The Increasing Standards of Geriatric Care and Deducting the Cost of a Caregiver

Today’s facility needs to provide increased levels of both comfort and care. Here are six key criteria geriatric patients are using to measure hospitals and long term care residence.

  1. Quality of Care – This will Never change. Geriatric patients demand and expect top-notch care when they are in the hospital, rehap or Senior Living community. The Baby Boomers are demanding better care and doing their research on their condition and will ask questions to ensure they are receiving the best care from highly qualified personnel.
  2. “Privacy” – I Want A Door. HIPPA laws have led to a construction boom as hospital administrators strive to make Waiting Rooms, Treatment Bays, Exam Rooms and other areas of hospitals HIPPA compliant. They do not want to Share a Room!
  3. Room Comfort – Some hospitals are acting like hotels. More space for family to visit their loved one – some are like suites and provide additional luxuries. Requesting Unrestricted visiting hours, and on-site facilities for eating.
  4. Food Quality – Healthy and Tasty Diet. Emotional health is connected to physical health and physical health connected to a healthy diet. Providing healthier foods and diet will make the patient happier and healthier – improve & go home faster.
  5. Personnel with Professional and Caring Personalities. Patients rely heavily on facilities employees. When patients are ill or frightened, they need to feel confident they can depend upon staff to treat them correctly and with respect. Patients demand knowledgeable, efficient, comforting and – above all – pleasant staff.
  6. A Calm and Clean Environment. Every administrator knows that the better a patient feels emotionally, the faster they will heal physically. The atmosphere of the facility is one of the “key” things patients look for when deciding on a healthcare facility. Geriatric patients want tranquil environments that are tastefully decorated, cheerful and clean.

While these are not the only standards used to select healthcare facilities they are some of the Most important considerations. Facilities need to provide their patients in innovative ways, beyond their clinical needs, never forgetting that the quality of care and medical service is the Primary concern.

Can Someone Deduct the Cost of a Caregiver? With tax time upon us this is asked frequently. Our parent has a personal caregiver who works for them full time in their home. The parent(s) pay the cost of approx $4,000 per month out of their own income. Can they deduct the cost as a medical expense on their income tax?

Answer: YES, assuming they are “qualified long term care services.” To satisfy the IRS, one must have to verify primarily by a carefully written letter from her/his personal physician that: (a) she/he is chronically ill (b) the services are provided in accordance with the physician’s plan of care, and © she/he are required care and supervision to protect them from threats to health and safety due, for example: to her/his diminished capacity. A CPA will rely on Section 213 of the IRS Code in determining whether or not their care qualifies.

Note: Physicians do not think about tax deductions when they care for their patients. Its OK to tell them about this opportunity and about the need for an appropriate letter or written plan. Also, these expenses can only be itemized deductions if they exceed 7.5% of the patient(s) adjusted gross income. *Remember to issue 1099s for each of the Caregivers and submit to the IRS at year end. Check with your CPA…..

Brenda Dever-Armstrong, CEO/Owner/CSA/Geriatric Advisor/Lifetime Advocate
The Next Horizon Senior & Military (Veterans/Spouses) Services/Resources/Locator



Since 1868, Americans have set aside one day a year to honor the over 1.1 million men & women who gave their lives while serving their country. While Memorial Day comes just once a year, VA and its employees uphold the meaning behind it each and every day by providing the best care possible to our Veterans.

Initially called Decoration Day because families & friends would spend the day decorating the graves of their fallen loved one; the day was renamed Memorial Day during WWII and became a federal holiday in 1971. It serves to honor the men & women whose lives & actions in battle helped to shape not just our Nation, but the World! Whether they were present when the first shot was fired at Lexington & Concord or they’ve walked the streets of Baghdad, they’ve had a direct impact on history.

A simple way to both show your respect & support living Veterans & their families is through the purchase of a RED POPPY, known as the “flower of remembrance,” the poppy gained popularity after Canadian surgeon, Lt Colonel John McGrae, penned the poem “In Flanders’Field” during WWI. He describes the crimson flowers growing between the crosses marking the graves of those who fell during that pivotal battle. It was proclaimed the official memorial flower of the VFW in 1922. Now, artificial poppies are manufactured by patients & residents in VA hospitals and homes, with proceeds going to support Veterans, widows and orphans affected by war. By purchasing and wearing a red poppy, you can honor Memorial Day while making a difference in a living Veteran’s life.

