A Boomer's Guide to Eldercare

Writing a Thank-You to Your Aging Parent's Caregiver? Here are Samples

2012-02-11T19:23:00.000-08:00

Perhaps you want to write a thank-you letter for your aging parent's caregiver. But you don't know how to start. You're not alone. I'd like a nickel for everyone who've found my blog by searching for "writing a thank you to my parent's caregiver."

Just in time for Valentine's Day, here are two samples of thank-you letters that will give you a start on formulating your own.

Dear Mary,

Our whole family is so lucky to have you care for Mom! You make her day special in so many ways: from applying cream on her hands and doing her nails, to tidying her room so it always looks neat, to playing her favorite music when she needs to relax. When I mention your name, Mom's eyes light up and a smile spreads across her face.

In caring for Mom with compassion and enthusiasm, you give me peace of mind. While I'm at work all day, I'm confident Mom is happy and well cared for. The other family members feel the same way.

I hope you'll show this letter to your supervisor. I'm sure she already knows what a great caregiver you are. But perhaps my words will confirm her ideas. You are wonderful!

Sincerely,

Here's another letter:

Dear John,

My Dad and I want to thank you for the great care you provide! Because of you, he always looks clean and well-groomed from head to toe. You take him through his day in style, from shaving and grooming him, to taking him for a walk, to remembering to turn on the sports channel on television so he can watch the big games.

Your compassionate care puts our whole family at ease. At work I don't worry about Dad's happiness or well-being. I know you're helping him do the best he can every day.

Please don't hesitate to show this letter to your supervisor. I want her to know how much I appreciate the big and small things you do for Dad and for us all.

Sincerely,

Advocating for Your Aging Parent at the Doctor's, Part Two

2012-01-18T20:11:00.000-08:00

Fifteen minutes to solve the world's problems? Or cure your aging parent's ills? I can't promise a miracle, but I have found a few keys that have helped me and others advocate for their parent at the doctor's office.

Prepare, prepare, prepare. A little forethought goes a long way. Consider investing in a "black book." True, the color doesn't matter. What does is your dated observations, questions, and comments about your parent's health,such as "June 15: Daddy has lost 10 pounds in the last month without trying. What's up?" The notebook is also a place to jot down a medication list and specific questions for the doctor.

Don't bite off more than you can chew. Your parent's diagnoses have multiplied over the years. He or she may be willing to wax eloquent about bunyons, warts and you name it. Your time with the physician is miniscule, however. Together with your parent, stick to one main concern.

Tip off the doctor. Doctors can advocate with you if they know in advance your concern. If, for example, your dad has experienced two fender benders in several months, you might want to call his doctor before the visit. Ditto if you feel your parent isn't safe at home. Advance knowledge about the problems help physicians use their persuasive powers to influence seniors.

Question, clarify and translate for your parent. During the visit, if your doctor speaks too rapidly and is losing your parent's attention, ask him or her to repeat. Periodically, summarize your understanding of what's been said and ask for clarification. You might say, "I think I heard you say ...Am I right?" Take notes. Afterwards, go over the notes with your parent and anyone else involved in his or her care.

Can you think of other tips on advocating for your aging parent at the doctor's office?

Advocating for Your Aging Parent at the Doctor's--Part One

2012-01-18T19:18:00.000-08:00

Your aging parent may need your help at the doctor's office. When do you start accompanying him or her on visits, and how do you work together with the physician?

First the when: If your parent wants you to go, the question is settled! But why is your presence so vital?

Seniors place physicians on pedestals, right next to God. In many elders' eyes, doctors are the keepers of the ultimate truth about the most important thing in life: their health. Ironically, that reverence for medical professionals often keeps seniors from telling the truth, the whole truth, and nothing but the truth. Especially about such things as incontinence, memory loss, falls and forgetting to take medications. An answer of "pretty good," to a question about taking medications, may really mean, "I take it once a month, whether I need it or not."

Second, at the visit, a doctor sees and hears at most, a 10 to 15-minute "video clip." You, on the other hand, have been observing your parent's actions and feelings over time. The comings and goings. The waxings and wanings. Your perspective is extremely value. For example, if your parent is losing short-term memory but is socially appropriate, the doctor may miss the same repeated question or phrase you hear every hour or so. So speak up and say, "I've been noticing ..."

Third, two heads are better than one. If your parent's doctor slips into "Medicalese" or explains complex information too quickly, your parent may miss out. You, as a Boomer, know when to say, "I think we don't quite understand that; could you explain it again." You can also summarize your understanding of the doctor's words--"So if I'm right, you're saying we should do..." Taking notes will also help.

In another post, I'll tackle some "how's" of effective advocacy at the doctor's office.

Have you and your parent's physician worked together well on behalf of your parent? Tell us how.

Advocating Tips: When Your Aging Parent Lives Far Away

2012-01-12T19:01:00.000-08:00

Deborah lives in London. But she bounces back and forth between England and Bellevue, Washington, to check on her 83-year-old dad. Last month Deborah moved him into our assisted living community.

As daunting as some days are, over the years Deborah has mastered some tricks to cope with caregiving and advocating from afar. If you, too, live miles and miles away from your aging parent, you may relate to Deborah's ideas and perhaps share some of your own.

1. Use technology to bond you. When miles separate them, Deborah uses Skype to touch base with her dad. "I'm the only daughter, and I feel guilty when I don't know what's going on,"she says, smiling. The visual nature of Skype captures her dad's facial expressions and reactions, giving her a more complete picture than traditional phone calls.

2. Keep in touch with his physician long distance by using the mode of communication the doctor prefers. "Usually before an appointment, I'll send a lengthy fax to the doctor, listing my observations, concerns and questions," she says. Afterwards the doctor faxes her a summary of the visit. Other caregivers from afar say they phone their parent's physician periodically, and especially before key visits.

3. When you're in town, contact your parent's physician and other health care professionals. Note changes, and be willing to accept their advice in making a move to assisted living, finding home care services, etc.

4. If your parent's condition changes, consider hiring an advocate to accompany him to his physician's visits. Deborah is thinking seriously about this. She is also considering asking a friend or paid advocate to attend care conferences at her dad's assisted living and email her or phone her with the report.

Some of you have siblings who live close to your aging parent. How do you partner with them long distance? A future post will cover some ideas.

Retirement Communities Help Caregiving Couples, Pt. II

2011-12-29T21:09:00.001-08:00

Your aging parent cares for a spouse who suffers from a chronic illness. You suppose that the "strong healthy" one will outlive the one who needs care.

Not always true. Just this week at Evergreen Court Retirement Community, where I work, one of our most vibrant residents died following a stroke. Her name was June. She cared for her husband, who suffers from dementia. Last May, with the blessing of their adult children, the couple moved to Evergreen Court primarily to simplify her life. Without cooking, cleaning and other chores, she could focus on caring for John.

The family assumed June would survive her husband by many years. That's not how life played out.

Research has shown that the stress of caring for a spouse with a disabling illness can shorten the life of the caregiving spouse. Dr. Nicholas Christakis, a Harvard Medical School physician and sociologist, came to this conclusion in a study published in February, 2006, in the American Sociological Review.

With 518,240 couples aged 65 and older, the study found that the causes of excess death in the caregiving spouse included accidents, heart attacks, lung disease and diabetes.

What will happen to John? Residents and staff in our community have showered him with love and will continue to do so. We've met with family members to discuss future options. In John's case, bringing home care into his current apartment wouldn't work because he needs direction and guidance around the clock.

The family chose an apartment in our assisted living. He'll move in two weeks. By staying in the same community but in a different area, he'll still enjoy his favorite things: chatting with others over a meal in the dining room, drinking coffee and reading the newspaper in the lobby. But assisted living staff will offer the support he'll need to process his grief in his own way.

When things work right, retirement communities can help make difficult times better for caregiving couples.

Do you have an experience with an aging parent who cares for a spouse? What support have they found that works?

Retirement Communities Help Caregiving Couples, Pt. 1

2011-12-22T19:53:00.000-08:00

You have two aging parents, and one cares for the other. If the caregiver goes down, they're both down. What's the answer?

A retirement community could offer a win-win situation.

The well spouse ditches domestic duties like shopping, cooking, cleaning and focuses on caregiving, hobbies and socializing with others. If caregiving gets to be too much, extra help such as assisted living or skilled nursing is available. Staff can help monitor how things are going.

Today I saw these truths with my own eyes. Emergency technicians entered Evergreen Retirement Community, where I work. June, a resident, had suffered a stroke. It happened in the activity room during a musical performance.

June cares for her husband John. Due to cognitive issues, he can't live alone.

Six months ago, they moved in. June immediately began immersing herself in volunteering and activities. She is chair of the welcoming committee. "I love people," she said. "I like getting to know everyone." She also says she doesn't mind giving up things like cooking meals and washing dishes.

Retirement community living offers John benefits, as well. He loves to drink coffee in the lobby and chat with residents and staff.

Today, staff supported John as he waited for his daughter to take him to the hospital to visit his wife. They offered hugs and listening ears.

What will happen? No one knows. We're praying that June will soon return home. In the meantime, we will work with their family to make sure John is ok. If June needs rehab in a nursing home for a while, John might stay temporarily in our assisted living. Or a daughter might care for him in the retirement apartment. If John needs transportation to visit his wife in the nursing home, we can provide it.

And of course, the coffee is always on. On a more serious note, I can't help but think June might not have made it to the hospital as early if she had been living with John in a single family home. Retirement communities aren't for every caregiving couple. But they're certainly worth considering.

Eldercare Tip: Tried & True Holiday Gifts for Caregivers

2011-12-15T15:54:00.000-08:00

Today candies, cookies and other sweet treats fill the staff rooms where your aging parent lives. And with good reason. You want to play Santa to the caregivers who've doled out unconditional love all year long. Even when Mom or Dad is naughty, they've been nice.

Great idea! Just a favor. PLEASE skip the sugar and other junk food!

I like the idea of group gifts. Most eldercare organizations don't allow family members to give individual staffers money or gifts. The rationale is that the housekeepers may not be as visible in your parent's care, but they play a key role nevertheless. Ditto for workers in the financial office or the groundskeepers.

Here are some tried and true Holiday group gifts that are light on the waistline and actually boost energy.

1. A fruit bowl, with mandarines, oranges, grapefruit, plus any-time favorites like apples and pears. Provide a paring knife. If you'd like to add some protein, nuts are a good selection.

2. A crockpot filled with hot spiced cider. Or bottles of sparkling juices.

3. A holiday-decorated tin of popcorn. Yum.

4. Cheeses and whole-grained crackers or a make-your-own sandwich spread. Toppings can be refrigerated.

5. Pizza for all or a group sub-sandwich.

6. A crockpot filled with chili or soup.

7. Cash. See if your eldercare organization has an employee appreciation fund that takes donations. In the retirement community where I work, Evergreen Court in Bellevue, Washington, families are encouraged to give money to the resident council which divides it evenly among all employees.

