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Nursing Home Care

Navigating Nursing Home Care

Aging Life Care Professionals, Long-Term Care, Making a Move, ,

Moving to a long-term care facility or nursing home can be a shock to an individual and to the family. And you’ve probably figured out how expensive it is. With questions ranging from cost to quality of care to food choices, you may feel overwhelmed or trapped. An Aging Life Care Professional™ can help you navigate the nursing home maze and be an extra set of eyes and ears.

By Suzanne Modigliani, LICSW, CMC – Aging Life Care Association™ Member and
Fellow of the Leadership Academy

 

Why Nursing Home Care

There are many reasons someone may be living in a nursing home. After a hospitalization, your loved one may have been placed in rehabilitation; and during that rehab stay, it may have become clear the person can no longer live alone. If finances preclude in-home care, nursing home care can be covered by Medicaid if the individual is clinically and financially eligible. Or if the individual’s needs are so complex that the care of a registered nurse on a regular basis, a nursing home is a practical solution.

Paying for Nursing Home Care

All of a sudden you are told your loved one’s time in rehab is up and that he/she must go home or move to long-term care.  While the rehabilitation stay may have been covered by Medicare, the transition to a long-term care can be confusing. You probably have figured out how expensive nursing home care is. Medicaid will pay for long-term care if the individual meets specific eligibility requirements. There are very specific rules, some depending on if there is still a spouse in the community, as well as others regarding how much money the elder can have spent for certain things. If you are confused or unsure about the Medicaid application process, reach out for professional assistance from an Aging Life Care Professional or even an Elder Law Attorney.

Choosing a Nursing Home

Which nursing home is best for your loved one? A great place to begin your research is with Medicare’s Nursing Home Compare website. Nursing Home Compare allows consumers to compare information based on yearly surveys conducted in person by the Department of Public Health according to strict criteria. It contains quality of care information on every Medicare and Medicaid-certified nursing home in the country, including over 15,000 nationwide.

For information beyond the survey, a local Aging Life Care Professional can offer up to date information and an insider’s view based on having clients at a particular facility. Staff changes frequently and having this personal, up to date view is invaluable. Aging Life Care Professionals will know the little things like whether all those activities on the calendar really happen.

Navigating the Maze

An Aging Life Care Professional can be your guide to all things nursing home. Whether you live in the same town or across the country, an Aging Life Care Professional can be your eyes and ears. These experts can also help you answer all of the questions that may be racing through your head, or that may come up along the way such as:

  • Does my relative get to choose a roommate?
  • Can she still have her favorite foods?
  • Who is my contact person at the facility?
  • Who do I tell that my mother never wears her hair that way, or that red lipstick makes her day?
  • Who is responsible for laundry and should clothes be labeled?
  • What if the roommate keeps the TV blasting late into the night?

Though nurses are on staff, the bulk of the care is provided by certified nursing assistants who are taking care of a number of people on a daily basis. Forming a bond with the regular CNAs that assist your loved one will help you get timely information and also go a long way towards making sure your loved one is getting the care you hope for.

Nursing homes are required to have quarterly care plan meetings to establish exactly what they are doing for a resident. There need to be goals with progress towards those goals reviewed. Having an advocate attend with you – or in your place – can be invaluable. If the Aging Life Care Professional knew your relative before placement in long-term care, they may have important history to share with the facility staff.

With experience working in and with nursing homes, Aging Life Care Professionals are great partners to work successfully with nursing home staff. Find a local Aging Life Care Expert at aginglifecare.org.

About the author: Suzanne Modigliani, LICSW, CMC is an Aging Life Care™ specialist in Brookline, MA who works with families to find solutions to complicated elder care problems. She has been a leader in the Aging Life Care Association and quoted extensively in the media as seen on her website modiglianigeriatrics.com.

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association™ and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

Aging Life Care Professionals can relieve families of caregiving stress

Avoid Caregiver Burden

Aging Life Care Professionals, Aging Parents, Caregiving, Making a Move, , ,

When a Santa Fe couple needed help finding the right assisted living community – and they didn’t want to burden their children – they turned to Aging Life Care Professionals™ for help.

With one spouse needing more hands-on care and the other desiring more social interaction, it was important to find the right community to meet their differing needs. After completing a full assessment,  Aging Life Care Professionals Jeffrey S. Pine, MS, MSPCH, CMC and Lydia Sckalor, RN developed a care plan that provided for the intense care of the wife while still allowing for the husband’s independence.

Though it is most often adult children or family members calling for Aging Life Care™ assistance, this couple was proactive in seeking professional help. It was important to them that they let their children be family and rely on professional expertise for care management – eliminating any caregiver burden.

What Can Aging Life Care Professionals Do for You?