Fly your American flag at half-staff. Guidelines: when putting the flag at half-staff, raise it quickly to the top of the staff, then slowly lower it halfway down. The flag should only be flown at half-staff from dawn until noon before being raised to full-staff until sunset.

Take time on Memorial Day to pause for the National Moment of remembrance. At 3 pm local time, take one minute to pause and reflect on the sacrifices made by those who have lost their lives fighting for the United States! If you are driving, turn your headlights on to show your participation. SPREAD THE TRUE MEANING BEHIND MEMORIAL DAY…..

Each and every day beyond Memorial Day, over 365,000 VA employees dedicate their lives to serve those who have made the ultimate sacrifice for their country.

Brenda Dever-Armstrong, CEO/Owner/CSA/Geriatric Advisor
The Next Horizon Seniors & Military (Veterans/Spouses) Advocate/Resources/Services/Locator (Military Spouse of 40 years)

SENIORS ARTICLE: Register to Vote in Texas – 2024

ARE YOU ALREADY REGISTERED: To confirm your voter registration status, visit Am I Registered application. If you moved from one place to another in the same county, you can change your information online at the Secretary of State’s Voter Registration Name/Address Change website.

WAYS TO REGISTER: To register to vote in Texas, simply complete a voter registration application and return it to your county election office at least 30 days before the upcoming election date. To complete an application, you may: (1) Complete an application using the SOS ONLINE VOTER REGISTRATION APPLICATION. Simply fill in the required information, print, sign and mail directly to your county election office. (2) Request a PRINTED APPLICATION. The office will mail a voter registration application to the address provided. (3) Contact or visit your local VOTER REGISTRAR to complete registration process.

YOU ARE ELIGIBLE TO REGISTER TO VOTE IF: (1) You are a United States citizen (2) You are a resident of the county where you submit the application (3) You are at least 17 years and 10 months old and you are 18 years of age on Election Day! (4) You are not a convicted felon (you may be eligible to vote if you have completed your sentence, probation and parole); and (5) You have not been declared by a court exercising probate jurisdiction to be either totally mentally incapacitated or partially mentally incapacitated without the right to vote.

SHOW OF (7) ACCEPTABLE FORMS OF PHOTO ID: (1) Texas Driver License; (2) Show Texas Handgun License; (3) Texas Personal ID Card; (4) US Citizenship Certificate with Photo; (5) Texas Election ID Certificate; (6) US Military ID card with Photo; (7) US Passport – Card or Book

MILITARY & OVERSEAS VOTERS: “Overseas” is defined as anywhere outside the U.S. (Includes Mexico/Canada). You can use the regular registration and early voting by mail process (known as “absentee” voting)

VOTERS WITH DISABILITIES: (1) Citizen of US (2) 17 years & 10 months time of registration BUT to vote must be 128 years by Election Day (3) Have not been convicted or a felony or if they have been convicted, have completed all of their punishment, parole, supervision, probation or have received a pardon (4) Have not been determined by a final judgment of a court to be totally mentally incapacitated or partially mentally incapacitated without the right to vote (5) Individuals who have legal guardians may be eligible to register, depending on whether the court took away their right to vote. All guardianship orders issued after 1 September 2007 must state whether the individual can vote (6) People with disabilities can receive assistance registering to vote from any state agency that provides services to persons with disabilities or from any person they choose (7) On 1 September 1999, Texas became the first state to require all new voting systems be accessible to voters with disabilities and provide a practical and effective means for voters with disabilities to vast a secret ballot. ALL POLLING PLACES IN TEXAS MUST BE ACCESSIBLE!

VOTERS MAY VOTE EARLY, EITHER IN PERSON OR BY MAIL: Voters who vote during Early Voting Period may vote at any early voting site in the political subdivision that is holding the election. If a voter will be 65 years of age or older on Election Day, has a disability or will be outside the county during early voting hours and on Election Day, the voter can apply to vote by mail. Submit a completed and signed Application for a Ballot by Mail any time from the 60th to the 11th day before Election Day to the proper county early voting clerk. For more information read “Early Voting In Texas”

Secretary of State – Elections Division, PO Box 12060 Austin, TX 78711-2060

*Information provided by:
Brenda Dever-Armstrong, CEO/Owner/CSA Senior Advisor
The Next Horizon Seniors/Military Advocate/Resources/Services/Locator


Here is a four-step process to find out most everything you need to know about a surgeon’s background & skill level.

