Transitions new progress

Transitions
A Family Caregiver Workbook
This helpful booklet is full of support groups, articles on understanding the
Health Care System, Home Care, Home Health, Hospice, Senior Housing,
Medicare, Social Security, and much more.
A
FREE
Publication

Let Us Help.Let Us Help.
We help take care of Mom or Dad so
you can relax and be the daughter.
(713) 521-2221
(Providing Personal Caregivers throughout
Greater Houston since 2003)
www.AmbassadorsCare.com
insured, bonded, licensed by department of aging and disability svcs
Ambassadors Caregivers
Tired of being
Super Hero?

Ambassador Foundation, 501©3 Non-profit Organization
©2015, All Rights Reserved
Physical Address: 2118 Oakdale St, Houston, TX 77004
Mailing Address: PO BOX 301189, Houston, TX 77230
Office: 832.819.0505
Fax: 832.460.3000
Email: info@myAmbassador.org
Website: www.myAmbassador.org/transitions
Editor: Victoria Ai Linh Bryant, PharmD
Special Thanks:
Andrea Hoxie
Ron Bryant, MD
Michael Gorman
Thao Pham
Photographer Michael Hoang Huynh
Rose Rios, The Gardens of Bellaire
i

This workbook is dedicated to
Rachel Dang,
a friend, a fighter, a transplant recipient, a giver of life,
and a servant of humankind.
As a healthcare provider and a caregiver, I have encountered numerous
individuals and families who are not prepared or equipped to care for
themselves or loved ones. When faced with life and death circumstances, they
make rash decisions that do not reflect the patient’s true wishes and desires.
Often, it is due to the lack of understand of what those wishes are.
It is for those reasons that Ambassadors Foundation developed this workbook:
to help you and your family take a proactive approach to planning ahead while
considering the healthcare goals for everyone involved. Because the healthcare
systems and processes can be complex and frustrating, this workbook provides
resources to help you navigate these challenges.
Whether you are in the 30s, 40s, 50s or beyond, it is a good time to
communicate and write down how you want to live out your life. If you are a
family caregiver, it is also a good time to talk with your loved ones’ about their
golden years, so that any decisions made are true reflections of their wishes.
It is never too early to start the dialogue, and the discussion is inevitable. This
workbook serves as a guide to help you and other co-caregivers understand how
to better care for your loved ones.
So don’t delay. Start today. Plan your care, and care for your plan, so no one else
has to second-guess your wishes.
Victoria Ai Linh Bryant, PharmD
President, Ambassador Foundation
ii

iii
Table of Contents
Dedication Page ii
Introduction 2
Having the Talk 3
Personal Wishes and Goals 4
General Assessment CHART 5
Home Care or Personal Assistant Services 6
Health Checklist - Medical Information 7
Architectural Designs to Live Independently 8
Medical Information Checklist 10
Health Checklist – Medication List 11
Senior Housing Choices 12
Home Health Care 13
Long-Term Acute Care Hospital (LTAC) 14
Skilled Nursing Facility (SNF) 16
Transportation Checklist 17
Out of Hospital Do Not Resuscitate Order (OOH DNR) 18
Long-Term Care Insurance (LTC) 19
Home Maintenance Checklist 20
Advance Directives 21
Financial Checklist 22
Knowing Your Medicare Options 23
Medicare Plans In Harris County 25
Personal Information Checklist 26
Social Security: What You Should Do at 62 27
What is Hospice? 30
911 Emergency Kits 31
Community Resources 32
Advertisement pages 33

2
PROOF
Ambassador Foundation | 832.819.0505 O | www.myambassador.org/transitions | info@myambassador.org
IntroductionWhen it comes to planning for the future, we think about our children’s college education,
wedding costs, and retirement funds. But there is one thing we often forget to include: having
a care plan for an aging parent or loved ones. We tend to think about caring for them when it
hits us between the eyes, and at that point, we scramble to balance our personal life, stretch our
finances and struggle to find the resources that will help us.
We should have a clear understanding and an open dialogue to help loved ones age gracefully
while maintaining their independence. We should discuss possibilities and prepare for practical
changes without an abrupt disruption in family dynamics. When we prepare and expectations are
known, a peaceful environment is sustained.
The purpose of this workbook is to create a dialogue with an aging loved one and begin thinking
about how the rest of their life will play out in order to care for them appropriately. This alleviates
the sense of guilt, lessens the stress, creates a better balance with your own personal life and
enables you to know what they want. There are articles between the workbook pages on topics
related to caring for an aging loved one. Community resources are listed in the back of the book
if you need to reference them.
What is the Strategy?
To understand the wishes and desires of your loved ones
To understand your role and other family caregivers involved
To have legal, financial and other necessary documents ready
To understand the healthcare process and what they mean
To be knowledgeable about available resources