Aging Life Care / geriatric care management is a holistic, client-centered approach to caring for older adults or others facing ongoing health challenges.  Working with families, the expertise of Aging Life Care Professionals™ provides the answers at a time of uncertainty. Their guidance leads families to the actions and decisions that ensure quality care and an optimal life for those they love, thus reducing worry, stress and time off of work for family caregivers through:

  • Assessment and monitoring
  • Planning and problem-solving
  • Education and advocacy
  • Family caregiver coaching

Aging Life Care Professionals are engaged to assist in a variety of areas, such as:

  • Housing – helping families evaluate and select appropriate level of housing or residential options
  • Home care services – determining types of services that are right for a client and assisting the family to engage and monitor those services
  • Medical management – attending doctor appointments, facilitating communication between doctor, client, and family, and if appropriate, monitoring client’s adherence to medical orders and instructions
  • Communication – keeping family members and professionals informed as to the well-being and changing needs of the client
  • Social activities – providing opportunity for client to engage in social, recreational, or cultural activities that enrich the quality of life
  • Legal – referring to or consulting with an elder law attorney; providing expert opinion for courts in determining level of care
  • Financial – may include reviewing or overseeing bill paying or consulting with accountant or client’s Power of Attorney
  • Entitlements – providing information on Federal and state entitlements; connecting families to local programs
  • Safety and security – monitoring the client at home; recommending technologies to add to security or safety; observing changes and potential risks of exploitation or abuse

Local, cost-effective resources are identified and engaged as needed.

A care plan tailored for each individual’s circumstances is prepared after a comprehensive assessment. The plan may be modified, in consultation with client and family, as circumstances change.

To find an Aging Life Care Professional or to learn more about Aging Life Care visit aginglifecare.org.

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association™ and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

 

Hiring In-Home Caregivers

Aging in Place, Aging Life Care Professionals, Caregiving, Costs of Aging, Financial, Uncategorized, ,

Hiring in-home care providers — on your own or through an agency — is not a decision to be taken lightly. Understanding the financial and legal responsibilities of hiring a household employee is critical. Take a look at these important considerations and  case studies before making any hiring decisions.  

What You Need to Know Before Hiring Private In-Home Caregivers

by Bunni Dybnis, MA, MFT, CMC – Aging Life Care Association™ Member and Fellow of the Leadership Academy

 

For aging adults with physical and cognitive limitations who wish to remain in the familiar environment of their own home, paid in-home care workers often provide the solution. Understanding the differences in care providers and the roles and obligations of hiring are essential to create a positive experience for all involved.

In-home caregivers provide a wide range of assistance including personal care needs such as bathing, dressing, supervision, help with toileting, medication reminders; or assistance with daily living activities, such as meal preparation, light housekeeping, laundry, transportation, and companionship.

Being responsible for the care of a dependent or older adult is a demanding job that often involves many tasks. Choosing a full-service agency shifts the responsibility of care and liability away from the family and can provide respite from many of these demands.

Primarily because of cost considerations, many families seeking to hire in-home help will turn to private individuals rather than hiring through an agency. At first glance this may seem reasonable; however, it can cause numerous problems and can create unexpected liabilities for the individual who becomes the employer.  When hiring in-home care, understanding responsibilities and employer obligations is essential.

Tax Obligations

As a private employer, the individual is required to pay Social Security, unemployment, and payroll taxes. Often the in-home care providers will represent themselves as independent contractors, ostensibly relieving both themselves and the hiring individual of these tax obligations. In most situations, the worker does not meet the criteria of an independent contractor. If the aide has not met his or her tax obligations, the responsibility falls to the employer. This can have serious consequences involving back taxes, civil fines, and the possibility of criminal penalties. Recent changes in minimum wage laws, overtime, and mandatory sick days create even more potential liability for the employer.

Example Case

Mrs. S. was an 85-year-old widow who lived independently in a large condominium complex.Due to failing vision she was initially in need of assistance with grocery shopping, bathing, and some meal preparation. Occasionally, she needed to be driven to medical appointments. Her daughter hired a home care aide, who worked with other condo residents, and employed her on a part-time basis. As time went on, Mrs. S. became increasing frail and began to suffer memory loss. The family decided to employ the aide full time. This very loving relationship lasted until Mrs. S. passed away. In working for Mrs. S. full-time the aide had given up all her part-time clients. Having no other immediate employment, the aide filed for unemployment benefits.  At this point, the IRS became aware of the employer and filed a lawsuit for unemployment taxes, penalties, and fines. Additionally, the caregiver hired an employment attorney to help her become compensated for overtime and minimum wage violations, The family and mother’s estate found themselves in a legal action that took many months and thousands of dollars to resolve.

