Month: November 2020

After the arduous decision-making process of picking out a long-term care option, next comes the question, “How will we pay for this?” Each care option has its own set of rules on what payments are accepted or not accepted, and it can be confusing navigating the options. We want to make the process easier for you and your loved one. We will discuss the various payment options that are accepted for elder care, and we will break it down for nursing homes, assisted living facilities, and in-home care. Here are some common forms of payments that are used to pay for long-term care: 

• Cash
• Reverse Mortgage
• Home Equity
• Long Term Care Insurance
• VA
• Medicare
• Medicaid

How to Pay for Nursing Homes

Nursing home facilities give a high level of attention and supervision to its residents, even more so than any other long-term care facility including assisted living. Residents can receive personal care, supervision, prescription therapies, rehab, room and board, and skilled nursing care. Due to the high level of care offered, it is no surprise that this type of facility is the most expensive, sometimes costing hundreds of dollars a day.

These long-term care expenses can put a real strain on a family’s finances. About half of nursing home residents use cash, employer health plans, VA benefits, long-term care insurance, and pension to cover the costs. Alternatives include Medicare and Medicaid, government funding programs that have strict limitations on who can qualify, how long payments will continue, and which facilities are eligible for the program. 

Also, the cost of care averages for nursing home care vary wildly from state to state. For example, in a private room in Alaska, the cost of nursing home care is $23,451 a month, while a similar facility in Louisiana costs $5,171. And keep in mind the average stay at this type of facility is about 835 days. Now that we have an idea of how much a nursing home might cost you, let’s explore some payment options. 

Cash: A lot of people use private funds and cash out-of-pocket when they first move into a facility. This may be because Medicaid requires that you have used up all of your assets and personal funds before you can qualify for their federal payment program. 

The more fortunate among us can opt to pay all from their funds. For such an expenditure, it is said that you would need at least a few hundred thousand dollars. This could come from pension plans, Social Security, or investments. One advantage of paying out-of-pocket is that you can negotiate a private pay rate. This is especially likely when a nursing home does not have a waiting list and they want to fill beds. 

Reverse Mortgage: Another payment option is getting a reverse mortgage on your home. This would enable the homeowner to take from the equity accrued on the home while deferring the loan payments until the last homeowner has either moved out or dies. For this option to work, one spouse would have to continue to live in the home while the other is in nursing care. This option is a good way to leverage your home equity, but the amount of money you qualify for will depend on your age and the value of your home. 

Home Equity: This type of loan can be used to borrow money against the value of the home as collateral. Usually, a home equity loan is used to pay for a major expense such as home repairs or medical bills, but can also be used for nursing home expenses. Unlike a reverse mortgage, the equity received is not completely free. The loan must be paid back, with interest.

Long-Term Care Insurance: Long-term care (LTC) insurance generally covers care not covered by health insurance. LTC will cover long-term services and support, including personal and custodial care. Having a long-term care insurance policy will give you some peace of mind. This type of policy will pay a specific amount for long-term care for a stated length of time. This allows you to keep your assets, and the specified expenses will be taken care of.   

VA: Run by the Department of Veterans Affairs (VA), the U.S. veterans network has many benefits for those who’ve served their country. Like Social Security, veterans’ benefits are dependable and will be paid to you by the Department of Treasury. Some estimates for amounts a veteran may be paid can be up to $1,794 a month, $1,153 a month to the surviving spouse, or $2,127 a month for a couple. A new type of agreement for veterans has been created through the VA Mission Act of 2018, called Veterans Care Agreements. These are agreements in which the VA works together with community providers not in the community care network to provide care to Veterans. This ensures the veterans will get the care they need when the facility is not in the normal network. 

Medicare: Medicare is a federal government program that pays for hospital care and medical insurance to people 65 and over. It can also include specific ill or disabled people. About 40% of Medicare and Medicaid subscribers seek out nursing homes. However, Medicare doesn’t cover the room and board in a nursing home if the stay is long-term. Typically Medicare assistance is utilized when the nursing home stay requires short-term rehab after an inpatient hospital visit. Medicare covers 100 days of care in a skilled nursing facility, if at least 3 days were spent in the hospital. However only during the first 20 days will they pay for 100% of the care. The remaining days will require a co-payment, which could be about $167.50 a day. 

Medicare Part A is insurance for a hospital visit, while Medicare Part B is an optional supplementary medical insurance that costs a small monthly premium. There are also Medicare Part C Plans, known as Medicare Advantage Plans. These plans provide skilled nursing care coverage, though costs and benefits can vary. Additionally, there are Medicare supplement plans, called Medigap policies. They also help pay for skilled nursing care, but the care must be covered under the original Medicare plan. 

Medicaid: Another federal government funding program is Medicaid, the most common way people pay for nursing home costs. This program helps pay for select health services as well as nursing home care for those with low income. Medicaid works with privately-owned nursing home care facilities and then helps eligible residents pay for the costs. The program can pay anywhere from 45 to 65% of nursing home costs. However, Medicaid has strict eligibility requirements that consider the age, place of residence, and marital status among other things. To be eligible, your assets and income will be assessed to see if you fall below the line. As a general rule, a person’s assets have to be nearly gone to qualify. Additionally, they cannot receive more than around $2,250 a month in income. The requirements are different in each state. 

When you are first admitted to the nursing home, you may be required to pay out-of-pocket. Many people liquidate their assets before qualifying for the program. As Medicaid assesses your eligibility, they have complicated guidelines as to what qualifies as an asset. The person’s home is exempt from the assessment, as well as some marital assets. Here are a few things Medicaid will be reviewed to determine your financial eligibility:

• Social Security
• Wages
• Pensions
• Royalties
• Rents
• Gifts
• Annuities
• Investment dividends
• Savings interest
• Half of working spouse’s income

How to Pay for Assisted Living

An alternative to nursing home care is assisted living. An assisted living facility provides personal and medical assistance to residents, who can still maintain their independence. Personal care and skilled nursing services are available. Some care centers have a memory care facility for those with Alzheimer’s disease and other forms of dementia. Often this kind of facility provides a lower level of care than a nursing home. However, living in an assisted living home can still be pricey. The average annual cost is about $48,000. And in recent years, the cost of assisted living residency has increased up to $1,321 annually. 

Cash: Most residents and their families pay for this type of facility out-of-pocket. They use retirement accounts, personal savings, pensions, annuities, veteran’s benefits, and Social Security payments. However, $4,000 a month may be a bit more than most people can afford. 

Reverse Mortgage: A reverse mortgage may not be the best option for a person who is living in an assisted living facility. This is due to the fact if the owner lives out of the home for 12 months, the home may be sold. Of course, if a spouse is still living in the home, it is still a viable option. Otherwise, selling or renting the home would be better for an assisted living facility resident. 

Home Equity: Getting a home equity line of credit (HELOC) to pay for care may not be a good option for single individuals and married couples that are in good health. However, those that have immediate care needs may want to get a HELOC since there is not a requirement that they remain in the home, as in a reverse mortgage. Having a HELOC allows some flexibility when there is a sudden increase in care expenses, as well as the flexibility to come back home if care needs allow. It is helpful to think about the level of care as well as the duration the care will be required. 

Long-Term Care Insurance: LTC policies will pay for most assisted living facilities, as long as they are accredited. Your policy can pay for 100% of your costs, but this will be one of the more expensive insurance plans. A good rule of thumb for picking out a long term care policy is that your premium shouldn’t exceed 5% of your monthly income. 

You can receive anywhere from $2,000 to $10,000 on average through your insurance program. You can easily compare this to the average assisted living expenses at $4,000 to see that this type of insurance can be quite helpful. 

Though these facilities do accept these insurance payouts, sometimes the insurance company may not approve of the facility. Reasons the facility doesn’t meet the insurance company’s standards could be anything from small size to not having enough staffing. Therefore, it is wise to make sure your policy will be good for the care home you reside at. 

VA: The VA does some assisted living costs for veterans and their spouses. This is through the Non-Service Connected Improved Pension Benefit with Aid and Attendance program. It is required that the veteran had served active duty for at least 90 days and at least one day in wartime. 

Medicare: Though Medicare doesn’t pay for room and board at an assisted living facility, they may pay for medical expenses. This is also true for any medical services received in a hospital, doctor’s office, or home setting. 

Medicaid: Coverage for Medicaid varies from state to state. For instance, some states will only pay for personal care, while on the other hand others will also pay for room and board. Some states do not assist, but here is a list of most of the expenses that usually can be covered by most states: 

• Personal care services 
• Housekeeping services
• Meal preparation
• Laundry
• Case management
• Transportation
• Personal emergency response systems

Even with Medicaid services, some assisted living residents still have trouble covering the remaining costs. Some states may help these residents by placing limits on the amount the facilities can charge. If the resident still has an issue paying, there are other non-Medicaid programs like Supplemental Security Income that can assist. 

How to Pay for Home Care

Home care is becoming a more popular option as other long-term care choices rise in price. This option can be more affordable, plus you will have the ability to stay in the comfort of your own home. One disadvantage is that there are usually substantial out-of-pocket costs that may not be reimbursed. 

