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The Official Blog of Episcopal Retirement Homes

How US Senior Life Compares to Other Nations Around the Globe

Posted by Bryan Reynolds

Dec 17, 2014 10:05:37 AM

globeAccording to the World Health Organization (WHO), there will be over two billion people aged 60 or older, worldwide, by 2050. That's a staggering number of people who will need additional care and it represents, as the WHO noted, both a challenge and an opportunity.

Senior care in the United States is approached in a very different manner than it is in other countries.

In fact, the United States and other developed, Western countries lag behind other nations in some respects when it comes to providing future care. Here's a look at some of the lessons we can learn from abroad.

A high national GDP doesn't equate to better senior care.

Per the WHO, an estimated four to six percent of older people in developed, high per capita-income countries have experienced some form of abuse or mistreatment at home. Maltreatment is not just limited to physical abuse— financial misappropriation by loved ones or friends, as well as psychological and emotional abuse, are major contributors to depression, mood disorders and other psychiatric illnesses experienced disproportionately by the elderly.

Unfortunately, this percentage is expected to rise as high-income countries— the United States included— experience an overall aging of their population (due to stabilized or decreasing birth rates) relative to developing nations. The problem may be even more widespread in US nursing homes (where seniors should arguably feel safest and most cared for).

"Rates [of elder abuse in nursing homes] may be high," the WHO stated, as among nursing home staffers, "36% witnessed at least one incident of physical abuse of an elderly patient in the previous year; 10% committed at least one act of physical abuse towards an elderly patient; 40% admitted to psychologically abusing patients."

The problem is undoubtedly worsened by limited resources— the USA's healthcare system is overburdened and this creates gaps in vigorous monitoring and enforcement of the lowest-tier nursing homes.

The quality of care in accredited, well-funded retirement communities is, on the whole, much better. But that sort of disparity shouldn't exist, and it represents an area for national improvement. It also speaks to a critical necessity facing seniors and loved ones today: planning for, and paying for, better care than basic Medicaid will provide.

A society's perception of "old" has a lot of bearing on how much respect it gives its elders.

According to Elizabeth Jacobs, reporting on anthropologist Jared Diamond's 2013 TED Talk lecture about the differences in elder care across nations, "the perceived value of the elderly is an important factor in determining whether seniors are respected or not."

And the threshold age for "elderly" in a given culture may be the determining factor of that perceived value.

"In the United States a senior citizen is defined as someone who is 65+," Jacobs wrote. "But in other parts of the world, like New Guinea, anyone 50 or over is considered lapun, or an old man. As Diamond points out in his book, The World Until Yesterday, this difference has wide implications, as the two age groups tend to have a different set of physical and mental abilities."

The younger "old" people in New Guinea are thus afforded reverence and respect, whereas in the United States, "old" people are often seen as frail and senile, and are commonly lampooned in pop culture.

Unfortunately, that lampooning may have harmful consequences. As younger people ingest those lines of satire and comedic thought, they can all too easily begin to believe them, and come to disrespect, or even despise, their elders.

The interesting case of Japan.

In Japan, there are expected to be nearly double the number of persons aged 80 or older than in the US by 2020. Adult diapers already outsell baby diapers there. Like America, Japan faces a crisis in funding and caring for its elderly population; its national pension system has been on the brink of insolvency for years.

Yet, even with more Japanese seniors living among younger family members in extended family arrangements than their American counterparts, elder abuse and neglect is less frequent. Why?

Like the United States, Japan has a high per capita income and an aging population. Unlike in the US, however, there is an endemic cultural reverence for the elderly that has withstood economic development.

The Japanese celebrate their elderly.

In fact, the third Monday in September is celebrated there as National Respect for the Aged Day— a paid holiday from work even for young adults— on which families gather for meals and to give gifts to grandparents and great-grandparents. In the United States, by contrast, the flow seems to operate the other way, with many holidays (like Christmas, Halloween and Easter) focused on making children happy.

This may be due, said The Week's Karina Martinez-Carter, to Western religions. Whereas the traditional Shinto belief system in Japan reveres ancestors, Western youth-centricism, "relates back to the Protestant work ethic, which ties an individual's value to his or her ability to work— something that diminishes in old age."

So is the United States getting anything right when it comes to providing future care?

Of course. We're by far not the worst off among all nations. But there are clearly areas for improvement that we need to address, and other countries customs and practices warrant examination.