Worker’s Compensation, Disability, & Liability Issues

As the employer, the individual or family paying for private home care is held liable for any work-related injury that occurs on the job. This can include the cost of medical expenses, disability, and loss of income payments that might become applicable. Homeowners insurance is often limited in scope and can exclude direct care including tasks such as lifting, transferring or bathing. It is essential to check homeowners ’policies to understand the extent of coverage.

The employer also assumes liability that arises out of accident or injury to both the person being cared for and property. Further protections such as TB testing, influenza vaccines and other precautions that can be provided by agencies are now the responsibility of the family/employer. Families who hire an independent caregiver are also no vulnerable to theft, damage or other losses incurred in their employment.  Short of criminal prosecution, there is often little recourse.

Example Case

As a home care worker, Mary had a history of back injuries from years of assisting with the physical needs of stroke patients. Her back problems appeared stable during her last several years of employment caring for a cognitively impaired woman who required minimal physical assistance. Being very pleased with the love and compassion in which Mary treated her mother, the daughter recommended Mary to a friend whose father, Mr. H., had suffered from a minor stroke and the family did not want him to live alone.

 Initially, Mr. H. needed minimal physical care. As time went on, he suffered several additional strokes that decreased his mobility and function. Mary found herself increasingly assisting with his physical care. Transferring, dressing, and bathing put a particular strain on Mary’s back. Having become very attached to Mr. H., Mary did not express her concerns to the family that hired her.

One day as Mary bent over to assist Mr. H., her back went out and she was unable to straighten up. Mary found herself with permanent back injuries. The doctor told her she would not be able to work as an aide again. Mary filed for worker’s compensation and disability insurance. At this point, the government became aware of the employment situation and held the family responsible for medical expenses and disability coverage. The cost far outweighed expenses of working through an agency or getting the proper insurance coverage.

Abuse & Exploitation

With increased frailty, limited function, and memory impairment there is a greater potential for physical abuse and financial exploitation of the elder. While the vast majority of those who provide care for the elderly do so out of their desire to help others and provide the best care possible, there remains a small segment that use this opportunity to take advantage of this vulnerable population. When these older adults are isolated from regular contact with family or community there is often little or no supervision of workers.

Geographic distance and personal demands of family members, lack of expertise, and close ties between an aide and those receiving care all contribute to a lack of oversight. Often families who hire individuals through informal channels are so grateful to have care provided, at a below market rate, they neglect performing basic screening and reference checks — not to mention criminal background checks and on-going monitoring. The naiveties of family members, who have little experience as an employer in these situations, make the individual elder vulnerable to being manipulated and exploited.

Example 

Susan L. lives in New York while her widowed mother remains in California.  When her mother suffered a stroke and wished to remain in her home, Susan realized that she would have to hire someone to assist. Susan felt fortunate when a neighbor’s housekeeper recommended someone who was moving to California and was looking for a place to live and work.

Meeting the caregiver for only a few minutes before flying back home, Susan neglected to have the worker complete a basic employee application. Things seemed to be going well and Susan’s mother became very attached to her caregiver. Several months later Susan came to visit her mother and realized that her mother was physically and intellectually frailer. Susan learned that her mother had begun using the caregiver to assist in paying bills and other banking needs.

At that point, Susan went through her mother’s bank stubs and was shocked to find hundreds of dollars in canceled checks to grocery stores and several thousand more made out to cash. When Susan confronted the caregiver, she tearfully explained that she had a “family emergency” and would pay it back. The caregiver left for a lunch break and neither she nor the money was ever seen again. 

Supervision & Monitoring

Supervision, monitoring, and oversight of employees can make the difference between a successful and disappointing caregiver relationship.  When constraints of distance, time, expertise, or objectivity become too overwhelming this role is often best provided by a professional. An Aging Life Care Professional™ can provide this on-going supervision either as independent professionals or through a small but growing number of agencies who have integrated these Aging Life Care™ into their delivery of in-home care.  Duties can include matching caregivers by needed skills and personal qualities, helping aides to understand the changing needs of clients, providing proper guidelines for care, and mediating difficult relationship issues between families, older adults and caregivers. Not only does supervision provide benefits to the client and family, but support for the caregiver can improve job satisfaction which translates to a positive working attitude and less caregiver turnover.

Providing care to an individual in a home can result in many challenges for caregivers. It is not uncommon for care providers to be of different cultural or faith backgrounds, have different expectations in terms of eating preferences, personal hygiene, and scheduling needs. Professional oversight can clarify roles and expectations for both the caregiver and the recipient. The Aging Life Care Professional  can be particularly beneficial in providing guidance in situations where there are challenging personalities or behavioral issues due to both cognitive changes and other psychiatric symptoms. Supporting the caregiver and providing tools to understand and respond appropriately to a variety of situations results in a successful partnership.