Cash: Many home care clients pay by way of their assets, savings, or investments. Family members may also pitch in to cover costs. They may liquidate assets like vacation homes, boats, land, or vehicles. Unfortunately, most of us do not have this option.

Reverse Mortgage: A good option to pay for home care would be a reverse mortgage if the individual does not need immediate care. This will allow them to live independently in their home for years to come until their health needs to take a turn. The proceeds from the reverse mortgage can then be used for long-term care insurance. 

Home Equity: Home equity loans are also an option you could use to pay for long-term care services. However, single individuals and married couples in good health might want to use it as a last option since their care needs are undetermined at that moment. Not knowing the extent of how much future medical care you will need leaves a big question mark for how much equity to take out. In which case, a reverse mortgage might be a better option for healthier elderly individuals receiving their care at home. 

Long-Term Care Insurance: It is important to be aware that some LTC policies will not pay for in-home care. In this case, it might be a good idea to convert the life insurance policy to cash to help pay for care. 

VA: It is possible for veterans and their surviving spouses who require personal care services may qualify for an Aid and Attendance (A&A) benefit, along with their monthly pension. This is available to those veterans who served at least 90 days of active duty or at least one day of active duty during wartime. It also includes those discharged from service under dishonorable conditions. 

Medicare: Some services covered by Medicare for in-home care include intermittent skilled nursing care, therapy, and home health caregiver assistance. Home health care may be covered by Part A or Part B, depending on the circumstances. Here are some instances in which you would be covered: 

• You are homebound
• You need skilled nursing services and/or skilled therapy care intermittently
• You have a doctor’s visit 90 days before you start a home health care
• You have a doctor’s vision 30 days after the first day you receive care
• Your doctor presents you with a home health certification stating that you are homebound
• You receive care from a Medicare-certified home health agency (HHA)

Medicaid: Medicaid and Medicare offer Programs of All-Inclusive Care for the Elderly (PACE) to seniors who need assistance through in-home care. PACE provides medical and social services to eligible individuals who wish to remain in the community rather than reside in a nursing home. Financing for the program is capped, allowing these providers to attend to what the individuals need, instead of limiting them to reimbursements through fee-for-service plans. PACE is offered through Medicare but is only available through Medicaid as a state-by-state option. This program is great for those with a limited income and few assets, and wish to stay at home. 

Preparing for the Future

Your eyes may be crossing with the dizzying array of numbers and options we’ve thrown at you. As you can see, each type of facility has many payment options available to you. Whatever option you end up choosing, knowing ahead of time what your choices are will help you prepare for the future. Establishing a plan ahead of time will give you some peace of mind and could save you money in the long run. Out of all the pay and care options out there, we here at CareAsOne hope you find the one most financially sound for your own needs. 

The phrase “alert and oriented” is one you may have heard in a healthcare setting. It refers to a description of one’s level of awareness of reality at that moment. Orientation can be described as being aware of person, place, time, and sometimes situation. Assessing one’s orientation helps in the evaluation of mental status. It could help in the diagnosis of dementia or other conditions, as well as generally assessing one’s cognition. 

Having problems with awareness can lead to disorientation, an altered mental state. This can be caused by numerous factors. Usually, the disorientation will affect one’s grasp of the situation first, then time, then place, and finally of the person. Being disoriented can also happen alongside some other common symptoms like:

• Confusion
• Delirium
• Disrupted attention
• Delusions
• Believing false things
• Agitation, aggressiveness, or restlessness
• Hallucinations
• Wandering

Perhaps your loved one is showing some of the symptoms listed above. If that is the case, we strongly recommend that they visit their doctor, where they will receive a mental status check. This status check is a common procedure which medical professionals conduct. Assessing one’s awareness should be performed after a variety of circumstances have occurred. Some common circumstances would be:

• When patient intakes are performed
• After a procedure in which anesthesia or painkillers were used
• To assess the progression of a disease or urinary tract infection
• To check a reaction to a medication
• After an accident, shock, or major trauma 

Assessment of Levels of Orientation

At times a patient might be perfectly capable of carrying on a normal conversation, but then not know their name. This is why checking one’s orientation is so important. Carrying out a mental status exam is as simple as the doctor asking a few questions. These questions may come across as small talk, but the simple answers they coax out are quite informative as to one’s cognitive abilities. Some assessment questions a doctor may ask could be:

• What is your name?
• Where are you?
• What is the date?
• What day of the week is it?
• Why do you think you’re here?
• What just happened to you?

The patient’s level of consciousness is then characterized in a mnemonic format. The acronyms AO or A&O (alert and oriented) are commonly used, while the abbreviation AAO (awake, alert, and oriented) can also be used. The acronym is followed by a multiplication symbol (x), then a number. Some examples would be AOx2 or AAOx3.

The level of awareness is expressed by x1, x2, x3, or x4. The number describes how aware the patient is, x4 being the most aware of reality. Here are the varying levels or orientation:

• Oriented to Person (x1): This person knows his or her name and can also recognize their significant others. The common questions to determine this would be, “Who are you?” and “What is your name?”

• Oriented to Person and Place (x2): This person knows his or her name as well as where he or she is.  The common question to determine this would be, “Where are you?”

• Oriented to Person, Place, and Time (x3): This person knows his or her name, location, as well as the day of the week, date, and season of the year. The common question would be, “What is today’s date?”

• Oriented to Person, Place, Time, and Situation (x4): This person knows his or her name, location, and time, as well as why they are currently being treated. The common question would be, “Do you know what is happening right now?”

Asking these questions when a patient is first being seen by the doctor can be compared against any following visits. Any change in the conscious state may help bring to light any underlying issues the patient may be having. Sometimes a patient can answer parts of the questions, but not all. They may know their name and what day it is, but don’t know exactly where they are. In this case, they would be considered AOx3 minus place.

It is also helpful to know that some medical settings only assess the patient’s knowledge of person, place, and time. Therefore AOx3 would be the highest orientation level instead of AOx4. In some settings like within emergency response teams, the letters can be documented as conscious, alert, & oriented (CAO) instead of awake, alert, and oriented (AAO). For example, it would read COAx4 instead of AAOx4. Often the emergency teams ask the patient questions before doing a physical examination in case there is a serious injury that is indicated from how they answer. 

Another completely different system of measuring the level of consciousness is the AVPU scale. This scale is typically used within first aid and emergencies. The acronym AVPU stands for Alert, Voice (responds to), Pain (responds to), and Unresponsive. Healthcare providers will determine what level the patient embodies checking in order from the best-case scenario (A) to worst (U). This is done to avoid any further tests on someone who is not conscious. When the determination is that the patient is alert, they can then pick up on the orientation scale and assess if they are x1, x2, x3, or x4. Still another way to assess the level of consciousness is through the Glasgow Coma Scale. 

Ailments Which Cause Disorientation

It is still unknown which part of the brain affects one’s awareness of reality, but lesions on the brain stem and hemispheres have been said to cause disorientation. This suggests that these parts of the brain work together to maintain awareness. There is an array of physical ailments or situations that cause disorientation. Some of them include:

• Vitamin deficiency
• Stroke
• Amnesia
• Concussion
• Carbon monoxide poisoning
• Dehydration
• Brain tumor or hematoma
• Fever
• Drug overdoses
• Epilepsy
• Hypothyroidism or hyperthyroidism
• Hypoxia
• Electrolyte abnormalities
• Renal failure
• Mitochondrial disease
• Orthostatic hypotension
• An emergency which causes distress
• Triggering of mental disorders

Though all of these can cause disorientation, we will go over some of the most common causes of this cognitive disability in the elderly. These include Alzheimer’s disease, other forms of dementia, and delirium. 

Alzheimer’s Disease and Other Types of Dementia

Alzheimer’s and other types of dementia develop slowly. The symptoms are consistent and progressive, disorientation, and short-term memory loss being some early signs. Alzheimer’s disease is a form of dementia that affects memory, behavior, and thinking. People with the disease commonly become disoriented about where they are, as well as time. They often think they are living in a much younger version of their lives from long ago. It is common for them to be confused about where they are as the disease progresses out of the early stages. They may believe they are living in a completely different area, perhaps even one in which they lived as a child. The late stages of Alzheimer’s could disorient the person to an AOx1 level where they do not even know their name. 

Someone unaware of their location and time can often start to wander and may even try to leave. For example, he or she may think they are in their childhood home, and that they must leave to go to school. It is common for Alzheimer’s sufferers to wander, getting confused, anxious, and lost. In this situation, being in a memory care facility is the best option to ensure your loved one’s safety. 

Other types of dementia do not all have the same orientation issues like Alzheimer’s disease. Alzheimer’s’ patients experience issues with awareness and memory, whereas with frontotemporal dementia, memory is more often impacted. However, disorientation does often occur in other forms of dementia like Lewy body dementia and vascular dementia, especially in the later stages. 

Family members’ interaction with the individual is critical for detecting dementia. Making sure they are aware of reality by asking them simple questions like where they are can help with early detection. These are questions you wouldn’t usually think to ask, but being aware of early warning signs can help get your loved one treatment sooner rather than later. When taking your loved one for check-ups with their doctor, he or she must note what questions they have asked, and what answers were given. The following visits may have different answers, indicating a progression of the disease. 