The issues associated with an aging population aren't going to diminish in the near future; they're going to increase. The Baby Boom, the largest generation in US history, is nearing peak retirement. We need more solutions for providing quality, affordable senior life care, and we need them fast. Good care is available to most in the United States, but it should be available to all.

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Topics: future care, Senior Life, elder abuse

How Can I Convince My Elderly Parents to Accept the Help They Need?

Posted by Bryan Reynolds

Nov 21, 2014 10:17:01 AM

adult-child-with-elderly-motherOne of the toughest conversations you will likely ever have with your parents is the discussion about assisted care.

No one wants to move into assisted living; the necessity of a move brings with it a great deal of natural fear that must be addressed. According to Dr. Donna Cohen, a psychologist who wrote the elder care guide The Loss of Self: A Family Resource for the Care of Alzheimer's Disease and Related Disorders, pride can be a strong barrier to an aging parent's acceptance of care.

"Many older people see themselves as proud survivors," she wrote. "They think, 'I've been through good times and bad, so I'll be fine on my own.' Plus, they don't believe their children understand the physical and emotional toll of age-related declines."

An older parent naturally fears a loss of control over his or her personal affairs. And some aging parents might even feel ashamed, because they feel like they have become "burdens" on their children.

Strategies for Bridging the Subject of Long-term Care

Many children feel uncomfortable discussing long-term care with their parents. They might feel a sense of sadness about their parents' decline or wish to avoid arguments. Some figure they can "cross that bridge when they get there." But rather than avoiding discord, these caregivers set themselves up for more unnecessary difficulty.

Instead, the best strategy for dealing with the transitioning of an elderly parent to assisted living is to be proactive. Ideally, you would begin having discussions about your older parent's long-term care before the need arises. And you should be involving your parent in the decision-making process about future care from the get-go.

Never blindside an elderly loved one with the suggestion that he or she may need to move into a retirement home.

Ask Open-ended Questions and Actively Listen to Responses

Barbara Kane, co-author of Coping with Your Difficult Older Parent: A Guide for Stressed-Out Children, suggests that asking questions and trying to determine the root cause of resistance can help you figure out the most mutually-acceptable course of action.

"Is it about a lack of privacy, fears about the cost of care, losing independence or having a stranger in the house?" she asks. To build trust, Kane says, you must empathize with your parent and validate his or her feelings, instead of dismissing them out of hand.

If fear of losing her independence is one of the primary causes of arguments with your aging mother, you can alleviate her concerns by asking her up front what her desires are for the inevitable time she becomes unable to care for herself. Talk about what decisions regarding her medical care she would like to make now— before she loses the ability to do so— via an advance care directive or living will.

If your father's sense of pride makes him feel ashamed of the cares he will place upon you, engage him in talking openly about it. Ask him what he would prefer to happen, and sound out his willingness to either accept in-home nursing care from a third party care provider, or to look into moving into a retirement community. Try visiting retirement communities together and making a list of his preferences. Then, when the need for more care arises, he will feel like he was the one who was ultimately in control of the decision to seek additional care.

Involve an Impartial Third Party

It can help an older loved one to become more open to accepting care if there are other voices advising him or her to do so. "Sometimes it's easier for a parent to talk to a professional rather than a family member," Cohen wrote.

Having regular extended family meetings, or soliciting advice from trusted professional like a geriatric psychologist, doctor, or minister, can provide an elderly parent with an impartial perspective that he or she will find more difficult to argue with.

Ask your parents to join you in seeking others' opinions. If your parents are the ones asking questions of others, they will be more likely to accept the answers.

Be Honest

You might be able to avoid conflict by asking questions that guide your parent to the decision you know should be made. If your mother is forgetting to take her medicines, or is becoming unable to feed herself, ask her to imagine how you would feel if she allowed her health to decline just because she was unwilling to accept help. If you are honest with her about your fears and feelings, you may find her more becoming more receptive.

But if your parent is absolutely steadfast in resisting assisted care, don't beat yourself up about it. As long as they are not endangering themselves or others, you should let them make their own choices.

"You can't be at your parent's side all the time," Cohen writes. "Bad things can happen, and you can't prevent them. You need to accept limits on what you can accomplish and not feel guilty."

Caring for elderly parents isn't easy

Making decisions about their future care isn't easy, either. But by involving your parents directly in the decision-making process, actively listening to them and sharing your feelings openly with them, you will find that transition to long-term care may be easier than you thought it would be.