Example

Mr. and Mrs. L. need assistance with most aspects of daily living in order to live in their home. They  depend on caregivers to help with all Mrs. L.’s  personal needs (including bathing, dressing, feeding, and toileting), as well as assisting Mr. L. with household duties.

Their daughter has been hiring caregivers through word of mouth. In the past six months, she has hired at least ten different caregivers. Each time a new caregiver arrives she has to take off work to train them. Her father complains there is no one who knows how to cook, clean, or assist in an adequate manner.  Finally, upon the recommendation of a fellow coworker, she hired a company that has a professional Aging Life Care Manager that partners with the company caregivers.

Before placing another caregiver, the Aging Life Care Manager met with both Mr. and Mrs. L. She learned that Mr. L. was unhappy because none of the aides kept the house like his wife had and he no longer felt like he was living in his own home. By going through Mr. L.’ s daily routine, his wife’s recipes, and learning about his other expectations,  the care manager was able to guide the caregiver to what was best suited for this couple. With a few follow-up conversations and additional guidance, the caregiver was able to form a mutually respectful relationship with the family. The caregiver enjoyed learning new recipes; and after she gained Mr. L’s trust, he began to enjoy some dishes that the caregiver had learned from her country of origin.

Independent or Through an Agency

Hiring in-home care providers — on your own or through an agency — is not a decision to be taken lightly. An Aging Life Care Professional can help you make the best decision taking into consideration the  following:

  • level of care needed
  • personalities of the caregiver and care recipient
  • level of family involvement
  • financial resources
  • tax and insurance obligations
  • supervision

To find an Aging Life Care Professional near you, visit aginglifecare.org. You can also search for ALCA Corporate Partners that provide in-home care or others that handle payroll and tax services for household employees.

About the author:  Bunni Dybnis, MA, MFT, CMC  is Director of Professional Services for LivHOME in Los Angeles, CA. Bunni is an Advanced Professional and Fellow of the Leadership Academy of the Aging Life Care Association. 

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association™ and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

downsizing and selling personal property

Downsizing: What Are We Going to do with All of Grandma’s Stuff?

Aging Life Care Professionals, Making a Move, ,

The family had a great visit with Grandma over Thanksgiving. In fact, Grandma initiated the conversation about relocating to be closer to family.  But what now? Grandma has so much “stuff” that there is no way it will fit in a small condo. Is it worth anything? Do we want it? These are common questions that Aging Life Care Professionals™ hear frequently, and so they often turn to professional move managers for expert guidance.

What am I going to do with “all my stuff”?

By Marie LeBlanc, BS, MBA – Aging Life Care Association™ Corporate Partner

 

When rightsizing or downsizing a home in preparation for a move to a new location or an assisted living facility, the question of what to do with a lifetime of acquisitions is always a difficult one to answer.

Once you have organized and sorted everything into: 1)Taking With Me or 2)Gifting to Others, the balance of household goods then needs to be further separated into: a) Donate, b) Sell, or c) Dispose of.

It is this second phase that is most challenging. People often ask me where they can sell their treasures to get the amount of money that the item is worth. The answer to: “How much is it worth?” is simple – it is worth what someone is willing to pay when you want to sell.

There are a number of resources online that can help you find out the value of items you want to sell. First, you will want to get an appraisal for those items that fall into the “antique” category.

Use a certified appraiser who is accredited and meets professional and ethical standards. He or she will give you an objective judgment because they are not buying or selling. You can expect to pay either a flat fee or an hourly rate depending on their expertise and location. Don’t use an appraiser whose fee is based on a percentage of the item’s value. And remember, it is illegal for a Certified Appraiser to offer to buy an item for which you have requested an appraisal. The American Society of Appraisers; Appraisers Association of America; or the International Society of Appraisers are good sources of information.

There are professional appraisers and other experts online who can give you an estimate of value. You upload photos of your items and provide descriptions. Within a week, you receive a valuation. Value My Stuff charges $10 for one appraisal, $25 for three, or $75 for ten. Worth Point charges $30 for one item or $75 for three. You can also subscribe for unlimited valuations at $20 per month.

Kovels Antiques & Collectibles Price Guide is updated each year and reports recent prices paid for 35,000 items in more than 700 categories at auctions, shops, shows, flea markets, and online.

Searching on eBay or on Craig’s List may also give you an idea of the prices others are selling and buying similar items to yours. There is no charge to search either of these sites.

When advising clients on the items they want to sell, I ask them to send me photos that show the decorative details up close, along with a comprehensive description that includes whatever information they have: the manufacturer, model or serial number; how long it has been in their possession; and any stories about the item that might support its provenance.

If you decide that selling will take too long or that the items aren’t worth what you had hoped, you can consider making a tax-deductible donation.

Just remember, you do not have to tackle “the stuff” alone. Contact an Aging Life Care Professional to find the right professional move manager and resources to make a smooth and stress-free move.