Delirium

Delirium is a sudden worsening or change in one’s mental state. He or she may experience reduced thinking capacity, short attention span, unusual speech, and hallucinations. People who are affected may become disoriented. Delirium may be caused by many things including a certain type of medication, an infection, a change of location, or a trauma. Someone can experience this mental state change after undergoing surgery or being in an emergency room. 

There are three types of delirium, including hyperactive, hypoactive, and mixed. Someone experiencing hyperactive delirium may be behaving with agitation and having hallucinations. Hypoactive delirium is characterized by drowsiness and becoming withdrawn. Mixed delirium may have symptoms of both of these types. 

Those experiencing this state change can see it go away within days or weeks. Not all cases are the same, and your loved one’s character may fluctuate. The disorientation may only last for a short period. However, if your loved one is acting disoriented without any warning signs from a known disease or other explanation, it is recommended that you take them to see a doctor immediately. Continue to assess their awareness and orientation while he or she is delirious to see the progression.

Ability to Participate in Legal Proceedings

Now we know a bit about those experiencing varying levels of consciousness. It can be easy to imagine that someone who doesn’t know their name simply cannot make decisions for themselves. But at what point are they considered unfit to determine their legal matters? 

Often someone with Alzheimer’s or another ailment which affects one’s consciousness level will need to sign a power of attorney for someone to handle their affairs for them. This should be done at a time they are deemed oriented enough to understand what is going on. Otherwise, someone with a low level of awareness may be coaxed into a decision that could be bad for them. It is also important that someone who is not properly oriented is not allowed to make any critical decisions for him or herself. Therefore their level of consciousness must be known by any attorney or judge involved in the process. 

As stated before, A&Ox4 is the highest level of awareness, indicating that someone is completely normal and based in reality. Comparatively, those with a level of A&Ox2 do not know what time it is or what is happening. Someone at this capacity probably will not carefully read and attempt to understand legal documents presented to them. Keep in mind, however, that the level can change from day-to-day. He or she may be an A&Ox2 one day, and then at an A&Ox4 the next. During the day they can also fluctuate from one end of the spectrum to the other. It is important to monitor your loved one’s awareness throughout the day to predict when he or she will be most alert.

Knowing the patterns of your loved one’s consciousness level can help know when it is a good time to put legal documents in front of them. The window of time when someone has the mental capacity to sign important legal documents is called a lucid interval. Even those with Alzheimer’s or other forms of dementia may experience lucid intervals. The interval can last anywhere from minutes to hours. Sometimes lawyers will meet with their disoriented clients a few times just to ensure their awareness of what they are doing, and that they understand the process. 

The attorney involved must be questioning whether someone might challenge the legal proceeding taking place. If, for example, the disoriented person is trying to leave all the ownership of his or her estate to one child, and not another, this may raise a suspicion of the attorney. The attorney must be sure to assess the person’s orientation level to be sure that he or she is deciding with awareness. 

The determination of whether or not the client is lucid enough is a mix of medical, legal, and psychological judgments. This is often done by the attorney and based on conversations with the client, their family members, social workers, and even medical advisors. Sometimes a judge will be involved in the process of guardianship decisions are being discussed. Medical doctors or doctors of psychiatry are not able to make the judgment of whether or not the disoriented person is lucid enough to make a legal decision. They do, however, give their evaluation of the patient to the attorney who will use it to make the determination. If the attorney still cannot decide based on all the evidence, a neuropsychologist may be sought out to evaluate whether the person is aware enough to understand the situation. 

How to Interact with Someone Who is Not Alert and Oriented

Dealing with a loved one who is experiencing disorientation is difficult. The person does not seem to be who you used to know them to be, which can be sad, frustrating, and confusing. However, despite how this change may make you feel, it is important to still treat your loved one with gentleness and kindness. Reminding them of the date, season, time of day, and location can help jog their memory. There are also a few other things you can do to help:

• Be aware of their habits, medical history, medications, and symptoms. By knowing these things and presenting any of the information can help the doctor determine a diagnosis. 
• Create a calm environment. You can do this by making their surroundings familiar to them. Surround them with their favorite objects to soothe them. If their location has to change, bring along these objects to give them some sense of familiarity. 
• Surround them with familiar people, including yourself. People that bring your loved one comfort will help calm and relax them, which can help ease disorientation. It is also helpful to be around when your loved one is examined by the doctor. Having a familiar face can help the doctor assess what their normal behavior is like. 

Person, Place, Time, and Situation

If your loved one is showing signs of disorientation and has yet to seek medical help, encourage them to visit their doctor. If he or she is so disoriented that they seem like a danger to themselves or others, call 911. We here at CareAsOne think that checking in on your loved one is not only good for their mental health but assessing their consciousness level can help you catch some diseases early. 

In this article, you have learned that determining someone’s awareness level is as easy as asking questions regarding their person, place, time, and situation. Asking these simple questions regularly will help you easily zone in on cognitive impairment. And keep at it. We commend you for your care and dedication to your loved one’s health and wish you all the best. 

The time has come. Every elderly person dreads the day they have to step out of their home to make their way to the nursing home. This transition can be complicated, emotional, and downright scary. You or your loved one may be worried about Medicaid planning, nursing home costs, home upkeep, health issues, and even putting the house up for sale. However, before you put that real estate sign up, you must understand some of the Medicaid rules regarding homeownership. 

The requirements for Medicaid qualification are a fine tightrope you must walk to qualify for the program. Or perhaps you or your loved one have already qualified with the house considered an exempt asset. You must realize that the sale of your home could throw off the balance of the Medicaid eligibility. In this article, we will detail some of the income and asset limitations Medicaid specifies, what could happen if you sell your home or not, and how to prevent Medicaid liens being placed on your property. 

Qualifying for Medicaid

If you or your loved one needs a nursing home or long-term care, there is a program that helps individuals with general health coverage or coverage for nursing homes or assisted living services. This is called Institutional Medicaid. You can enroll in Medicaid to help pay for long-term care. This program is meant for those elderly people with low income and few assets. 

All states have these programs, but the Medicaid rules and eligibility requirements are different in each state. The services that can be financed by Institutional Medicaid include room and board, nursing care, personal care, and therapy. Medicaid may finance 100% of your costs in a Medicaid-approved facility. Getting this financial aid isn’t easy though. You can only qualify for this program if you meet the nursing home eligibility requirements and have income and assets below the limits specified for your state.  

• Nursing home eligibility requirements: To determine you qualify for a nursing home level of care, states will assess how well you can function, as well as how much help you need with activities of daily living (ADLs). ADLs can include things like bathing, dressing, mobility, and toileting. 

• Income limitations: Income limits vary from state to state. However, the hard income limit for Medicaid in 2020 is $2,349. Some income sources are counted, and some are not. Check with your state to learn the rules that apply to you. Some states have programs for those over the hard limit but have high medical bills to spend down their extra income. 

• Asset limitations: It is said that a single Medicaid applicant can keep up to $2,000 in countable assets in most states. Some assets are considered exempt or “non-countable,” but often up to a specific amount. Once the specific amount is exceeded, the then “countable” asset will add to the $2,000 limit. Here are some common assets that typically qualify for an exemption:

• Primary residence
• Personal belongings
• Vehicle (1 only)
• Property essential to self-support
• Life insurance with a value of less than $1,500
• Prepaid burial plot/arrangements
• Assets held in specific kinds of trusts

Anything other than these assets listed above will be counted toward the countable asset limit. There are also different rules and limits for married couples when one is applying for Medicaid benefits. It is important to realize when you are applying for Medicaid that all of your assets will go toward the financing of your care. If you receive a large sum of money, you will be disqualified from Medicaid coverage until that money has been spent. 

Home Requirements

So the good news is that your house doesn’t count toward your asset limit in most cases.  If a spouse or dependent child is living in the home while you are in the nursing home, the home is considered exempt no matter what. If not, there are a few fundamental Medicaid qualifications for your primary residence to be exempt. 

• The home must be in the same state that the homeowner is applying for Medicaid in.
• The applicant’s equity interest of the home must be $595,000 or less, though some states set a higher limit of $893,000. The equity value of the home would be calculated as the fair market value minus debts. California on the other hand does not have a maximum equity value limit set. 
• The applicant has to continue to live in the home or have the intent to return home if they are in a nursing home. 

If you don’t fall under the above specifications, your home may count as an asset. If the home is determined to be a countable asset, Medicaid may use it to repay what they have spent to cover care for you, once you no longer need care or become deceased. This involves filing a lien for the property and could mean they will sell your home to pay off the lien in the future.  

Five-Year Look-Back Period: No Gifting or Transfers

The process of evaluating a candidate is rigorous. Besides meeting the specified asset and income requirements, it is also necessary for Medicaid to look back through five years of your financial statements. In some states, the look-back period may be less than five years. The program is very meticulous in ensuring the aid they give is needed. If at any point the applicant has transferred an asset for less than its fair market value five years previous to the Medicaid application date, it will disqualify their application and there will be a penalty period before you can apply again. This means you cannot shelter assets in the form of gifts or selling them for $1 to a family member. If the look-back uncovers any assets you’ve attempted to shelter, Medicaid will go after them to aid in the payment of your care. 