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Topics: life after retirement, senior healthcare, assisted living

Seniors Need to Get Savvy about Financial Planning

Posted by Bryan Reynolds

Oct 31, 2014 1:44:25 PM

elderly-financial-planningIn this world of escalating expense, can seniors afford to live comfortably? Senior life frees a person from the hustle that comes with maintaining a job, but it can also create financial chaos.

There are many changes that come with getting older from the growing list of everyday aches and pains to accepting that someone else may eventually have to handle your finances. While you may not be able to predict every health problem that will come your way, though a well-balanced diet and regular exercise can help keep you happy and healthy into your golden years, your finances are a little easier to plan for in advance. And planning ahead will help ensure that you’re living well—even on a fixed income.

We have some tips that can help get you there.

Work with People You Trust

If you yourself are not a licensed financial planner, you’re probably going to need expert help planning your retirement. But that doesn’t mean you should pick just any financial advisor. Do your research. There are many scams out there offering to take money out of your savings and double or even triple it. Choose wisely and know what you are getting into when creating an investment plan.

The Financial Industry Regulatory Authority (FINRA) offers tools that help you look up the professional designation of an investment advisor and provides tips on choosing the right individual.

The Federal Deposit Insurance Corporation (FDIC) suggests you designate a trusted family member or friend to handle your finances in case you become unable to manage them.

Write down all of your banking and investing information including account numbers and passwords. Keep the details in a safe place such as a lockbox and provide instructions on how to access them in case of an emergency.

Develop a Budget Plan

Senior life usually means living on a fixed income, and that actually makes budgeting easier.

Sit down and develop a spending plan that keeps you within budget. Make a list of your expenses– weekly, monthly and annually– and then look for sustainable ways to cut costs. You don’t want to cut back so much that it’s difficult to enjoy your new life after retirement.

Reduce the temptations that create debt, too. You might keep one or two credit cards handy for emergencies, but put them away. If you don’t carry them around, you will not be tempted to use them every time you shop. Add your name to the Do Not Call Registry to avoid getting new offers, as well.

And don’t forget to start saving early! Assisted Living Today recommends everyone over the age of 50 save at least 20 percent of their income to cover unexpected expenses.

Downsize Your Space

It costs money to maintain a house. Now is the time to consider how you can reduce the hassle and expense of homeownership. Finding affordable senior living is easier than you think, and joining a community actually brings a number of benefits.

The Assisted Living Federation of America explains seniors should focus on three concepts when researching communities.

  • Quality of life
  • Standards of Care
  • Cost and value

It is critical that you examine the property and services as a whole. Say, for example, you were looking for a good community in Greater Cincinnati. You might want to look at St. Paul Village or Shawnee Place.

At St. Paul Village in Madisonville, each person or couple has their own apartment that includes a carpeted living room and full kitchen. The community offers services such as on-site security, exercise rooms, shuttles to local businesses and even a hair salon. With a focus on wellness care for its residents, the community offers services like evaluations to determine exercise needs and nutrition standards and visiting nurses available to help manage medical problems and even an on-site social worker.

Shawnee Place in Springfield, OH is designed for comfort at an affordable price! A converted hotel that now offers independent living apartments to seniors over the age of 55 that meet the income requirements, rents range from 425 to 510 dollars a month. Each apartment includes a full kitchen and a bathroom with a walk-in shower. There is a laundry on-site, as well.

The community offers a monthly bus trip, spiritual care and a wellness clinic to residents.

Senior life requires you to make some financial changes. It is about planning ahead to find a balance that allows you to live well on a budget while still enjoying your life in retirement.

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Topics: living well, Senior Life, financial planning

Did Your Aging Parent Purchase an On-Exchange Health Plan?

Posted by Bryan Reynolds

Sep 24, 2014 10:30:00 AM

aging-parent-with-caregiverWhen it comes to the state of health coverage in America today, there's really only one thing everyone agrees on: the system is confusing. With passage and implementation of the Affordable Care Act (ACA), many more Americans now have coverage than before, but providers and insurers have shifted more of the cost burden onto consumers in response.

If you or your aging parent bought an exchange medical plan this year, having up-to-date, unbiased news is one of the most powerful tools for caregivers can use to sort things out.

What is the debate about subsidies?

Under the ACA, Congress legislated that the federal government would issue tax subsidies to defray the cost for Americans of limited to moderate income who buy coverage from state-based health insurance exchanges.

But not all the states set up their own exchanges.

So the debate is essentially this: does the IRS have the right to extend tax credit subsidies in the states where federal government is running exchanges?

