Fong Law Group

How Older Adults Can Stay Safe During Heat Waves

Takeaways

• Older adults are particularly susceptible to heat-related illnesses due to chronic conditions, medications, and physiological changes, making it crucial for them and their caregivers to recognize symptoms of overheating.

• Preventative measures such as staying in air-conditioned environments, staying hydrated, and seeking financial assistance for cooling can help older adults stay safe during heat waves.

The United States set a record in 2023 for heat-related deaths, and the planet recorded its highest-ever average temperatures in 2024. Hot weather poses a particularly significant risk for vulnerable populations such as older adults. As the Centers for Disease Control and Prevention (CDC) reports, those 65 and older are predisposed to experience heat-related health problems. By understanding how chronic conditions and medications can exacerbate heat complications, older people and their loved ones can take steps to help them stay safe during heat waves.

Excessive Heat Is Dangerous for Older Adults

Elevated temperatures can be hazardous for seniors. With lower muscle mass, decreased reflexes, and lower immunity, older adults generally have a higher risk of experiencing disorders that affect the body’s ability to maintain a normal temperature. When the weather fluctuates, it can be more difficult for older individuals to adjust to these changes.

Older adults are also more prone to chronic conditions that can impact how their bodies respond to heat. Managing chronic conditions can involve taking prescription or over-the-counter medications that shape how the body controls temperature or sweat to keep cool.

According to one study, neurocognitive diseases, including Parkinson’s and Alzheimer’s diseases, cause the body to encounter problems controlling temperature. Medications these patients take to manage these conditions can further alter how their body maintains its temperature, causing both too-high and too-low extremes.

In addition to Parkinson’s and Alzheimer’s diseases, other disorders of the central nervous system can put aging adults at risk during heat waves. These include certain brain injuries, spinal cord injuries, and tumors, which may impair sensing and central control.

Endocrine disorders can lead to problems with regulating one’s temperature as well. Certain thyroid conditions, for one, can cause someone to become too cold or too warm. Those with diabetes become dehydrated more quickly, and complications from diabetes can lead to heat exhaustion and heat stroke, according to the CDC.

Other medications that many older adults may rely on can aggravate heat problems, the Associated Press reports. Blood pressure pills can cause dehydration, antidepressants can interfere with cooling, and aspirin and other over-the-counter pain relievers can reduce fluid sodium levels, making it challenging to respond to high temperatures.

Heat Complications in Aging Adults: What to Watch Out For

Overheating can cause several health problems, which may prove severe and require immediate medical attention.

Because heat-related illnesses can involve dizziness, confusion, and dehydration, it can be difficult for someone experiencing one to think clearly. Older adults, their caregivers, and loved ones should look out for signs of overheating.

Note that while sweat can indicate a problem, some heat-related illnesses and chronic conditions impair sweating. A lack of sweating can in fact indicate too much heat.

Other signs of overheating include the following:

• A rapid or slowed pulse
• Flushed appearance
• Dizziness and fainting
• Confusion and difficulty thinking clearly
• Thirstiness
• Dark colored urine, indicating dehydration, or urinating less than normal
• Lethargy, fatigue, and weakness

The National Institute on Aging (NIA) flags the following heat complications that can affect older adults:

• Sudden heat-related dizziness, known as heat syncope, can happen when someone is active in hot weather.
• Cramping can occur in the stomach, arms, or legs.
• Swelling in ankles and feet is known as heat edema.
• Heat rash involves small clusters of blisters on the skin.
• Heat exhaustion causes thirst, dizziness, weakness, and nausea. Some may also feel cold and clammy or have a rapid pulse.
• When body temperature exceeds 104°F, it is a medical emergency called heat stroke. Fainting, confusion, lack of sweating despite heat, flushed skin, and changes in pulse can point to heat stroke. Seek medical attention right away.

If you or a loved one experiences symptoms of a heat-related condition, seek medical help. The NIA also recommends drinking water and resting in a cool location.

Staying Cool Amid High Temperatures

Elderly community members and their loved ones can take steps to prevent them from becoming too hot during heat waves.

• Stay inside an air-conditioned location during high temperatures. Close blinds and curtains to stop the sun from warming the home and use fans to circulate air.
• Before a heat wave, stock up on essentials to avoid needing to go out.
• Stay hydrated; drinking cold water with ice can help people stay cool while preventing dehydration.
• Take a cold shower or bath to lower body temperature.
• Seek medical attention for heat-related symptoms.
• Many seniors enjoy being active outdoors, taking part in walking, gardening, or playing pickleball. Consider engaging in these types of activities early in the morning, in the evening, or in an indoor, air-conditioned space.

If an older adult in your family or community does not have air conditioning, consider helping them get to an air-conditioned location for the duration of the heat wave. Some federal assistance is available to help low-income older adults access air conditioning, and many communities have cooling stations.

The CDC has launched an online tool where users can input their ZIP code to see forecasts for the heat risk in their area. The tool also provides recommendations on how to protect your health during a heat wave.

Access to Air Conditioning for Low-Income Older Adults

Staying inside air-conditioned residences during heat waves can help older adults avoid overheating. Seniors who may not be able to afford to keep their homes cool and have trouble avoiding extreme heat are vulnerable to its adverse health effects, particularly for those who are homebound.

The National Council on Aging identifies several programs to help older people with limited income and resources access air conditioning or other ways to keep their homes cool.

• The Low-Income Home Energy Assistance Program (LIHEAP) financially supports older adults who cannot afford heating and cooling bills. In some states, the program may pay for an air conditioner or a fan.
• The Weatherization Assistance Program (WAP) assists limited-income households in weathering their homes. Contact your state weatherization administrator to learn more about the program.

State and community programs may also be able to help. Some states have programs providing free fans to those in need. Local senior centers and service organizations may offer cooling assistance programs funded by community donors.

Many places also have cooling stations, such as libraries, school auditoriums, religious institutions, and other public spaces. These areas are often open to people who would otherwise lack access to air conditioning during heat waves. For assistance finding a cooling station, contact your local Area Agency on Aging.

Keeping Medications Safe

Many older adults rely on medications to manage chronic conditions. These medications can become ineffective if they become too hot. Exposed to heat and moisture, certain types of drugs can lose their potency before their expiration date.