8. Donations toward a specific item all employees can share. Often the administration knows of needs that can benefit everyone: a new television (or money toward one) for the staff room, an espresso machine, a piece of exercise equipment, etc.

Can you think of other gifts for caregivers and others in your aging parent's life?

Hooray! My Eldercare Blog Has Hit 100--Posts, That Is!

2011-11-26T20:24:00.000-08:00

My friends Hope and Pete just turned 100. Wow! I now have a tiny taste of their thrill in reaching this magic number. This is my 100th post since I began "A Boomer's Guide to Eldercare" in February, 2010.

Thank you, readers! Most of you are Boomers who seek how-to help and inspiration dealing with your aging parents. Others of you work with seniors and their families every day. A toast to you all!

In celebration, I'm reprising some of my most popular posts, and a few personal favorites.

Most Popular:

1. Affordable Senior Housing--Three Models

2. How to Sell Your Parent's Home in Seven Days

3. Before Using a Senior-Care Referral Agency, Ask These Questions...

My Favorites:
1. Your Aging Parent Has Two Developmental Tasks

2. Ready, Set, Go! Tips for Moving Your Parent Closer to You, Part Two

3. Seize the Day! Celebrate Your Elder

I'm always looking for new ideas. Do you have a particular challenge with your ading parent that you'd like help in problem solving? I'm game.

Eldercare Nurses: Seek Out the Good, Run from the Bad

2011-11-17T21:13:00.000-08:00

As our parents age, we Boomers meet lots of nurses. Most are good--of the Florence Nightengale or Clara Barton ilk. But we also may encounter our own version of Nurse Ratchett, the infamous character in One Flew Under the Cuckoo's Nest.

I met my Nurse Ratchett in the final weeks of Daddy's life. I was visiting from out of state. Daddy's Parkinson's was taking its toll; the doctor gave us children the option of installing a feeding tube. We gave the ok for the procedure, knowing that he still could aspirate, even with the tube.

My gut told me Daddy might not live too long. I struggled with when to book flights for our kids to visit. They had to give notice at work, but time was not on our side. I needed advice--support--from someone in the medical field. So I approached Daddy's nurse at the nursing home.

"Do you have any idea how long my Dad has? My kids haven't seen him in a long time, and I'm wondering about booking flights?"

Her answer blew me away. "Your father could live two days, two weeks, two months or two years," she said. I felt as if an ice storm blew through the room.

I could have come up with that answer on my own, without an RN after my name.

I found Mother's nurse. I asked the same question, adding, "I wasn't exactly asking when Daddy would die. No one knows that. I was asking her advice on when I should book flights for the kids, given the situation."

"Did anyone mention 'comfort measures only'?" she asked. I shook my head.

"Comfort measures only refers to the treatment a person receives during the final hours or days before death."

"If you were me, you'd book the flights soon, though?"

"Absolutely."

She was my Clara Barton. Or Florence Nightengale. Take your pick. I wouldn't hold her responsible if things didn't turn out like she'd predicted. After all, she wasn't God.

Just a messenger from God. I learned to take my nursing advice with a grain of salt. To seek out the angels of the long-term battlefield, and to run from the others.

Have you encountered nurses who helped--or hindered--your decision-making in regard to your parent's care?

Eldercare Moving Tip: Corral Your Kin to Get the Job Done

2011-11-04T09:38:00.000-07:00

Your to-do list stretches to the sky. Why? Your parent is moving to retirement or assisted living. But how will it to happen?

A few days ago two siblings and spouses sat at my table. Their 85-year-old mother was lonely and wasn't eating. Her income was low. Our affordable retirement community worked for her. But Mom hesitated. Subject to Mom's approval, the siblings set the date and "the team" sprung into action.

"Be sure to take Mom to Social Security within the next few days to get her benefit letter," one daughter said to a brother-in-law.

The group started assigning tasks including:

1. Financial paperwork--one daughter with expertise tackled the job

2. The "talk" with Mom and subsequent tour and lunch--a son and son-in-law decided Mom might feel "ganged up on" if the whole group met with her. Their approach worked and Mom got on board.

3. A main contact and a back-up for me during the process--two siblings gave me business cards. As the financial approval process moved forward, or if I needed additional information, I emailed them.

4. Move-day organization--one son-in-law took on the job, contacting grandchildren about availability of strong, healthy young adults.

5. Change-of-address forms, shut-off utility notices, and television and telephone installation--another sibling said "yes" to the job.

This doesn't include all the tasks, but you get the idea. The process of "Divide and Conquer" is working. My first and second contacts are keeping in touch, and I with them. Things are getting done, and people are talking.

Best of all, Mom is warming up to the idea. Her move date is set for November 19.

But what happens when you're all alone helping your parent or parents move? How do you tackle that huge job? Good question. If you have some answers, please share. I'll also treat that subject in a future post.

Spending Down to Medicaid--Prepaying Funeral Costs

2011-10-25T21:08:00.000-07:00

Your aging parent has more care needs than dinero. He or she is on the road to Medicaid. As the dollars shrink, mostly to cover eldercare, you can do some things to provide for your parent's future.

Welcome to the world of the Medicaid spend-down. Each state sets its own rules for Medicaid eligibility and how people can spend their limited funds before they reach the asset limit--usually $2000.

My favorite spend-down strategy is prepaying funeral costs, probably because my family's experience ended happily.

The story went like this: Daddy and Mother's tiny retirement nest egg of $60,000 dwindled rapidly soon after they both moved to a Wisconsin nursing home. My sister Carol landed on a great idea. Having power of attorney, she set aside in a specific account, earmarked funds to pay all their funeral costs, including preparation of the body, minister's and soloist's fees, and other expenses related to the service.

In addition, the plan included monies for plots, burial stones, and even enough for a dinner for family and friends. Funds were set aside for our family's out-of-state flights, hotel costs, and car rentals, too. When the time came for the funerals, we adult children didn't worry about money.

What a blessing not to be stressed about finances! And later, after all the accounting, there was money left over--not much, but some.

It was a good way to spend down money before they converted to Medicaid funding.

Losing Your Marbles? A New Way of Looking at Eldercare

2011-10-19T21:24:00.000-07:00

Juggling generations is dicey. The needs of an eighty-year-old aging parent for peace and quiet run counter to a two-year-old grandson's penchant toward screaming. And it's up to us Boomers to keep it all together.

Try as we might, life often unravels before our eyes. We start losing our marbles. For me, it happened on the eve of my parents' fiftieth anniversary surprise celebration. When I met them a week earlier at the airport, they were hunched in wheelchairs, exhausted from their five-hour-flight. What a shocker! Daddy's Parkinson's had progressed so much since I'd seen them last. Mother, also frail, looked like she could tip over.

During their two-week visit, we crammed in two graduations--one high school and one college--plus a wedding and the surprise 50th anniversary celebration. But what I remember most was the continual feeling of being split in a hundred pieces. Teenage sons crying, "We're out of milk, AGAIN." Mother and Daddy shuffling here and there, accidents waiting to happen. Like little birds, they chirped out their needs: Fleet enemas, dry cleaning, clean underwear. And of course, there were the needs of our daughter, the bride.

One day I remembered the "marbles" presentation. Years earlier at a conference for senior care professionals, a motivational speaker underscored the importance of positive words. To help him remember to say kind things to his spouse, his coworkers, his family, he placed 10 marbles in his left pocket at the beginning of the day. With every sincere compliment he would transfer a marble to his right pocket. His goal was to give 10 compliments a day.

During my parents' visit I didn't actually buy marbles to transfer from pocket to pocket. But the idea of intentionally complimenting folks in all the generations helped me cope. I started "seeing" the good, rather than just the sea of need. One day I caught my Dad, a retired minister, explaining a New Testament passage to our 18-year-old son. "Grandpa can really help you understand the Bible, can't he?" I said.

When Grandpa voiced his fears of tripping as he walked down the aisle at Shari's wedding, I assured him, "Tim is strong. He loves you. He'll make sure you're OK."

No, the marbles idea didn't take all the stress away, but it did give me a better handle on things. Just thinking of the marbles put a smile on my face.

If you think you're losing your marbles, you might be right. But try transferring them, from pocket to pocket, as you say kind things about the generations. The situation won't always get better. But you probably will. Take it from soneone who knows.

Your Aging Parent Refuses to Spend Money on Eldercare

2011-10-10T20:47:00.000-07:00

A penny saved is a penny earned. All her life your aging parent has lived by Ben Franklin's words. But now, she needs assisted living or in-home care. The cost scares her to death.

Eighty-three-year-old Lois felt that way. Over the years she'd collected diagnoses like barnacles: diabetes, congestive heart failure, and more. She needed medication management, plus help with showers, dressing and other daily activities. As we talked, she fixated on the expense.

"It's SO expensive. It's SO expensive," she repeated.

"You can afford it," her son said, citing numerous investments. Lois wasn't convinced. So what to do?

Perhaps your parent's story is similar. Before you point out the "facts," try drawing her out with an open ended question. Something like: "I know you're really concerned about spending so much money. What troubles you most about that?"

You might be surprised at what you hear. Having grown up in the Depression, she may feel a sense of failure at spending money on herself, even though needed, instead of providing a larger nest egg for the kids. I've heard other elders say, "I've always given a substantial amount of money to the church. If I go to assisted living, I won't have as much to give." Still others are paranoid they'll run out of money. They've never spent more than their monthly income.

Whatever they say, listen before speaking your peace. And try to affirm their concerns. Then you can calmly point out how what the monthly fees will cover and how life will be better should they get care. Another tactic: Let them know that you'd like to move to assisted living or hire home care so YOU don't worry. The idea of sacrificing for you and your family members may make sense.

I often use this phrase:

"Remember during your lifetime you always saved for a rainy day?" "Well, right now it's beginning to drizzle." Or "It's pouring!"

Have you used other words to help convince your parent to get care? Tell me about it.

Selling Your Parent's Home--A Broker's Tips

2011-09-30T17:00:00.000-07:00

Van Cooper sells seniors' homes. As a Senior Real Estate Specialist (SRES) with Windermere in Kirkland, Washington, he helps Boomers and their parents market what is usually the family's largest asset with the most emotional value.

"Lots of feelings can pop up during the process including loss of control and abandonment," he says. "My goal is to treat people fairly, with dignity and respect. My position is to facilitate a sale that's as easy and low stress as possible."

Cooper shares his tips on selling your parent's home.