Some say that the law, as written, only allows for federal tax subsidies to be paid to people who purchased from state-run exchanges and have even filed suit in Washington D.C. to challenge the IRS' extension of tax credits to purchasers on federally-run exchanges.

At the same time, a similar suit was filed in federal district court in Richmond, Virginia. In July, the judiciary panels in both cases issued conflicting rulings, within hours of each other.

In Washington, the judges struck down the federal government's subsidies to purchasers on federally-run exchanges, issuing a literal interpretation of the ACA that would indicate Congress intended to provide subsidies only to state-run exchange purchasers.

In Richmond, however, the court issued a broader interpretation of the ACA, which upheld the IRS decision to offer credits to all income-qualified applicants and found that Congress' intent was to make health care more affordable for all Americans.

With the lower courts in conflict, the issue is likely to be taken up in the near future by the Supreme Court of the United States— a landmark case with far-ranging implications for the nation's health care system and for future legislation.

Will subsidies be going away?

The Obama administration has directed the IRS to continue crediting tax subsidies to all income-qualifying, on-exchange buyers, regardless of where they purchased health coverage. So, unless the Supreme Court takes up the case and rules against them, or Congress repeals the subsidies provision of the ACA, subsidies are here to stay.

So, here's what you need to know:

  • If you live in a state that runs its own exchange, your subsidies are clearly unaffected, even if the Washington court's strict constructionist interpretation of the ACA eventually stands.

 

  • If you or your aging parent purchased on-exchange coverage this year, and qualified for income-based tax credit subsidies, you're in the clear for now. There is nothing you need to do at this time and you do not need to cancel and repurchase an unsubsidized, off-exchange plan. Until a firm ruling or legislative change is made, the subsidies will continue.

 

  • If you purchased an off-exchange plan to begin with, or if your coverage is offered through your employer, this debate has nothing to do with your type of plan.

 

  • If you or your aging parent is on Medicare or Medicaid and is not covered under a privatized Medicare or Medicaid PPO, you also needn't worry — traditional Medicare and Medicaid plans are unaffected. They are not part of the exchange system.

 

  • Medicare or Medicaid beneficiaries who purchased an on-exchange, privatized Medicare PPO or Medicaid PPO, or a Medicare / Medicaid supplemental plan, through a state-run exchange are similarly unaffected.

 

  • If you purchased a Medicare or Medicaid PPO, or supplemental plan, on a federally-run exchange, you will continue to receive any subsidy you may have qualified for, until a firm ruling or legislative change is made.

It's going to be an interesting year. Be sure to follow the news.

But as you do, make sure you turn to unbiased sources. The healthcare debate is one of the most politically-charged issues to arise in America in the past century, and reliable information can be hard to come by.

Be wary of hearsay, social media posts and talking heads on cable networks, and stick to vetted, professional news. Staying in the know and developing a deeper understanding of the law will help you to frame the discussion and inform your stance and your votes.

Regardless of the outcome of the ACA tax subsidy cases, we all need to be better aware of the health care resources that are available to us, so that we can use them wisely and maintain our wellness!

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Topics: caregiving, affordable care act, health tips for seniors, health and wellness

3 Critical In-Home Services Every Caregiver Needs to Know About

Posted by Bryan Reynolds

Aug 27, 2014 11:30:00 AM

caregiver-helpAs any caregiver will tell you, providing in-home care for aging parents or for loved ones who are dealing with cognitive memory loss, is more than a full-time job. Often, fatigue, stress and financial strains can become an issue for even the most patient caregivers. That can reduce not only the quality of care that you are able to provide, but negatively affect your own health, too.

But there are powerful tools for caregivers that can help you provide your loved one with the best care possible, without impacting your own wellbeing.

1. In-home therapy and in-home nursing

Shuttling aging parents back and forth to many different doctor appointments can be a large drain on time and resources. That can be exacerbated if your parent requires physical rehab, occupational therapy or memory care. Many of these services, however, can be arranged on an outpatient basis, to take place in your home.

In-home nursing is also an option if you need assistance providing for your loved one’s medical needs or daily necessities.

Say, for example, that your father is a bed-bound, post-amputation diabetic. He requires daily finger stick blood screenings (FSBS), Glucophage doses, and insulin injections and must be assisted to the commode and to the bath. An in-home nurse can be arranged to come to your home daily and monitor vitals, administer medications or injections, and provide lifting, toileting and bathing assistance.

2. Respite care

Because you are, in fact, a human being, there are going to be times when you need a break—for the sake of your own health and wellbeing. But there’s no reason that should make you feel guilty.