Be sure to store medications as directed, often in a temperature-controlled environment away from heat and humidity. Take special note of any potential issues if you receive your medications by mail order.

Baylor College of Medicine recommends throwing away medications that show signs of heat exposure, such as changes in color, texture, or odor. Capsules or pills that stick together, show changes in hardness or softness, or have cracks and chips are additional indications that a medication may have spoiled. Consulting a doctor or pharmacist can be essential to determining whether a medication is still safe.

New Law Supports Home Care, Caregivers for Military Veterans

Takeaways

• Legislation signed in January 2025 seeks to secure better access to home- and community-based care for military veterans.
• The bipartisan Dole Act also focuses on coordinating assistance for family caregivers of veterans.

On January 2, 2025, President Biden signed into law the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act. The legislation represents a significant step forward in supporting the needs of veterans, their families, and their caregivers.

Named in honor of former United States Senator Elizabeth Dole, a longtime advocate for military families, the law represents a significant advancement in the services and support provided to U.S. veterans. Through the Department of Veterans Affairs (VA), this new legislation aims to enhance veterans’ access to home and community-based services (HCBS). The Act also recognizes the critical role that caregivers play in ensuring the well-being of veterans and seeks to provide them with better support and resources.

Expansion of Home and Community-Based Services

The Act requires the VA to increase access to HCBS for eligible veterans, enabling them to receive care in their own homes or communities rather than institutional settings. Before this law passed, a veteran could receive HCBS only if those services did not exceed 65 percent of the cost they would be if administered in a VA nursing home.

Under the new law, veterans can receive HCBS if the cost is equal to the cost of receiving the same care in a VA nursing home. The VA can also allow home and community-based services that exceed the cost of VA nursing home services if the VA determines that paying the higher cost is in the best interest of the veteran.

HCBS can include personal care, homemaker services, adult day health care, respite care, and other services.

Support for Caregivers

In addition, the Elizabeth Dole Act will provide enhanced training and education programs for caregivers of veterans. Such programs will seek to help them manage the unique challenges of caring for this population. The legislation also will make more veterans and their families eligible for the VA’s Program of Comprehensive Assistance for Family Caregivers.

Pilot Programs and Innovation

The law calls for the development of various pilot programs, including one focused on exploring innovative HCBS models that provide homemaker and home health care services to veterans who live in communities with a shortage of home health aides. Recognizing the importance of a skilled workforce, the Act provides funding for training programs to increase the availability of home health aides and other professionals specializing in veteran care.

Addressing Challenges for Veterans and Caregivers

Veterans often face unique health challenges, including physical disabilities, post-traumatic stress disorder (PTSD), and chronic illnesses. These conditions can make daily living tasks difficult, increasing reliance on caregivers. For many veterans, caregivers are loved ones who often sacrifice their own well-being and financial stability to provide care. By strengthening HCBS and caregiver support, the Elizabeth Dole Act addresses both veteran-specific health needs and the burdens placed on caregivers.

Other Benefits of the Legislation

The law’s emphasis on home-based care aligns with veterans’ preferences to age in place and maintain their independence. By reducing the reliance on institutional care, the legislation also has the potential to lower overall health care costs. Furthermore, the Act’s focus on caregiver support may help improve the mental and physical health of those providing care, ultimately benefiting veterans by ensuring consistent and high-quality assistance.

“The Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act will better support veterans, caregivers, and survivors by improving access to VA health care and benefits, expanding long-term care programs, strengthening programs for student veterans and military family members, and more,” said U.S. Senator Jerry Moran, a sponsor of the bill.

Learn More About Benefits for Veterans

Many benefits are available for veterans, although navigating the different benefit systems can be confusing. Your elder law attorney can guide you through available options and ensure you receive the benefits to which you are entitled.

Unpaid Family Caregiving Is Worth a Six-Figure Salary

As the population ages, the number of people affected by Alzheimer’s disease and other forms of dementia continues to rise. In turn, families increasingly find themselves providing unpaid care to loved ones with cognitive impairments. This caregiving role, though essential, comes with hidden personal, financial, and societal costs that can be substantial. In fact, a new study reveals that family caregivers of loved ones with dementia, if they were paid for their services, would be making six figures.

The Scope of Unpaid Family Caregiving

Nearly 7 million Americans aged 65 and older are living with Alzheimer’s, a figure projected to reach nearly 14 million by 2060 if trends continue. Many families shoulder the responsibility of care, as residential facilities and formal caregiving options can be financially prohibitive. In 2023, it was estimated that around 11 million Americans were providing unpaid care for family members with dementia, contributing an estimated 18.4 billion hours of care annually. The estimated value of this unpaid care is $346.6 billion.

Unpaid family caregivers often provide a wide range of support for their loved ones with dementia. This may include assistance with daily activities such as bathing, dressing, and eating, as well as managing medications and medical appointments. They also may offer emotional support, companionship, and help with household tasks, ensuring their loved ones maintain a sense of dignity and comfort in their daily lives.

Caring for a loved one with dementia can be particularly stressful. Caregivers often experience emotional strain from witnessing their loved one’s decline, leading to feelings of sadness and helplessness. The physical demands of caregiving can result in exhaustion, while the constant need for vigilance can create anxiety. Balancing caregiving responsibilities with their personal life can further contribute to feelings of isolation and burnout.

The Costs of Dementia Care

Unpaid caregivers often face financial challenges as they balance caregiving responsibilities with their own employment and personal financial stability. Some key financial costs include:

• Lost Income and Job Disruption: Many caregivers reduce their work hours, take leaves of absence, or even quit their jobs to care for loved ones. This reduction in income can be significant, especially for those in their prime earning years. Caregivers also lose out on career advancement opportunities, retirement benefits, and Social Security contributions, which can have long-term implications for their financial well-being.
• Out-of-Pocket Expenses: Caregivers frequently cover out-of-pocket costs associated with their loved one’s care. These expenses include home modifications, transportation, medical supplies, and other caregiving necessities. According to the AARP, caregivers spend an average of $7,200 annually on caregiving expenses, a figure that can climb higher for those supporting someone with dementia due to the progressive and intensive nature of the care required.
• Health Care Costs: Caring for a loved one with dementia can take a toll on the caregiver’s own health and quality of life, leading to increased health care expenses. Studies have shown that caregivers of people with dementia often experience higher rates of depression, anxiety, and chronic conditions, such as heart disease. These health issues can require costly medical treatments and medications.