1. Give your parent as much support as possible. Depending on your situation, you may be handling the decision making yourself, or taking a lesser role. Even if your parent says, "I want to do this on my own," offer your eyes, ears and thoughts, to ask questions and clarify things. Point out that this is a difficult transaction for anyone, and you'd like to help wherever you can.

2. Interview at least three potential real estate agents. Chatting with them will give you a good idea if they're a good emotional fit. During the interviews, they will offer you competitive market analyses, including comparable properties. If some of those homes are still active, ask to drive with the realtor to look and compare them with your parent's home. Another tip: "Ask for a second visit. If he or she is edgy, that's a huge red flag," Cooper says.

3. Ask more questions. Does the agent tell you how much it will cost to update your parent's home, and what updates will boost the selling price the most? Is the agent offering a team of professionals who can do the remodeling, clean the home, stage it, hold estate sales, and do other tasks as needed?

4. Decide on the details of the process. Will your parents move before the house is upgraded and listed, or will they stay in the home? Cooper says both ways work. If your parents continue to live in the home, it's best that viewings are done by appointment, so you or others can take them out of the home while strangers are looking around.

5. Determine how often the agent will communicate with you and in what manner. Emails? Phone calls? Personal visits? Letters and cards? If time goes on, you may need to discuss lowering the price, usually 3 to 5 percent if the property was priced correctly at the beginning.

Is this easy? Probably not. But working with a real estate agent who knows and understands seniors helps tremendously, Cooper says.

Have you heard of an SRES (Senior Real Estate Specialist)? It's an endorsement that requires two days of study, plus fees and exams. "People who get this certification are more likely to have an interest in providing seniors the service they have earned," Cooper says.

Aging Parent Alert: Watch Out for Scams on Veterans Aid & Attendance Program

2011-09-18T19:00:00.000-07:00

Phone scams. Mail scams. Just days ago, a client named Vicki told me about another scam that almost got the best of her aging mother. It involved the Veterans Aid and Attendance Program.

The VAA Program is legitimate. If your parent is a veteran who served in wartime, or the surviving spouse of a wartime veteran, he or she may qualify for monthly help of as much as $1644 for a veteran, or $1056 for a surviving spouse, and still more for married veterans. To be eligible, the applicant must have limited assets and income and also need help with activities such as bathing, dressing or medication management.

Unfortunately, some "professionals" are twisting the intent of this program and taking vulnerable seniors for a ride. In Vicki's mom's case, she'd served in Korea years earlier. Recently the 76-year old woman toured a retirement community in rural Southwestern Washington, more than 100 miles away from her daughter.

"My mom was ready to move in," Vicki said. Her mom placed a deposit on an apartment. One huge problem: the monthly fee was $2500. Her income was less than $1500. She had few assets.

"You're a veteran, and I can help you apply for a program that will give you up to $1644 a month," the marketing representative said. She pulled out an application for Aid and Attendance. Once approved, Vicki's mom could receive benefits, retroactively to the date of application. The monthly benefit would help cover her fees.

Over the next few days the marketing rep "helped" Vicki's mom complete the lengthy application and kept assuring the older woman this was a sure thing. But something didn't seem right.

"You walk with a cane, don't you?" Vicki's mom shook her head. "Well, you do now!"

The marketing rep blew out of proportion the older woman's disability. Another troubling thing: Vicki's mom would need to take out a loan or find other funding to help pay her retirement community rent until her application was approved.

By this time, Vicki knew something was amiss. "I discovered that if the application didn't go through, my mother would still be liable for her retirement community rent!"

Vicki pulled her mom's deposit. The story ended happily.

If you think your parent might be eligible for Aid and Assistance, go straight to your nearest Veterans Office. Specially trained service officers can answer your questions and help your and your parent through the application.

Your Aging Parent's Move Prompts Grief? Relief? or Both, Part II

2011-09-05T20:01:00.000-07:00

I'd love to have a dollar every time a Boomer confides in me, "I know moving to an assisted living community is best for Mom. But I worry that she might not adjust and be happy."

Grief. Relief. Or some of both. On moving to an assisted living community, elders often experience all or any of the above. "I miss my house, my flowerbeds, and my cat," one woman said. Others grieve the loss of physical ability, their memory and relationships.

On the other hand, others almost jump for joy. "I cooked all my life, and now it's time to give it up," is the sentiment. And yet other elders bounce between grief and relief during those first days and weeks.

How can we help them adjust?

1. Probably the biggest gift we can give our aging parent is to listen, without censorship. While it's easy to answer a complaint like, "I so miss our house!" with, "But it was so big and so difficult to keep up," it's far better if we bite our tongues, and sympathize. A statement like "I know you loved that house. And you took such good care of it," lets your parent know her opinion is valued.

2. Upon move-in, trust your instincts as to how much of your time your parent will need. Often it's best to set up the apartment in advance, so it's ready to go when your parent moves in. Some adult children will sleep the first few nights in their parent's new apartment. Other family members eat meals with their elderly parent as often as possible during the first few days.

3. Give your aging parent time to adjust. Fortunately staff of assisted living communities are used to listening to their new residents' stories: of grief, and of relief. Staff can also distract new residents by getting them involved with Bingo, Bridge or other diversions. After a month or two, given lots of tender, loving care, your mom or dad will begin thinking, "This is my home!"

Do any of you have any other ideas on how to help your aging parent adjust to a new setting, such as assisted living, or a nursing home?

Your Parent's Move Prompts Grief, Relief, or Both, Part 1

2011-08-29T15:06:00.000-07:00

Do you recall your child's first day of kindergarten? If you're like me, you bit your nails and downed M and M's wondering: Will her teacher be a mix of Mary Poppins and Fraulein Maria? Will the kids like her? Will she return that afternoon wearing a smile?

Fast forward many years. That same angst can return when our elderly parent moves to a retirement community or care setting. When faced with this huge change, will he or she experience grief? Relief? Or some of both? In 16 years of working with seniors and their families, I've seen all of the above.

Grief--For many seniors, the idea of leaving their posessions tears at their soul. One client struggled with downsizing. She said, "Looking through my papers and other stuff reconnects me with what I've done and where I've been. Getting rid of things is like getting rid of part of me." Others grieve their loss of independence, physical strength and self esteem. Seeing walkers, wheelchairs and oxygen tanks in the hallways of their new home reminds them daily of their mortality. Still others grieve the loss of a mate or friends gone by. The new setting may not take those losses away.

Relief--Recently three newly widowed women moved to our retirement community. When each came into my office, the old adage, "Don't make any major changes in the first six months" ran through my mind. I bit my tongue, though. They all settled in. One of them expressed her relief in giving up the care of a big house: "I'm starting a new chapter in my life. I want to do things I've never done before." Even seniors not facing the loss of a spouse may relax by moving into a smaller space, where they can focus on enjoyable activities, and not on chores.

A little of both--That's where many seniors land--sad about leaving familiar things behind yet realizing there may be light at the end of the tunnel. Teary one moment and beaming the next--that, too, is normal. There are some things you can do to help ease the transition.

The next post tackles ways you can help make your parent's move easier.

Write a Great Thank-You Note to Your Parent's Caregiver

2011-08-15T21:10:00.000-07:00

So many word searches from my readers--and would-be readers--include phrases like, "How do I write a thank-you letter to my parent's caregiver?" Here are my thoughts.

First, congratulations on desiring to show appreciation for your parent's caregiver. Saying "Thank you" is something you can do daily. Writing is even better! Read and reread, your thank-you letters are valued by your parent's caregiver, shared with his or her family and often with coworkers.

Second, thank-you letters aren't hard to write. They are similar to a professional recommendation. You'll start by brainstorming. Think about the specific acts of kindness you've seen your parent's caregiver perform. Some examples are: "I love how you dress Mom in her favorite colors, and style her hair with matching hair clips." Or "I enjoy how you remember to turn on the television to the major league baseball game which Dad so enjoys." Or "When I mention your name to Mom, her eyes light up, because you make her feel special."

Third, think about specific character qualities you've observed in your parent's caregiver: compassion, humor, dedication, patience. Soon concrete examples of these character traits will spring to mind.

Fourth, write a rough draft. Be warm and sincere. If appropriate, you may want to run the rough draft by your parent for his or her input. Don't hesitate to ask a friend or family member to edit your draft. For the final take, hand write it on a decorative sheet of paper.

Deliver it and see what happens. Chances are good the work you put into this project will pay off!

Have you written a letter to your parent's caregiver?

Eldercare Dilemma: One Parent Says, 'Let's Move,' the Other Says, 'No Way!'

2011-08-08T21:07:00.000-07:00

It's a common tug of war. Your elderly mom wants to say goodby to the big house, leaving the driving, shopping, cooking and cleaning behind. Retirement living sounds like a dream come true.

"No way," counters Dad. In his eyes, the house in which they raised you, cared for your pets and babysat your children is fine forever.

Like many men in the Greatest Generation, your dad may resist moving to a retirement community (or getting in-home help). Here's why:

He already lives at home in a retirement community. It has one employee--your mom--who provides everything. He forgets that when he stopped working in his sixties, his wife didn't. Like the EverReady battery, she kept going and going--cooking, cleaning and tending to his needs. Now, years later, she's spent. But he may not see this.

Your dad may think retirement communities aren't for "real men." If he enjoys gardening, woodworking or puttering, he may wonder, "How will I continue to keep busy?" He may not realize that many retirement communities do offer woodshops, gardening areas and poker clubs. Another option: he can continue to help you with your home projects, as he is willing and able.

He may not see the "big picture." Statistically, your mom will probably outlive your dad. He may not want to think about the difficulties she might face in moving alone, especially in the face of grief. Those challenges include choosing the community, selling the home, downsizing, moving, establishing new friendships. If a married couple moves together to a retirement community, the widow's later adjustment is often easier.

So how do you help your parents in making a decision when both are at loggerheads? Although ultimately the "To Move or Not To Move" question is theirs to resolve, you certainly can offer your listening ear and even your opinion, especially if one person doesn't seem to be heard.

Have any of you faced this dilemma, either with your parents or your clients? Tell us about it.

Eldercare Review: Red Cross Family Caregiving Program is Worth Your Time

2011-07-31T16:39:00.000-07:00

I'd blame my tardiness on sun stroke. Except I'm from Seattle, where sun is in short supply. During May and June I attended the American Red Cross Family Caregiving Program, held at Evergreen Retirement Community, where I work. I promised a review.

If you care for your aging parent either full-time or part-time, or are supporting your parent who is caring for his or her spouse, this national program is worth your time. First, there's no cost. Second, caregivers can select one or more segments. Third, sessions are facilitated by Red-Cross certified leaders. Mike Davis, of Always Best Care-Eastside, led our discussions.