To Sell or Not to Sell, That is the Question

When deciding whether or not to sell the home, you must factor in any expenses or upkeep difficulties it may cause you or your family members. If you or a family member is spending a lot of time and money just to take care of an empty home, you might consider selling it. You have to determine the long-term costs it will produce and factor that into your decision. However, if the home is occupied, it might be a better idea to keep it. Let’s explore whether to sell or not to sell. 

Choosing To Sell

People usually choose to sell if no other family member needs to live in the home. This might be a good option for a single Medicaid recipient. Choosing to sell the home versus keeping it as an exempt asset means thinking in terms of how much of the recovery funds Medicaid would be looking to have paid back. If the care costs for the person are expensive, the amount of recovery could quickly diminish the home value. If this is a possibility, it might be a good idea to apply for Medicaid right before or after selling the home. If the Medicaid expenses won’t be significant, then maybe keeping the home would be a palatable option for the family.

While you own your home, it doesn’t count toward your income. But if you sell it, this will change your income and asset levels significantly. You will be taking an exempt asset and turning it into a countable asset, which likely exceeds the $2,000 limit. As a result, you will automatically be disqualified from the Medicaid payment system and will be in the private pay system. Once you have spent the money from the sale of your home, you can reapply for Medicaid assistance. This is called “spending down” your assets.

Spending Down Assets

If someone is over the income and asset limits, they will typically pay out-of-pocket for their long-term care until their assets have been diminished enough to qualify for Medicaid. This is called “spending down” their assets. You can spend down your assets by paying off debt, buying an annuity, taking a vacation, buying a funeral trust, or paying for long-term care. 

You could also consider the half a loaf gifting strategy in which you transfer about 50% of the funds to another party. This could prevent the anticipated recovery against the house, which could quickly eat up its value. Additionally, selling the home while the homeowner is alive enables the capital gains exclusion by reducing or eliminating the taxes owed through capital gains. 

If you do decide to sell your home and then spend down the funds, consider consulting an attorney to enlist some guidance in the best way to do so in your particular case. 

Choosing Not to Sell

It is important to be aware that the rate Medicaid pays for your care is going to be lower than the private pay rate. This means it is cheaper, in the long run, to stay within the Medicaid system by not selling home. 

If you decide not to sell your home, you may ask that your heirs simply wait till you are deceased to sell the house. Or they may choose to keep the house. Either way, you must realize that your heirs will most likely have to repay Medicaid due to liens being put on the home. Repayment can be done from the money made from the sale of the home or repaid from the heirs themselves if they keep the home. If the property is sold, the profits will go to Medicaid first as repayment for your care. Then what is left over will go to your heirs. 

Medicaid Liens

They say nothing in life is free, right? It turns out that even though your house may be considered exempt from your countable assets, it is possible that Medicaid can still put a lien on your home when you are in their system. A lien is a claimed right to the property until the debt owed has been paid. Having a lien on your property will guarantee that the government is repaid the money they provided for your long-term care costs. This is implemented through the Medicaid Estate Recovery Program (MERP) whose goal is to recover funds Medicaid has spent on its beneficiaries. MERP recovers the sum of these payments at the time of death through the deceased’s estate. 

This means that upon your death, the debt incurred is due and payable. First, your appointed heirs will be confronted with the bill. If they are unable to pay the money (they will be given the chance to get a loan to repay), Medicaid Estate Recovery may sell the home. The sale proceeds will first go toward the debt owed to the government as well as any expenses, and then the rest is given to your heirs. 

Depending on what state you live in, there are a few options that may protect this from happening. Planning for this situation is the best thing you can do. Talk to an elder care attorney about the best options for your situation. You can look into options like:

• Gifting the home: This creates a penalty that can be reversed in almost every state. If the advantages of gifting the property outweigh the consequences of a penalty, it is still a viable option. If the Medicaid beneficiary is incapacitated (as in the case of late-stage Alzheimer’s disease), a power of attorney with gifting rights must have been set up before incapacitation.

• Community spouse still lives in the home: A Medicaid lien cannot be placed on your home if your spouse is still living in it. The state will also not try to recover funds even after the community spouse has died. In the states that do attempt to recover funds, the community spouse may be able to gift the property. 

• Bypassing probate: There are a handful of states that attempt to recover funds through the probate process. This means that planning ahead of time to bypass probate could prevent the recovery of funds by MERP. Some strategies for this could include a living trust or changing the title to joint ownership with rights of survivorship. 

• Irrevocable trusts: An irrevocable trust which meets Medicaid requirements and includes the title to the home may help avoid recovery. However, if this trust has been transferred within five years, there will be a penalty. One exception to this is in a state where the community spouse is the sole homeowner and has the power to transfer the property title without affecting the nursing home spouse’s eligibility.

• Promissory Note: It may be possible to sell the home on a promissory note. This would change its status from an asset to a loan. This was a common strategy before the Deficit Reduction Act came into effect. Now, the rules make this option a bit more limited.

• Ladybird Deed: This deed is not available in all states. It transfers ownership of the property upon the death of the Medicaid recipient. Since transferring ownership while living, a Medicare beneficiary incurs a penalty, transferring upon death still incurs a penalty but it is not assessed. Since the beneficiary is no longer alive, the transfer cannot be considered a gift.

• Life estate: This form of ownership allows the parents to give the home to their adult child or family members. The parents then live in the house for the rest of their lives, but the house is already in the heir’s names.

• Caregiver exemption: In this rule, a parent is allowed to transfer the home to his or her adult child under certain circumstances. The adult child had to have lived with the parent at least two years before he or she moved into a nursing home or assisted living facility. Also, the adult child had to have provided care which delayed the parent from entering into the care facility.

Long-Term Estate Planning is Key

Thinking ahead is important to protect your savings and assets. Estate planning long-term will help you continue to support your family members but also still allow you to qualify for Medicaid. Think about possibly gifting things long before you require nursing home care. Doing so five years ahead of time may save you from lots of penalties incurred through Medicaid. 

If you gift things ahead of time, and in increments, you will not only avoid Medicaid fees but also avoid gift taxes, as well as the potential for estate taxes. Just make sure to find out what is the limit amount in your state for gifts not to be taxed in a given year. 

Entrusting an elder law attorney or a Medicaid planner for advice is a good idea in any decision you may choose. They can help you become aware of possible actions that could save you and your loved ones money in the long run. Whether you decide to sell or not to sell, we here at CareAsOne hope this transition goes as smoothly as possible.

Nobody likes needles. But these cringe-inducing skin-prickers are imperative in the delivery of IVs, which are a staple in the healthcare industry today. Chances are, you or your loved one will undergo some type of IV therapy in your medical history. The vast applications of this therapy reach anyone with cancer, to someone who simply experiences dehydration. It is used for both medical and nutritional purposes. In this article, we will define IV therapy, naming some common uses and types, then we will explore vitamin therapy as well as complications that can occur from IVs.  

What is IV Therapy?

IV therapy is the direct administration of nutrients and fluids into veins, allowing them to become immediately absorbed into the body by bypassing the digestive system. This is done by way of a small tube inserted into the vein, known as a cannula. IV therapy is short for “intravenous therapy.” Intravenous means “inside the vein.” This is the fastest way for nutrients to spread through the body and get to the organs. This mode of nutrient administration results in up to 100% absorption rate, in comparison to a 20-50% absorption rate when taken orally. 

You may have heard about IV therapy being the latest health trend popularized by athletes and celebrities. However, the history of injections and transfusions goes back centuries. Up until relatively recently, IVs have been used for medical intervention during an illness. But these days it has become trendy to utilize vitamin drips. Intravenous therapy can consist of incorporating fluids, blood transfusions, medications, or nutrients into the bloodstream. As you can see, different kinds of IVs are used for different purposes. We will first explore these uses:

Uses

• Fluids: Fluids can be administered by IV to replace or expand the number of fluids in one’s body. This could be done as a result of dehydration. A saline solution is the most commonly used fluid, a water-based solution made up of 0.9% salt. 

• Medication and treatment: A patient’s medications can be mixed with fluids like saline or dextrose solutions. Since the medication can spread so quickly to the entire body, this is a commonly used method in emergencies. IVs can also be used for chronic health conditions like cancer, by administering the chemotherapy treatment through the veins. IV medications also can replace oral medications which cause nausea or diarrhea due to the bypassing of the gastrointestinal tract. In certain cases, some in-home treatment plans allow patients with severe chronic pain to administer their pain medication intravenously.

• Blood transfusions: Blood product refers to the blood which has been collected from a donor and given to a recipient in the form of a blood transfusion. This often occurs in times when blood has been lost due to some trauma or surgery. It is also performed for people who are severely anemic. 

• Nutrition: People who cannot get nutrients through normal eating and digestion of food may get an IV containing things like salts, amino acids, lipids, dextrose, and vitamins. What they receive will depend on their deficiencies. 