3
PROOF
HavingtheTalk
withMomorDadIn many cases, our loved ones age quite gracefully
and can remain completely independent at an
advanced age. In other circumstances, limitations
may set in earlier. Regardless, it is recommended that
family members initiate discussions with an elderly
or disabled loved one to ensure his/her physical and
emotional needs are being met and consider options
for additional care. For that reason, Ambassadors
Caregivers developed THE TALK, an easy-to-
remember method that outlines key message points
for such a conversation.
THETALK
T Transportation concerns. “How safe do you feel when driving? Is it a hassle getting
groceries, going to see the doctor, etc.? Are there more dents or scratches on the car?”
H How is he/she? “How are you feeling these days?” Addressing the emotional needs of
seniors cannot be overestimated. Up to 32 percent of individuals referred to physicians for
dementia are actually suffering from depression.
E Errors with medications. “Are you having trouble keeping all your medications straight?
Can you show me how you do it?”
T Transition/Transfers. “It looks like you have a little more trouble getting around the house,
huh? What about getting from your bed to the walker/wheelchair?” The statistics on falls and
risk factors are alarming for seniors.
A Assistance. “Do you need some help with chores around the house? What about getting
yourself ready in the mornings?”
L Look. “How does he/she look? Are there signs of weight loss, dehydration, or weakness? Is
Mom no longer caring for herself the way she used to?”
K Kickstart talks about assistance. “I know you like your independence. Have you ever
considered getting a little help so you can stay as independent as possible? I was thinking it
might be good if you had a little help around the house.” Or, “What do you think about maybe
making your life a little easier at a nice retirement facility or getting someone to come over and
help from time to time? It would free you from having to worry about as many things.”

4
PROOF
Personal Goals and Wishes
of an Aging Loved One
Whether it is to remain independent, volunteer, or give to charity, it is important that we
incorporate a care plan with that of our loved ones ….
Start by asking your loved ones which of these is important to them. Take the time to understand
their wishes and help make it a reality.
______ Remain at home for as long as possible
______ Remain as independent as possible
______ To move to a smaller home
______ To volunteer and be involved in the community
______ To move to a different location
______ To give to charity
______ To travel
______ To have a pet or keep existing one(s)
______ To move closer to family and friends
______ To start or focus on a hobby
______ To continue working
______ To be financially independent
______ To find a companion
______ To maintain an independent and active lifestyle
______ To go back to school
This form can be downloaded at www.myambassador.org/transitions

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PROOF
Personal/Medical Information Tasks Person In Charge
Living Arrangements &
Home Maintenance Home safety evaluations
Home maintenance & upkeep
Grocery shopping & Meal preparation
Lawn care & Pet care
Housekeeping
Name
Phone
Email
Financial Information Paying mortgage/rent, utility bills
Tracking Financial Records Name
Phone
Email
Transportation & Appointments Driving Safety
Coordinating Physician visits & Appointments
Transportation to salons, shopping, outings
Name
Phone
Email
Personal Care Organizing professional caregivers
Solicit family members & friends’ help
Personal care: bathing & grooming
Neighbor or friend to check in frequently
Social functions
Name
Phone
Email
Healthcare Make appointments
Explain medical decisions
Coordinate prescription pick up
Prepare pillbox & monitor medication compliance
Order medical equipment and adaptive devices
(wheelchair, cane, walker, medical alert)
Name
Phone
Email
Communications Keep family members informed
Coordinate visits
Name
Phone
Email
General Assessment Chart

6
PROOF
Home Care or Personal Assistant Services?
What is home care?
Home care is a non-medical professional caregiver serviced by a licensed agency to help clients
in their home with activities of daily living (ADLs).
How is it different from home healthcare or hospice?
Home care provides non-medical services such as personal hygiene, transportation, toileting,
light housekeeping, medication assistance, companion care, feeding, and meal preparation.
Home healthcare provides the medical component while the patient is at home. Services include
physical therapy, nursing care, wound care, social services and other medical needs.
Hospice care is palliative care and comfort care usually provided during the last 6 months of an
individual’s life.
How is service started and who pays for it?
The client and/or their family can initiate service anytime. Private pay and long-term care
insurance usually covers this service. Regular health insurance and Medicare do not typically pay
for this service. Medicaid clients will have to contact Medicaid to be qualified for this service.
What services are provided?
aCompanion care aMedication Assistance
aMeal prep and feeding aLight housekeeping
aLight laundry and ironing aTransportation and errands
aPet or plant care aPhysical assistance
aBathing and toileting aGrooming and hygiene
aAttend social or church functions
Who should use this service?
aThose recently discharged from the hospital and need help during their recovery
aThose who are frail and need to take fall prevention measures
aThose who need extra help to age in place at a senior community
aFamily caregivers who need a break, run errands or need extra help
aFamily caregivers who need an advocate or an ambassador for their loved one
aThose who need a companion
aThose who need help getting to an appointment or function
aWhen family or friends cannot be around to help

7
PROOF
Health Checklist - Medical Information
Items Notes Where is it kept?
Durable Power of Attorney
For Health Care
Medicare Number
Medicare ID Care
Medicare Part:
Medicare Advantage Plan Plan Number:
Medicare Prescription
Drug Coverage
Medicaid Number
Medicaid ID Care
Do Not Resuscitate Order
(DNR Order)
File one at MD office
Keep one in a visible place at home
Health Insurance Policy:
Premium:
VA ID #
Advance Directive

8
PROOF
It is unlikely that any of us want to move into a nursing home. But the reality is that many of us
will end up in a nursing facility if we do not plan properly. According to the National Institute
of Health, eight out of ten seniors want to remain in their home as long as possible. More than
53 percent of falls occur in the home setting with 30 percent being in the living area and the
bedroom. These falls cause 95 percent of all hip fractures.
To remain in your home, you need to begin preparing now by moving to a suitable place
that allows you to age in place for as long as possible or by remodeling your current living
arrangements so you can live longer and safer in your home.
These are some insights for you to consider when making those changes or finding a new living
space.
General Considerations
aTo have at least one step-free entrance into the home
aA home with a bedroom, full bath and kitchen on one level
Fixtures for Safety
aConverting doorknobs and faucets to lever handles
aConsider kitchen countertops mounted at varying
heights, to be used while standing or seated
aDoor handles and light switches should be below 48
inches high.
aEnsure bathtub or showers have a non-slip surface
aInstall strong and sturdy grab bars and towel racks in
the bathroom
aAll areas of the home should be well lit from all loca-
tions: outside, hallways, bathrooms, and bedrooms
aInstall low or no-threshold stall showers with built-in
benches or seats
aAdd grab bars to bath walls using specially designed
hollow-wall anchors.
aHave hand-held showerheads
Construction and layout
aCarpet pile should be less than ½ inches thick.
aConsider 36 inches doors and 42 inches hallways
aInstall reachable controls and switches: 42-48”, outlets 18-24” from floor
aEnsure windows can be opened with minimal effort
aInstall shallower, but taller, pedestal sink for easier wheelchair accessibility
aIncrease safety rails on both sides of the bathroom
Architectural Designs to Live Independently
“Is your home conducive to live in till you’re 99?”