Booklets on the various topics--home safety, general caregiving skills, positioning and helping your loved one move, assisting with personal care, promoting healthy eating and caring for the caregiver--were helpful, as were the videos.

The best part of these sessions was the lively discussion. Some participants worked in the eldercare field, helping adult children and their aging parents. Others were caregivers themselves.

"There's great value in people getting together to discuss caregiving issues and to work toward problem-solving," said Mike Davis.

For more information on the program and locations near you, contact the Red Cross Family Caregiving Directory.

What's MOST Important to Your Aging Parent?

2011-07-25T20:28:00.000-07:00

What does your elderly parent want most? Especially if he or she is facing a transition? Is it comfort, tasty food, friendliness, or excellent care?

In my job as Marketing Director for Evergreen Court Retirement and Assisted Living Community, I ask that question daily. One recent response caught me off guard.

"I want to be treated with kindness," 85-year-old Jean told me on the phone.

"Tell me more," I asked.

"It's not that I haven't been treated with kindness," she said, "But I want that to continue. I need to be treated with dignity and respect."

After Jean moved in, she confided she'd experienced some hurts earlier in life. She needed a safe place to land, where she was cared for.

Have you asked your elderly parent to name what's most important? If you do, don't be surprised at what you hear. The words "kindness, respect, dignity," may surface. Together, you can help him or her find that good place.

Eldercare Dilemma, Part II--Listening to the Same Old Story

2011-07-17T21:22:00.000-07:00

Your elderly parent launches into "the story." You know it by heart. After all, you've listened--sort of--until your ears ache. Do you:

1. Pinch yourself periodically, as you struggle to stay awake?

2. Put on a happy face and nod now and then?

3. Worry that your aging parent is losing his mind--or you're losing yours?

A month ago, on Father's Day, my friend Linda had an Epiphany relating to this subject. When her 91-year-old dad began to recount scenes from his boyhood, as he'd done so many times, Linda said, "I began listening with new ears."

She asked questions. "What did you like most about the walk to school?" "Tell me about your favorite teacher?" "Was recess fun?" "How did you deal with bullies?"

"My questions set Dad off in a different direction," she said. New information surfaced, and the old, old story suddenly came alive. In the process, Linda honored her dad by her active listening. He gave her information about her heritage. Both their minds were fed.

Does engaging your parent during the story sound like it's worth a try?

And as to the repetive stories indicating dementia, either for your or your aging parent, rest your mind. Nearly every elderly person repeats stories. It's just what they do.

How do you respond when your aging parent repeats stories?

Affordable Senior Housing: Tips on Applying

2011-07-10T20:42:00.000-07:00

Remember the FAFSA? Years ago, many of our parents burned the midnight oil submitting this multi-page financial aid application. The goal? Scholarships and grants for us. Today if your aging parent is seeking low-income senior housing, you could be facing a "mini" FAFSA.

Once you've chosen a community offering subsidized senior housing or retirement living, your parent will receive an application. Similar to FAFSA, but simpler, this document "proves" that your parent's income meets the community's limits, which are based on a percentage of the average income in that county. In King County, where Seattle is located, a single person can have income no higher than $36,000 for most programs, and $41,100 for a couple.

Most seniors I work with at Evergreen Court Retirement Community ask their adult children to help with the application. They helped you with the FAFSA; now it's your turn.

Some commonly asked questions:

1. What is the application process? A representative from the community will give you and/or your parent the paperwork and explain how to complete it. When you've finished, you'll have a second meeting to go over it and check documentation. The community sends the package to a third-party compliance officer, to double-check the numbers and determine eligibility.

2. Do assets count? Assets such as brokerage accounts, money market accounts, CD's, homes, real estate, etc., must be declared, and documented by presenting the most recent statement. For a home not yet sold, the county assessor's last assessment statement will prove its value. In computing total income, the compliance officer looks at the income (or potential income) generated from the assets and adds it to the monthly income. For more specifics, consult the manager or marketing director of the community you're looking into.

2. What other items need to be submitted? A driver's license or ID card, provides proof of age. Other documents: Pension statements and a Social Security benefit letter, which the agency sends to all recipients in December of each year. You'll look at the top line for the gross monthly amount, before Medicare is taken out.

3. What about bank accounts? All must be declared. For checking accounts, six months of statements are required. For savings and money market accounts, the most recent statement is sufficient.

Does that sound daunting? The process may be a bit grueling, but the payoff makes it worthwhile. Often seniors can save $500 a month or more over market rate rent by opting for subsidized senior housing. For help in locating options, contact Eldercare Locator.

Eldercare Organizations: Consider a Not-for-profit for Your Aging Parent

2011-06-30T18:53:00.000-07:00

I'd swear on a stack of Bibles. Not-for-profit eldercare organizations aren't perfect. After all, they're headed by fallible people.

Still, not-for-profits are worth considering for your aging parent's health care needs. Nationwide some 5400 such organizations deliver excellent retirement and assisted living, skilled nursing care, home care, etc. Since my entry into the eldercare field in 1994, I've worked for three not-for-profits. I've seen and applauded their good work.

What sets not-for-profits apart?

1. Corporate investors don't set the organization's policy. Rather, boards of directors, who are community volunteers with various areas of expertise, make the key decisions. Extra dollars go, not to stockholders or owners, but to improving staffing ratios, training employees and building innovative programs that make seniors smile. No wonder Consumer Reports recommends not-for-profit nursing homes over others when seeking quality care.

2. Not-for-profits are mission-driven and accountable to the community at large. Many are connected with a church or a hospital, and their responsibility to the community is well defined. Their tax exempt status presupposes the practice of "giving back." For example, in Everett, Washington, Bethany of the Northwest hosts an annual elder health fair for the city's seniors. In Seattle, Foss Home and Village, a nursing home and asssisted living facility, sponsors a countywide senior annual volunteer recognition. Another big plus: not-for-profits often sponsor benevolent funds for elders who run out of money. Many not-for-profits take Medicaid funding.

3. In general, not-for-profits have lower staff turnover. I've watched the organizations I've worked in do many things--big and small--to attract excellent caregivers and other employees and to keep them. In-services, scholarship opportunities and specialized training build staff morale and increase longevity. It's not uncommon for an eldercare worker to celebrate 25 years of service. That number is growing! Staff longevity builds confidence by the elders and families.

For more information on not-for-profit eldercare organizations, contact their national association, LeadingAge.

Not-for-profit eldercare organizations aren't perfect, but definitely worth your consideration. Have you had experiences--good or bad--with not-for-profits?

Eldercare Trend: Top Factors That Influence Your Choice of Retirement Communities

2011-06-22T20:37:00.000-07:00

Shopping for a retirement community for your aging parent? As you weigh the factors involved in choosing this new home, the following key words may come into play. I've heard these again and again over the last 16 years.

1. Location. Does your parent want to live close to one child? Or somewhere between several children? And what about rural versus urban living? Consider these questions: Is your parent a city girl at heart? Or a died in the wool country boy? Still another factor for many elders is living close to their current physicians and hospital or to their church.

2. Affordability. For some seniors, the question isn't "Can I afford this community?" but rather, "Even if I have the money, do I want to spend that much?" I remember the words of one resident named Wallace, "It's important to be able to give my children a certain amount of money. At the end of the day, that's important to me." For those at the other end of the economic spectrum, a great option may be "affordable" senior housing, designed for elders with low to moderate incomes.

3. Comfort. Retirement communities are a little like going on vacation, or living in a dorm or sorority, except with no drunken parties. Meals are prepared, activities are planned, and life is simpler than it used to be. It's "Leave the driving to us." But within those parameters, there are many variables. If your parent enjoys dressing up for a steak dinner or equivalent virtually every night, he can opt for that lifestyle at some retirement communities. Or maybe he prefers wearing blue jeans and a golf shirt for his favorite meal of macaroni and cheese. That option is available, too, and all shades of in between.

4. Food. Some key issues here are: "Do staff assign seats to residents?" and "Is there one seating for meals, or can residents come and go during a certain time period?" Seniors often have strong options on both these issues. If you don't discuss these questions with your parent beforehand, you may hear his or her complaints afterward. Often they're not pretty!

5. Space. One size certainly doesn't fit all. One daughter was adament in her desires: "My mother has to have a studio. Anything larger would overwhelm her." We didn't have studios, so I referred her to the lucky retirement community down the street. Other space considerations: square footage, closets, outside access, storage compartments.

6. Activities. For many, the trips to museums, drives to the country and live music on site make their day. But not everyone is created equal! Weigh your parent's preferences against the community's activity schedule to see if it's a match.

Good luck in your search! This post didn't have the space to address the most important element in any retirement community: caring staff. More later.

Eldercare Tip: Ways to Cut the Cost of Retirement Living

2011-06-09T20:55:00.000-07:00

Your parent lives in a retirement community. Chances are, once a year the dinnertime chatter erupts into a chorus: "How much will they raise the rent?" and "Can I still afford to live here?"

If your aging parent worries about running out of funds, she is not alone. Fortunately seniors can save money without giving up meals, housekeeping, transportation and activities--the main reasons they chose retirement living in the first place. Consider these tested ideas.

1. Ask to transfer to a smaller or cheaper apartment within the same community. Often building managers would rather keep a resident than spend time, effort and dollars to move in someone new. My friend Eleanor moved twice in seven years, first from two bedrooms to one after her husband's death. Later she chose a studio when her assets dwindled. Keep in mind the transfer option is not without sacrifice. Downsizing is difficult, but writing a smaller check each month can pay off in peace of mind.

2. Move to a retirement community with fewer amenities. If your parent enjoys cooking, for example, he or she can often save about $300 to $500 a month by moving to a retirement community offering one meal a day, rather than three.

3. Consider a lower priced retirement community. In Bellevue, Washington, where I work, independent retirement living can range from $1560 for a studio, one-meal program, to over $9000 for two-bedrooms with three meals.

4. If your parent is beginning to need services such as bathing, dressing and medications, a home care agency can help her remain in her retirement apartment. In our community, an independent resident can save $1000 or more a month by using home care instead of moving to assisted living. One caveat: if your parent needs staff support all day long, home care agencies will not save money over a transfer to assisted living.

Can you think of other money-saving ideas?

Red Cross Family Caregiving Class Gets an A at Mid-Term

2011-05-31T18:30:00.000-07:00

So far so good. That's my take on the American Red Cross Family Caregiving Program, being held at Evergreen Court Retirement Community, where I work. With the first three segments behind us--Home Safety, General Caregiving Skills and Positioning and Helping Your Loved One Move--the program rates an A in my book.

