An Article and a Presentation: Long-term Care and a Stroke Video Project

I know, I know. Insurance companies have a dismal reputation because most of them deserve it. They talk insurance speak--of deductibles, annuities, disability income, expense ratio, hospital indemnity coverage--as if everyone is supposed to understand. And the acronyms the insurance companies use will drive you "mad."

So listen up, family and friends: If you already had a stroke, it's too late to buy Long-term Care insurance, but if you're healthy, you can't make a better investment. That's why I'm guest hosting, albeit and thankfully dummied down, an article by Hazel Bridges that I think is worthy of attention. The author's views are her own. Here it is, from AgingWellness.org:

Every American who reaches age 65 qualifies for Medicare. You can rest assured knowing that your or your loved one’s medical needs will be covered by this government-subsidized health care program. What you might not realize is that Medicare doesn’t cover every need for seniors.

There are two types of Medicare: Original Medicare and Medicare Advantage Plan (Part C). Under original coverage, there’s Part A for hospital care, skilled nursing facilities,
hospice, lab tests, surgery and home health care; and there’s Part B for medically necessary services and preventative services. Part C falls under private insurance with Medicare approval, and the out-of-pocket costs are lower than original Medicare.

What might interest you is what Medicare doesn’t cover: eye exams, dental care, cosmetic surgery, foot care, hearing aids, acupuncture, or long-term care. 

Long-term care (LTC) is especially important to understand because many seniors need this later in life for several years at a time and not everyone plans for it. Long-term care usually refers to custodial care, which is help with daily living. This includes activities such as getting dressed, eating, getting around the house and medication assistance. Since most of these needs are not medical, Medicare generally doesn’t pay for it.

Long-term care can take shape as home care by a skilled nurse or home caregiver without medical training, but it can also involve long-term stays at facilities. Some seniors prefer (and are able to) remain at home with help, but other seniors either don’t have long-term living arrangements or are unable to live outside of a facility that can provide 24/7 care. This is where assisted living facilities and nursing homes come in.

Medicare only covers long-term care under certain circumstances. Skilled nursing care has to be short-term (100 days or less), preceded by a hospital stay, and as recovery from an illness or injury that’s not from a chronic condition. There’s also a helpful program called Medigap, which is an insurance supplement from private insurance companies to cover the gap that Medicare doesn’t cover.

Unless you’ve thought about your retirement years in advance and have all your ducks in a row, you might find yourself struggling to cover the costs of long-term care. Perhaps you’re a junior who is taking care of an aging family member who needs long-term care, and you don’t know what your options are. Or, maybe you’re simply looking into a plan for your own future LTC needs.

Whatever your intention and needs are, you can plan ahead for LTC. If you’ve already reached that point, you can find ways to subsidize the cost with your current income and assets. The most direct choice is long-term care insurance, which does exactly what it says: pays for long-term care. These policies are typically taken out after age 50, years before the service is needed. A healthy 60-year-old can also take out a policy, but your premium rises as you get older or have a condition that could require LTC later down the road.

If cash is needed to help pay for long-term care, one popular option is a reverse mortgage. In a reverse mortgage loan, homeowners can convert the equity in their homes into cash. The lender makes tax-free payments to the borrower since it’s a loan advance rather than a form of income. Just be careful to weigh the pros and cons of this decision.

You may have a long future ahead of you, or you might find yourself trying to make ends meet for yourself or a loved one. Whatever your situation, make sure you understand what your insurance policies cover, how Medicare can help you and how your assets can be converted to cash. You have one life, and you should take care of it as best you can.

Congrats, Hazel, for this informative article. 

And I received this stunning email from Maggie Whittum:

Hello Joyce, my name is Maggie and I'm a stroke survivor and filmmaker. I had a massive stroke at age 33, leaving me disabled. I'm hoping to do something good with my shattered life.

I wanted to tell you about this documentary film project of mine.
Please check out this two-minute teaser.

I'm trying to convey to people what my life is like with 

pain/disability/a shattered sense of identity.

https://vimeo.com/244729372

It's a documentary film on stroke, disability, loss, 

resilience, and the healing power of art. It’s for  

stroke survivors, and people who struggle with 

chronic illness or chronic pain.  

If you would like to share it with others, please do.

Thanks for all that you do!

Maggie

Wow! A filmmaker and a stroke survivor, attempting to
make a difference from her shattered life. Kudos, Maggie,
for an ongoing project very well done! Best wishes!

You can leave comments below for Hazel and Maggie.
I'll pass them on.

The Reason I Had a Stroke: Protein S Deficiency, aka Lousy Genes Will Get You Eventually

My mother, bless her deceased soul, used to have her favorite vegetable at dinner for us most of the time: overcooked string beans, and I, following in the tradition of my mother, use to serve the same thing when I married, dried out and sorry-looking green beans that looked as if they had died last week.

Anyway, overcooked string beans provide little, or none, of the beneficial nutrients. And I ate them, too ignorant of nutrients as a child to care. As an adult, I tended not to have vegetables, except those overcooked green beans, always on my shopping list. So I developed Protein S deficiency, unknowingly to put me right in line--eventually--for a stroke. I was not aware of that deficiency for 55 years.

Medscape's Mohammad Muhsin Chisti, MD, says, "Protein S is a vitamin K–dependent anticoagulant protein that was first discovered in Seattle, Washington in 1979 and arbitrarily named after that city. The major function of protein S is as a cofactor to facilitate the action of activated protein C.