How Much Would a Family Caregiver Make?

What if family and friend caregivers were paid for the caregiving services they provide to their loved ones with dementia? According to a recent study conducted by Salary.com and Otsuka America Pharmaceutical, Inc., a caregiver would earn a six-figure salary for the daily help they provide. In fact, the approximate salary would be $114,000, on average.

The two companies created a calculator for caregivers to estimate how much they would make if they were paid for their time and effort. Check out the interactive Family Caregiver Calculator.

The Economic Effects on Society

The economic cost of unpaid dementia caregiving extends beyond individual families to society as a whole. The Alzheimer’s Association estimates that the economic value of unpaid caregiving for individuals with dementia is almost $340 billion annually. If caregivers were unable to provide this support, the health care system would face immense pressure to meet these needs, potentially straining public resources.

Getting Support and Planning Ahead

Unpaid caregiving for older adults with Alzheimer’s and other forms of dementia is a deeply meaningful yet challenging responsibility. Thankfully, there are resources for these caregivers.

Family caregivers of individuals with dementia can access a variety of resources designed to provide support, education, and respite. Here are some key resources available to help them navigate this challenging journey:

• Support Groups. Many organizations, including the Alzheimer's Association, offer support groups where caregivers can connect with others facing similar challenges. These groups provide a safe space to share experiences, gain emotional support, and learn coping strategies.
• Educational Programs. Workshops and seminars are often available to educate caregivers about dementia, its progression, and effective caregiving techniques. Understanding the disease can empower caregivers and help them manage their own loved ones’ needs more effectively.
• Respite Care Services. Caregiving can be physically and emotionally exhausting. Respite care services offer temporary relief by providing professional caregivers to take over duties for a short period. This allows family caregivers to rest and recharge, which is essential for their well-being.
• Online Resources. Numerous websites and online forms provide valuable information, tips, and community support. These often offer articles, videos, and tools to help caregivers find the information they need at their convenience.
• Financial Assistance Programs. Some organizations offer financial assistance or guidance on navigating insurance and government benefits. Understanding available resources can help alleviate some of the financial burdens associated with caregiving.
• Home Health Care Services. For families needing additional help, home health care services can provide skilled nursing, therapy, and personal care. These services can be tailored to meet the specific needs of an individual with dementia, allowing caregivers to focus on emotional support.
• Legal and Financial Planning Resources. Caregivers may benefit from consulting with professionals who specialize in elder law and financial planning. These experts can help families navigate issues such as power of attorney, guardianship, and long-term care planning.

By utilizing these resources, family caregivers can find the support they need to manage their responsibilities more effectively, ensuring both their well-being and that of their loved ones. Caregivers need to remember that they are not alone, and that help is available.

The Centers for Medicare & Medicaid Services recently launched a nationwide test program called Guiding an Improved Dementia Experience (GUIDE) Model. This pilot program seeks to support individuals living with dementia and their family caregivers. It allows eligible patients with Original Medicare to consult with a health care provider participating in the model. A 24/7 help line is also available.

For help with planning for long-term care services and other elder-care needs, contact an experienced elder law planning attorney near you. They will guide you through the options available to meet your unique needs and can help you plan for the future.

What Are the Different Types of Adult Day Care?

Adult day care, also known as adult day services, includes programs that assist seniors in completing activities of daily living, such as bathing, going to the bathroom, and getting dressed. Adult day services also help older adults remain social as they age, an important part of maintaining a healthy lifestyle.

If you are the caregiver of an older adult, you may consider using an adult day care to increase their quality of life. Here, learn more about services that can enhance their physical, mental, and social health. You’ll also find information on potential payment options and whether these services are a good fit for your loved one.

Types of Adult Day Care Services

There are three categories of adult day care services:

1. social adult day care,
    
2. adult day health care, and
    
3. specialized adult day care.

You may choose one type or another based on your needs or the needs of your older family member. Fortunately, many facilities provide each service under one roof. Continue reading for more details about each type of adult day care service.

Social Adult Day Care

Social adult day care includes non-medical supervision and care for patients. Social adult day care focuses on patients’ mental and physical health by increasing social interaction and providing nutritious meals.

Adult Day Health Care

Adult day health care provides physical, occupational, and speech therapy services. These programs usually have trained nurses on staff. Patients can look forward to receiving good meals and participating in social activities.

Specialized Adult Day Care

Specialized adult day care services tailor their care to patients with Alzheimer’s or other types of dementia. Caregivers adapt the available social and health services to patients’ abilities.

How Much Does Adult Day Care Cost?

The cost of adult day care services depends on the state. According to the Genworth Cost of Care Survey, the following is a state-by-state monthly cost of care breakdown:

• Alabama = $758
• Alaska = $1,562
• Arizona = $2,102
• Arkansas = 1,733
• California = $1,842
• Colorado = $1,950
• Connecticut = $1,842
• Delaware = $1,661
• Florida = $1,517
• Georgia = $1,300
• Hawaii = $1,625
• Idaho = $2,167
• Illinois = $1,885
• Indiana = $1,733
• Iowa = $1,353
• Kansas = $1,788
• Kentucky = $1,690
• Louisiana = $1,788
• Maine = $2,600
• Maryland = $1,928
• Massachusetts = 1,587
• Michigan = $1,733
• Minnesota = $2,167
• Mississippi = $1,408
• Missouri = 1,907
• Montana = $2,600
• Nebraska = $,1842
• Nevada = $1,788
• New Hampshire = $1,842
• New Jersey = $1,950
• New Mexico = $1,993
• New York = $1,907
• North Carolina = $1,197
• North Dakota = $3,383
• Ohio = $1,733
• Oklahoma = $1,495
• Oregon = $2,654
• Pennsylvania = $1,625
• Rhode Island = $1,798
• South Carolina = $1,408
• South Dakota = $2,600
• Tennessee = $1,733
• Texas = $769
• Utah = $1,939
• Vermont = $3,224
• Virginia = $1,690
• Washington = $2,600
• West Virginia = $1,083
• Wisconsin = $1,723
• Wyoming = $1,733

The numbers above can seem staggering, especially since it is a monthly expense. Fortunately, there are many ways to offset the cost of adult day care, including Medicaid, veterans programs, and private payment options.