Caregiver fatigue, also known as “caregiver burnout,” is a very real condition that impacts the ability of a caregiver to function and provide adequate care. Virtually all senior care experts would agree that it’s beneficial—for both caregivers and those they care for—to have regular periods of times away from the immense responsibility of ensuring the health, safety, and wellbeing of a loved one.

And respite care can provide that opportunity.

Respite care programs come in many forms—many of which are offered as day programs at retirement communities. But there are some models that provide in-home sitters who allow the primary caregiver to be away from home for a portion of the day— long enough to go to work, run errands, or just take a few hours of personal time every day.

3. Geriatric care managers

Hiring a professional senior care expert, such as a geriatric care manager, to consult on or actively manage your loved one’s care can alleviate stress and improve the quality of care your relative receives.

A geriatric care manager will sit down with you and your loved one to develop a workable plan for in-home care now. With a care manager, you can map out a formula for your loved one’s future care— including any contingency plans for a later move to assisted living or a skilled nursing facility, if such becomes a necessity. A geriatric care manager can also:

  • Monitor your parent’s medication regimen to ensure they are complying with treatment, not missing medications or experiencing any adverse drug interactions.
  • Continually evaluate your loved one’s physical, cognitive and emotional function and arrange outpatient support, such as physical or occupational therapy, mental health counseling, or specialized memory care, as necessary.
  • Coordinate in-home nursing services, personal care assistance and ancillary support services, such as Meals on Wheels deliveries.
  • Help you and your loved one negotiate the often-complicated process of health coverage pre-authorizations and appeals, help your loved one to evaluate and apply for Medicare and Part D plans during annual enrollment and steer you toward financial assistance programs when health care costs exceed ability to pay.

A geriatric care manager’s goal is to ensure your loved one receives care at home for as long as possible, and to make life easier for you as a caregiver.

You don’t have to go it alone.

Caring for an aging parent can be isolating — especially if you do not have strong support from other family members or friends. It is important that you take advantage of all the resources available to you to ease the burden under which you find yourself, and to make the care you provide the best it can be.

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Topics: caregiving, geriatric care management, Memory Support, in home care, senior care, for adult children, aging at home, aging in place, respite care

The Older Adult’s Guide to Retirement Tech

Posted by Bryan Reynolds

Aug 2, 2014 9:50:00 AM

tech-savy-seniorOlder Americans are becoming increasingly savvy at using digital communications and technology in their day-to-day lives— from maintaining family contacts, to forming new relationships, managing medications and planning for retirement and future care. Take a look at some novel ways seniors like you are finding ways to make technology work for them.

It’s not a hearing aid… it’s my Bluetooth!

Older adults with minor hearing loss can be quite sensitive to the suggestion that a hearing aid might help them to communicate better. Some perceive it as a stigma; others just don’t want to accept the notion that they are getting older and their needs are changing. But some seniors are quietly turning to new technology to surreptitiously address those needs, while preserving their self-image.

The good folks at Sound World Solutions have produced a hearing assistance device, the CS50, that looks like (and, in fact, doubles as) a wireless Bluetooth phone headset. For people who can hear sounds, but have trouble distinguishing words from background noise, the device is a clandestine way to improve hearing, while giving off the appearance of being super tech savvy.

The CS50 works with Android or Apple smartphones, is customizable and can even stream music. So, if you’re having a little more trouble talking over dinner in restaurants these days, pop in your CS50 and chat away. People will just think you’re waiting to take an important business call.

Manage your portfolio from the comfort of home.

Remember the days when you had to go to the bank or to your stockbroker’s office to make a trade or make a change to your investment allocation? No more. Online banking and low-cost e-brokerages like Scottrade and TD Ameritrade have, in the past 15 years or so, made it easier than ever to invest in the markets and manage your money from home.

A word of caution, though: online brokerages have also made it easier than ever to lose your shirt. With convenience and bare bones financial service comes the increased risk of making under-researched or ill-advised impulse trades. Seniors who are using online money management services should be cautious about making potentially risky investment decisions on their own— especially when it comes to nest egg allocations.

For additional fees, many banks and e-brokerages do provide professional guidance and financial planning services. Or, you could spend the money to consult a certified financial planner for investment and tax advice, then save cost on the execution side by making your own trades online.

Keep close to your loved ones.

Seniors represent the fastest growing group of social media users nationwide; an estimated 43% of Americans over age 65 are now regularly using sites like Facebook or Twitter to stay in touch with family, look up old friends and keep connected to their communities. And e-mail, camera-equipped smartphones and video conferencing software like Skype are making communication faster and easier than ever before.