  1. CONFIRM STATE CREDENTIALS. The Federation of State Medical Boards can tell you if the surgeon is licensed in your state. Go to and click on Consumer Resources to get to the free tool, “Learn About Your Physician.”
  2. CONFIRM SURGICAL CERTIFICATION. To find out if the surgeon is board certified or eligible in a particular specialty, check with the American Board of Medical Specialties (go to Board Certified means a physician has undergone lengthy training in a specialty and passed a stringent exam. It means the doctor has finished the appropriate residency but has yet to pass the test. It’s OK for young doctors to be board eligible – they have a few years to take the test. But, thee ABMS recently issued a ruling that physicians who try to use the term “board eligible” for their entire careers face penalties.
  3. UNCOVER PROFESSIONAL REPRIMANDS. Knowing if a doctor has been sanctioned by a professional licensing board should be an essential part of your search. For a $9 fee, the Federation of State Medical Boards will provide the disciplinary history of specific doctors in any state (click Credentialing, then Physician Data Services on its website). State medical boards also have doctor profiles that include board certifications, board actions, criminal convictions and medical malpractice claims. There are links to state websites; go to
  4. CHECK RATINGS, NUMBER OF PROCEDURES PERFORMED & COMPLICATION RATES: Pro-Publica & Consumers’ Checkbook both have websites where they rate surgeons & provide information on the number of procedures and complication rates, based on recent Medicare data. Plug in your zip code at the ProPublica website and you will find a directory of local hospitals that perform eight common procedures, along with surgeons on staff who perform them, the number of procedures they have done and their complication rates. from the nonprofit group provides a more comprehensive analysis that encompasses more than 5 million operations performed by 50,000 surgeons. It compares surgeons’ results for 12 types of surgery.

SURGERIES & SIDE EFFECTS: These 10 are the most common surgeries for Americans over 50, and the most common complications.

CATARACT REMOVAL: Complication: Posterior capsule opacity (blurry or cloudy vision develops after surgery. (Occurrence 20%)

PACEMAKER IMPLANT: Complication: Hematoma (a collection of blood outside a blood vessel) (Occurrence 2.2% patients over 70)

COLECTOMY: (partial or total colon removal). Complication: infection (Occurrence 12.4%)

CORONARY ARTERY BYPASS: Complication: Atrial Fibrillation (irregular heartbeat). (Occurrence About 24%)

HIP REPLACEMENT: Complication: Dislocation (Occurrence 2%)

KNEE REPLACEMENT: Complication: Blood Clot (Occurrence 1%)

PROSTRATE REMOVAL: Complication: Bleeding (Occurrence 5.3%)

INGUINAL HERNIA: Complication: Infection (Occurrence 0.2% (laparoscopic surgery), 0.3% (open surgery)

CHOLECYSTECTOMY: (gallbladder removal) Complication: Infection (Ocurrence 1% (laparoscopic surgery), 7.6% (open surgery)

APPENDECTOMY: (appendix removal) Complication: infection (Occurrence: 1.9% (laparoscopic surgery), 4.3% (open surgery))

*Information provided by International Journal of Surgery

Brenda Dever-Armstrong, CEO/Owner/Senior Advisor
The Next Horizon Seniors & Military (Veterans/Spouses) Advocate/Resources/Services/Locator
Business Cell: 210-275-3002


There are simple ways you can support an aging loved one you know and help seniors enjoy the holidays a little more this year. For most, the holidays bring feelings of joy, anticipation & excitement. Spending time with friends an family attending holiday gatherings and exchanging gifts all symbolize the season of goodwill. However, close to 18 million seniors live alone. Many often struggle with grief over the loss of a loved one, sadness, confusion and isolation, especially if they do not have family close by. This can bring on the holiday blues and make it difficult for seniors to enjoy this time of the year. Whether it’s an aging parent, friend or neighbor, there are simple ways you can help seniors enjoy the holiday a little more this year.