Does Medicaid Cover the Cost of Adult Day Care?

The criteria to qualify for Medicaid programs that cover adult day services vary by state. Medicaid Waiver Programs sets the standards who is eligible for senior day care. Examples of what the Medicaid Waiver Programs consider when apportioning payment for day services include the applicant’s income, financial resources, and functional ability.

Am I Eligible for Medicaid Adult Day Care Coverage?

Medicaid Waiver Programs are partially based on the applicant’s financial status (income and the value of their countable assets). The financial criteria vary from state to state.

Income requirements for Medicaid are set by the state. Factors that your state’s Medicaid Waiver Programs may consider include your and your spouse’s combined incomes and your countable assets.

Do Veterans Affairs Programs Cover Adult Day Care Services?

If you are a retired service member, you may qualify for veterans benefits that cover adult day care. If you qualify for community care and meet the clinical criteria for an available service, your adult day service costs are likely covered.

Tips for Choosing Your Adult Day Care Provider

Choosing an adult day service is an important task. The facility will be caring for your family member, and you are making a large financial commitment. Consider the following before making your final choice:

• The services the facility offers
• The mental and physical functional ability of your loved one
• Staff-to-patient ratio
• Staff training
• Whether they dispense medication

This is not an exhaustive list. If you are considering enrolling in an adult day service, find expert help online.

An Epidemic: Substance Abuse a Growing Problem Among Seniors

The United States population of aging adults has grown exponentially over the past decade. According to projections published by the U.S. Census Bureau, the number of Americans aged 60 and older increased by 34 percent from 55.7 million to 74.6 million between 2009 and 2019. Unfortunately, amid their growing numbers, more and more seniors are facing a substance use disorder problem that in large part has remained silent.

What Are Substance Use Disorders?

According to the Centers for Disease Control and Prevention, substance use disorders include “treatable, chronic diseases characterized by a problematic pattern of use of a substance or substances leading to impairments in health, social function, and control over substance use.”

Seniors are an overlooked group regarding substance abuse issues, but the problem is growing nationwide. Learning the extent and cause of substance abuse among seniors can help improve outcomes for this population.

Rates of Substance Abuse and Misuse Among Older Adults

Seniors often get disregarded in conversations about substance misuse. Yet according to some estimates, nearly 1 million adults aged 65 and older were reported to be living with an addiction as of 2018. Today, that number could be much higher.

Drug Abuse

Drug abuse among older adults is a dangerous problem, in part because health care providers and caregivers so often overlook it. It may even be diagnosed incorrectly as a health condition related to aging.

Seniors are likely to use one or more prescription medications. Adverse drug interactions between multiple prescriptions, nutritional supplements, and over-the-counter medication can inadvertently harm one’s health.

Misuse of certain prescriptions can also lead to a substance use disorder. Opioids, for example, have been prescribed to millions of people suffering from chronic pain. The proportion of U.S. adults aged 55 and up who have sought treatment for opioid use disorder has been surging over the past two decades; between 2013 and 2015 alone, it jumped more than 50 percent. One 2006 study stated that at least one in four older adults were using prescription drugs that have potential for abuse.

Many seniors are at risk of developing a dependence on nonprescription, over-the-counter, and illicit drugs as well. Meanwhile, research has suggested that American seniors use illicit drugs at a higher rate than older adults from most other countries.  

Alcohol Use

Surveys show that alcohol use among people 65 and older has increased 22 percent over the past two decades. The extent of alcohol abuse remains unknown due to the impact of underreporting. However, seniors in some studies do report binge drinking and at-risk drinking.

People binge drink when they have five or more drinks in one setting. According to one study, more than a tenth of older adults in the U.S. are regular binge drinkers.

Research published by the National Library of Medicine defines at-risk drinking as consuming more than three drinks on one occasion or having more than seven drinks in one week. The prevalence of at-risk drinking among men is estimated at 16 percent and 10.9 percent among women.

Note that the National Institutes of Health offers a series of free worksheets that can help you evaluate your use of alcohol and learn how to make positive changes.

Why Do Seniors Abuse Substances?

Seniors are less likely to abuse substances for a euphoric effect. Older adults typically use drugs and alcohol to self-medicate against the physical and emotional pain that comes with aging.

Some common causes of substance abuse among people aged 65 and older include:

• Loss of a spouse or family member
• Decreased income
• Change in living arrangements
• Trouble sleeping
• A mental and physical decline in health
• Conflicts with family
• Lack of purpose
• Retirement

A senior’s coping style early in life may correlate with late-life substance abuse. People with avoidant coping styles tend to rely on substances to deal with stress and change. If seniors spend their lives avoiding stress or problems, they are more likely to develop a late-life drinking problem than those who cope in other ways.

Social Factors Leading to Substance Abuse Among Older Adults

Various social factors appear to increase the chance of late-life drug and alcohol abuse. The following social factors are among those that may lead to increased substance misuse:

• Unexpected or forced retirement
• Social isolation
• Being divorced, separated, or single
• Lack of religious affiliation
• Affluence or feeling comfortable with the availability of financial resources
• Grief

Physical Factors Leading to Substance Abuse Among Aging Adults

Older adults with substance abuse disorder typically have these physical factors in common:

• Comorbidities
• Chronic medical conditions
• Reduced mobility
• Chronic pain
• Poor health status

Psychiatric Risk Factors Leading to Substance Abuse Among Seniors

Psychiatric risk factors among older adults with substance abuse disorder include:

• History of substance use disorder
• Current or previous mental illness
• Feeling socially isolated
• Having an avoidance coping style

Symptoms of Substance Abuse Among Older Adults

Substance abuse is a serious medical condition. Prompt diagnosis and treatment can help seniors get the help they need to improve their quality of life. Caregivers and medical providers should watch out for the following symptoms of substance misuse:

• Depression and loss of interest in previously enjoyable activities
• Use of a prescription drug more often than what is outlined in the instructions
• Memory problems
• Change in appetite
• Social withdrawal
• Irritability and sadness
• Change in sleeping patterns
• Decline in hygiene

Leading Substance Use Disorders According to Region

Substance misuse is occurring everywhere in the U.S., regardless of age, but certain areas are seeing abuse of specific types of substances. The Agency for Healthcare Research and Quality compiled the following data for 2016 through 2018 about regions nationwide:

• New Jersey and parts of Appalachia have a concentration of opioid-related substance use disorders.
• The Midwest, Appalachia, Rhode Island, and Nevada saw a higher concentration of alcohol dependency issues than other parts of the country.
• Appalachia saw a more-significant-than-average concentration of sedative-related substance use disorders.
• Stimulant-related disorders appeared more in the Midwest, the South, and Appalachia.
• Cannabis-related substance abuse disorders occurred in Mississippi and other Southern states.

Health Impacts of Substance Abuse on Seniors

The health implications of substance abuse disorder are more significant for older people. Older people are more vulnerable than other groups to the effects of drug use on mental health. Seniors who take prescription medication risk negatively impacting their mental state by mixing their medicine with recreational drugs or by abusing alcohol.

Drug and alcohol abuse can also lead to increased fall risk, physical impairment, adverse psychiatric effects, worsening of other physical conditions, and death.

In fact, among people aged 65 and over, certain types of opioid overdose deaths increased by 53 percent between 2019 and 2020 alone. The number of alcohol-related deaths for this age group rose by 18 percent over the same timeframe.

Recovery Options for Older Adults

Whether a senior should receive inpatient or outpatient treatment depends on their needs. Older adults with a substance use disorder may benefit from inpatient treatment if they meet some of these criteria:

• A high likelihood of relapse
• Suicidal thoughts or thoughts of self-harm
• Likelihood of experiencing withdrawal symptoms
• No familial support
• Previous attempts at detox
• Co-occurring severe medical conditions that need continuous monitoring

Seniors may also need the following to get the most out of recovery:

• Careful case management
• Family, group, and individual counseling
• Cognitive behavioral therapy

How Can the Health Care Industry Help Older Adults With Substance Use Disorder?

Much work is needed to decrease the substance abuse rates among older adults. There is a critical need to address this problem.

Primary care physicians are the first line of defense. Education for clinicians should include skill and strategy development to treat substance abuse issues among older adults. Health care workers should know how to identify substance misuse with proper screening and assessments. Understanding co-occurring disorders and the connection between mental illnesses and substance use disorders is also crucial.

If you notice signs of addiction in a loved one, it is essential to get them professional help. In addition to improving their quality of life, you may save them from succumbing to this disease.

Will Robotics and AI Be the Future of Elder Care?

Adults 65 and older constitute the fasting-growing age demographic in the United States. When it comes to elder care, this expanding population is facing a scarcity in people equipped to support them as they get older.

One estimate predicts a shortage of 151,000 paid direct care workers and 3.8 unpaid family caregivers by 2030, increasing to a gap of 355,000 paid workers with 11 million unpaid family caregivers by 2040.

Technological advancements in robotics and artificial intelligence may be opening the doors to new possibilities for supporting aging people.

Innovations for Aging in Place and Beyond

Many older adults wish to stay in their homes for as long as possible. According to AARP, 77 percent of adults over 50 want to continue residing in their homes for as long as they can.

Yet aging can lead to challenges with mobility and memory, such that older individuals often need additional assistance to live independently. Innovations in robotics and artificial intelligence may have the potential to provide support on this front, allowing seniors to continue living at home as they age.

Developments in robotics and AI could also fulfill unmet needs in nursing homes and assisted living, increasing efficiency, helping caregivers complete tasks, and reducing the number of staff required.

Meanwhile, artificial intelligence technologies may be able to help older adults manage health conditions from home as well as receive more efficient care in hospital settings.

Robots Helping Out in Health Care Facilities

How might robots help seniors in their homes, nursing homes, assisted living facilities, and beyond? Here is a glimpse into some emerging products:

• Panasonic has developed robotic exoskeletons designed to augment wearers’ abilities. This self-reliance support robot aims to help aging people perform everyday tasks, get in and out of bed, and sit on chairs or the toilet. The device could help individuals to perform physical tasks without assistance. Another portable exoskeleton, the APO, may be another type widely used one day in health care to help prevent falls in seniors.
• The TUG robot is already assisting in hospitals by delivering medicine, meals, supplies, and tests, freeing nursing staff to focus on tasks requiring more education and expertise.
• Social robots may prove another avenue for improving older adults’ mental health. Paro, a robotic seal, gives patients the benefits of pet therapy in health care settings and dementia wards where bringing live animals would be impractical. Similar to pet therapy, some individuals may find it easier to connect with robots than with people.

In the coming years, other kinds of socially assistive robots may become increasingly common in elder care. These types of robots engage with residents, provide entertainment and interaction, perform tasks, or help ensure safety:

• A socially assistive robot called Stevie, designed at Trinity College Dublin in Ireland, was tested at a Washington, D.C., nursing home from 2018 to 2020. Stevie entertained residents by telling jokes, playing bingo, and leading karaoke. It also provided reminiscence therapy using stories and music and could clean the facility with ultraviolet light. Recognizing commands like “help me,” the robot also can alert staff when residents needed assistance.
• Pepper, a humanoid robot funded by the Minnesota Department of Human Services, is similarly designed for socializing with residents. Able to recognize faces and read human emotions, Pepper is being introduced into nursing homes and other elder care facilities.
• Aeo, a robot created by Aeolus Robotics, interacts with residents socially. In addition to taking selfies with residents, it performs various essential functions, such as disinfecting surfaces, opening doors, pressing elevator buttons, and alerting staff when a resident has fallen or needs help.

Technology at Home

Older adults who live alone and people with disabilities can already use Personal Emergency Response Systems (PERS), also known as Medical Emergency Response Systems. These lightweight, battery-powered wearable devices allow individuals to call for help at the push of a button. For an installation fee and a monthly monitoring charge, users receive a device that contains a radio transmitter and a console that connects to a telephone. An emergency response center monitors incoming calls.