Seniors are even using technology to kindle new passions.

For many older Americans who have lost a spouse or been through a divorce, the advance into late middle age and retirement can bring feelings of loneliness. But many dating websites, including Match.com and eHarmony are now specifically catering to the dating needs of people aged 50 and older. Even the AARP has gotten in on the act, having launched its own online dating service. Some dating sites are free; others let users post profiles for free, but may require a fee in order to unlock the user’s ability to search or respond.

Technology is making senior lifestyle easier and more rewarding than ever.

All it takes is a little patience to learn. Even the learning process can be a great opportunity to connect with others— call up the grandkids to come over and teach you how to use that new tablet! They’ll love showing you how to do something, and you’ll love the time spent together.

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Topics: Technology, lifelong learning, senior living, Cincinnati

The Little Lies We Tell Aging Parents Who Are Suffering from Dementia

Posted by Bryan Reynolds

Jul 31, 2014 9:46:00 AM

aging-parentsMany of us who deal with aging parents suffering from dementia have faced the difficulty of imparting to them bad news, or of trying to convince them to accept care that they need when they can no longer live independently. Sometimes, these conservations can become quite heated.

You’ve probably always been told to be truthful with everyone and especially with your parents. But now, some geriatric care experts are beginning to advise caregiving children to employ white lies in order to ease tensions and help parents with dementia to maintain dignity.

Why would anyone advocate lying to a parent?

Let’s first be clear: we’re not talking about big lies, and we’re not talking about employing them with a parent who has normal cognitive function and unimpaired decision-making abilities. We’re only talking about situations in which you are dealing with a parent who is suffering from Alzheimer’s, or other dementia-type disorder, that limits his or her ability to self-manage and make sound decisions.

Aging parents with dementia can often become frustrated, or even recalcitrant, when they perceive that they are losing control of the ability to make decisions for themselves. Their senses of dignity can become more easily offended; they might transfer their anger at their own decline onto the people around them.

But 90% of senior care managers surveyed by the National Association of Professional Geriatric Care Managers (NAPGCM) in April, 2014, said that small lies, or what they call “fiblets,” are OK to tell dementia patients when they refuse care, or when a truth would otherwise be painful for the patient to learn.

So what is a “fiblet?”

According to NAPGCM President Emily Saltz, a fiblet is a small lie that, “is therapeutic because it calms and reassures, reduces anxiety and protects self-esteem.”

The experts who advocated using them in sensitive discussions were careful to caution that they should only be used to support or protect a patient and should never be used for personal gain.

Which “fiblets” are OK?

The majority of geriatric care experts who responded to the NAPGCM survey (83%) felt that telling a demented parent that an in-home caregiver was coming to the parent’s home to help a spouse, or to perform “some other concrete role,” such as helping to keep the house tidy, cook, or make small repairs, could help the parent feel less anxious and might head off a confrontation.

Another common, therapeutic fib that 68% of responding care managers endorsed is telling a demented parent who can no longer safely drive on his or her own that the car is in the shop for repairs. This can prevent the parent from attempting to drive unsafely, or prevent arguments over keys.

68% of care managers also agreed that keeping a dementia patient from knowing the true cost of in-home or assisted care is ok, if knowing that cost would prevent him or her from accepting care. This seems like a no-brainer; if a parent’s only objection to life-improving care is the cost involved, then one cannot allow that cost to be known. Money is the last thing that should keep a person from receiving the care he or she needs.

Over 6 out of 10 care managers also said that they felt it to be OK to avoid telling a dementia patient about family problems that he or she cannot help or control, such as a loved one’s unemployment, an impending divorce, a loved one’s death, a family member’s drug abuse or incarceration, or other peripheral worries. All this would accomplish would be to add to the patient’s overall stress and anxiety level. It’s counterproductive to their care.

If, for example, a significantly demented patient continually asks where her husband is, even though he died years before, most care managers feel it is OK to tell the patient that her husband stepped out for a moment and would be back later. This prevents the patient from having to continually re-learn and re-process her spouse’s death, and alleviates her immediate fear.

You need a supporting team.

Virtually all the care managers who responded to the NAPGCM’s survey agreed that families should approach delicate or sensitive interactions with a clear support group in place, including the involvement of a professional geriatric expert.

All family members need to approach the patient with a unified purpose and a consistent message, so that internal dissensions or conflicts aren’t perceived by the patient and add to his or her general anxiety level.