9
PROOF
Paint and Decorate for Living
aPaint doorstep edges, especially those with different thresholds
aClear clutter and unnecessary décor; move everything off the floors and onto the walls
aRemove throw rugs and tack down carpet
aHave a “landing area” to place keys, coats, purse, etc.
aRemove untacked rugs/carpets
aEliminate chairs and stools with wheels
aReduce hot water temperature to less than 120 degrees F.
aCoffee tables should be made clearly visible by color contrasting.
aChairs must be contrasting to the floor
aChairs need to be light enough to move around but stable enough not to tip over
aRaised front-loading clothes washers, dryers, dishwashers, and side-by-side refrigerators
aEasy-access kitchen storage (adjustable-height cupboards and lazy Susan’s), Multi-level kitchen
countertops with open space underneath, so the cook can work while seated
Personal Safety First
aWear non-slip, low heeled shoes
aAvoid walking in socks
aKeep it simple and routine
aRemove clutter off the floor
Preparing to age in place means you have to prepare for all possibilities, such as being
wheelchair bound. Aging can cause depth perception, spatial orientation, reduced ability to see
contrast, and altered color perception. Older people need three times as much contrast to find
objects than the younger folks. All these considerations help to keep you safe and independent
while you remain at home.

10
PROOF
Medical Information Checklist
Personal Information
Name
Retirement Community
Address
Date of Birth
Social Security
Phone Number
Emergency Contacts
Name
Relationship
Phone Number
Name
Relationship
Phone Number
Primary Care Physician
Name
Address
Phone Number
Specialty Physicians
Name Physician
Specialty
Address
Phone Number
Name Physician
Specialty
Address
Phone Number
Profile Last Updated:
My Allergies:
My Medical Conditions:
Name Physician
Specialty
Address
Phone Number

11
PROOF
Medication Form Dosage
How Much &
When
Use
Start/Stop
Dates
Notes
1 Aspirin Tablet 325mg
1 tablet in the
morning
Everyday
Jan 3, 2000 -
ongoing
Take with food
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
* Examples of Over-the-Counter, Vitamin Supplements and Herbals: CQ10, Garlic, Vitamin D, hydrocortisone cream, bengay cream,
mederma, Theraflu, etc.
* Many Over-the-Counter, Vitamin Supplements and Herbals may appear insignificant or unrelated to our medication history but in
reality can enhance, negate, or cause significant drug interactions with our prescribed medications.
* It’s important to list all Over-the-Counter, Vitamin Supplements and Herbals so that our healthcare providers have a more thorough
history especially if we become ill or hospitalized. Vitamin Supplements and Herbals are not regulated by FDA therefore do not hold
the same standard of manufacturing like our prescription medications. Active ingredients and fillers may vary depending on the
manufacturers. Caution should be taken and consultation should be sought when buying or consuming them.
Health Checklist - Medication List

12
PROOF
Senior Housing Choices
There are many levels of senior housing
available depending on the need, costs,
amenities, qualifications, and preferences.
Senior living and levels of independence can
be broken down in to three types of housing.
The most independent level of housing is
the 55+ senior living communities or one’s
own home. Independent living communities
are like apartments and do not have licensed
nurses on staff. One has to be completely
independent to reside there.
The next level of care is the assisted living
community. Assisted living homes with under 16 beds are called personal care homes. Assisted
living communities are paid for privately or via long-term care insurance. Medicare does not
cover this type of housing. The cost can range from $3000 to more than $5000/month with
add-on services. In assisted living communities, one has a private room or semi-private room, a
shared dining area, medication management, assistance with bathing and grooming, a calendar
of activities, a nurse on staff around the clock, housekeeping, two meals a day, and other
amenities depending on the community. There are assisted living communities with a memory
care wing for those that require a more directed and secured level of care.
The last level of care is the nursing home. When assisted living is no longer appropriate and
more care is warranted by the resident, nursing home is the next option. Nursing homes
provide nursing care around the clock, assistance with meals, hygiene, bathing, housekeeping,
and activities for its residents. Nursing home costs usually range from $2000 to $5000/month.
Medicaid, private pay, or long-term care insurance pays for nursing home.
Alternatively, to continue aging in place and to remain at an independent living or an assisted
living community, the resident can hire professional caregivers to help in addition to adaptive
equipment or room modificatons. Caregivers can help with tasks and personal care so one can
continue to age in place for as long as possible.
Please visit www.seniorvantage.com to see a full list of senior living facilities.