Technology using artificial intelligence, motion sensors, and camera monitors can also provide more comprehensive assistance and monitoring for seniors aging in place:

• CarePredict, a device worn on one’s dominant arm, tracks the wearer’s activity. When it detects deviations from behavioral patterns, it alerts a caregiver.
• With Envoy at Home, caregivers can place small sensors in their loved one’s home that alert them when their loved one could be at risk, such as when they leave home, exhibit disturbed sleep, visit the restroom frequently, or display inactivity.
• Integrating AI with smartphone usage is one more emerging area in senior care. A 2021 survey by Pew Research Center found that the majority of older adults use smartphones. Technology utilizing smartphones could make in-home health monitoring more accessible, particularly for homebound seniors who may postpone doctor visits or rely on telehealth.
• With AliveCor, older adults can monitor and track their heart activity on their phones. AliveCor is a wireless personal electrocardiogram (EKG) placed on the back of the smartphone. Using an application, individuals can view their EKG results and can share results with their cardiologists.
• Using the smartphone’s camera, artificial intelligence, and machine learning, Healthy.io makes medical assessments of urine by analyzing the concentration of chemical elements and chemical compounds in urine.
  Healthy.io also empowers users to take photos of their wounds for a digitalized wound assessment, which can track healing and help doctors make recommendations.
• Luminostics is a diagnostic platform that attaches to a smartphone. It can recognize bacteria, viruses, proteins, and hormones from bodily fluids.

A Growing Market

Advances in medical technology are already helping health care providers manage, identify, and treat medical conditions in older adults.

According to Healthcare Dive, the Food and Drug Administration (FDA) authorized 91 AI- or machine-learning-enabled medical devices in 2022 alone. These include tools for radiology, cardiology, neurology, and more.

Going forward, AI may also become the norm for performing administrative tasks in clinical settings, giving health care workers more time to spend directly helping patients.

Is "Aging in Place" Right for Me?

Most older adults want to remain in their homes and communities as they age rather than move into assisted living facilities or nursing homes.

For those who wish to maintain their independence and continue living at home as they grow older, taking certain steps to protect their physical, mental, and financial welfare is essential.

What Does It Mean to Age in Place?

The Centers for Disease Control and Prevention defines aging in place as a senior’s “ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.” According to 2021 data from AARP, more than three-quarters of adults 50 and older say they would prefer to age in place.

Health Considerations for Older Americans Aging in Place

Older adults must consider their physical, emotional, and social well-being when deciding where to spend their later years. They may consider adding supplemental services over time to help improve their quality of life.

To ensure that you will have the support you need for safely aging in place, take the following into consideration:

Resources to Manage Chronic Diseases

Disease management is vital for anyone, especially an older person with a chronic illness. Many older people suffer from at least one chronic illness. If a senior has a chronic disease and wants to age in place, they and their caregivers should focus on:

• Ensuring that spaces in the home are safe and easily accessible to make getting around easier;
• Learning about proper nutrition; and
• Increasing access to dental health services. Research has found that proper oral care can help prevent the progression of many chronic diseases.

Eating Well While Aging at Home

Proper nutrition is a vital part of caring for yourself at home. In facing potential changes to your financial situation after retirement, you may need help buying nutritious meals even after budgeting.

If you find yourself in need of meals, community resources may be available. Neighborhood senior centers, places of worship, and charities may provide a hot meal while you make new friends. If you cannot leave your home, some meal delivery services drop off food at your door for little or no cost.

Support for Mobility

Exercise and maintaining your mobility can increase overall physical and mental health even as you grow older. Seniors aging in place need to be able to move around their homes and neighborhoods safely. Aging in place is a much more realistic goal if you can walk for exercise, access transportation to medical appointments and errands, and maintain a safe environment at home, free from increased fall risks.

If you desire to age in place, consider simple changes you can make to your home to promote your safety. Examples of helpful modifications around the house include handrails, temporary ramps, no-slip bath rugs, and assistive seating.

Mental Health, Substance Abuse, and Memory Care Services

There is an increased need among older adults for mental health, substance abuse, and memory care services. An estimated 20 percent of older adults have a mental health disorder, and the total number of seniors with a mental health or memory care diagnosis is likely to increase over time.

Suggestions for addressing mental health concerns among older people include:

• Focusing on preventative care. Seniors and their caregivers should work with their primary care physician to identify warning signs of depression, anxiety, other mood disorders, and memory care problems. Preventative care can help mitigate the progress of these disorders and improve quality of life.
   
• Looking for common signs of a substance abuse problem. This is an often overlooked area of older adult mental health care. Older adults may turn to substances to deal with unresolved childhood problems or to avoid a feeling of loss of meaning and purpose. Some common signs to watch for include reduced hygiene, unexplained bruises, erratic behavior, and the smell of alcohol on their breath.
  
  If you are a senior’s caregiver and suspect substance abuse, you can find resources and support through the Substance Abuse and Mental Health Services Administration (SAMHSA).

The Need for Social Connection Among Aging Adults

Older adults benefit tremendously from social connections and interaction. People over 65 are likely to live alone, so creating a community outside the home is necessary. Feeling a sense of purpose is beneficial to mental and physical health. For seniors looking to create a sense of community and purpose, they may benefit from such activities as:

• Joining an organization or social club

• Volunteering for a cause close to their hearts

• Learning a new hobby

• Attending a religious institution

• Adopting or fostering a pet

• Using technology to stay in touch with friends and family

Wearables and Smart Monitoring Devices

Technology can help us not only remain connected to one another, but also monitor our health and that of our aging loved ones. Many devices make detailed health information readily available at our fingertips. These devices benefit seniors because they can learn more about their health and make the most of doctor’s visits by communicating effectively about their medical needs.