About the author: Marie LeBlanc, BS, MBA, is the president and owner of Transitions Liquidation Services in Hyannis, MA, a move management and rightsizing company founded in 2002.  Transitions Liquidation Services has completed over 700 transitions and Marie is an active speaker on the topics of moving, rightsizing and hoarding.  Follow Marie on Facebook and LinkedIn.

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association™ and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

I am an only child caring for aging parents

Are You at Risk for Caregiver Burnout?

Aging Life Care Professionals, Caregiving, Family Members, Mental Health,

Caregiving can take a toll mentally, emotionally, and physically whether you’re providing hands-on care, managing a paid caregiver, or anything in between. With the pressure of determining a loved one’s care needs and how best to care for them, it’s easy to forget that caregivers need care too. As we honor caregivers during National Family Caregivers Month, take time to look for the signs and symptoms of caregiver burnout. 

By Patricia Charles, LMSW, CMC – Aging Life Care Association™ Member

 

During a recent visit with a friend, I couldn’t help but notice that he was exhibiting some of the classic signs of caregiver stress. Not only do my professional skills equip me with the clinical tools to make this assessment, but my personal experience as a family caregiver for my mother makes me even more sensitive to the issue.

In addition to looking tired, it was clear that he had also lost weight and was not his normal, cheerful self. I made some gentle observations about how he looked a little worn out and asked him if he had started a new diet. Normalizing these difficult experiences allowed him to acknowledge that he was indeed exhausted; he hadn’t been sleeping that much and he was so busy that he found it difficult to make time to eat. He confided that not only was he balancing his own work and commitments, but he was taking a more and more active role in managing his aging mother’s household, hiring and scheduling caregivers, and paying all the bills.

During our conversation, it became clear that this was more than normal caregiver stress and I suggested that he may be suffering from caregiver burnout. He didn’t believe me at first, protesting, “I don’t provide hands-on care for my mother. If anything, I feel guilty that I’m not doing enough.”

Does this sound like you or someone you know?

Many people believe that if they have enlisted help from others in caring for their loved one, they can’t be experiencing caregiver burnout.  They may feel guilty since they are not providing the hands-on care.  Ironically, guilt is a major source that can contribute to caregiver burnout!

Caregiving can take a toll mentally, emotionally, and physically whether you’re providing hands-on care, managing a paid caregiver, or anything in between. With the pressure of determining a loved one’s care needs and how best to care for them, it’s easy to forget that you need care too.

While stress is a normal part of life, burnout is emotional and functional disengagement caused by cumulative stress. Signs and symptoms of caregiver burnout may include:

  • Inability to sleep or broken sleep during the night
  • Inability to concentrate – your thoughts seem to drift from time to time
  • Sudden bursts of emotion
  • Appetite loss or changes in appetite
  • Signs of sadness/depression
  • Life revolves around caregiving
  • You may be a little touchy – more irritable than normal
  • You have stop doing the things you enjoy doing
  • Decreased contact with friends and others
  • Feeling trapped and lack of control

It’s normal to experience these emotions occasionally, but if you find yourself consistently experiencing these signs of burnout you can’t take good care of yourself or your loved one if you don’t take action and seek help.

If you or someone you know is experiencing some of these signs and symptoms, start by talking to someone you trust, such as a close friend, or seek professional advice. Take an inventory of your activities and consider getting re-involved in activities you once enjoyed and are no longer doing. You can also join a caregiver support group in your community or local hospital so you can learn how others cope with the stress and burnout.

Hiring an Aging Life Care Professional™ to provide an unbiased external perspective can help you determine what type of care your loved one needs, identify resources and options, and coordinate interventions you choose while taking some of the pressure off of yourself.

If you are still suffering from the signs of caregiver burnout, it may be helpful to talk with your physician and make sure that you are not suffering from clinical depression.  If you have a history of depression, seek professional help immediately.

Taking care of your personal needs will not only help you be a more effective caregiver for your loved one, but will also allow you to enjoy spending time with them outside of your caregiving role.

About the author: Patricia Charles, LMSW, CMC is the Lead Training Consultant with SeniorBridge. She  has been a social work professional in nonprofit and philanthropic organizations for the past 30 years and a member of ALCA since 2008. She is a highly skilled Aging Life Care™ Manager, as well as a lecturer and educator. You can email Patricia at pcharles@seniorbridge.com and follow SeniorBridge on Facebook, Twitter, and LinkedIn.

 

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association™ and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

warning signs to look for during holiday visits

Home for the Holidays: Making the Most of Visits to Aging Parents

Aging in Place, Aging Life Care Professionals, Aging Parents, , ,

Holidays are occasions that many of us spend with family, whether we live down the block or across the country.  For those with aging parents or loved ones, these visits are an important time to take stock amidst the hustle and bustle, and to make plans. 