If you care for your aging parent either full or part-time, this free nationwide program is for you. Facilitated by Red Cross-certified leaders, the series has eight modules in all--we're using six. Mike Davis, of Always Best Care-Eastside, leads our discussion. Videos and booklets bring the content to life. Another plus: caregivers can choose the segment or segments they'd like to attend.

Things I learned from the Home Safety module:

It's important to check the water temperature with a bath thermometer or the back of your hand before your loved one enters the tub or shower. The temperature should not exceed 105 degrees.

Set the hot water heater to low or set no higher than 120 degrees.

During "Positioning and Helping Your Loved One Move," I watched with interest caregivers use correct body mechanics and work with their loved one on performing range of motion exercises.

I look forward to the next three segments: Assisting With Personal Care, June 1; Healthy Eating, June 8 and Caregiving for the Caregiver, June 15, all beginning at 7 pm.

I'll tell you what I think. For more information on the program and locations near you, contact the Red Cross Family Caregiving Directory.

Fall Prevention: Steps You & Your Parent Can Take

2011-05-25T20:29:00.000-07:00

"I'm falling and I can't get up."

Remember that silly commercial? It brought belly laughs 20 years ago. But not today. Especially when it's your parent who's at risk.

"A fall is the number one reason for a senior's illness or death," said Kerry Hopkins, Care Manager for HomeWell Senior Care in Seattle. "Our bodies can handle the impact of a fall, but for seniors, it's another story."

We can't follow our parents around all day long, but we can work with them to reduce the risk of falls. Here are a few of Hopkins' pointers.

1. Most falls occur at night.Upon waking, either low or high blood pressure can trigger dizziness and/or disorientation. If your parent feels lightheaded, encourage him or her to sit for a moment before trying to stand.

2. A corollary to the above: Place nightlights in both your parent's bedroom and in the bathroom. Seniors rely on light--both in the room they're leaving and in their destination--to help with balance.

3. In the evening, encourage your parent to limit, not only liquids, but also sugary foods. The energy rush can spark shakiness, possibly resulting in a fall.

4. Fluids in the daytime are great! They help prevent dehydration and urinary track infections, both potential causes of falls.

5. Check the house, especially stairs. "Falls happen most on the bottom two stairs or the top two stairs," Hopkins says. Marking those stairs with tape or fabric may encourage safety. Another home safety tip: clear walkways of toys, books, etc.

6. Most important? "Learn to slow down and think before you move," says Hopkins. It's good advice for our aging parents--and ourselves.

Advocating for an Aging Parent? Choose Your Words Wisely

2011-05-14T15:21:00.000-07:00

The eldercare field would do well to learn from hotels.

In a well-run hotel, staff bend over backwards to anticipate needs. A forgotten toothbrush? No problem. A special birthday? A birthday cake arrives at the door. But in a your parent's physician's office, hospital, nursing home or other care setting, you're on your own. At their dizzying pace, health care staff can't read your mind to see what you or your parent needs.

To combat frustration, try these simple words: "Could you tell me...?"

As in "Could you tell me approximately how long we'll wait to see the doctor?" Or "Could you tell me when my parent has a change in his or her medical condition?" Or "Could you tell me the signs a person exhibits when death is imminent?"

When you ask in a direct, yet friendly way, "Could you tell me why I've seen the call lights flash more lately?" or "Could you tell me why my mother's bed was wet this morning?" it's obvious you want an answer. You're not whining, or complaining; you're asking.

Even if the answer isn't what you want, your friendliness will cause the other person to take notice of your concern and address you with respect. Your positive attitude will pay off in many ways, including making life better for your aging parent.

"Could you tell me...?" has worked in addressing medical professionals involved in my own aging parents' care. I've also seen my clients use these words with me, with remarkable success.

Seeking Eldercare for Your Parent? Look for Happy Employees

2011-05-06T16:56:00.000-07:00

Searching for health care for your aging parent? Consider this phrase: "The Customer Comes Second."

In 1993 Hal Rosenbluth coined this phrase for the title of his best seller aimed at business management. The book was revised in 2003. But does "The Customer Comes Second," apply to eldercare? Especially when the primary customers--you and your parents--need lots of attention and care?

For 16 years I've seen Rosenbluth's premise play out in the senior care field. I agree with his words: "Hire people who have the right personality, and then train them to have the right skill." If employees feel valued and have opportunities to grow and enjoy their work, their enthusiasm will rub off on the customers and result in excellent service, he says.

When you're looking for eldercare for your parent, ask questions of management about "employee care." Do caregivers, food servers and housekeepers have vehicles for public recognition and for encouraging each other? Are they given opportunities for in-service training? Does the organization encourage entry level workers to move up the ranks or to finish nurse's training? Does the organization hire for the right personalities and then train employees for the tasks? Are employees encouraged to have fun with their elderly clients?

Ask about staff retention. In the senior care field, turnover for caregivers is extremely high--averaging 70% or more. That means that at the beginning of a year, if 100 employees were hired the previous year, only 30 would remain. Some health care settings are able to keep their staff longer, promoting consistent care.

Carol, a daughter of a resident of our retirement community, said she moved her mother out of another local retirement community because of high turnover. "Employees were coming and going all the time. That lack of continuity was unsettling to the residents," she said.

Besides speaking with management, visit the community or care setting and observe employees in action. Watch for smiles on the faces of workers and elderly like. Listen for jokes. These will tell you whether the organization puts their people first.

Bottom line: Happy employees are more likely to treat your mom or dad like royalty. Remember Queen for a Day? That's the goal.

Note: I first read "The Customer Comes Second" when I entered the senior care field in 1994. It's well worth reading.

To Mom With Love: Mother's Day Gifts, Celebration Tips

2011-04-30T17:19:00.000-07:00

Two Questions:

What do you give your aging mother for Mother's Day?

And how do you celebrate any occasion with your aging parent despite difficult circumstances?

I'm reprising two posts from the archive which address these topics. Enjoy!

Mother's Day Gift Ideas From the Pros

Seize the Day: Celebrate Your Elder

Moving Mom to a Retirement Community? Her Wish List May Surprise You

2011-04-19T12:15:00.000-07:00

Moving is tough. But if your parent moves to a retirement community, his or her "wish list" may be shorter than you'd think. And your parent's "must-haves" may have little to do with the building's age or decor.

In both vintage and spanking brand new communities, I've watched Boomers and staff team together to make their elders' dreams come true.

A 90-something woman said: "I can't live without baking cookies to give away." She kept the flame of her baking passion alive in her new retirement community, thanks to a toaster oven which baked eight cookies at a time. On Wednesday, baking day, the aroma of chocolate, vanilla and other sweet ingredients wafted down the hall. On Thursday she fed residents and staff, as well as feeding her own soul.

A gardener who by his own admission was older than dirt said: "My green thumb keeps me sane. I have to plant." He and his daughter chose a retirement apartment at ground level. He planted annuals and bulbs, and enjoyed watching his garden grow.

A self-proclaimed standup comedian at 85 said: "I want to make people laugh." Procuring a tutor at his new retirement community, he learned to surf the Internet, finding corny jokes to add to his already hefty store of humor, culled from a lifetime.

Even more than living in beautiful surroundings, these seniors wanted to continue to do their favorite things, and be themselves. As adult children, it's our job, not to worry so much about creating a fairytale perfect world for our parents, but to help make their simple dreams come true.

"Look beyond the chandelier," says Marcia Byrd, Executive Director of Patriots Glen, a cozy assisted living community in Bellevue, Washington, not too far from mine. I couldn't have said it better. Simple pleasures don't always come in glitzy packages.

Does your parent have a skill, pasttime or passion that feeds his or her soul? Try to enable your parent to continue it, even in a new setting.

Warning: Your Aging Parents' Home May Be Hazardous to Their Health

2011-04-14T19:19:00.000-07:00

We Boomers remember the childproofing years. Our kitchen sported cupboards that toddlers couldn't pry open (sometimes we couldn't, either) and gates kept little ones from tumbling down the stairs.

Your aging parent may need the same level of vigilance. Falling at age 80-plus is almost a recipe for a broken hip. And hazards that we Boomers can skirt around are deadly for them.

So snoop around. I give you permission to peruse your parent's house for anything that may present a safety issue. Better yet, take your parent along. Specifically, look in these rooms:

Tour the kitchen. Open the refrigerator door. Does it contain ketchup, mustard, mayonnaise, green olives and little else? Not a good sign. The other extreme is also bad: it's crammed full of odds and ends, many with "interesting" aromas and colors, mostly green.

Check out the living room. Are the carpets secure? And what about those piles of "Saturday Evening Post" and "Life" magazines on the floor? Are there extension cords lying about, ready to be tripped on? What about easy chairs--do they fit well?

Walk through the bathroom. Look around: if your parent has a bathtub, is there a bath bench or seat? What about grab bars? If he or she uses a toilet riser, is it secured well? On the door of the medicine cabinet, is there a list of the medications, along with the doctor's name and phone number? This helps emergency technicians tremendously.

Stroll through other rooms. Does the laundry room look like the "Wreck of the Hesperus?" Or maybe the bedroom has become the laundry room, with clean and dirty clothes strewn around. Another room to check is wherever your parent keeps his or her medications. Do the medi-sets look exactly the same as they did a month ago?

This obviously isn't a complete list, nor is it meant to be. You'll see other things, too. As you make your tour, you'll notice some "themes" running through the home. Does your parent need help with shopping? Cooking? Preparing food? Housecleaning? Laundry? Medication management?

Our elders are notoriously poor reporters. They may say, "I'm great!" when their homes say otherwise. Once you do your tour, discuss your findings and chart a plan.

Tell me about your "tour of dreams." Did you find some surprises? We usually do.

Afraid of Talking About End-of-Life? 'Five Wishes' Helps

2011-04-11T21:18:00.000-07:00

Talking about end of life issues with your aging parent can be tough. How do you begin? What do you say?

A powerful booklet called "Five Wishes," can help. Jim Towey, who worked with Mother Teresa for 12 years and spent one of those living in a hospice in Washington, DC, wrote "Five Wishes." Recognized by 42 states, "Five Wishes" aims to help people plan for the time when they might be seriously ill.

The booklet has been called a "Living Will With a Heart." Easy to use, and stripped of medical and legal jargon, it has check boxes and blanks to fill in. You can discuss it together with your parent, tackling the wishes in any order.

The Five Wishes deal with naming a health care agent, deciding which medical care someone wants or doesn't want, specifying their preferred comfort measures, deciding how they want to be treated; and determining what they want their loved ones to know when they pass.

At Evergreen Court Retirement Community in Bellevue, Washington, where I work, we had a Five Wishes presentation by Greg Robbins, Social Worker from Providence Hospice of Seattle, a few weeks ago. Besides the residents, adult children, a pastor and other members of the public came. The response was positive.