Examples of wearable health and smart-home monitoring devices include:

• Smartwatches and smartphones, which can track your cardiac health, fitness activity, and sleep patterns
• Medical alert bracelets and personal alert necklaces, which can aid in detecting falls or contacting emergency services when necessary
• Contact sensors and smart locks, devices that can alert caregivers when their loved one living at home leaves a window, garage, or door open, or has forgotten to lock them
• Smart plugs, which can automatically turn on and off lights, space heaters, thermostats, security cameras, and more

Money Management While Aging in Place

Money management can also be an area of concern for seniors and caretakers. Seniors want to make sure they have sufficient financial resources to remain in their homes and communities comfortably, eat well, care for their medical needs, and have fun.

Creating a budget with the help of financial counselors and geriatric care managers can benefit someone on a fixed income. There may even be volunteers in your area that offer a similar service. Being aware of how to prevent and avoid common types of scams that target the senior population is equally as important.

How Can Caregivers Help Seniors Age in Place?

Seniors often choose to age in place to remain independent and avoid becoming a burden to their family. Caregivers can support their goal by teaching them to use technology to communicate and track their health, helping them establish a budget, and setting them up with a routine that may include visiting their doctor, running errands, and making time to socialize.

There is nonmedical support that your loved one will need, too. Caregivers may opt to support their aging loved ones by pitching in with or hiring services for lawn care, cleaning, cooking, laundry, or pet care.

Is Aging in Place Right for You?

Careful planning is the best way to accomplish your goal of staying home as you age. If you are considering plans to age in place and want assistance, contact your elder care attorney.

2023 AARP Report Recommends Supports for Family Caregivers

Many older Americans choose to have their family members care for them as they age. Despite the comfort a familiar face may provide, there is a significant cost for the loved ones who sacrifice their time, and often their upward economic mobility, to ensure that they can secure proper care for their senior parent.

In a report issued in March 2023, AARP stresses the importance of supporting family caregivers in their financial, emotional, physical, and professional lives. The analysis gives a glimpse into the experiences of family caregivers and also offers recommendations on policies, practices, and programs – across public as well as private realms – that policymakers should consider enacting or enhancing in support of caregivers and the individuals who are in their care.

How Much Does It Cost to Be a Family Caregiver?

Being a family caregiver can come at a great financial cost. The average cost of caregiving has risen exponentially in the past several years, and the trend is expected to increase more over time.

In its report, AARP estimates the value of family caregiving in 2021 at $600 billion dollars in unpaid contributions – up from $470 billion dollars in 2017.

The monetary value of caregiving is not the only cost of care. For family caregivers, some of the intangible costs of included:

• spending an average of 18 hours per week to tend to the needs of their loved ones
• facing higher risks of chronic loneliness, which may have negative health effects
• neglecting their own self-care

What Are the Major Issues in Family Caregiving?

According to the AARP report, by 2034, the population of people over 65 will outnumber the population of children under 18. With this historic shift, the researchers suggest that the impact on family caregiving will become even more prominent in several key areas:

The Need for Tailored Support for Diverse Caregivers and Their Families

Family caregivers across diverse cultures, ethnicities, sexual orientations, and gender identities often face concerns about access to support that is specific to their community. Ensuring that affordable, inclusive, readily available policies and services are in place to meet these needs of these caregivers will continue to be critical.

Direct Care Workforce Shortage

Amid a shortage of professional caregivers that only worsened during the COVID-19 pandemic, AARP notes that the turnover rate among the direct care workforce averages between 40 percent and 60 percent each year. Failing to recruit and retain a dedicated workforce in caregiving as the aging population grows will inevitably add to the burden carried by unpaid family caregivers.

Economic Impact on Working Caregivers

Most family caregivers – nearly two-thirds of them in 2019, according to AARP – hold a full- or part-time job in addition to caring for their loved ones. These workers often take an economic hit because they need to split their time between their jobs and their home responsibilities.

Without such supports as telecommuting, paid leave, and respite care, they may have no choice but to call out of work, turn down promotions, or even leave their job altogether to dedicate themselves fully to providing care. This can then mean additional financial stress as well as adverse effects on their career and future earning potential.

A Growing Sandwich Generation

In 2019, about 30 percent of older Americans were living with their children or grandchildren. The so-called “sandwich” generation represents those who are responsible for caring for their children and their aging parents at the same time, while also working. These caregivers, who are likely to report more emotional and financial pressure, now tend to include workers across an ever-expanding age span – from 35 to 64.

Recommendations

The AARP’s report recommends specific policies and practices to support family caregivers going forward. These recommendations to policymakers include the following:

• Including family caregivers in planning and decision making across health care settings
• Improving access to respite care for family caregivers
• Ensuring that publicly funded programs and supports for caregivers are inclusive, culturally appropriate, and designed to meet the needs of diverse populations
• Offering family caregivers a tax credit
• Expanding protections for workers who rely on the Family and Medical Leave Act and related state programs while providing long-term care for family members, including instituting paid leave for working family caregivers
• Allowing for other programs that pay family caregivers
• Improving Social Security benefits for people who provide long-term care services to family members

Additional Resources

Having a care plan in place for your loved ones in advance may help decrease the financial costs and other stresses associated with paying for long-term care for aging adults. Your elder law attorney can help you create a comprehensive long-term care plan that will address the costs associated with tending to the people you love. 

What Is Respite Care? Can It Help With Caregiver Burnout?

It is easy to burn out when you are responsible for providing full-time care to an aging or disabled loved one. In some cases, caregiver burnout can result in resentment toward the individual they care for, despite their love for them.

The fact is, we all need a break sometimes. That is why respite care exists. If you are a caregiver who needs to take time for yourself, read more to learn about respite care.

What Does Respite Mean?

Taking respite means having a temporary period of rest. For primary caregivers, this typically refers to securing short-term care for your loved one – even several weeks or months – so that you can recharge amid the very real burdens of caregiving.

In finding respite, you also might make time to practice self-care, from going to the gym to connecting with friends. Do not forget to find ways to maintain your sense of self while you are in the midst of giving so much of your time and attention to someone else.

Caregivers Want Information About Respite Care

In a 2022 survey of caregivers, Caregiving in America found that most were unaware that respite care was available. Many caregivers need more education about their options for respite care and how to build a network of support to share the load of providing financial and emotional support to an ailing loved one.