BE A COMPANION. Make it a point to visit and spend time with a senior(s) loved one. Participate in an activity, play their favorite game or ask them to tell you about their life. You can give a puzzle with the grand-great grand kids pictures on it. Make a Family Tree by printing out pictures of family and relatives & create a Family Photo Tree! Go to Tapestry Family Tree ( or Simple Shapes Family Tree Wall Decal ($99), at Storytelling and memory sharing is a great way to lift a senior’s spirit and important to the aging process. Listen to music, take them to a movie, play or out for dinner. You can also help them Skype. Zoom or Facetime so they can visit with out of town family or friends.

BE A CHEF. Prepare one of their favorite meals and stay to visit. Invite them to your home and help prepare a dinner with family and friends. Make a favorite recipe together. Family members need to include their loved one(s) and let them help with placing the table (for Memory patients…let them fold napkins, place silverware (with assistance if needed), be part of watching the cooking for the holiday meal(s).

BE A HOME HELPER. For some senior, housework can be difficult due to their mobility. Helping them around the house by cleaning, de-cluttering and picking up anything on the floor that could be a tripping hazard to ensure their safety. Help with yard work if needed by getting the outdoor Christmas decorations ready. (Keep it simple)

BE A CHAUFFEUR. About one in five seniors over the age of 75 do not drive. Offer to take them to the store, movies, doctor appointments, dental check ups and eye exams. If possible help take them to their senior center, volunteer opportunities and holiday events so they feel comfortable knowing there is someone to safely transport them…quality time.

BE SANTA’S LITTLE ELF. Help with setting up and decorating their Christmas tree or helping with putting ornaments on the tree. Help decorate their living area, or help with gift wrapping and write /mail their holiday cards. Make holiday cookies together.

The holidays can get busy, hectic and overwhelming for all of us. It’s important to remember what the holidays are all about—a season of peace, joy and giving! Remember the aging senior in your life. Just by spending time with them you can help them have a happy and joyous holiday!

Merry Christmas/Hanukkah to All! Keep Christ in your heart!!

Brenda Dever-Armstrong, CEO/Owner/CSA
The Next Horizon Seniors & Military Advocate/Resources/Services/Locator,


Millions of people in the U.S. are affected by mental illness each year. It’s important to measure how common mental illness is so we can understand the physical, social and financial impact – and show that no one is alone. The numbers are also powerful tools for raising public awareness, stigma-busting and advocating for better health care.

In my business/profession, my team and I have seen more “mental” issues in the last year than ever before. Below are some fast facts:

  • 1 in 5 U.S. adults experience mental illness each year
  • 1 in 20 U.S. adults experience serious mental illness each year
  • 1 in 6 U.S. youth aged 6-17 experience as mental health disorder each year
  • 50% of all lifetime mental illness begins by age 14, and 75% by age 24
  • Suicide is the 2nd leading cause of death among people aged 10-14
  • One in 5 adults experienced mental illness last year

More facts: Texas ranks 50 out of 50 states to access for care.
Texas operates 39 local mental health community health services. (In the San Antonio area, we recommend only 3 Behavior hospitals that do a good service helping those with behavioral issues). We have some excellent behavioral facilities outside of San Antonio.

One can be detained up to 48 hours after arriving unless a judge signs an order of “protective” custody. The most common mental illness in America is:
Anxiety disorder, major depression, & bi-polar

Question asked is: What can get you or a loved one sent to a mental hospital?
If high risk of serious harm to themselves or others and need to be in a place of safety.

One organization for those needing to reach out for help is NAMI – National Alliance on Mental Illness in San Antonio. NAMI provides free peer-led mental health education classes and support groups for individuals living with a mental health condition and their loved ones. NAMI provides advocacy, education, support and public awareness so that all individuals & families affected by mental illness can build better lives. NAMI offers FREE training of six core modules.

PTSD is also common among civilians not just our military men & women. For those who are veterans/spouses of a veteran, we have VA resources we can provide to those needing information and/or care.

This is a topic that needs to be addressed as it is a “crisis” in America.