Again, white lies and fiblets aren’t appropriate for dealing with an aging parent with normal cognition. But when caring for a loved one with advancing dementia, they can be powerful tools for caregivers who want to ease the parent’s anxieties and allow him or her to get the assistance he or she needs.

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Topics: caregiving, dementia, future care, senior health, aging in place, assisted living

Figuring out the Basics of In-Home Caregiving

Posted by Bryan Reynolds

Jul 26, 2014 9:42:00 AM

caregiverFor many adult children, it gradually becomes obvious thatmom and dad aren’t safe living at home alone. Small signs begin to add up— scorched pots from meals that have been forgotten on the stove, dirty laundry that has piled up for weeks, burned out bulbs that have never been replaced. 

It’s a realization that’s fraught with anxiety— these grown daughters and sons find that they have no idea what to do when they are thrown into the role of caregiver.

A lot of concerned children of aging parents will attempt to ease transition by offering a move into the child’s home, where care can be provided by family members. But few seniors relish the prospect of moving away from their homes and into an assisted living situation, even if that assistance is provided by a caregiving child.

So what if your parent keeps resisting a move to your home?

Sometimes, that does happen. You need to be calmly and gently persistent. But you also need to know when to ease off. Leave the invitation open and look for the right openings to broach the topic again. 

If, for example, your mom mentions to you that grocery shopping and cooking for herself are becoming a real chore or that cleaning the bathroom leaves her knees sore for the rest of the day, you might remind her that an offer to move her in with you is on the table.

And it may be that your parent has to learn a hard lesson before he or she will consider change. It’s interesting how life can come full circle— just like you might have learned that riding your bike in gravel may cause you to fall, and thus you learned not to do so, a parent might learn that continuing to live unassisted in a cluttered home might result in a scary fall, and that they need more help.

Give your parent as many options as possible.

It’s important that your parents are not made to feel as if they are losing control of life decisions. Make sure that you lay out all of the options— in-home services, an assisted living community, moving into your home— though you can, of course, make what you believe to be the best choice seem like the most attractive option.

And as with most difficult choices, it’s best not to beat around the bush.

Be frank in bringing up your concerns about a memory lapse, but don’t take the choice away from your parent. Say, “Dad, I’m worried about your memory and these falls you’ve been having recently. I think you need a little more help. Should we start talking with your doctor about whether you need to consider assisted living? Or maybe you’d like to try moving in with me for a while so that I can make sure you’re getting everything you need? I’m happy to provide input, but I’d like to know your thoughts.”

Make sure everybody is on the same page.

If you have siblings who would want to be involved, make sure that you consult them and that you all present a unified front to your parents. The worst thing you can do is to appear inconsistent or to argue in front of your parent.

You also need to make sure that your parent designates a healthcare power of attorney and fills out advance directives and a living will. That way, there will be clear expectations and clear leadership for any future care decisions.

During this time, bear in mind that this is likely a stressful situation for you and your aging parent. But using these powerful tools to persuade your parent of the best course of action, you will make sure that your parents are safe and have the care and the caregivers they most need.

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Topics: caregiving, future care, aging at home, assisted living, assisted care

Help Your Aging Parents Make the Right Choices about Senior Care

Posted by Bryan Reynolds

Jul 24, 2014 9:35:00 AM

senior-woman-and-adult-daughterThere comes a time when many adult children realize that their aging parents are no longer able to take care of themselves. A lot of heartache and agonizing decision-making can result—especially when mom and dad are loath to admit that they need help.

So when the time comes for mom or dad to stop living independently, how do you convince him or her that a move is in his or her best interest? Here are tips you can put into practice— powerful tools for caregivers that you can use in your efforts to keep your parent safe.

Consult the experts.

According to registered nurse Stella Henry, co-author of The Eldercare Handbook, many aging parents are simply unrealistic in their estimation of their abilities to manage alone. She states that early and open communication between family members is the key to tearing down the walls that the senior might put up. If the groundwork for discussions about future care has been laid down before your parent ever needs assistance, Henry asserts, his or her fears will most likely have been alleviated by the time extra care does become necessary. 

Involve your parent’s primary care doctor or geriatric specialist in discussions, if possible. This will ensure the decisions you make together are medically appropriate, and will give your parent additional evidence to support your claims. If he or she is hearing the same message from doctorand family, it may be more convincing.

Develop an advance plan together.