13
PROOF
Home Healthcare
What is Home Healthcare?
Home healthcare consists of a wide range of medical services that is given wherever you call
home. The goal of home healthcare is to treat an illness or injury. It is to help you recover from
an illness, to regain your strength and help you get back on your feet as soon as possible.
What services are provided?
The home healthcare nurse evaluates each person to determine what services are needed.
Services provided are usually intermittent service, as opposed to continuous or hourly services.
Nurses, physical therapists, speech therapists, occupational therapists, medical social workers,
and home health nursing assistants may provide services. Example of services include:
• Wound care for pressure sores or a surgical wound
• Patient and caregiver education
• At-home intravenous or nutrition therapy
• Injections
• Monitoring serious illness and unstable health status
• Prescription management
• Pain management
How to qualify for home healthcare?
A healthcare provider identifies the need for home healthcare after a hospital stay or after a visit
to the doctor’s appointment. Your physician has to write an order for homehealth care. You may
choose the home healthcare company of your choice.
To qualify, you need to be under the care of a physician, in need of short-term acute health-care
such as nursing or therapy care, and have difficulty leaving your home.
What is NOT included in Home Health Care
It does not include non-medical services such as housekeeping, cooking, cleaning, bathing,
personal hygiene, transportation, toileting, medication reminders, or assistance with activities
of daily living (ADLs). These services fall under the home care category and are paid privately or
through long-term care insurance.
Who pays for it?
Medicare and some private insurance pay for home healthcare.

14
PROOF
Long-Term Acute Care Hospital
(LTAC)
A long-term acute care facility is a specialty-care
hospital designed for patients with serious medical
problems requiring intense, special treatment for
an extended period of time—usually 20 to 30 days.
LTACSs offer more individualized and resource-
intensive care than a skilled nursing facility, nursing
home or acute rehabilitation facility. Patients are
typically transferred to a long-term acute care hospital
from the intensive care unit of a traditional hospital,
because they no longer require intensive diagnostic
procedures offered by a traditional facility.
LTAC-appropriate patients have primary medical
or respiratory complexity that requires daily intervention by a physician, nurse practitioner, or
physician assistant. (i.e. hyper alimentation, IV therapy, hemodialysis, daily labs, etc.).
Type of Stay
The patient usually has three to six concurrent active diagnoses and an acute episode on top
of several chronic illnesses and co-morbidities that cannot be treated. The patient has multiple
acute complexities as determined by a physician assessment and subsequent documentation
requiring daily physician intervention.
Primary conditions under this category include chronic renal insufficiency, gastrointestinal
conditions, and malignant/end stage disease or necrotizing pancreatitis. Patients must also
require active management/treatment of two co-morbid conditions (i.e.: AMS, CHF, COPD,
Diabetes, DVT, hepatic insufficiency/ encephalopathy, infection, malignant/end-stage disease,
malnutrition, renal insufficiency, extensive wound care, etc.).
Services provided:
aPulmonary services or vent weaning aWound care
aComprehensive rehabilitation services aPain management
aHead trauma treatment

15
PROOF
You do not have to pay a second deductible in an LTAC if you were:
1. transferred to a LTAC directly from an acute-care hospital
2. admitted to a LTAC within 60 days of being discharged from an inpatient hospital stay.
However, if you were admitted directly to the LTCH more than 60 days after any previous
hospital stay, the patient would pay the same deductibles and co-insurance as if you were
admitted to an acute-care hospital.
How is it paid?
Under Medicare, the patient is responsible for one deductible for any benefit period. A benefit
period begins the day the patient is admitted to a hospital or skilled nursing facility (SNF), and
ends when you have not received inpatient care in a hospital or SNF for 60 days in a row. This
applies whether you are in an acute care hospital or an LTAC. You may choose the LTAC hospital
of your choice.

16
PROOF
What is Skilled Nursing Facility (SNF)?
How is it paid?
Medicare typically covers the costs of skilled nursing
care for the first 20 days, after which Medicare
will cover 80 percent and the patient (or private
secondary insurance) is responsible for the remaining
20 percent for up to 100 days. If you go home from
a SNF within 30 days, you can go back and have
another stay under Medicare if the days have not
been exhausted.
Under Medicare, the SNF days can be restarted with a hospital stay of at least three days and
after 60 days from the previous hospital admission.
You may choose the SNF hospital of your choice.
Skilled Nursing Facility (SNF)
A skilled nursing facility is typically housed within a
nursing home or senior community complex. A SNF
often serves as a point of transition in care, usually
after a hospitalization. For example, a patient whose
medical conditions have stabilized but needs physical
therapy may benefit from this level of transition
before discharging to their home environment, which
may be an independent living, assisted living, or
nursing home.
Please visit www.seniorvantage.com to see a full list of skilled nursing facilities.

17
PROOF
Auto(s) Make/Model:
License Number:
Auto Loan Lien Holder:
Account Number:
Loan Balance: $
Title for Car
Car Insurance Insurance Company:
Account Number:
Phone Number:
Parking/ EZ Tag Premium: $
Account Number:
Phone Number:
Public Transportation Options
Transportation Checklist