Do you have experiences with "Five Wishes?" For more information, contact Aging With Dignity.

Good Grief! Helping Your Aging Parent Cope With Loss

2011-03-31T20:39:00.000-07:00

Your aging parent's losses are legion. (That means many.) But longevity has taught him or her how to cope.

That was the message Chaplain Greg Malone of Providence Hospice of Seattle gave last month to the residents of Evergreen Court, where I work. His topic, "The Care and Feeding of the Human Spirit," explored grief and ways to handle it.

Writing the word, LOSS, on the white board, Malone asked the residents--people in their 70s to 90s--to list the losses they'd faced: mate, mother, father, child, pet, friend, sibling. These elders also mentioned balance, independence, memory, sight, hearing, employment, home.

Wow! Your parent could probably come up with quite a list, as well.

Grieving, though difficult, helps us cope with loss. "If you don't grieve, it sits inside you and comes out in negative ways," said Chaplain Malone.

Singing, crying, telling one's story, participating in counseling, plus praying, writing, and creating are all ways to express grief. The group mentioned they nourished themselves in the midst of loss by serving others, enjoying nature, doing crossword puzzles, and being with people.

We can help our parents deal with their grief by realizing their methods might not be ours. A newspaper food columnist told me she remembered hearing from a frantic reader who had just lost her husband. "I can't find my recipe for apple butter. It was his favorite. And I just have to make it!"

A close relative of mine buried herself in reading while grieving the loss of her husband. In the middle of the night, surrounded by stacks of books, she immersed herself in the words. In the process, she worked through the immense grief page by page.

How has your parent dealt with loss? How do you see your role?

Red Cross Rolls Out New Family Caregiver Training

2011-03-25T18:00:00.000-07:00

Are you caring for an aging parent? Whether you share the role with others or shoulder it by yourself, it's not easy. Some say it's a recipe for stress.

Knowledge can help. That's the premise of the American Red Cross' new program, Family Caregiving, being taught nationwide. With eight one-hour sessions, the course covers topics from home safety and general caregiving, to nutrition and personal care, to self-care for the caregiver, to legal and financial issues.

There are two options. Attend a class, led by a Red Cross-certified facilitator, or learn on your own through a modular home study program. Either method allows you to pick and choose any session, at little or no cost.

Are you already involved in a caregiver support group? Family Caregiving can come to you.

I'm personally excited about this program. Evergreen Court of Bellevue, Washington, the retirement and assisted living community where I work, is hosting the Family Caregiving Program, weekly from May 11 through June 15, beginning at 6 pm. A certified facilitator from Always Best Care-Eastside will lead the class.

I plan to publish posts about what we learn. If you'd like to attend, please RSVP by calling 425-455-4333.

To locate an American Red Cross Family Caregiving training, contact their directory.

Penny-wise Advice About Medicap Policies

2011-03-20T13:44:00.000-07:00

Suppose your aging parent decides to save money by dropping his Medicare Supplement. What do you do? Joy Nicholson-Kane has a ready answer: "Just say 'No.'"

Nicholson-Kane is a social worker at Skagit Valley Hospital's Kidney Center in Mount Vernon, Washington. Working with elders and their families daily has convinced her of the value of Medicare Supplement plans. They're also called Medigap plans.

"The biggest mistake people make in dealing with Medicare is not buying a supplement. People are sure Medicare will cover all their medical expenses, but it won't," she says.

If people depend solely on Medicare coverage, they could be paying hundreds--or even thousands of dollars out of pocket for things like hospital, nursing home, and home care costs.

Here's how these plans can help your parent.

In the hospital: Most Medicare supplements pay the $1,132 hospital deductible. Without a Medicap plan, your parent is out $1,132.

In a nursing home: If your parent is sent to rehab after hospitalization, Medicare A pays in full for the first 20 days. For day 21 and thereafter, there's a daily coinsurance of $141.50. Most Medicare supplements cover this; without such a plan, your parent pays out of pocket.

For medical appointments, therapy, and home health care: After a $162 deductible, Medicare pays 80%, leaving your parent with 20% unless he has a supplement.

All Medicare supplement plans are not alike, however. Ten plans are categorized from A through J. They vary in cost and coverage. Nicholson-Kane advises her patients to purchase an F plan, because its coverage is the most comprehensive.

For more information about these kinds of plans, contact State Health Insurance Assistance Programs (SHIPS). This federally funded national program has trained telephone counselors who can give advice on your parent's insurance options.

Your Aging Parent and the Age-Old Generation Gap

2011-03-06T14:00:00.000-08:00

A balanced blog works on a formula: 85% information; 15% sales.

Today I'm pitching me--I love to speak to Boomers on issues relating to their aging parents. If you need a presenter, I'm ready, willing and able!

Now for information. Remember the 60's term "Generation Gap?" Does it generate images of long-haired Hippies and finger-pointing parents? That term came up last week in a presentation I gave to 40 Boomers at First Free Methodist Church in Seattle. We were finishing a series "Understanding Your Aging Parent."

"Does a generation gap exist today?" I asked. Together, in a lively discussion, we came up with the answer. Yes. Fortunately, we're older and wiser now than in the Flower Power Days and more willing to examine the events that shaped our parents' view of the world. With hindsight, we can also better understand ourselves.

Our aging parents want RESPECT. They survived the Great Depression and World War II--both periods of national sacrifice. One 83-year-old resident of Evergreen Court, where I work, told me,"As a kid I remember standing in soup lines. And one day I had a tooth pulled in a government-run dental clinic. Without Novocaine." In the same breath, she said, "My mother did the very best she could."

Later in World War II our parents rallied their support in countless ways. They lost limbs, siblings and friends, while learning respect--for clergy, the military and authority. Afterwards they sacrificed to build longstanding marriages, forge lifelong careers and send us to college. No wonder they value RESPECT, even today.

Our key value as Boomers is APPRECIATION. During our growing up years, unity and respect for authority gave way to change and turmoil, beginning with the assassination of President John F. Kennedy--remember that fateful day?--and continuing with the Civil Rights and Women's Movements, the Viet Nam War and aftermath. We finally calmed down, but even today, we are less committed to the term respect. Our word is appreciation. We want to be thanked for our contributions, appreciated for our good work, praised for our helpfulness. Convinced of its value, we find it easy to give others appreciation.

Our understanding of these values can help bridge the generation gap. We can show respect, our parent's key value, by being on time to appointments or by keeping them apprised if we can't do something we promised. We can keep them in the loop--about medical issues, about income tax, etc. The biggest thing we can do is minimize our expectation about receiving appreciation for our role in their lives. They may not say, "I'm so thankful for all you do for me," or "I truly appreciate you." We can get our appreciation fix from our peers. Our parents just need our respect.

My Eldercare Blog Turns One Year Old!

2011-02-26T14:39:00.000-08:00

A Boomer's Guide to Eldercare is a year old! Like the mother of a toddler who stuffs an entire piece of birthday cake in her mouth, I'm beaming!

Help me celebrate. I'd love to hear from you as I toddle along into the second year. I promise I won't be a "terrible two" next time.

Here are several of my most popular posts. Enjoy! They're less fattening than chocolate cake.

Help! I've Lost My Way Finding a New Place for Mom

Now You See Them, Now You Don't--Long Distance Caregiving

How to Sell Your Parent's Home in Seven Days

Before Using a Senior Care Referral Agency, Ask These Questions...

'Affordable' Senior Housing--Three Models

2011-02-18T15:22:00.001-08:00

"Affordable Senior Housing" isn't a marketing term. It describes housing for low to moderate-income elders that offers clean, well-maintained apartments at a low price. Perhaps your aging parent might be interested.

Nationwide,low-budget senior living options take many forms. While they all have age and income limits, they differ in terms of cost, sponsorship, services and amenities. Here are three models in the Greater Seattle area.

HUD Affordable Housing--Northaven Retirement Apartments in North Seattle, offers more services than most HUD communities. Its 194 apartments have "market rates" rents from $468 to $624. Even lower rates are possible for those with incomes of $18,000 or less. The biggest plus about Northaven are the extras--one meal each weekday for $125 a month, plus housekeeping, transportation and on-site assisted living.

Other Income Qualified Apartments--Woodlands at Forbes Lake in Kirkland, Washington, offers subsidized senior housing of a different sort. A newer building, it has spacious common areas including a library, dining area, kitchen and computer area. Apartments are larger than found in HUD housing--no studios. Rents range from $726 to $1050, well below market. This community is owned by SHAG (Senior Housing Assistance Group.)

Full-Service Retirement Community--Evergreen Court in Bellevue, Washington, is a retirement and assisted living community for low to moderate-income seniors. With three meals a day, weekly housekeeping, transportation and activities, it fills a unique niche in this region. Besides retirement living, ranging from $1712 to $2446 for spacious one and two-bedrooms, assisted living is also available.

Affordable senior housing takes other forms: vouchers and apartments set aside for low-income people within a building which is otherwise market rate.

To find affordable senior housing in your area, contact your senior services department.

Is 'Affordable' Senior Housing in Your Parent's Future?

2011-02-16T16:04:00.000-08:00

For many elders on limited incomes, "affordable senior housing" is a magical term. It promises low and/or subsidized rents, plus services and social contact. Perhaps it's an answer to your aging parent's prayers.

Low-income senior housing began in the early 60s with the HUD model. More recently other subsidized programs have sprung up nationwide to fill in the gap between fixed incomes and rising rents. These affordable options have the following characteristics:

Location: Affordable housing programs are often located near bus lines, hospitals, medical clinics, senior centers and shopping.

Services/Amenities: Most affordable senior apartments don't have a dining program. They offer limited transportation--trips to the grocery store, senior center, and infrequent excursions. Monthly potlucks, frequent card and game nights, and exercise classes are examples of calendar items and are generally led by volunteers. With notable exceptions, assisted living is not usually located on campus.

Age Qualifications: In most communities, residents must be at least 55 or 62. Some affordable senior apartments accept disabled younger people.

Financial Qualifications: Eligibility is based on a percentage of the median household income of the surrounding area. For example, in Bellevue, Washington, where I work at Evergreen Court Retirement and Assisted Living Community, our residents qualify for the tax credit (subsidized) program if their income is not more than $36,000 for a single or $41,100 for a couple. That number is 60% of the median household income of King County.

The next post will profile three different kinds of senior affordable housing. Stay tuned!

Do You Know Your Aging Parent's 'Love Language'?

2011-02-06T11:40:00.000-08:00

Valentine's Day is coming! What a perfect season to dust off The Five Love Languages, Gary Chapman's best-seller from 1992. Initially aimed at married couples, the book's popularity continues today. There are hundreds of discussion groups and spinoffs including The Five Love Languages of Children and The Five Love Languages of Teenagers. Chapman's premise is useful in any relationship, including with our aging parent.