By Heather Imhoff, MSW, LMSW – Aging Life Care Association™ Member

Notable changes in an aging person’s appearance, behavior, or environment can be warning signs that his or her health, mentation, and function are changing.  If you notice changes during your visit, dig in while you are there together to further assess the situation and determine if intervention is needed.

Start by Making Observations

Person-centered:

  • Has your loved one’s hygiene changed?
  • Is he or she wearing clothing that is dirty, falling apart or inappropriate for the weather?
  • Has there been a significant weight change?
  • Has his or her gait changed? Are they “couch surfing” or using furniture items for support while walking through the home?
  • Any bruises or cuts that you can see?
  • Are they using mobility or other adaptive equipment properly?

Behavior:

  • Has mom or dad stopped going out for social engagements? Discontinued activities that were important to them?
  • Do they have any new friends or organizations who they have a lot of contact with? Is anyone or any organization asking for repeated or large donations or loans?
  • Do they seem forgetful or more repetitious in conversation?
  • Does he or she seem more withdrawn or sad?

Environment:

  • Looking at their home environment, are there areas of disrepair? Obstructed walkways?  Burned out light bulbs?
  • Any changes in cleanliness of the home, especially in the kitchen and bathroom? Are there items piling up on counters, table tops, or spare rooms?  Unopened mail?
  • Check the fridge to see if there are expired or spoiled food items.
  • Does their car have scratches or other areas of damage?
Important Conversations

If any of these questions lead to concerning answers, it is vital to start a conversation with your loved one about your observations.  Try to remain open and curious, not making assumptions or judgements since issues great and small can lead to similar presentations.

Here’s an example:

Dad is wearing light summer clothing even though it seems too cold.  This may be because his cognition is declining and he is not oriented to what month or season it is.  Alternately, you may learn that most of his warmer sweaters have buttons and his advancing arthritis makes it difficult for him to manage these closures.  Perhaps his winter clothing is stored in the attic or a high shelf that is difficult to access because of strength or balance issues.  Or he may relay that he’s been very busy with his men’s group and just hasn’t gotten around to switching out his wardrobe.

It is important to understand whether your loved one is aware of the issues you’ve noticed, and if he or she sees it as a problem or not.   What are her thoughts, has she attempted to address the situation? What are the barriers that he or she has encountered to resolving the problem.

It can be difficult for someone with a lifetime of independence to admit that they need assistance.  Many of these red flag issues are highly personal in nature, so depending on the circumstances and the personality of the older person, these topics may need to be approached gently and with compassion.

Preferences and Health Care Wishes

Also consider talking about what is important to your loved one.  What gives them a good quality of life?  And a vitally important question: What are their health care wishes?  People fall all over the spectrum when it comes to thinking about, talking about, and making legal documents specifying their health care wishes.  Wherever your loved one falls on this spectrum, it is important to check-in regularly or in some cases, for the first time about their thoughts and preferences about medical care, where they want to live, and what they want their lives to look like.

If dad has already prepared legal documents designating health care decision-making agents and even some advance directives about treatment options, does he still feel the same?  Do the appropriate people and organizations have copies of these documents?  If this conversation has never been broached, test the waters.  See if this is a topic your loved one avoids or welcomes.

The observations made and conversations that take place during holiday visits are most often starting points rather than final conclusions.  Most of these topics are on-going and evolving as your loved one continues to age.  There are resources available in all states to help navigate elder support services and having as clear a picture as possible about what your loved one is struggling with will help target these resources.

A good starting point is your communities Area Agency on Aging offices or connect with an Aging Life Care Professional™ in the area who can offer assistance.  Most importantly, enjoy your time together celebrating and giving thanks!

About the author: Heather Imhoff has eight years of experience as an Aging Life Care Professional in both publicly and privately funded sectors.  She is currently a care manager at EGIS Care & Support in Santa Fe, New Mexico.  Follow Heather on Twitter at @egis_care or email her at heather.egisnm@aol.com.

 

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association™ and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

Seniors and driving

Aging Parents and Driving: Having the Tough Conversation

Aging Life Care Professionals, Aging Parents, ,

As an Aging Life Care Professional™, I’ve seen it first-hand – adult children would rather talk about finances and death with their parents than ask them to retire the car keys. Keep reading for more on how to spot the signs of risky driving, how to have the tough conversation, and ways you can help ease the transition from driver to passenger.

The Toughest Conversation:  Retiring the Car Keys

by Jullie Gray, MSW, LICSW, CMC – Aging Life Care Professional™

 

If, like many fathers, yours drove a tractor at age eleven, flew bombers during World War II, and helped pay for your first car, the idea of starting “the driving conversation”, even if his driving is now terribly risky, sends shivers down your spine.