• Sports: Intravenous therapy can be used by athletes for hydration, though these days the practice is not as common. This is due to the abuse of the method, enabling athletes to change blood and urine test results which would reveal their use of performance-enhancing drugs. These days athletes are not allowed more than 100mL every 12 hours. 

• Hangover: Dr. John Myers developed an IV solution consisting of vitamins and minerals in the 1960s. This was called the “Myers’ cocktail,” and was used for the treatment of hangovers, and general wellness. Clinics that serve these “cocktails” became popularized in the 2010s by celebrities. Heavy drinkers may experience acute ethanol toxicity, and thus use intravenous therapy to help increase their electrolytes and vitamins.

Types of IVs

The type of IV used depends on how long the treatment needs to take effect, as well as how much needs to be injected. It also depends on if more than one substance needs to be transfused at a time. Here are the 3 types of intravenous methods: 

• Bolus/IV Push: A bolus intravenous treatment is administered by a syringe into an access port that has been pre-established. The solution is delivered rapidly with one quick depression of the syringe, or over a few minutes. After a bolus dose of medication has been administered, sometimes an IV flush is added afterward, which includes a bolus of plain IV solution. This helps the medication push into the bloodstream. Some medications are not suitable for Bolus doses because of how quickly they can take effect. One such medication is potassium. Bolus doses typically take 15 to 20 minutes and incorporate 30 to 60 ml of fluids. This type of intravenous treatment must be supervised by a medical professional the entire time.

• Infusion/IV Drip: This type of intravenous treatment is infused slowly through the use of a catheter directly into the vein with a needle. The needle is removed once the catheter reaches the vein. Infusions can be administered in either a pump or a drip method. In the US, a pump infusion is the most common. Pumps are attached to the IV line, sending the medication solution into the catheter slowly. This is a useful method when the dosage has to be precise. Drip infusions use gravity to deliver a steady amount of medication over time. This is done with the medication solution dripping from a bag to your catheter by way of a tube. IV drips usually take 45 to 60 minutes. They will infuse anywhere from 250 to 1000 ml of fluids at a time. Patients can lay back and relax during this process. 

• Secondary/IV Piggyback: A secondary IV may be administered while an infusion is connected. Also called an IV piggyback, the secondary bag is held above the primary bad, allowing the fluid to flow into it. Connecting the bags reduces the need for more IV sites in the arm, meaning you get stuck with fewer needles. This is helpful as long as the two solutions are compatible with one another. 

Intravenous Vitamin Therapy

It’s all the rage. But since IV vitamin therapy has turned into a fad glamorized by the rich and famous, it may be hard to take it seriously. We ask, does IV therapy work when you incorporate vitamins? It turns out that having higher levels of vitamins and minerals directly shot into your bloodstream can lead to a greater absorption into the cells. This will allow them to fight illness easier and stay healthy longer. If these nutrients are taken orally and therefore absorbed through the stomach, there are a variety of factors that affect the body’s ability to efficiently do so. Some factors include things like age, health, genes, metabolism, and kinds of products and food we consume. Having a direct shot into our bloodstreams bypasses all of that. With a direct IV infusion, we are more easily able to treat a wide range of health issues. 

Treated Conditions

One of the more popularized vitamin cocktails is the Myers’ cocktail, as mentioned previously. Today these vitamin infusions are still popular and have a lot more benefits than simply treating a hangover. This type of therapy is also recommended for those who don’t eat enough, or who suffer from a condition that doesn’t allow them to properly absorb all the nutrients.

Some common conditions that can be benefitted by a Myers’ cocktail treatment are:

• Asthma
• Chronic fatigue syndrome
• Fibromyalgia
• Migraines 
• Muscle spasms
• Allergies
• Pain
• Sinus infections
• Respiratory tract infections
• Angina
• Hyperthyroidism
• Dehydration

Benefits

Besides the list of conditions above, there is a wide range of added benefits associated with various vitamin treatments. For this reason, many people who are otherwise quite healthy will utilize intravenous vitamin therapy to boost wellness and energy, among other things. The list of benefits of IV therapy goes on and on. Some of them are:

• Boosted immune system
• Energy boost
• Clearer skin
• Stress relief 
• Removal of body toxins
• Balance hormones
• Enhanced mood
• Better concentration
• Calmer and more relaxed
• Balance of blood sugar
• Quicker sports recovery time
• Better sleep
• Quicker jet lag recovery time
• More fertile
• Signs of aging reduction

Intravenous Vitamin Therapy Process

Each vitamin cocktail is tailored to each person’s needs. The client must be evaluated beforehand to make sure he or she is a good candidate for the treatment. Only rely on this medical advice given by a healthcare professional that you trust. Here is a breakdown of how the process usually goes: 

1. Before the treatment, the client’s medical history, medications, and allergies will be considered. There may even be a blood test performed just to see where the client’s nutrient levels are, and to infuse the proper amount into the IV. 
2. A pharmacist will concoct the solution in most cases, following a doctor’s specifications about your specific needs. 
3. Then, a qualified healthcare professional will disinfect the skin (usually on your arm), locate and access the vein, then secure the needle. There is only slight discomfort when the skin is first punctured. A dehydrated patient may have to experience this a few times till the nurse hits the vein. 
4. Then the vitamin infusion will begin, monitored by the healthcare worker. Once the catheter is placed, the infusion could take anywhere from 15 to 45 minutes. The amount and how quickly the fluid is given is influenced by factors like age, weight, type of treatment (IV drip or push), and medical condition. 

It is common for the patient will start to feel a boost immediately following the treatment but will feel all the effects fully 12 to 24 hours after. These effects can last anywhere from 8 days to 3  weeks. How long they last depend on the patient’s condition, the mixture, and the type of therapy. 

Common Intravenous Vitamins

So let’s talk about vitamins. The vitamins used in an infusion are water-soluble, which means your body will soak in the nutrients it needs, then excrete the rest through the kidneys and out through the urine. Infusions may contain a single vitamin or a cocktail mixture of vitamins and minerals. Some of the most common ingredients used for an intravenous vitamin drip contain vitamin C, B vitamins, calcium, magnesium, amino acids, and antioxidants. One particular antioxidant, glutathione, has been shown to improve rigidity, posture, speech, gait, and decreased body movement. There are multitudes of nutrients that can be infused into an IV treatment, but it is best to find what will work best with each person’s needs and tailor the infusion to that. 

Your doctor can assess your levels of these vitamins and minerals and recommend what would be best for you. However, it must be said that in general, most people can get enough of their daily nutrients through a balanced diet. Thus the need for an IV vitamin drip is questionable for most people. IV vitamin therapy really should only be utilized by those who have a medical need for it, and have been prescribed by a doctor. This is especially true since undergoing IV therapy does pose some risks associated with it.

Possible Complications

If you truly want to undergo intravenous vitamin therapy, make sure you do a fair amount of research first. Talk with your primary care physician to get his or her opinion on if it is right for you. Have them check for any vitamin or mineral deficiencies you may have that would be benefitted from such a treatment. Be sure that your doctor is also taking into account any medical conditions you have when making the evaluation. 

Also, be sure that the doctor you see regarding the treatment is professionally established and board-certified. The clinic that you plan to attend the procedure may not be closely regulated. Be sure to check out their reputation as a well-respected IV therapy clinic by looking at reviews. Make sure the clinic is clean, and that the medical professionals are washing their hands and changing gloves when necessary. You even have the right to ask for their credentials if you feel suspicious of their level of professionalism.  

Undergoing an intravenous treatment is typically a safe procedure and does not often have adverse effects. However, your treatment must be the right amount of vitamins and minerals for you, otherwise having a higher amount may increase the risk of negative effects. Here are some side effects that may result from IV therapy: 

• Phlebitis: Veins may become inflamed from an IV therapy treatment. This occurs when the cannula is too big or isn’t secured well. This can be prevented easily by the healthcare worker using the smallest needle possible. Symptoms of phlebitis include warmth, pain, swelling, and redness around the vein. 

• Extravasation: This occurs when the IV fluid leaks into the tissue that surrounds the vein. It also happens when the cannula is too large. Symptoms of extravasation include a burning sensation and swelling around the site of the IV

• Air Embolism: When an air bubble gets into a vein, it could be fatal. This is because the air can reach the brain, heart, or lungs. The best way to avoid this is to make sure the patient is well-hydrated and laying on their backs when the IV line is injected and removed. When an air embolism is occurring, the patient’s skin may appear blue, they may have a hard time breathing, and they can have low blood pressure. 

• Hypervolaemia: This occurs when there is an increase in blood volume that is out of the ordinary. This happens mostly to pregnant women, children, the elderly, or those with kidney issues. Some symptoms may be an increased heart rate and bloated neck veins. 

• Infection: If the IV line, port, or the site of the injected are not properly sterilized before the insertion of the IV, there is a greater risk of infection. This can easily be prevented through sterilization of everything beforehand. Symptoms may include pain, swelling, and fever.