Brenda Dever-Armstrong, CEO/Owner/CSA/Geriatric Advisor
The Next Horizon Seniors & Military (Veterans/Spouses) Advocate/Resources/Services/Locator (TX & nationwide)
Bus Ph: 210-275-3002


This is an excellent article for those that may have a loved one with signs of Dementia/Alzheimer. Recently, my team and I are seeing more families with a loved one with these early signs.

Early Detection Matters:
(1) Memory changes that disrupt daily life (early signs forgetting recently learned information).
(2) Challenges in planning or solving problems (Difficulty concentrating or taking longer to complete a task).
(3) Difficulty completing familiar tasks (Complete daily tasks: driving familiar area, managing their budget)
(4) Confusion with time or place: (Cannot remember appointment(s) or location).
(5) New problems with words in speaking or writing (May have trouble following a conversation or joining in a conversation). They may repeat themselves. Trouble finding the right words.
(6) Misplacing things and losing the ability to retrace steps (Placing things in unusual areas). Often accuse others of stealing and re-occurs more often.
(7) Decrease or poor judgement (Demonstrate unusual changes in judgement or decision-making).
(8) Withdraw from work or social activities (They remove themselves from family, hobbies or sports).


HELPING THE PERSON COMMUNICATE: Helping someone communicate takes patience and understanding. Here are some Suggestions:
(1) Be calm and supportive. Maintain eye contact and use touch to reassure them. Show them you are listening.
(2) Show your interest in what he/she is saying or feeling.
(3) Pay attention to their voice/gestures for clues to what they are feeling. Sometimes, their emotions are more important than she they are trying to say.
(4) If you do not understand what they are trying to say, encourage them to point or gesture.
(5) If they cannot find a word, they may be less frustrated if you offer a guess.
(6) If they use the wrong word, and you know what they mean, supply the correct word. If this upsets them, do not correct future mistakes!
(7) Do not try to get them to explain as this may make them more upset. If possible just go along with what they are saying or agree with them – less agitated.
(8) Approach the person from the front but some may feel more comfortable if you talk from a handshake distance away.
(9) Keep confusion, distraction and noise to a minimum.
(10) Say your name first then address their name to get their attention.
(11) Speak slowly and distinctly. Use a lower voice pitch to convey sense of calm.
(12) Pay attention to your tone of voice. A person with Dementia/Alzheimer can sense your emotions. Limit the number of “don’t) and avoid harsh or direct orders.
(13) Confrontation may make the situation worse or get the person “worked up.”

Your observation and sensitivity will make a big difference. A hug or kiss can express affection. Remember: Treat the person with dignity and respect.

I suggest for any family or family member to go to The Alzheimer Association provides so much information about the “Stages” of Alzheimer. They also list the Support Groups throughout Texas for family members to attend – FREE! The support from other families going through this disease with their loved ones can provide “insight” on how they have handled their “loved one” and also received support from outside Speakers.

We need to keep on Congress to provide more “funding” for research….there is NO CURE at this time. The information listed was provided by the Alzheimer Association whom I work very closely with for my updated training working with families who have a loved one with this terrible disease.

Brenda Dever-Armstrong, CEO/Owner/CSA/Geriatric Advisor
The Next Horizon Seniors & Military (Veterans/Spouses) Advocate/Resources/Services/Locator (TX & nationwide)
Bus Ph: 210-275-3002


Many of us baby boomers are reaching the point in our lives where the children are grown up and moved out of the house. After a year or so or as we age we talk about downsizing into a smaller home or could be retirement continuous care community (CCRC) or a garden home. Many of us baby boomers would like to stay in our current home and do some remodeling. If you decide to stay in your home this may be the time to consider to do some modifications as you age. One can do little things at first, such as installing grab bars where needed. That is a start and at a minimal cost and will possibly save you from falling.

Here are a few suggestions when planning to “age in place.” PRIORITIZE YOUR WISH LIST: Take a look at the rooms in your home and determine which ones fit your new lifestyle and ones that may need some work. It may be “minor” changes or could be a “redo” altogether. Create a general plan and prioritize the items on your list.

FOCUS ON IMPROVING LIVABILITY: Many folks interview a few remodeling firms to help design your new living arrangement. Stairs can be a problem as we age or moving master bedroom downstairs or enlarging the bathroom or installing a “walk-in shower.” Re-do the laundry room to be more accessible. If you have steps from outside to inside of the home, consider a professional installing “ramps”…..may not need them now but sooner or later easier on the joints. You may have small or unused “spaces” that could be utilized or expanded.