Chapman asserts that everyone has a primary "language" to give and receive love. Those are: acts of service, quality time, giving and receiving gifts, physical touch and words of affirmation. When we undertand our aging parent's primary love language, and give him what he needs, he receives a sort of electronic shock in his soul.

The key is identifying your aging parent's "language." If she gives love in a certain way, she will likely appreciate receiving in that same language. Here's how the love languages work in some of my family members.

1. Acts of Service: Grandpa Harley, a man of few words, mowed the church's lawn, tended to the flowers and quietly prayed for the pastor every Saturday night. He appreciated Grandma Lena's incredible meals and help with domestic chores.

2. Quality Time: My father-in-law enjoys taking friends and family out to lunch. He loves an invitation to our extended family dinners.

3. Receiving Gifts: Every chance she gets, my mother-in-law brings all of us homemade jam, soup and other goodies. She appreciates cards and gifts and hand-colored pictures from the grandchildren.

4. Physical Touch: Carolyn, our hugging relative, can't let five minutes go by at a family gathering before she corners the kids and anyone else within reach, giving them a bear hug. Obviously, she likes to receive them, too.

5. Words of Affirmation: Uncle Dale is a "connector." When he introduces people, he affirms each person with positive comments about their achievements. He appreciates the same.

Try to observe your aging parent. Can you guess their primary love language? Their secondary one? Tell us about it.

Surprise! State Surveyors Pay a Visit to Your Parent's Nursing Home

2011-01-24T20:13:00.000-08:00

Suppose strangers enter your home unannounced. They rummage through your cupboards, financial statements, medical records and more. And then they tell you what's not up to snuff. If your aging parent lives in a nursing home, assisted living or adult family home, that's what happens yearly when state surveyors pay their surprise visit.

Nursing home surveys are the strictest. The licensors look for noncompliance with hundreds of federal and state laws. When they find something wrong, they deem it a "deficiency." Deficiencies can be as minor as finding crumbs in the toaster or as severe as discovering evidence of abuse and neglect.

Surveys in assisted living and adult family homes focus on state laws only, are generally shorter (often two or three days as opposed to four to five for a nursing home), and concentrate on issues relating to quality of life.

Many long-term care employees shake in their boots figuratively when surveyors arrive. Some facilities will hire extra help the day their visitors arrive, so they'll "pass the test." Such tactics remind me of college students cramming for a final exam, hoping the information will enter their brains in time.

You can help the surveyors do their job. They want to know what the facility is like on a daily basis, so they ask mentally competent residents, and family members, too. That's where your valuable input comes into play.

Before finishing the visit, surveyors discuss the results with the staff. If surveyors issue deficiencies, the staff have 10 days to submit a plan of correction in writing.

You don't have to wait until a state survey happens to voice your concerns. In between surveys, the ombudsman is your go-to person if you suspect neglect or abuse.

Do you have experience with state surveys?

Adult Day Programs: Just the Facts, Ma'am

2011-01-07T21:07:00.000-08:00

Adult day programs are booming. And for good reason. Similar to children's day care centers, they give caregivers a much-needed break. For the ill loved one, these centers can open doors to the wider world.

Perhaps your aging parents could benefit from such a program. Last week Sandy Sabersky, Executive Director of Elderwise Adult Day Care in Seattle, spoke to a group of senior care professionals. Here are some facts about adult day care, from Sabersky and other sources.

1. Adult day social programs focus on community, friendship and engaging activity. Elderwise is such a program. "The aging person is a whole person," Sabersky says. Her goal is to stimulate the physical, mental, emotional and spiritual parts of the elder's life.

2. A second type of day care, adult day health, specializes in health-related services such as physical, occupational and speech therapy.

3. Programs vary. Some offer drop-in options, others are a four-hour session, from 10 am to 2 pm, etc. Some are designed for elders with memory issues.

4. Adult day sessions often begin with a greeting/coffee time, similar to a supported coffee shop experience.

5. Water color painting, working with clay, and focused discussion on current topics are some of the possible activities.

6. Lunch is included. "We do everything together," Sabersky says.

For more information on adult day programs, check out the National Adult Day Services Association.

Forgot Your Parent's Caregiver During the Holidays? Try These Free Gift Ideas

2011-01-02T19:17:00.000-08:00

In the holiday gift buying frenzy, you may have forgotten your aging parent's caregiver. Though you missed the deadline, you can still remember that special person, without breaking your piggy bank.

The following gifts cost absolutely nothing, except a bit of your time and attention. I've seen caregivers, wait staff and housekeepers beam when they receive these.

1. Give sincere compliments. Does your parent's special person shine when singled out for public recognition? Or do they prefer a quiet whisper? Whatever their style, they'll appreciate your attention.
2. Write them a thank-you note. I have a folder stuffed with notes from adult children and their parents with whom I've worked over the years. Just thinking about those kind words makes me smile. When you write, be as specific as possible, such as, "I so appreciate the backrubs you give my mom. It makes her feel so special."
3. Write a thank-you note to the special person's supervisor. Fill it with glowing compliments about the caregiver's compassion, creativity, dedication, etc. Use examples. Close by asking the supervisor to consider including this letter in the caregiver's personnel file. Mail or hand-carry a copy to your caregiver.

Perhaps you can think of other ways to show appreciation to caregivers and other key people in your aging parent's life. Tell us about them.

Is a Continuing Care Retirement Community Right for Your Parent?

2010-12-27T20:08:00.000-08:00

CCRC is short for Continuing Care Retirement Community. That's a buzzword for a type of community which works well for many aging parents. Perhaps yours.

In a CCRC, healthy, active seniors typically move into independent apartments. They pay an entrance fee, ranging from less than $100,000 to more than $1,000,000. The entrance fee reduces their monthly rent over what they'd pay in a comparable rental community. When a resident leaves the CCRC, part or all of the entrance fee often is returned to them or to their estate.

As in other communities, residents in a CCRC no longer worry about shopping, preparing meals and doing the dishes. Ditto for housekeeping and home maintenance. With the extra time, they can enjoy fun activities and fellowship with peers. If they give up driving, transportation is available.

A big difference: When independent residents of a CCRC need help with such things as bathing, dressing or medication management, they can move to on-site assisted living. And if they need either long or short-term nursing care, they can receive it in the on-campus health care center. As seniors travel through the system, they'll know the staff and the residents. For many, that brings security.

A CCRC works particularly for several groups of seniors (assuming the entrance fee is within their budget.) See if your aging parent falls into one of these categories:

1. Your parents are both living, but worry how the survivor (usually Mom) will do when the other passes. Typically when a couple moves into a CCRC, they begin developing friendships with neighbors. When a spouse dies, the survivor has support from others who've traveled the same road. Widows or widowers go out to dinner or to movies together. And sometimes, romance strikes the widowed, and marriage follows.
2. One of your parents cares for her spouse, who suffers from a chronic illness. A CCRC offers the healthy spouse help with the domestic duties so she can focus on caregiving. He or she can easily take a break by attending activities and support groups on campus. If the ill spouse needs assisted living or nursing care, it's an easy walk from the healthy spouse's apartment.
3. If you are advocating for an aunt or uncle without children, a CCRC can be extremely helpful. When your relative needs more care, the staff in a CCRC will bend over backward to make the transition as easy as possible.
4. Your mother or dad is alone and needs companionship. All types of retirement communities can help brighten someone's outlook. When I talk to senior clients and their families, I often say, "Retirement living is a little like living in a dorm, sorority or fraternity. There's a difference, though. No wild parties."

Do you have any experience with CCRCs you'd like to share?

Before Using a Senior-Care Referral Agency, Ask These Questions...

2010-12-20T19:28:00.000-08:00

If you're thinking about employing a senior-care referral agency, you'll need some education. For starters, read "Senior Care Placement Companies Scramble to Cash In," Michael Behrens' report published in The Seattle Times, Dec. 11.

The principle behind this rapidly growing industry is simple. Private agencies "match" seniors who need care with facilities that have openings. The receiving community pays a fee. The family pays nothing.

Behrens' article points out huge problems. Over the last three years 143 individuals in Washington were victimized after companies placed them in facilities that had documented serious violations.

How do you find a credible senior-care referral agency? (Yes, they're out there.) Ask these questions:

1. What are your credentials?

Many senior-care referral agencies are run by nurses, social workers, former assisted living administrators. Find out how long they've been operating and what experience they have working in long-term care.

2. Where do you receive most of your clients?

Some work exlusively on the Internet. Others find their clients from referral sources through networking, through referrals from satisfied customers, plus advertising and the Internet.

3. Do you check facilities often to make sure they have no violations with the state?
Behrens' article notes that one on-line agency, A Place for Mom, placed seniors in facilities with past records of substandard care.

4. How well do you know the facilities that contract with you?

Reputable agencies will have a profile on each contracted facility. They visit them periodically and look for potential problems.

5. How much time will you spend with me?
Internet-based agencies tend to do their business online and by phone. Other agencies will conduct a face-to-face interview with you, schedule tours and accompany you, to help you make your decision.

Do you have experiences with senior-care referral agencies? Tell us about it.

Eldercare Placement Companies: The Good, the Bad & the Ugly

2010-12-18T08:24:00.000-08:00

Panic. Stress. Our parent breaks a hip, suffers a stroke or other malady and can no longer live at home. We search online and find senior-care placement companies making alluring promises. They'll move heaven and hell to help us find the right fit--assisted living, adult family homes or home care. For free.

Not so fast. Last week, the Seattle Times published Michael Behrens'report, "Senior care placement companies scramble to cash in," the most recent in a series "Seniors for Sale." Behrens contends that while some companies do an excellent job in linking seniors with needed care, others have referred families to facilities with documented histories of substandard care.

Analyzing records of the Department of Social and Health Services over the past three years, the Times staff found 143 cases of seniors victimized after companies placed them in a care setting. Mentally ill adults were drugged into submission to control their behavior. Mentally ill adults were locked in rooms to prevent wandering. Bedbound seniors were left without assistance up to 16 hours.

The key problems:

1. Washington and many other states have no licensing, education or training requirements to open a placement agency. (This is a fairly new industry nationwide.)

2. Most companies don't screen for past violations. So a senior can end up in an abusive setting.

3. The largest company, A Place for Mom, sited in the Times report, works exclusively online and by phone. There is no face to face connection between the senior care adviser and the client.

As a marketing and admissions professional for 16 years in various care settings, I've worked with some great eldercare advisors, and some who have driven me crazy. I've also worked with angry families who completed an online profile "just for the future," only to receive unwanted phone calls and emails from 7 to 8 different care organizations which had received the profile from the broker company, with the strong suggestion that this family wanted immediate placement.