Why is it so hard? Americans prize self-sufficiency. There is no question that driving is deeply connected to our sense of independence and freedom. Then there is the practicality of it all; without a car, our parents will have trouble getting to places like the grocery store, doctor’s office, or a department store sale. Opportunities to socialize with others will be tricky too, leaving your suddenly car-less parent more likely to feel isolated and depressed.

What the research shows

Participants in a 2013 Pfizer study about growing older said the hardest conversation to have with elderly parents is telling them to stop driving– more difficult even than talking about their final wishes or wills. That sentiment hasn’t changed over the years. In 1997, the New York State Office for the Aging conducted a survey of over a hundred families and caregivers to understand how they dealt with older driver safety concerns. Seventy percent said it took a year or longer to address the issue once they personally observed problems, heard feedback from others, or their parent actually crashed the car.

Families cited two major reasons for not talking to their loved one immediately. First, taking away independence is a hard thing to do to someone you care about. Second, families worried their parent would never forgive them for intervening.

Though this is an emotionally charged topic, we should not postpone tough conversations because we anticipate feeling guilty. Keep in mind, it’s more important to avoid accidents or death than to avoid talking about unpleasant and difficult topics.

If you notice danger signs and your parent doesn’t, it’s time to have “the talk.”

Signs of risky driving include:
  • Confusion or getting lost in familiar places
  • Difficulty maintaining lane position
  • Failure to stop at a red light or stop sign
  • Scrapes or dents on the car, mailbox or garage
  • Bad judgment making left-hand turns
  • Citations for driving

Some studies have found an association between falling and driving problems. It makes sense if you think about it. Frail older people who fall tend to have more health challenges and often take medications that can impair driving skills. Age-related changes in mental processing speed, vision, hearing and physical function may also cause difficulty. Those at highest risk appear to be over the age of 80 – but many octogenarians have no trouble at all.

What can I do?

My advice – Have that first conversation about driving safety with your parent before it becomes a problem. This can help establish an open dialogue and give your parent time evaluate his or her own skills and find acceptable solutions before a crisis.

But if you missed that opportunity, to increase the chance of a successful conversation after you notice problems, AARP and the Hartford Insurance Group suggest selecting a person the older driver trusts to initiate the discussion such as a spouse, physician, adult child, or close friend.

Easing the transition

Making the transition from driver to passenger is a big step and isn’t always easy or smooth. Giving up one’s driving privileges brings up lots of questions, fears, and challenges. Will I be able to get out of the house as often as I want?  I hate being dependent on other people; how will I manage?  How will I see my friends? Will my family see me as just another burden?

An Aging Life Care Professional is a very valuable asset to families struggling with this difficult conversation.  We can help evaluate the situation, and when necessary, develop a plan for driving cessation.  We can also:

  • Facilitate important family meetings to open the discussion
  • Be a sounding board and problem solver if a risky driver balks at the idea of retiring the keys
  • Explain how to utilize formal driving evaluation programs and state licensing reexamination procedures
  • Clarify options for services, transportation and supportive housing to prevent isolation and help alleviate those nagging feelings of dependency

Putting the brakes on driving is a real challenge, but with an Aging Life Care Professional’s help, the transition can be much smoother. Find your own Aging Life Care Professional at www.aginglifecare.org.

About the author: Jullie Gray has over 30 years of experience in healthcare and aging. She is a Principal at Aging Wisdom in Seattle, WA. Jullie is the President of the National Academy of Certified Care Managers and the Past President of the Aging Life Care Association. Follow her on LinkedIn and Twitter @JullieGray, or email her at jgray@agingwisdom.com. Aging Wisdom has a presence on Facebook – we invite you to like our page.

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association™ and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

Top Tips for Caregivers

Top Tips for Caregivers

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As part of National Family Caregivers Month, Amy Goyer – AARP’s family, caregiving, and multigenerational issues expert – shared her top tips for caregivers on Today with Kathie Lee & Hoda as well as on the AARP’s Take Care Blog.

In the segment, Goyer offered immediate go-to resources and tips for those finding themselves suddenly in the position of a caregiving role. In addition to speaking with the hospital social worker or discharge planner, Goyer recommends contacting an Aging Life Care Professional ™ (also known as a geriatric care manager) to help you “navigate, coordinate, create and even implement a care plan.” Goyer’s other top sources for help include:

Once you have addressed the immediate crisis or needs, Goyer offers these steps for caregivers:

1. Build your caregiver team.
2. Connect with other caregivers.
3. Get organized.
4. Care for yourself, too.

To read more on Goyer’s tips and resources for caregivers, visit the AARP Take Care Blog. To view the segment, follow this link:  http://www.today.com/video/resources-to-help-you-succeed-as-a-family-caregiver-557216835935.