18
PROOF
Out of Hospital Do Not Resuscitate
Order (OOH DNR) (Texas)
What is an OOH DNR?
In Texas, the Out-of-Hospital Do-Not-Resuscitate
program allows you to decide if you do not want
to be resuscitated. The program enables you to
declare that certain resuscitative measures will not
be used on you. Per the state, those resuscitative
measures specifically listed in the OOH DNR
legislation are cardiopulmonary resuscitation (CPR),
advanced airway management, defibrillation,
artificial ventilations, and transcutaneous cardiac
pacing.
When should you have one?
This form should be completed while you are
competent and alert. You can revoke or change
your mind at any time. As part of the care plan, this form comes highly recommended to
alleviate any doubts about your wishes. This form is filled out by the individual or family,
notarized, and must be signed by the physician. One copy should be kept at the physician’s
office, one with other important documents, and one with the emergency kit on the refrigerator
at home.
Why should one have an OOH DNR order?
Should you have an emergency at home, the ambulance will look for this form as a way to honor
your wishes. Should they not find one, the immediate response will be to resuscitate you to the
fullest capacity to treat your illness. Additionally, should you become incompetent, comatose,
or any other conditions that do not allow you to make your own decision, this form will take
effect and healthcare professionals will honor it as they treat your condition. Should you not have
this form, your power of attorney, next of kin, or your physician can make the decision for you
depending on your circumstances.
So do not wait, choose to make your decision now. Communicate with your family or power of
attorney your wishes and desires if you become incompetent so that your wishes are not left up
to chances.
You can download the form on our website www.myambassador.org/transitions or directly at
https://www.dshs.state.tx.us/emstraumasystems/dnr.shtm#form

19
PROOF
Long-Term Care Insurance (LTC)
What is LTC?
LTC is an insurance that helps cover the cost of long-term care beyond a pre-determined period.
It usually covers care for an individual that is not covered by regular health insurance, Medicare
or Medicaid. LTC takes effect when you are
unable to perform activities of daily living
(ADLs). ADLs include dressing, bathing,
eating, toileting, continence, transferring from
bed or wheelchair, or walking.
When should you consider getting LTC?
Because you do not know when you will be
debilitated or cannot do your ADLs, you
should consider LTC as soon as possible.
Statistics show that 60 percent those over 65
years old will need long-term care, and 40
percent are between the ages of 18-64. There
are many schools of thoughts, but one should
consider a LTC plan at ages 45-50 years. Like
any insurance plans, the cost of the plans also
increases as you get older.
What services do LTC cover?
LTC insurance covers home care, assisted living, adult day care, respite care, hospice care,
nursing home, and Alzheimer’s facilities. Depending on your policy allowance, home care
services can include visiting or live-in caregiver, companion, housekeeper, therapist or a private
duty nurse up to 24/7/365 days a year. Each policy and plan is different, so it is recommended
that you consult with an insurance agent.
Other benefits include coverage for out-of-pocket expenses, decreased burden of care from
friends and family caregivers, paid premiums may be eligible for a tax deduction, and depending
on the business, premiums paid to employees can be 100 percent deductible.
What are the types of LTC policies and the costs?
There are many types of policies and coverage. Make sure your policy is a taxed qualified policy.
The requirement to use the policy varies, but you can expect that the person will require care for
at least 90 day and unable to perform at least one of the ADLs without substantial assistance.
The second qualification is that the person needs care for at least 90 days and need substantial
assistance due to severe cognitive impairment. In many cases, a physician must certify these
findings. Other policies will require a healthcare professional to certify these findings.
The cost will depend on your age, daily benefit amounts, how long the benefits pay, the
elimination period, inflation protection and heal rating. Once you purchase the policy, it is
renewable for life. It cannot be canceled or changed by the insurance company for health
reasons. They can only cancel for non-payment of premiums. Consult your insurance carrier to
get the full information.

20
PROOF
Mortgage or Lease Documents Account #:
Contact Info:
Utility Bills Electric Provider:
Gas Company:
Cable/Internet:
Telephone Bills Home Phone Provider:
Cell Phone Provider:
Home Owners Insurance Policy Insurance Agency:
Premium:
Property Tax Yearly Tax: $
Flood Insurance
Wind & Hail Insurance
Personal Property
Insurance
Policy:
Premium:
Garbage Services
Recycle Services
Heavy Trash Pick-up
Which Day:
Which Day:
Which Day:
Home Maintenance Checklist

21
PROOF
Advance Directives
Advance Directives are legal documents used to communicate end-of-life decisions ahead of
time. It is a way to communicate to family, friends and healthcare professionals about your wishes
so that there is no confusions later. These forms are extremely important in defining how much
medical intervention you want if anything happens to you. There are several forms you should
complete and keep in an accessible location when the time is needed.
1. Directive to Physicians and Family – This form allows you to communicate your medical
treatment if you succumb to a certain illness or injury and are unable to make your own
decisions.
2. Medical Power of Attorney – This document helps you name and authorize the person
you select to make any health decisions for you if you cannot make them for yourself.
3. Out of Hospital DNR – This form instructs medical personnel and other healthcare
professionals to NOT perform resuscitates and to permit the patient to have a natural
death peacefully. This form does not affect other emergency care such as comfort care.
This form should be kept in a visible location at home, especially for EMS along with a
copy for the primary care physician.
4. Statutory Durable Power of Attorney – This form allows a designated person who can
take certain actions regarding your property and finances. This form does NOT authorize
anyone to make medical decisions for you. An attorney can incorporate this into your
living will.
5. HIPPA Authorization for Release of Medical Records - This form allows your
authorized representative access to your medical records and health information from
the hospital, physician and healthcare facilities when you cannot communicate or is
incompetent.
6. Last Will and Testament (must consult an attorney) - This documents allows you to
communicate your wishes regarding your estate, belongings, animals, and personal
items to your children, grandchildren, and anyone else you wish to list in your will.
What happens when your medical wishes are not clearly spelled out?
Many times families have a tough time making a decision or deciding in a timely manner. Other
times, the physician intervenes on the patient’s behalf. You may be placed on medical treatments
that may or may not be your desires. The precise decision is the one that is from you. If you do
not have family members, it becomes even more difficult and the decisions may be left to a
distant family member or the physician.
Can you make changes to these documents?
You can make changes and revisions to these forms, your power of attorney or anything else at
any time, as long as you are competent.
Where can you find these forms?
Your attorney can prepare these for you.

