Moreover, there can be the loneliness factor as cohorts pass away. Better to relocate closer to family.

As a geriatric care manager, I'm often asked to assess whether the particular elder needs or doesn't need to relocate to assisted living, independent living, a continuing care retirement community, etc... This is usually quite easy to answer. The answer's "no". The only question I might ask that might lead me to a different answer is "Do you like your privacy or do you long to be surrounded by a lot of company, activities, etc... literally right outside your door?" Should it be the latter, perhaps a move is advised. But, then again many communities offer this locally (albeit, not likely right outside the door). The point I am trying to make is that, in most instances, the services and amenities of these alternative communities are available RIGHT AT HOME. Some for little or no money. One caveat, I've not cited nursing homes. Nursing homes are also known as skilled nursing facilities (SNF's). When there's a skilled nursing need, the situation is different. Not inconceivable for skilled needs to be met at home but usually financially prohibitive.

Firstly, home care. This will vary from state to state and then often from county to county within. Medicaid in many instances will pay for a certain amount. In NYS, its conceivable to get 24/7 home-care. Its not easy. It may require an elder law attorney in certain instances. And, even with that you might not be eligible. So, in that case it must be paid for. Happily, there are still opportunities for reverse mortgages. Government National Mortgage Association president, Joseph Murin, said "the reverse mortgage market is stable, secure and steadily growing." Arguments abound about the costs, interest rates, etc.. of RM's but... they're there. And, don't forget the underutilized VA program called "Aide and Attendance" that can pay thousands for care in the home.

Secondly, transportation. Most communities over a variety of public funded senior transport. Additionally, there are often significant discounts for accessing mass transportation available to all. As well, throughout the country are volunteer organizations recruiting seniors to drive seniors voluntarily throughout the community.

Thirdly, social life. Depending on the community, there are senior centers, adult day care, churches, synagogues, etc... The internet has provided an incredible opportunity to find tens of thousands of groups that meet for every conceivable interest. Go here and have a look:

Clearly, the urgency to relocate, in most cases is non-existent. There is usually a plethora of alternatives nearby. Of course, as they say, you can spend your time or you can spend your money. The elder Bush implored in a speech "not to destroy the 1000 points of light". He was talking about the thousands and thousands and thousands of private organizations serving the myriad social and human needs of the nation. And, so it is, the "1,000 points" are quite alive and well. But, finding them can be quite a job. That's why God invented geriatric care managers. This is the relatively new profession that is made up of social workers, nurses and gerontologists who are there to, amongst other things, sort out all these points of lights. They'll find them, apply for them, coordinate your loved one's interaction, etc... As well, they'll assess, oversee care, rebuild the home and on and on. Its easy to find one in your area. Go to Oh, and by the way, did I mention that the author is one as well (
NorthStar Care and Guidance, LLC