Be Your Judge

Intravenous therapy has boomed in the last century, despite being a centuries-old technique. These days we have seen celebrities and athletes get pricked by needles, alongside people with a growing number of treatable conditions. The advancements in technology, equipment, and knowledge of proper techniques have caused this therapy to become a relatively painless and risk-free process. The successful treatment of a condition by IV often far outweighs the possible complications that can occur. However, you must be your judge. 

Besides weighing the possible complications, it is important to pay attention to who you are allowing you to treat you with an IV. Make sure you surround yourself with authorized experienced professionals that will treat you with the best care. And consider if something like treating a hangover is worth possible negative side effects. We here at CareAsOne hope that this article has given you a better idea of what you can expect from this type of therapy. Knowing your options can help you communicate with your doctor about treatments you might be interested in. From anything from chronic disease to stress symptoms, we wish you only the best health running through your veins.

Some conditions are eased with a healthy diet. One of these conditions is sarcoidosis. Sarcoidosis is characterized by granulomas, which are inflamed patches of red, swollen tissue usually affecting the lungs and skin. It can also develop in other organs. This condition is rare, affecting less than 200,000 people a year in the US. The symptoms that occur will depend on what organs have been affected. Usually not severe, these symptoms can get better without treatment after a few months or years. Some of them are:

• Dry cough
• Fatigue
• Shortness of breath
• Chest pain
• Red tender bumps on the skin
• Patches of bumps
• Blurred vision
• Red teary eyes
• Pain in bony areas due to cysts
• Painful, swollen joints
• Enlarged lymph nodes

When the disease is based in the lungs, it is called pulmonary sarcoidosis. In a few cases, people may see their symptoms appear gradually and worsen. These severe cases are known as chronic sarcoidosis. Additionally, because sarcoidosis patients have increased inflammation, they may also be at risk of other inflammatory conditions, like high blood pressure or lung disease. 

Causes

The exact cause of this condition is still unknown due to a lack of sarcoidosis research. However, it is speculated that granulomas form when the immune system has gone into overdrive responding to foreign substances like bacteria, viruses, dust, or chemicals. It has even been suggested it could be caused by an abnormal reaction to one’s body proteins. The granulomas could be a manifestation of the body attacking its organs and tissues. Though concrete evidence in the exact cause of granulomas is lacking, there are still some patterns that show certain demographics that are more at risk of developing sarcoidosis. This condition can happen to anyone, but here are the most at-risk groups.

• People between the ages of 20 and 40
• Women
• People with Scandinavian, Irish, Peurto Rican, or African ancestry
• People with the condition in their family

There is currently no cure but symptoms can usually be managed with medication like corticosteroids. Sometimes no treatment is necessary at all. It can even go away on its own. It is possible, however, that sarcoidosis can last years and cause damage to your organs in the process. Pulmonary disease is the number one common cause of death for those with sarcoidosis. To prevent the worsening of symptoms as well as the worst-case scenario, we highly recommend implementing a healthy balanced diet and supplements to your treatment plan. In this article, we will talk about some of the best foods you can eat, herbs and supplements you can take, and foods to avoid if you have sarcoidosis. 

Sarcoidosis Treatment Diet

Sarcoidosis is an inflammatory condition. Therefore the best way to treat it is to target the inflammation. You can do this by eating the right foods that neutralize the flare-ups. Although not a lot of research has been done on sarcoidosis specifically, there are other inflammatory conditions that have been studied. Results show that certain patterns of eating can help lower inflammatory levels. This is the case for a decrease in C-reactive protein found in the blood, which is an indicator of inflammation. 

Several popular anti-inflammatory diets incorporate these eating patterns. In general, they all incorporate whole foods. They also have lots of fruits, vegetables, herbs, spices, nuts, and seeds. Any of the following diets can work to help ease the symptoms of sarcoidosis, as well as contribute to weight loss. They are: 

Cuisine-based diets:

• Mediterranean Diet: This diet is based on the traditional cuisine of countries along the Mediterranean Sea, and is considered one of the best diets to prevent heart disease. It is particularly high in vegetables, fruits, whole grains, beans, nuts, seeds, and olive oil. Fish, poultry, and eggs are eaten in moderation, and red meat is eaten only occasionally. Low-fat Greek or plain yogurt is a good choice in the dairy department and only small amounts of cheese. Herbs and spices are used to enhance flavor to avoid the use of salt. But the staple of this diet is the higher intake of fruits and vegetables. Typically the goal is to eat 7 to 10 servings of fruits and vegetables daily. To make it truly Mediterranean, share meals with friends and family while drinking a glass of red wine. 

• Nordic Diet: This one is great for weight loss goals and lowering blood pressure. The Nordic diet centers around the cuisines of Denmark, Finland, Iceland, Norway, and Sweden. Staples of this diet include whole-grain cereals, like rye, barley, and oats, as well as berries and other fruits. Vegetables may include cabbage, potatoes, and carrots, alongside fatty fish like herring, salmon, and mackerel, and legumes such as beans and peas. Rapeseed oil, also known as canola oil, is used. This oil has a high amount of healthy monounsaturated fat, and also includes alpha-linolenic acid (ALA), an omega-3. 

Guideline-based diets:

• DASH Diet: This diet is especially helpful in lowering blood pressure by reducing sodium and eating foods rich in potassium, calcium, and magnesium. There are two versions of this diet, a standard version and a lower sodium version. In the standard DASH diet, you are able to consume up to 2,300 mg of sodium a day. With the lower sodium version, the limit is 1,500 mg of sodium a day. Compare this with the regular American diet which can have 3,400 mg of sodium a day. The stapes of the DASH diet include whole grains, vegetables, fruits, and low-fat dairy products. In moderation are fish, poultry, legumes, nuts, and seeds, which are limited to a few times a week. Red meats, sweets, and fats are allowed in small amounts.

• MIND Diet: This diet was designed specifically for preventing dementia and loss of brain function associated with aging. Therefore the foods chosen for the MIND diet are those that are said to promote healthy brain functioning. Some of them are vegetables, especially green leafy ones, berries, nuts, olive oil, whole grains, fish, beans, poultry, and wine. 

General Diet Rules

All of these diets above have certain elements in common. We have compiled them into some general rules to follow. Here are some general guidelines on foods to implement when developing your diet to treat sarcoidosis:

Antioxidants: Foods high in antioxidants can protect your cells from free radicals, and thus reduce excessive inflammation. Some of them include: 

• Garlic
• Onions
• Spinach
• Seaweed
• Extra-virgin olive oil
• Ginger
• Beets
• Blueberries
• Broccoli
• Flaxseed
• Green tea

Magnesium-rich: It has been shown that diets low in magnesium can lead to chronic inflammation. Those with low levels of magnesium have high levels of CRP, an inflammatory marker. They also have higher blood sugar, triglycerides, and insulin levels. Adding magnesium into the diet can reduce CRP, and thus inflammation. Magnesium can be found in:

• Fatty fish
• Dark chocolate
• Barley
• Bran
• Corn 
• Rye 
• Oats 
• Soy
• Brown rice

Use healthy oils: All oils are made up of monounsaturated, polyunsaturated, and saturated fatty acids. The ratio of how much of each of the three determine whether the oil is healthy or not. Healthy oils are considered the ones with a lower amount of saturated fats. Therefore oils with unsaturated fats, both mono and poly are the best for your overall health. Monounsaturated and polyunsaturated fats can help lower your cholesterol, thus helping prevent heart disease. For the sarcoidosis, we would most recommend using: 

• Olive oil
• Grapeseed oil
• Walnut oil
• Avocado oil
• Canola oil

Lean meats: Fish is the best choice when it comes to fighting inflammation, due to its high amount of omega-3s. Some of the best fatty fish are salmon, tuna, halibut, or sardines, and try putting one of them on your plate twice a week. Additional lean meats you can add to your diet in moderation are chicken, turkey, grass-fed beef, lamb, or bison. It is also helpful to remember to keep your portion size small when it comes to meat. We recommend the serving size of your palm. 