22
PROOF
Bank Checking/Savings Bank Contact:
Bank Phone Number:
Durable Financial Power of
Attorney
Records of Loans or Guarantees
Lists of Assets & Debts
Federal & State Tax Returns
(3-5 years)
Other
Financial Checklist

23
PROOF
Knowing Your Medicare Options
There are generally two options to access Medicare:
1) Original Medicare and
2) Medicare Advantage Plans (MAPD).
There are, however, options within those options.
Knowledge of those options and the needs of each
individual are critical to making an informed decision.
Original Medicare consists of Part A (hospitalization) and
Part B (doctors, some specialty drugs, diagnostics, etc.).
There are deductibles and co-insurances that are the
responsibility of the insured’s.
The current deductible for Part A is $1,216 per benefit
period. A benefit period is 60 days. For someone who is in
and out of hospital several times a year, that could be as
much as $6,080 for one year.
The current deductible for Part B is $147 for the year. After the Part B deductible is met,
Medicare pays 80 percent of the Medicare approved rate and the beneficiary pays 20 percent.
There is no limit to what that 20 percent can be. For those who opt for Original Medicare,
supplemental policies are available to cover deductibles and co-insurance that Medicare does
not pay.
There are several “MedSupp” policies with letter designations (A, B, C, D, F, G, K, L, M and N).
While each policy is designed the same, there are some MedSupp policies offered by specific
companies that provide coverage beyond what Medicare provides, through riders. Also, if the
Original Medicare option is chosen, it will be necessary to enroll in a Part D prescription drug
plan. Drug plan premiums start at about $13/month and can exceed $100/month. The maximum
drug plan deductible $310. Penalties apply for those who are late enrolling in Medicare Part
B (10 percent per year for each year not enrolled past the initial enrollment period) and Part D
(10 percent of the national average premium per month for each month not enrolled past the
initial enrollment period). There are no maximums for these penalties. MedSupp premiums vary
by location and age. Some companies offer premium choices based on “issue” age rather than
“attained” age. Issue age premiums do not increase as the insured gets older. Original Medicare
is the most flexible option to access health care. Referrals to specialists are not required, and any
Medicare-approved doctor will accept Medicare’s white card with the red and blue stripes.

24
PROOF
Medicare Advantage Plans come in a variety of designs — HMO (health maintenance
organization), PPO (preferred provider organization), PFFS (private fee for service), CSNP (chronic
special needs plan for certain chronic medical conditions), and DSNP (dual special needs plan
for Medicare and Medicaid eligible beneficiaries). Most MAPDs offer additional benefits beyond
the required Medicare coverage such as vision, dental, fitness club memberships, publication
discounts, and transportation. There is a cap on out-of-pocket (“MOOP”) expenses for
beneficiaries. The maximum is $6,700. Several plans cap the MOOP at $3,400.
Many MAPDs have “zero” monthly premiums and most include Part D prescription drug
coverage. MAPDs are not as flexible as original Medicare. Many require the coordination of care
through a primary care physician (“PCP”), who generally makes referrals. Many have networks
of healthcare providers, and accessing healthcare through a non-network provider may mean
higher cost sharing or no payment for those services unless the situation was a life-threatening
emergency. MAPD plans can change every year in terms of co-pays, formularies, additional
benefits, and network providers. For these reasons, beneficiaries should review their MAPD
annually to determine if a change should be made for the following year.
More information can be found in the Medicare & You handbook, which is published by CMS
and mailed annually to beneficiaries. For personal attention to your own particular concerns,
consult an insurance professional with knowledge of Medicare and access access to detailed
plan information for several companies.
Medicare Advantage Plans for Texas:
http://www.q1medicare.com/PartD-SearchMA-MedicarePartDPlanFinder.
php?state=TX&countyCode=48201&showCounty=Harris

25
PROOF
Medicare Plans in Harris County, Texas
THESE COMPANIES OFFER PRESCRIPTION DRUG PLANS
(there are 34 prescription drug plans in Harris County)
AARP Medicare Humana 
Aetna CVS/pharmacy MedicareRx Rewards
Blue Cross Medicare SilverScript
Cigna-HealthSpring  Symphonix
Cigna Medicare TransAmerica    
EnvisionRxPlus Silver  United American
Express Scripts Medicare Wellcare
First Health Windsor
HealthMarkets
THESE COMPANIES OFFER MEDICARE ADVANTAGE
PLANS WITH PRESCRIPTION DRUG COVERAGE 
(there are 34 Medicare Advantage plans with prescription drug coverage in Harris County)
AARP MedicareComplete Erickson
Advantra  Humana
Aetna  KelseyCare
Amerivantage TexanPlus
Blue Cross Today’s Options
Cigna-HealthSpring Wellcare
THESE COMPANIES OFFER MEDICARE ADVANTAGE PLANS 
WITHOUT PRESCRIPTION DRUG COVERAGE
(there are 8 Medicare Advantage plans without prescription drug coverage in Harris County)
Cigna-HealthSpring KelseyCare
Humana  TexanPlus
Erickson Today’s Options

26
PROOF
Birth Certificate
Marriage Certificate
Divorce Papers
Death Certificates (Deceased Spouse)
Passport / Citizenship Documents
Military Records Branch of Service
VA ID#:
Veterans Military Service Record
(DD-214)
Dates of Service:
Driver’s License
Organ Donor Card
Bereavement Arrangements Cemetery Plots:
Burial Instructions
Trusts
Wills
Life Insurance Policies
Social Security
Long-Term Care Insurance
Disability Insurance
Lists of Friends and Family
List of Church members and
Organization members
Pet Care Arrangements
Safety Deposit Box Location:
Number:
Key:
Other Public Assistance Programs
Others
Personal Information Checklist