Amy Goyer is AARP’s family, caregiving and multigenerational issues expert; she spends most of her time in Phoenix, where she is caring for her dad, who lives with her. She is the author of AARP’s Juggling Life, Work and Caregiving. Follow Amy on Twitter @amygoyer and on Facebook.

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association™ and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

My elderly neighbor needs help

What to Do When Your Elderly Neighbor Needs Help

Aging in Place, Aging Life Care Professionals, Alzheimer's, Caregiving, Dementia, ,

Have you seen your elderly neighbor speeding by the park? Or perhaps driving slower than a snail, in the wrong lane? Maybe you’ve found him wandering the streets confused? Or noticed that she hasn’t come outside when, normally, she waters her garden every other day?

Not everyone has family nearby to routinely check-in or monitor their well-being. So if you think your elderly neighbor needs help, it is important to call on professionals for help before the situation becomes dangerous.

Here is one story from an Aging Life Care Professional™ about how concerned neighbors needed expert help to reach one fiercely independent neighbor.  Persistent and creative in her approach, Aging Life Care Professional Amy Natt, MS, CSA, CMC describes how over time she was able to calm her client’s anger, fear, and mistrust and build a relationship of trust, comfort, and compassion.

To learn more about working with an Aging Life Care Professional, visit aginglifecare.org.

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association™ and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

November is Family Caregivers Month

National Family Caregivers Month

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November is a month to honor family caregivers and the contributions they make to our society.  In the United States, 90 million family caregivers fulfill a vital role on the care team of a family member according to the Caregiver Action Network – the organization behind National Family Caregivers Month. Throughout the month, the Aging Life Care Association™ will feature a variety of blog posts and highlight resources available for family caregivers.

“Respite: Care for Caregivers” is the 2015 National Famly Caregivers Month Theme

This year, the Caregiver Action Network shines the spotlight on the need for caregivers to take a break or respite from their caregiving duties.

” Respite – the chance to take a breather, the opportunity to re-energize – is as important as any other item on your caregiver’s to-do list. People think of respite as a luxury, but considering caregivers’ increased risk for health issues from chronic stress, those risks are a lot costlier than some time away to recharge. Respite is the key to your own well-being. Respite protects your own health, strengthens family relationships, prevents burn-out and allows your loved one to stay at home up to three times longer. No wonder respite is one of the most frequently requested support services for family caregivers.” – Caregiver Action Network

When you are responsible for the care of an aging loved one, a vacation or weekend getaway may seem impossible or out-of-reach. The questions race through your mind: What happens if mom falls? Who will remind Dad to take his medications? What if there is a storm? You feel overwhelmed and cancel your plans.

With a Plan in Place You Can Take a Break from Caregiving Duties

Not taking time away from caregiving responsibilities can lead to bigger problems – caregiver burnout, stress, or poor health. With some extra planning and help, you can take a break. Aging Life Care™ experts offer these tips to help make sure your loved one is safe and comfortable while you are away:

1. In-Home Caregivers: If there is not another family member or trusted friend or neighbor to fill in for you, connect with an Aging Life Care Professional™ who can help arrange for in-home care, monitoring, or transportation needs. Many Aging Life Care Professionals offer 24/7 service and can serve as an emergency contact while you are away. Depending on the individual’s needs, paid caregivers can assist with activities of daily living – bathing, dressing, mobility, meal preparations, house cleaning, or transportation. If you plan on using a caregiver, spend time getting the caregiver and your loved one familiar and comfortable with each other and to be sure that the caregiver is a good match.

2. Organize Important Documents: Prepare a folder or binder of information for the person/agency who will provide care and oversight while you are away. Include information on emergency contacts, physicians, preferred hospital, pharmacy, and other service providers, such as therapy services, Meals on Wheels, home care agency, etc. Also include your loved one’s medication list and other important documents such as Power of Attorney, Living Will, Advance Directives, and Do Not Resuscitate orders.

3. In-Home Technology: There are a variety of new technologies designed for keeping aging adults safe in their homes, including personal emergency response systems (PERS), GPS tracking devices, automated medication reminders and dispensers, as well as systems that allow you to remotely monitor or control the usage of certain electrical outlets or appliances.

4. Respite Care: Many retirement communities, assisted living facilities, and nursing homes offer respite care on a per diem basis for short stays. If your loved one just needs daytime-only activities or supervision, consider an adult day care center.

“Caregiving is exhausting and difficult work,” says Jeffrey S. Pine, Aging Life Care Association president, “but with some extra planning and research, it is possible to take some time away from your caregiving responsibilities to recharge your batteries.”

To access a nationwide directory of Aging Life Care Professionals, please visit aginglifecare.org.

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association™ and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.