Healthy fats: Besides fish and cooking oils, you can find healthy fats in a variety of other foods. Many of them have omega-3s and magnesium, which are essential to fighting inflammation. We strongly recommend a diet that incorporates nuts and seeds. Some healthy fats we recommend are: 

• Avocado
• Walnuts
• Pecans
• Soy
• Flaxseed

Probiotics: Try implementing foods that contain natural microorganisms with live, active cultures of good bacteria. These bacteria will populate our gut and fight the bad bacteria. There have been studies indicating that this type of bacteria can help decrease our overall inflammatory levels. Some common foods containing natural probiotics or have probiotics added to them are: 

• Yogurt
• Kefir
• Kombucha
• Sauerkraut
• Pickles
• Miso
• Tempeh 
• Kimchi
• Sourdough bread

Prebiotics: Besides implementing foods that have good bacteria, it is important to eat foods that stimulate the growth of good bacteria. This mostly includes fiber-filled vegetables which help these bacteria not only grow but thrive. Some examples of prebiotics include:

• Jerusalem artichoke
• Onions
• Garlic
• Leeks
• Asparagus
• Bananas
• Oats
• Barley
• Apples
• Cocoa

Good Carbs: Consider adding to your diet foods that contain powerful carbohydrates instead of empty carbohydrates which have been refined. These powerful carbs include large amounts of fiber, protein, and antioxidants. You can find good carbs in vegetables, fruits, nuts, seeds, and whole grains. Here are a few of our favorites: 

• Strawberries
• Almonds
• Peanuts
• Chia seeds
• Oats 
• Quinoa 
• Brown rice
• Lentils
• Kidney beans
• Peas

Best Diet Plan for Sarcoidosis

Keeping with these diet guidelines, we have calculated what we believe is the best diet plan for sarcoidosis. A typical day on this plan would go as follows:

Early Morning: Green tea

Breakfast: 1 slice whole-grain toast with peanut butter and fresh banana and blueberry Greek yogurt parfait

Mid-Morning: An apple

Lunch: 1 cup of brown rice and bean salad, and green garden salad with fresh vegetables

Evening: Hummus, flaxseed crackers, raw vegetables

Dinner: 3 oz salmon with asparagus

A few other tips to go along with your diet plan would be to make sure you are drinking enough water and exercise. It is important to drink 6 to 8 glasses of filtered water daily because hydration flushes out toxins, thus decreasing inflammation. We also recommend exercising at least 30 minutes a day for 5 days a week. Exercise is important because it can stimulate the immune system, which produces an anti-inflammation response from cells. Before proceeding, however, get the go-ahead from your doctor first before implementing a new exercise routine.

Herb and Supplement Plan

Although there is not a lot of scientific evidence associated with herbs and supplements treating sarcoidosis, it may still be a good idea to incorporate them into your daily intake. Be sure to consult with your doctor whether or not the herbs and supplements will affect the usage of your medications. 

Herbs

Herbs may help strengthen and tone the systems of the body. Though there are no herbs that are said to treat sarcoidosis specifically, these herbs are said to help with inflammation. 

• Turmeric (Curcuma longa): Recommended dosage is 300 mg, 3 times a day. This could help reduce inflammation. Be sure to consult with your doctor because turmeric can increase the chances of bruising or bleeding when combined with anticoagulants or antiplatelet drugs. This includes medications like aspirin, naproxen, clopidogrel, and more. 

• Cat’s Claw (Uncaria tomentosa): Recommended dosage 20 mg, 3 times a day. This could help reduce inflammation. This herb should not be taken by people with leukemia, rheumatoid arthritis, lupus, and a few more autoimmune diseases. Cat’s claw also may have side effects when interacting with some medications, so be sure to get your doctor’s approval before taking it. 

Supplements

Using supplements is another good way to have an impact on inflammation. Make sure the use of these supplements is in line with your doctor’s medical advice. Here are some of the most highly recommended anti-inflammatory supplements: 

• Multivitamin: consisting of vitamins A, C, E, and B-complex, as well as minerals like magnesium, calcium, zinc, and selenium. 

• Omega-3 Fatty Acids: If you do not like fish, taking a fish oil supplement might be a better way to get your omega-3s. We recommend taking either 1 to 2 capsules or 1 to 3 Tablespoons of oil, 1 to 3 times daily. Check with your doctor first because fish oil could increase the risk of bleeding, especially if you take blood-thinners. 

• Probiotic supplement: Choose one containing Lactobacillus acidophilus, the most commonly used probiotic. We recommend 5 to 10 billion CFUs (colony forming units) per day. These are “good” bacteria that help regulate the bowels, creating an unfriendly environment for “bad” bacteria. They help keep a healthy balance of bacteria and preventing disease. Talk to your health care provider if you are taking immunosuppressive drugs, or have a suppressed immune system. Be sure to refrigerate your probiotics for the best results. 

• Bromelain: This is a mixture of enzymes that originate from pineapple, and is often combined with turmeric. We recommend taking 500 mg a day. Talk to your doctor before you take it as it could increase the risk of bleeding, especially when combined with some medications. 

Foods to Avoid with Sarcoidosis

Since there are foods that help sarcoidosis, there are also foods that make it worse. Here are some of the dietary restrictions we would recommend to keep the condition at a minimum. 

Avoid Sugar Spikes: Certain foods cause blood sugars to rise quickly, which is known as a sugar spike. The sugar spike can increase inflammation. Therefore, it is a good idea to avoid foods that cause sugar spikes. Some of them include: 

• Sugary drinks like soda, juices, and sports drinks
• Processed foods and baked goods like cookies and cakes
• Refined grains like white rice, bread, pasta
• Breakfast cereals with added sugar
• Honey and maple syrup
• Coffee drinks with added flavor and sugar
• French fries
• Onion Rings
• Donuts
• Dried fruit (often contains added sugar)

Avoid caffeine, alcohol, tobacco. Caffeine and alcohol can both cause dehydration, which is the opposite of what we want when decreasing inflammation. We recommend drinking only one cup of coffee a day, if at all. Large amounts of alcohol can cause inflammation in the intestines, therefore it should only be consumed in small amounts, like one glass of red wine a day. As for tobacco, it has recently been discovered that nicotine can activate neutrophils, a type of white blood cell, which can release molecules that can increase inflammation. 

Avoid red meat: Red meat, as well as processed meat, is rich in saturated fats, which leads to inflammation. Red meat would include meat from cows, pigs, sheep, and goats. Processed meats include bacon, hot dogs, pepperoni, sausage, salami, meat jerkies, and some deli meats. 

Support for Those with Sarcoidosis

Living with sarcoidosis is not easy. You may feel anxious and uncertain about your future health. Your symptoms may even interfere with your daily activities. We want you to know that you do not have to go through it alone. Besides implementing some of these diet and lifestyle changes we have touched on, you can also join support groups to help manage your sarcoidosis. You will find yourself among people who share the same experiences and emotions, and can also provide you with new knowledge of your condition. We here at CareAsOne hope this article has given you some tools to get started on your treatment journey. We wish you ease and success in your recovery. 

Perhaps you’ve had a slip, a cut, a hard fall. Your injury may seem small and insignificant, so you shrug it off. However, even small wounds can develop into bigger problems if you do not properly care for them. You must clean and dress the injury, occasionally monitoring its healing process. In this article, we will delve into the subject of wound care, how to properly change your dressing, and how often, as well as possible complications. 

Wounds

An open wound occurs when there is an external or internal break in your body tissue. Typically this type of trauma is not serious and can be treated at home. They are usually caused by falls, sharp objects, or car accidents. However, if there is a lot of bleeding or the bleeding lasts for more than 20 minutes it is best to seek immediate medical care. 

There are two classifications of wounds: acute or chronic. Acute refers to a new injury, while chronic means lasting over a longer period. Acute wounds can turn into chronic ones if they last more than a couple of weeks. Sometimes chronic wounds can even last years. An example of a common chronic trauma would be pressure ulcers. Typically occurring in patients lying in hospital beds, these ulcers can become long-lasting, especially if not being taken care of properly.  

Wound Complications

Infections: Infections occur when bacteria or other germs enter the injury and multiply. This can greatly delay the healing of the injury. Some doctors prescribe antibiotics. These may not be necessary, however, since most lesions are not infected. The overuse of antibiotic ointment or antibiotics in pill form can toughen the bacteria to where they are immune to the medication. But if your doctor believes you have an infection or even an infection in the peri-wound skin, antibiotics will be prescribed. If you have pain, this is the first sign of infection. 

Necrosis: If your injury is not healing, this may be due to necrosis. Necrosis is dead tissue in the lesion and occurs when parts of the skin or tissue under the skin dies. It is necessary to remove this dead tissue to allow new cells to regenerate. Removal can be done by your doctor with a sharp knife or surgical instrument. Your doctor may even recommend a medication that will help necrosis. 

Debridement: The removal of necrotic tissue or infected tissue is called debridement. When the body is allowed to remove the dead tissue on its own, this is called autolytic debridement. This works well with certain types of wound and their dressings. 

Once the doctor has cleaned and debrided your injury, they will place a temporary dressing, like a gauze dressing or gauze pad. This is called a dry dressing because no medication or ointment has been applied. 

Types of Open Wounds

• Abrasion: Also known as a scrape or a graze, this happens when your skin is rubbed against a rough surface. Road rash is a common example. This type of open lesion typically does not have a lot of bleeding. To avoid an infection, abrasions need to be scrubbed and cleaned before they are dressed. 

• Laceration: This is a cut or tearing of soft tissue. This occurs from sharp objects, tools, or machinery. If the laceration is deep, there may be a fast rate and amount of blood flow.

• Puncture: Punctures are small holes produced by long, pointy objects like nails or needles. A bullet can even cause a puncture. They do not bleed much, however, they can be so deep that they damage organs. It is important to get a tetanus shot if you get even a small puncture. 

• Avulsion: Avulsions occur when skin and tissue have been partially or completely torn away. This can happen from explosions, gunshots, and other brutal accidents. 

Depending on the severity of the injury, it can be treated at home, or in a doctor’s office. 

Home Wound Care

If your injury is minor, you can easily treat the trauma at home. Practice good hand hygiene when touching your injury or items that come in contact with the injury. Sterile technique is imperative in reducing the spread of microorganisms to the wound.