27
PROOF
Social Security: What Should You Do at Age 62?Is 62 your lucky number? If you’re eligible, that’s the earliest age you can start receiving Social
Security retirement benefits. If you decide to start collecting benefits before your full retirement
age, you have company. According to the Social Security Administration (SSA), approximately
74 percent of Americans elect to receive their Social Security benefits early. (Source: SSA Annual
Statistical Supplement, 2012).
Although collecting early retirement benefits make sense for some people, there is a major
drawback to consider: if you start collecting benefits early, your monthly retirement benefit will
be permanently reduced. So before you put down the tools of your trade and pick up your
first Social Security check, there are some factors you need to weigh before deciding to start
collecting benefits early.
What will your retirement benefit be?
Your Social Security retirement benefit is based on the number of years you have worked and
the amount you earned. Your benefit is calculated using a formula that takes into account your
35 highest earnings years. If you earned little or nothing in several of those years (if you left the
workforce to raise a family, for instance), it may be to your advantage to work as long as possible,
because you will have the opportunity to replace a year of lower earnings with a higher one,
potentially resulting in a higher retirement benefit.
If you begin collecting retirement benefits at age 62, each monthly benefit check will be 25 to 30
percent less than it would be at full retirement age. The exact amount of the reduction depends
on the year you were born. Conversely, you can get a higher payout by delaying retirement past
your full retirement age - the government increases your payout every month that you delay
retirement, up to age 70.
However, even though your monthly benefit will be 25 to 30 percent less if you begin collecting
retirement benefits at age 62, you might receive the same or more total lifetime Social Security
benefits as if you wait until full retirement age to start collecting benefits. That is because even
though you will receive less money per month, you might receive more benefit checks.
The following chart shows how much an estimated $1,000 monthly benefit at full retirement age would be worth if you
started taking a reduced benefit at age 62.
Birth Year Full Retirement Age Benefit
1943-1954 66 years $750
1955 66 years, 2 months $741
1956 66 years, 4 months $733
1957 66 years, 6 months $725
1958 66 years, 8 months $716
1959 66 years, 10 months $708
>1960 67 year $700
Even if you start collecting Social
Security benefits at age 62, keep in
mind that you still will not be eligible
for Medicare until you reach age 65. So
unless you are eligible for retiree health
benefits through your former employer
or your spouse’s health plan at work,
you may need to pay for a private health
policy until Medicare kicks in.

28
PROOF
Have you thought
about your longevity?
Is it better to take reduced benefits at age 62
or full benefits later? The answer depends, in
part, on how long you live. If you live longer
than your “break-even age,” the overall
value of your retirement benefits taken at full
retirement age will begin to outweigh the
value of reduced benefits taken at age 62.
You will likely reach your break-even age
about 12 years from your full retirement age.
For example, if your full retirement age is 66,
you should reach your break-even age at 78.
If you live past this age, you will end up with
higher total lifetime benefits by waiting until
full retirement age to start collecting. However, unless you’re able to invest your benefits rather
than use them for living expenses, your break-even age is probably not the most important part
of the equation. For many people, what really counts is how much they’ll receive each month,
rather than how much they’ll accumulate over many years.
Of course, no one can predict exactly how long they will live. But by taking into account your
current health, diet, exercise level, access to quality medical care, and family health history, you
can make a reasonable assumption.
How much income will you need?
Another important piece of the puzzle is to look at how much retirement income you will need,
based partly on an estimate of your retirement expenses. If there is a large gap between your
projected expenses and your anticipated income, waiting a few years to retire and start collect-
ing Social Security benefits may improve your financial outlook.
If you continue to work and wait until your full retirement age to start collecting benefits, your
Social Security monthly benefit will be larger. Moreover, the longer you stay in the workforce, the
greater the amount of money you will earn and have available to put into your overall retirement
savings. Another plus is that Social Security’s annual cost-of-living increases are calculated using
your initial year’s benefits as a base - the higher the base, the greater your annual increase.

29
PROOF
Will your spouse be affected?
When to begin receiving Social Security is more complicated when you are married. The age
that you begin receiving benefits may significantly affect the amount of lifetime income you and
your spouse receive as well as the benefit the surviving spouse will be entitled to, so you need to
consider how your decision affects your joint retirement plan.
Do you plan on working after age 62?
Another key factor in your decision is whether or
not you plan to continue working after you start
collecting Social Security benefits at age 62. That is
because the income you earn before full retirement
age may reduce your Social Security retirement
benefit. Specifically, if you are under full retirement
age for the entire year, $1 in benefits will be withheld
for every $2 you earn over the annual earnings limit
($15,480 in 2014).
Example: You start collecting Social Security benefits
at age 62. You continue working, and your job pays
$30,000 in 2014. Your annual benefit would be
reduced by $7,260 ($30,000 minus $15,480, divided
by 2).
Note: If your monthly benefit is reduced in the short
term due to your earnings, you will receive a higher monthly benefit later. That is because the
SSA recalculates your benefit when you reach full retirement age, and omits the months in which
your benefit was reduced.
Other considerations
In addition to the factors discussed here, other financial considerations may influence whether
you start collecting Social Security benefits at age 62. How do other sources of retirement
income factor in? Have you considered how your income taxes will be affected?
What about personal considerations? Do you plan on traveling, volunteering, going back to
school, starting your own business, pursuing hobbies, or relocating? Do you have grandchildren
or elderly parents whom you want to help take care of? Every person’s situation is different.
For more information:
Source: Social Security Administration
If you want to estimate the amount of Social Security benefits you will be eligible to receive in
the future under current law (based on your earnings record) you can use the SSA’s Retirement
Estimator. It is available at the SSA website at www.socialsecurity.gov. You can also sign up
to view your online Social Security Statement at the SSA website. Your statement contains a
detailed record of your earnings, as well as estimates of retirement, survivor’s, and disability
benefits, and other information about Social Security.