CONTACT REPUTABLE REMODELING PROFESSIONALS: Remodeling professionals can help you to determine what your options are to remodel or build your home for your lifestyle. They can help find ways to create an open floor plan that is easier to navigate for those with mobility concerns. By incorporating these changes will help create a home that suits a changing lifestyle, may also “increase” the value of your home when you eventually decide to sell your home.

I do not promote just one business but finding a qualified remodeler who can share the most effective ways to remodel your home, go to (as a start)

Hope this will help with making a decision – and this is a “big” decision, stay in your current home or downsize.

Brenda Dever-Armstrong, CEO/Owner/CSA/Geriatric Advisor
The Next Horizon Senior/Military Locator/Resources/Lifetime Advocate


Each fifty states operates their Medicaid program differently. Individuals are required to reapply for Medicaid in the state in which they are relocating. This means one must close their Medicaid case, and hence their benefits, in their original state before applying for benefits in their new state. Fortunately, when it comes to applying for Medicaid, there are no residency requirements. After relocation, one can immediately apply for Medicaid benefits in the new state.

Common concern is the lapse of benefits between canceling one’s Medicaid plan in their original state and reapplying (and becoming eligible in the state in which you are relocating. Fortunately, most states allow Retroactive Medicaid coverage. This allows up to three months of Medicaid coverage immediately prior to the month of Medicaid application. Once retroactive Medicaid eligibility is established, Medicaid will pay unpaid, qualified medical expenses from this retroactive period.

Suggest you contact the Texas Medicaid office BEFORE moving. They may offer more information. I am sending you the “basic” steps to do first.

JAN 2023

Starting 1 January 2023, people with Medicare taking insulin: Plans cannot charge you more than $35 for a one-month supply of each Medicare Part D-covered insulin you take, and cannot charge you a deductible for insulin! If you get a 60 or 90 day supply of insulin, your costs cannot be more than $35 for each months’ supply of each covered insulin. Go to for more information.

*Information provided by:
Brenda Dever-Armstrong, CEO/Owner/CSA
The Next Horizon Seniors & Military Advocate/Resources/Services/Locator
Ph: 210-275-3002

SENIOR ARTICLE – Difference Between A Certified Nursing Assistant (CNA & a Caregiver)

Working with so many seniors & military veterans one of many questions asked is: What is the Difference Between a CNA & a Caregiver. Below is a brief explanation:

Basic Duties: Certified nursing assistants, called CNAs and Caregivers are often employed in home health care. Both are eligible to work as aides in hospitals, clinics, and assisted living facilities and Personal Care Homes.

CNAs: A certified nursing assistant is formally trained within a State-Approved educational facility and trained with at least 75 hours. Candidates must take an examination of competency to earn the title of CNA. CAN candidates also commonly have a criminal background check before certification. Graduates of CNA programs can work in the facilities (mentioned above) and can help a patient with the following: Help with bathing, dressing, transferring from bed to walker or wheelchair and oversee the patient take their medication (CNAs cannot administer or fill the medication box but watch the patient take their required medication only). CNAs can also help with cooking, cleaning, laundry, running errands and drive the patient (in the patient’s vehicle) to doctor appointments.

CNAs are usually working with a Caregiver Agency that employees them to be assigned to a patient, either in facilities or in the clients’ personal home. CNAs, if working in a hospital, may have a different job title, such as technician. Duties can include taking vital signs, caring for catheters, transporting patients, or help with discharging patients.

Caregiver: Caregivers provide assistance to the disabled or an elderly with day-to-day functions as helping with laundry, driving, paying bills, help the patient to eat or prepare meals. Many Caregivers are asked by the family to be a “companion” only….meaning, be at their bedside and read to them, or write letters for the patient or just be there to chat. Some Caregivers are employed as live-in companion, with room & board provided by the patient or patient’s family. A Caregiver that is NOT providing medical services needs no formal state-license as they are being more of a companion.

*Information provided by:
Brenda Dever-Armstrong, CEO/Owner/CSA
The Next Horizon Seniors & Military Advocate/Resources/Locator