Make sure to wash and disinfect the area, making sure to clean away any dirt or debris. Apply direct pleasure and elevate the injury to slow down the bleeding and swelling. Wrap it with a sterile dressing. You may not even need a bandage if the injury is minor enough. Keep the injury clean and dry for about five days. 

If you experience some pain from the injury, you can take a Tylenol as directed on the package. Stay away from aspirin as it can stimulate blood flow. If you have any bruising or swelling, apply an ice pack. If you will be outside, use a sunscreen with an SPF of at least 30 on the area. 

Medical Wound Care

If your injury is more serious, a doctor will need to take care of the wound. He or she will clean and may numb the area, then close it with skin glue, sutures, or stitches. A tetanus shot will be administered if the injury is a puncture. 

Your doctor may not close it, depending on its location. Some circumstances necessitate natural healing. This is called healing by secondary intention, where healing starts from the base of the wound bed to the epidermis. Often this kind of injury is packed with gauze to prevent infection and abscesses. 

Doctors often prescribe pain medications for open wounds. Penicillin or another antibiotic is prescribed if an infection has occurred, or if there is a risk of developing one. If something as serious as the severing of a body part has occurred, the body part should be brought to the hospital. To preserve it as best as possible, wrap it in a moist gauze, then pack it in ice. The sooner it arrives at the hospital, the better chance it can successfully be reattached. 

How Often to Change a Wound Dressing

The frequency of changing a wound dressing largely depends on the injury, and what type of dressing you are using. You will be advised by your doctor how often to change it. It will also be necessary to change it if it happens to fall off, becomes too wet, or gets dirtied by the external environment. 

After surgery: The first few days after surgery the wound will drain fluid. Bandages will quickly soak this up. Change as often as needed to keep the area clean and dry. The wound care dressings should be changed before the gauze becomes soaked by drainage. With a surgical wound, this could be anywhere from one to four times daily. If the bandage is wet when you change it, this is a sign you need to change it more often. 

Wound Dressing Change

Make sure you have all your wound care supplies assembled before getting started. You will need:

• A pair of non-sterile gloves
• A clean surface to place everything. You can place a clean piece of aluminum foil or paper to cover if your surface is not clean. 
• Ointment, if prescribed
• Q-tips
• Bandage tape, if needed
• The new dressing or dressings you are going to apply
• Normal saline or wound cleanser
• Sterile gauze for cleaning or wiping the injury
• Plastic bag for trash

1. Remove the Old Dressing

1. Thoroughly wash your hands with soap and warm water.
2. Put on non-sterile gloves.
3. Remove the tape carefully.
4. Gently remove the old dressing. It may stick to the skin; if so, sprinkle some warm water to loosen it. 
5. Remove any gauze pads or packing tape inside the injury. 
6. Place the old dressing and packing material into a plastic bag. Then remove your gloves and place them in the bag; set the bag aside. 

2. Assess the Wound

Wound assessment is important for catching any possible complications. Take a good look at the amount of blood exiting the injury. Notice the color and any drainage that is occurring. Is the drainage darker or thicker? Is there any increased redness, swelling, or bad odors? A small amount of bleeding is ok because it helps purge dirt and other contaminants out of the lesion. If there is heavy bleeding or worsening of the injury, medical care may be needed. Consult your healthcare professional. 

3. Clean the Wound

To clean a fresh wound: 

1. Wash hands and put on a pair of non-sterile gloves.
2. Clean the injury with running water, or use a moistened, soft washcloth.
3. Gently wash the skin surrounding the area of trauma with soap. Be careful not to get soap in the injury, as it can sting and cause irritation. However, it will not harm otherwise. 
4. Rinse thoroughly. Gently pat dry with a clean towel. Be sure not to rub it dry. 
5. If there are any particles like gravel or broken glass use tweezers to carefully remove them. 
6. Remove gloves and put them in the plastic bag.
7. Wash hands again.

You can use wound cleansers or saline to clean the injury as well. Here are some things to clean an injury with, and some to avoid:

• Saline: Considered the most appropriate cleaning solution, saline can easily be made at home. To make saline, sterilize water by boiling it for 20 to 30 minutes. Or you can use distilled water that has been boiled and filtered. Mix one cup, or 8 ounces, of distilled water with ½ teaspoon of table salt. Do not use sea salt since it contains additional chemicals. Stir salt in water till it has dissolved. Store in an airtight container in the refrigerator if possible. 

• Tap water: You can’t go wrong with cleaning with plain tap water. Along with saline, it is one of the most effective liquids that can be used to clean an injury. No need to complicate it.

• Wound cleansers: These are solutions that remove debris, exudate, and contaminants. They can also be used to irrigate an injury with a deep cavity. Some common ingredients could be surfactants, moisturizers, wetting agents, or antimicrobials. Wound cleansers can come in a rinse or no-rinse formula.  They can be used with gauze, sponges, or put into a device for irrigation and debridement.

• Antibiotic ointment: This ointment can be used to help reduce pain from raw injuries like abrasions. However, an antibiotic ointment is not necessary for cleaning. 

• Hydrogen peroxide: We do not recommend using hydrogen peroxide for cleaning an injury. It can even be harmful. It tends to bubble, which creates oxygen gas. The blood cannot handle this and could cause a gas embolism, which could be fatal. There isn’t a lot of proof that hydrogen peroxide helps with minor lacerations. It is best to stay away from antiseptics and disinfectants when cleaning an open wound. 

4. Cover the Wound

You should cover the area if it will come in contact with clothing or dirt. Use adhesive bandages for minor lacerations and abrasions. If the cut is less than 2 cm long, you can close it with butterfly bandages. But if the edges of the lesion cannot be pulled together easily, you may need stitches. 

There are a wide variety of wound dressings out there on the market today. There are those that dry, those that moisten, and those that protect. It all depends on your injury’s needs. Here is a summary of some common dressings and their purposes: 

• Gauze dressings: Great for minor injuries, as a primary dressing, or secondary dressing.

• Hydrogels: These work well for dry wounds or especially painful ones. 

• Alginates: Helpful for injuries with lots of drainage due to their ability to absorb moisture. These dressings for moist wounds need to be changed often. 

• Foam dressings: These work well for odorous injuries, and those thick wounds with a lot of discharge. Use for pressure injuries. 

How to Apply a Wound Dressing

Healthcare providers may prescribe an ointment to put on the injury. They may be used to protect the skin, kill bacteria, or help the wound heal faster. One of the most commonly prescribed ointment is silver sulfadiazine, which has antimicrobial properties. Ointment comes in gel, liquid, or spray. Some people prefer Vaseline because some people have allergic reactions to some perfumes in other moisturizers. Additionally, you may want to stay away from drying medicines like mercurochrome or lotions containing alcohol. You will apply it before dressing the injury:

1. Rewash your hands with soap and warm water for 20 to 30 seconds, then dry. 
2. Put on a pair of clean non-sterile gloves. 
3. Apply any ointment your doctor may have prescribed. Apply as directed. If necessary, use a clean Q-tip or cotton swab to spread it across the area. 
4. Pour saline into a clean bowl. Then put gauze pads and packing tape that will be used into the bowl.
5. Take out of the bowl, and squeeze the saline out until it is not dripping. 
6. Place the gauze pads or packing tape in the injury. Make sure the wound is filled, with no spaces open under the skin. 
7. Cover the wet gauze or packing tape with the primary dressing. 
8. If recommended by your doctor, add a secondary dressing. This dressing may have an adhesive part that holds it in place. Or, you may have to secure it with bandage tape. If a secondary dressing has not been recommended,  you can secure the primary dressing with bandage tape. 
9. Remove gloves, throw them in a plastic bag. Close the bag, then place it into another plastic bag, then securely close it. Throw away. 
10. Wash your hands. 

Complications

The main complication to proper healing is the risk of infection. If you have a puncture, deep laceration, have had a serious accident, or are bleeding significantly, call a healthcare professional. Also, call a doctor if you have: 

• A wound that isn’t healing
• Increased pain
• Increased redness
• Swelling
• Bleeding
• A tender lump in your groin or armpit
• Increasing in size or depth
• Increased drainage
• Drainage has not decreased after 3 to 5 days
• Drainage has a foul odor, 
• Drainage is thick, tan, green, or yellow
• You have a temperature over 100.5°F (38°C) for more than 4 hours continuously

These are all signs of infection. Your doctor can drain or debride the lesion. They will probably prescribe an antibiotic if a bacterial infection has developed. You may have to receive surgery to remove infected or surrounding tissue. 

Here is a list of other possible conditions caused by open wounds: 

• Lockjaw: This occurs due to a bacterial infection, and is characterized by muscle contractions in your neck and jaw. 
• Necrotizing fasciitis: This is an infection caused by Clostridium and Streptococcus bacteria, and can lead to sepsis and tissue loss.
• Cellulitis: This is when an area of your skin becomes infected that is not in contact with the injury. 

Always Consult Your Doctor

As a disclaimer, we should say that this article is meant for informational purposes only, and not intended as medical advice. Always consult your doctor when it comes to your wound management needs. We here at CareAsOne wish you quick healing and recovery.