30
PROOF
What is Hospice?
Hospice is an alternative choice to traditional medicine where the focus of care is shifted from
treating an illness or performing life saving measures to keeping a patient as comfortable and
pain-free as possible. In addition to caring for terminally ill patients, hospice is also extended to
the family to help transition, relieve, train, comfort, and counsel members during the patient’s
end-of-life stage.
Who qualifies for hospice?
To qualify for hospice, a physician must certify that you have a terminal illness with a prognosis of
6 months or less.
Who pays for hospice?
If you qualify for hospice, Medicare and most insurance companies will pay for it.
Where is the care provided?
Care for a hospice patient is usually in a home setting, but it can be provided anywhere from a
nursing home, hospital setting, or a separate hospice facility. Because the care is usually focused
on comfort and easing pain, there is no need for cumbersome machineries that require the
patient to be in a facility.
How do I request for hospice service?
Usually a discharge planner or physician would initiate the conversation with the patient and/
or family member(s). Ultimately, the physician has to certify the patient for hospice care. The
physician usually has a hospice he works with but the patient can also request to go with a
particular hospice company he/she choses. Other resources for hospice companies can found
at The National Hospice and Palliative Care Organization at www.nhpco.org and the Hospice
Association of America at www.nahc.org/HAA
What are the services provided by hospice?
Services are usually assessed by a nurse to evaluate the need of the patient and the family. They
include:
• medical care: a hospice physician to oversee and coordinate care, many times working
with the primary care physician
• nursing care: if needed, may include either around-the-clock, sporadically for checkups or
special services such as administering injections and training for feeding tubes
• help with daily needs, such as bathing, cooking and cleaning
• visits from a religious counselor, if requested
• counseling services for the patient and family members
• social services support, including help with insurance and financial matters
• respite care to provide breaks and rest time for family caregivers
• medical supplies/equipment such as hospital beds, bedside commodes, wheelchairs, and
oxygen
• medications to help control pain and symptoms
• other services may include physical, speech, dietary, and occupational therapy, and
• bereavement care or grieving support following a death.
Visit www.seniorvantage.com to see a list of hospice companies in your area.

31
PROOF
911Emergency Kit Checklist
(Use a zip lock bag to place items below in, and store it
on the refrigerator or easily accessible location)
☐ Medication List (update list every 3 months or after a hospital discharge)
☐ Health Checklist*
☐ Do Not Resuscitate Form*
☐ Medical Power of Attorney*
☐ Emergency Contact Information, Close relative(s) or POA

Name _____________________ Phone Number __________
Name _____________________ Phone Number __________
☐ Copy of Insurance, Medicare, Medicaid, or VA card
☐ Imminent Medical Conditions
☐ pacemaker
☐ history of surgery __________________
☐ history of transplants ________________
☐ history of heart failure, atrial fibrillation
☐ history of asthma
☐ Others ___________________________
☐ Special Medications
☐ Warfarin or Coumadin
☐ Other Blood Thinners: Aspirin, Lovenox
☐ Lithium
☐ Digoxin
☐ Levothyroxine
☐ Phenytoin
☐ Others ___________________________
*This form can be downloaded at www.myambassador.org/transitions

32
PROOF
Resources Description Website
211 Helpline
Harris County on Aging
Connects citizens with over 60,000 Health and Human
Services programs throughout Texas (Dial 211)
211texas.org/211
Alzheimer’s Association Information and resources for those with Alzheimer’s Alz.org
Ambassadors Caregivers An extra hand in caring for the disabled or elderly at
home, sitter service while they are hospitalized, post-
surgery or transplant
AmbassadorsCare.com
713.521.2221
Ambassador Foundation myambassador.org
Attorneys (Elder Law, probate,
estate, trusts, wills, POA)
Senior Non-profit 832.819.0505
American Diabetes Association Information and resources for those with Diabetes Diabetes.org
American Heart Association Information and resources for those with
Cardiac issues
Heart.org
Centers for Disease Control and
Prevention
Information and tools for people and communities to
protect health
Cdc.gov
Department of Aging and
Disability Services
Information on long term services and support for people
who are aging and who have cognitive and physical
disabilities
Dads.state.tx.us
Eldercare Locator Find elder care resources in the community Eldercare.gov
1.800.677.1116
Harris County Area Agency on Aging Nationwide network coordinating supportive services for
the elderly
Houstontx.gov/health/aging
832.393.4301
Meals on Wheels For those in need of meal preparation and delivery Mowaa.org
Medicaid Information about Medicaid programs Cms.hhs.gov/medicaid
Medicare Learn more about Medicare benefits, prescription drug
coverage & programs
Medicare.gov
1.800.MEDICARE
National Stroke Association Education and programs for stroke prevention, treatment,
rehabilitation, and support
Stroke.org
National Hospice and Palliative Care
Organization
Hospice www.nhpco.org
Hospice Association of America Hospice www.nahc.org/HAA
Housing Locator: SeniorVantage Online senior housing search for the greater Houston
area, discount coupons for senior communities, resources
for family caregivers, lists of support groups
SeniorVantage.com
Community Resources

33
PROOF
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