"Protein S deficiency may be hereditary or acquired; the latter is usually due to hepatic disease or a vitamin K deficiency. Protein S deficiency usually manifests clinically as venous thromboembolism (VTE)." Stroke, in other words.

The National Institutes for Health (NIH) Joshi and Jaiswal said, "Protein S functions as a cofactor of activated protein C. Its deficiency is a rare condition and can lead to deep vein thrombosis, pulmonary embolism or stroke. Protein S deficiency manifests as an autosomal dominant trait." [Explanation needed: To have an autosomal recessive disorder, you inherit two mutated genes, one from each parent. These disorders are usually passed on by two carriers.]

There's a test for Protein S and C deficiencies, but would you really want to know? A family member who shall remain nameless heard of my research into Protein S and C deficiencies, but he allowed the doctor to talk him out of it like ostrich-head-in-the-sand approach. 

On the other hand, if you really know of those S and C deficiencies, wouldn't you change your lifestyle a teeny bit, like eat more vegetables, raw even, and foods high in Vitamin K? 

Foods rich in Vitamin K are bearable, some even delicious:

• kale
• collard greens
• spinach
• turnip greens
• Brussels sprouts
• broccoli
• asparagus
• lettuce
• sauerkraut
• soybeans
• edamame
• pickles
• pumpkin
• pine nuts
• blueberries

Here's another view:

Check with your doctor and see if approval for Protein S and C deficiencies testing is do-able. Insist, even. Strokes suck in ways your wildest dreams can't imagine.

Why Do Stroke Survivors Lose Friends?

Through my involvement with stroke survivors at all levels, I heard from a lady who had to move 2000 miles away to get out of an already horrid relationship. Reason being, she was under so much stress that once she had the stroke, the situation was unbearable. The distance was worth it for two reasons, I imagine: the distance put, well, distance between her and him AND she is happily situated now, 10 minutes away, near her daughter. I'm a sucker for stories with happy endings.

My online stroke support group works on giving me distance, too--to stay away from people who can't tolerate that I'm different than when they knew me before! First, some research on why the intolerance.

Studies say it is predicted that by 2030, there will be 12 million stroke deaths and 70 million stroke survivors. It stands to reason that many stroke survivors feel unsupported. So the questions remains, can the complex needs of survivors and families and friends cope with the aftermath of stroke? Or any type of brain injury, for that matter.

It is estimated that up to one-third of survivors will have communication difficulties including aphasia, dysarthria, or apraxia of speech (language comprehension, producing speech, and/or difficulties with reading and writing). Research says stroke survivors with communication problems aforementioned may have difficulties living in a community with those that don't have such problems, resulting in a poorer quality of life and not joining activities of daily living. Furthermore, evidence of the survivors are also more likely to suffer depression and have reduced social interactions. 

The National Institutes of Health published an article about why people lose friends after a stroke and why this phenomenon occurs across the board . 

Under the helm of the English study, Northcott and Hilari explored why people lose contact with their friends, and how friendship loss and change is perceived by the survivors.

Between 8 and 15 months post stroke, 29 participants were recruited, 10 having aphasia. The researchers deduced the main reasons given for losing friends were: 

1. loss of shared activities 
2. reduced energy levels
3. physical disability
4. aphasia
5. unhelpful responses of others
6. environmental barriers
7. changing social desires 

"Those with aphasia experienced the most hurtful negative responses from others and found it more difficult to retain their friends unless they had strong supportive friendship patterns prior to the stroke," says the study. 

"The factors which helped to protect friendships included: having a shared history, friends who showed concern, who lived locally, where the friendship was not activity-based, and where the participant had a 'friends-based' social network prior to the stroke."

Another study by Martinsen et al in a nursing journal examined psychosocial consequences following a stroke and the survivors’ ability to participate in and carry out the ordinary and expected roles and activities of family life. 

Twenty-two stroke survivors aged 20–61 years were interviewed extensively six months to nine years after stroke onset. The struggles are summarized in two main categories: struggling to reenter the family and screaming for acceptance.

"Being provided with opportunities to narrate their experiences to interested and qualified persons outside the home context might be helpful to prevent psychosocial problems," the study says.

Normality includes feeling sad over the problems caused by stroke. However, a portion of the survivors experience a major depressive disorder which should be diagnosed and treated as soon as possible. The people we should focus on are the people with a major depressive disorders which includes a number of symptoms nearly every day, all day, for at least 2 weeks. 

These always include at least one or more of the following, and all the time beyond 2 weeks:
  1.  Feeling sad, anxious, pessimistic, and/or hopeless 
  2.  Loss of interest in things that the person used to
       enjoy
  3.  Feeling restless, loss of energy, and/or feeling
       fatigued constantly
  4.  Feeling worthless and/or guilty
  5.  Increase or decrease in appetite or weight
  6.  Problems concentrating, remembering, and/or 
       making decisions
  7.  Trouble sleeping or sleeping too much
  8.  Headaches and/or stomach problems
  9.  Sexual problems 
10.  Thoughts of death or suicide

What are the takeaway thoughts? There are two. 

First, it is normal for a stroke survivor to experience most or all of these feelings or emotions. Second, family and friends should take heed and be more supportive of the survivor regardless of the healthy one's sometimes biased, small-minded, and me-centered thinking.