If you want to bring your parent first into your own home before any move to future care in an assisted living facility, it would be wise for you and your parent to sit down and discuss this plan. Make sure that your parents understand that a plan for continuing care must be developed, but also ask for their input on what they would like to see happen going forward.

You might visit retirement communities and assisted living facilities together— in advance— so that your parents have a chance to view potential future homes and make their preferences known. If your parents are resistant to the idea of even visiting a senior living community, ask them to do so as a favor to you. It may help make a visit more palatable to them.

Once your parent sees a positive residential environment there, and that there is nothing to be feared about moving in to an assisted living community, he or she may become less apt to resist considering future care. You could even put a plan in writing together, so that your parent knows that his or her wishes have been heard and understood.

Appeal to your parent’s sense of empathy.

If your parents are able to see and understand that their condition has become a source of concern to you, he or she may ease up on the resistance.   Most parents don’t want to worry their children— as you yourself have likely experienced, a parent sees looking out and providing for their kids as a lifelong role.

“Make it your problem instead of your parent's problem," Henry suggests. "If you say 'you have to do this, or do that,' you'll lose them. Instead say something like, 'Mom, I'm concerned about you; it makes me worried to see you like this.'"

But you need to be wary of an aging parent’s attempt to hide his or her true condition, too. And that’s where regular, open and honest communication is again essential. If you are fostering regular, positive contacts with your parents, and they perceive that your concerns for their wellbeing are genuine, they will probably feel more comfortable about being honest with you.

 
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Topics: caregiving, future care, senior care, assisted living, assisted care

The Simplest Senior Care Devices May Be the Best

Posted by Bryan Reynolds

Jul 19, 2014 9:31:00 AM

simple-senior-devicesTechnology is supposed to make difficult jobs easier. Smart phones makes it easier to share personal experiences through pictures and videos, for example, and keeping a checking account balanced has never been easier since the invention of online banking. State-of-the-art toys featuring all the bells and whistles will always attract the attention of young people but simple devices have always found the best traction among seniors.

While young people have no problem adapting to the each new technology to come along, many seniors have trouble learning how to operate some of the more sophisticated gadgets.

Devices with multiple functionalities are overly complicated and difficult to use, especially in times of emergency. Many seniors become confused, overwhelmed and frustrated when technology, instead of offering much-need assistance, seems to make simple tasks more difficult. When this happens, some seniors simply give up trying to use these tools.

Don't Psych Yourself Out

It is a myth that older people cannot learn how to use new technology – six in ten seniors now go online and 77 percent have a cell phone, according to Pew Research Internet Project. But, despite these numbers, many seniors still remain uncomfortable with adopting new technologies-- at least when it comes to figuring things out on their own.

According to the Pew study, most seniors would be unlikely to sit down at a computer, or with a hand-held device, and play around until they figured out how things work.  77 percent of respondents said they would need someone to walk them through a new technological process.

Seniors who find help and overcome challenges to make technology part of their daily lives, however, will find a powerful tool in their future care arsenal.

Simplicity in Technology: Future Care for Seniors

Chronic medical conditions like arthritis, Alzheimer’s disease and other types of dementia, poor vision and hearing problems can make life difficult for seniors-- especially those who want to live independently at home. The little problems, like forgetting to take medication or leaving the stove on, can cause serious emergencies. Simple technologies help seniors stay independent by reducing the risk for life-threatening problems.

  • Medical alert devices are perhaps the easiest tool for seniors because they are simple– just press a button in case of emergency to call for immediate help. These devices are lightweight, unobtrusive, inexpensive and, best of all, easy to install and use. You do not need to dial a telephone to communicate with an emergency response center.
  • Medication reminders are another type of simple technology that seniors can really use. The old-fashioned pill trays keep daily dosages organized but don't let seniors know when it's time to take a pill. Today there is a variety of medication reminder apps for smart phones, automatic pill dispensers, and vibrating pill timers that help seniors take their medication on time. While these devices are handy, some may be difficult for the senior to set up or update with new medications.
  • Locator devices are essential for people who regularly lose their keys, eyeglasses case, canes, TV remote, and other household items. Manylocator devices work by simply pressing a button then following a high-pitched tone.
  • Other types of technology, not specifically meant for senior life, can also come in handy. Clocks and calendars help seniors keep track of time and important events. Clocks that show the time of day and day of the week are especially helpful to orient confused individuals.

In the future, care for seniors will likely include all the latest, greatest gadgets that engineers can dream up but the simplest senior care devices will always be the most popular because they are easy to use and reliable.

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Topics: Technology, senior care, senior living

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