Here are some of the study’s findings:

• Fifty-nine percent of respondents reported that they were the primary emotional support system for a sick or impaired loved one.
• Twenty-two percent of respondents said they worked more than 40 hours per week as the primary caregiver to a disabled family member.
• Forty-eight percent of respondents disclosed they needed emotional support for themselves.
• Forty-four percent of respondents shared that they wanted information about where to find respite care.

Caregivers need information about maintaining their own health while supporting a family member. It is essential to prioritize yourself when caring for an aging or disabled relative.

Preventing Caregiver Fatigue

The challenges of taking care of an ailing loved one can be extremely stressful. More than that, the strain of serving as a caregiver – often unpaid – can make a real and lasting impact on your own health if not kept in check.

Symptoms of burnout among caregivers may include the following:

• Losing sleep and extreme fatigue
• Feeling hopeless
• Having a quick temper
• Lack of interest in your favorite activities

If you or someone you know has taken on the responsibilities of caregiving, be aware of the signs of burnout and actively seek support. Respite care is among your potential options.

What Is Respite Care?

Respite care gives caretakers a chance to relax and take a break from the responsibility of providing full-time care to loved ones who are aging or disabled. Respite programs offer short-term replacement care. These providers will step in for a short period to take on the responsibility of caring for your loved one.

The types of care you can expect them to take on may include the following:

• Bathing and dressing
• Cooking and cleaning
• Helping your loved one eat, drink, and take their medication
• Getting into and out of bed
• Assistance with the restroom
• Spending quality time with your loved one
• Helping with exercise and personal care

How Much Does Respite Care Services Cost?

The cost of respite care varies depending on how long you use the service. You can schedule respite care for several days, weeks, months, or longer.

Who Pays for Respite Care?

Private insurance will typically not cover respite care, unfortunately. If your loved one is covered by Medicare or Medicaid, you may be able to secure five consecutive days of respite care. Your loved one must be receiving hospice care benefits for Medicare to cover respite care.

Finding Respite Care

Several organizations provide respite care. If your family member is covered by Medicaid, you can speak to a Medicaid planner in your state to determine what programs may be available. As mentioned above, Medicare covers respite care under its hospice benefit.

If your loved one is not covered by Medicare or Medicaid, don’t worry; there are private organizations that provide this service. These organizations include:

• National Adult Day Services Association (NADSA)
• Your Area Agency on Aging (AAA)

In addition, connect with your attorney to talk through your options.

Becoming a Family Caregiver for an Ailing Loved One

Taking on the responsibility of providing full-time care for an aging or disabled loved one can be a rewarding experience. Being a primary caregiver helps you rest assured that your loved one is receiving compassionate care from someone who will go above and beyond to ensure they are comfortable and looked after.

Despite your good intentions to create a comfortable environment for your loved one, full-time caregiving is a significant time commitment. There is also a financial reality that the caregiver must face. Fortunately, family members who want to serve as caregivers may have options to help cover the expense.

What Is a Caregiver, and What Do They Do?

Professional caregivers work intimately with seniors to meet their needs as they age. As individuals get older, their needs change and they may need more help going about their day.

Examples of the kinds of help caregivers provide include:

• Bathing and grooming
• Help with toileting
• Medical appointments and medication compliance
• Transportation
• Companionship
• Cooking, cleaning, and grocery shopping
• Care for animals
• Laundry
• Coordinate benefit care/speak to insurance companies on the senior’s behalf, if authorized

Family Caregivers: Know the Downsides

Having a family member serve in the role of caregiver can make for a better experience for your loved one and, in some ways, give you peace of mind as well. However, there are some downsides to be aware of if you are considering becoming a family caregiver.

Your own health, both physical and emotional, can be negatively affected when taking on the burden of caring for a family member. Be sure to engage in self-care, maintain a healthy diet, and watch out for signs of stress and burnout. When you do need a break, consider looking into respite care.

If your loved one has specific medical issues that will require the attention and expertise of a professional health care provider, you may want to reassess whether you should take on the role of family caregiver.

Taking care of a loved one who is getting older or who is disabled will likely require a great deal of your time, too. You may find yourself not performing as well at work or having a longer commute as you fulfill the needs of your ailing loved one. Not to mention that your own immediate family may be missing out on valuable time with you while you are caregiving elsewhere.

In turn, this could mean you will have less time to hold down a full-time job. In fact, a 2020 AARP survey showed that about 20 percent of family caregivers reported experiencing a high level of financial stress. Nearly 30 percent of them stopped saving altogether as a result of providing care for their loved one.

In these challenging economic times, you must be able to support yourself while ensuring the best care for your aging family member.

Can Family Members Get Paid for Their Work as a Caregiver?

Fortunately, certain programs are available to help family members care for ailing relatives. You may need to do a bit of research to find the right option for your circumstances.

• Medicaid Self-Directed Care

For individuals on Medicaid, the Medicaid Self-Directed Care Program is one option that gives them the authority to manage their services. In certain states, this program offers recipients the ability to use the resources allocated for home care to pay a family member to help them with their daily needs. The Medicaid Self-Directed Care Program lets seniors have more autonomy over their care.

Note that such programs vary by state, however, and not all states will have an option like this. Each state may also use different criteria to define who qualifies as a “family” caregiver. Find your local Area Agency on Aging to learn more about the possibilities, or call your local Medicaid agency.

Note that, generally, Medicare will not cover the costs of caregiving by a family member.

• Veteran’s Benefits

If your loved one is a military veteran, there are special benefits available to cover their home care, including the Veteran’s Directed Home and Community Based Services program. This program gives veterans a flexible spending budget that the veteran can use to pay a family member to act as their caregiver.

• National Family Caregiver Support Program

Note that this program does not pay caregivers directly. Rather, it helps fund several different types of services for family caregivers, from training in caregiving to respite care. Learn more about this program.

• Long-Term Care Insurance

If you are thinking ahead to who will care for you as you age, you may consider long-term care insurance when creating an estate plan. Certain long-term care insurance policies allow the policyholder to pay family members to work as caregivers. However, that is not true for every policy. Some policies do not allow policyholders to pay family members to work as caregivers if they live in the policyholder’s home.

Before taking out this type of insurance policy, you should speak to your attorney to ensure you are properly advised.