Have you had experience with senior placement companies? My next step will give you questions to ask placement companies before you place the future of your loved one in their hands.

Ways to Simplify the Holidays, For You and Your Aging Parent

2010-12-12T12:04:00.000-08:00

Keep it simple. I've found that an excellent admonition for celebrating the holidays with an aging parent.

To capture the "good old times" your parent may remember, try one or more of these simplified traditions.

If your parent enjoyed attending the Nutcracker, the Messiah or other live musical performances, listen to CDs or DVD's of these favorites together.

If your parent hosted family and friends during the holidays, give him or her a guest book and a tin of cookies or other treats for guests.

If she sang in a church choir, hold a carol sing-along, even if there are only a few of you.

If he faithfully chopped down and decorated the family Christmas tree, take a drive through a lighted neighborhood, stopping for cocoa afterward.

If she filled your Christmas stockings to the max, provide some wrapped candies she can give to the grandchildren and great-grandchildren.

If she baked traditional breads and holiday cookies, hold a family baking session, using her recipes and encouraging her to help if possible.

Can you think of other simplified versions of holiday favorite traditions?

For You and Your Aging Parent, Simplicity is Key to Holiday Joy

2010-12-01T20:57:00.000-08:00

Simplify. Simplify. Those words of Henry David Thoreau echo in my mind during the holidays, especially when I think about our aging parents.

If I have one piece of advice I've gleaned over the years, it's this: Don't let your parents' medical conditions steal your family's holiday joy.

First, you may want to start a conversation. Ask your parent, "What is most important to you during the holidays?" Just having the discussion honors your parent and may enlighten you as he or she shares memories of long ago.

Together, narrow the list to a few favorite activities that can be done with help from you and your family.

My father, a retired pastor, loved writing family Christmas letters. When he moved to a nursing home, he wanted to continue his favorite tradition. Parkinson's had robbed him of his ability to write. Fortunately, my younger brother Jim pitched in to help compose the letter. Jim's wife and children were enlisted to type, photocopy and address envelopes.

Your parent's list of favorite things will be unique. In the retirement community where I work, several residents make Christmas cookies, just as they have every year. Their kids provide ingredients and support. Others in our community are attending "The Nutcracker" as a group. Still others enjoy Christmas caroling.

Even if your parent is homebound, he or she may enjoy decorations, holiday music, movies and family recipes.

In my next post, I'll list more specific tips for bringing simple joy to the holidays.

Do you have any ideas you'd like to share for making the holidays special for your aging parent?

Your Parent Needs Cheerleaders, Quarterbacks

2010-11-23T20:57:00.000-08:00

No matter how long I work with Boomers and their aging parents, I come up short.

As I speak with an adult child, I may paint a glorious picture of when, how, and why their parent might want to consider a transition. In my business, it's a move to a retirement and assisted living community. More than once, though, I've heard, "What you say makes sense. It really does. But I don't think it will fly with my Mom."

Bingo! As professionals, it's easy to forget that we don't have all the answers.

You know what trips your parent's switch, what tries her patience, what makes him grin or brings her to tears. The professionals in your life, whether doctors, nurses, attorneys, or customer service reps are cheerleaders. If they're worth their salt, they'll applaud your efforts and coach you, offering information and advice which has worked for others. They'll also give kudos to your parent!

When you're firm about your parent's desires, telling them, "No thanks," hopefully they'll back off their agenda and move to the sidelines. You're the quarterback, the one who makes the plays.

Cheerleaders? Quarterback? Your parent needs them both, on Thanksgiving and all year long. Happy Thanksgiving to you, your aging parent and your entire family.

Meet Your Parent's 'Guardian Angel,' the Long-Term Care Ombudsman

2010-11-22T20:20:00.000-08:00

If your parent lives in a care setting--assisted living, adult family home or nursing home, chances are you worry. You can't be with him or her 24-7. You wonder, "Are his or her care needs being met?" and, "How can I be sure he or she isn't being exploited?"

You and your parent need a guardian angel, someone who can right the wrongs and fight for those who can't speak for themselves. Fortunately, there is such a person, called a long-term ombudsman. Assigned to your parent's health care center or assisted living community, he or she will visit, help solve problems and work to make changes at the local, state and national levels.

The National Long-term Ombudsmen Program is active in all 50 states and operates under the authority of the Older Americans Act. Each state has an office of the State Long-Term Care Ombudsmen, which oversees the work of the local paid and unpaid staff.

I spoke to a local ombudsman not long ago. A retired nurse, Bonnie, like other ombudsmen, has a heart for older people, especially those in care settings. Much of her job involves visiting with residents in her assigned nursing home. When problems arise, they feel comfortable to go to her.

If you don't know your long-term ombudsman, introduce yourself. He or she is especially trained to investigate complaints of family members, too, with a goal of helping improve the atmosphere for all.

Do you know your long-term care ombudsman?

Your Parent Says, 'Slow Down, You Move Too Fast!'

2010-11-14T17:04:00.000-08:00

Does your aging parent say anything like:

"You walk too fast!"
"You work too hard."
"You need to slow down."

I've heard these admonitions again and again from my elderly clients and my aging parents. Why? Their perspective is often worlds away from ours.

We Boomers are on fast forward, juggling jobs, relationships and generations. Our eyes are on the future, as we plan for vacations, dream of retirement or just anticipate the next challenge. Completing to-do lists and achieving goals is what we're wired to do.

Our aging parents, on the other hand, seem to have one speed: slow. If we're the hare, they're the tortoise, pondering each move. Weak legs, winded breath and pain dampers their physical progress. Their thinking is slow, too, deliberate and reflective. Everything takes longer: from doctor's appointments to shopping trips to decisions.

This pacing difference frustrates both generations. Some coping ideas I've picked up over the years:

1. Match your pace to theirs. At the first retirement community where I worked years ago, I kept hearing, "Alice, you walk so fast." That was a shocker! I'm 5'3". No one had ever accused me of speedwalking. But I decided if I wanted to connect, I needed to slow down. Ditto with my parents.

2. Don't overschedule. When planning activities with my aging parents, I had to divide my to-do list in half. One major event in a day was more than enough.

3. Let them ponder. If there's a big decision, like moving to a retirement community or bringing in home care, discuss the pros and cons but don't expect an immediate reaction. Leave literature with them so they can think about ramifications. That way, they can ponder on their own schedule.

Do you have any other ideas on slowing your pace or adjusting your speed for your aging parent?

'Shopping' for Medicaid? Save Time With These Tips

2010-11-07T13:50:00.000-08:00

Perhaps your parent needs a health care setting accepting Medicaid. The bad news is they're not located like Starbucks on virtually every corner. The good news is if you do your homework, on the phone and online, you can cut hours off your search.

Lists of assisted living communities, adult family homes and nursing homes accepting Medicaid are available from local agencies through a national government-funded website, Eldercare Locator. Look first within a half-hour's drive of your best destination--you may have to drive even farther to find current Medicaid availability.

Pick up the phone and ask:

1. Are you currently accepting Medicaid payment? Situations change, and your list may be out of date. If the answer is yes, ask:

2. Do you have any Medicaid openings today or in the near future? If the answer is yes, ask when you can tour. If not, ask:

3. Can we join a waiting list for Medicaid openings? (Ask this only if your parent can wait for placement.) Otherwise ask: Do you know of other communities or health care settings that might have current Medicaid openings?

Many communities give first priority to their existing private paying residents who run out of money. Some communities actually insist that new residents pay privately for a specific time period--often a year or two--before converting to Medicaid.

Once you've narrowed the field by phone, visit communities personally. If it's appropriate for your parent to join you, take her with you to the top two or so. Once you find something suitable, don't delay.

Be patient and flexible. Medicaid openings are few and far between, so don't expect to find a community five minutes from your home. Good luck!

Can you tell us about your journey looking for a Medicaid opening for your aging parent?

Your Aging Parent Can't Attend Church? Tips to Foster Her Spiritual Health

2010-10-31T18:37:00.000-07:00

Perhaps in days gone by your aging parent faithfully attended church. His or her devotion to God leavened every part of life: from praying and reading scripture, to visiting the sick, to serving and giving financially to the church or synagogue.

Today health issues may make church attendance impossible. Yet there are other ways to encourage your aging parent in his or her walk with God. Everyone is different, though, so I suggest you ask your parent, "How would you like to try ...?" before proceeding with any of the following ideas.

Some I've used some with my own parents. Other ideas come from adult children in the retirement and nursing homes where I've worked.

1. Your aging parent needs spiritual community. Worshiping God doesn't usually occur in a vacuum. If your parent has a connection with a congregation, a minister may arrange person in-home visits. Catholic parishes often train lay eucharistic ministers to take communion to the elderly. If your parent lives in an assisted living or nursing home, check into scheduled worship services, Bible studies or rosary groups.

2. Your aging parent needs inspiration. For many, the comforting words of the Bible are an anchor of hope in the midst of pain and suffering. When Daddy was struggling with Parkinson's in a nursing home halfway across the country, our family recorded his favorite Scripture verses. He enjoyed listening as our voices read those familiar, beautiful words. Other sources of inspiration for your aging parent are large print copies of devotional and inspirational magazines including, "The Upper Room," and "Guideposts." Inspirational DVDs, radio and television programs can also help fill the spiritual gap.

3. Your aging parent may need to be needed. Does that sound funny? As a retired minister, my dad wanted to continue to serve, even though his body didn't always cooperate. The Nurse Manager on the night shift called him when other residents showed anxiety. His prayers had a calming affect. Depending on your parent's physical and mental condition, his or her spiritual gifts may range from a thank-you note to a pastor, to a get-well-card to a friend who is hospitalized, to a hug and a knowing smile that says, without words, "God is here." And don't forget their prayers. My parents prayed for me and my family daily, and I was blessed.

4. Your aging parent may surprise you. Sometimes dormant faith springs to new life when nurtured, even in an older person. The mother of a friend was very religious in her early years, but shelved her faith in mid-life. Not long ago, at the invitation of a friend, she began attending church once again, exhibiting newfound fervor. "God works in mysterious ways," my friend says.

How have you endeavored to support your parent spiritually?

Suffering From 'Compassion Fatigue'? Here's Help

2010-10-26T20:19:00.000-07:00

Do any of these sound like you?

1. Your aging parent's needs are ballooning, and your patience and energy are eroding.
2. When the phone rings past 10 pm, your blood pressure spikes, and your first thought is, "Is Mom OK?"
3. As a professional working with elderly clients and their families, your day is often punctuated by crises.
Can you relate? If so, you're at risk for stress overload, also known as caregiver burnout or compassion fatigue. The good things you do for your parents--or your clients--may be great for them but bad for you when done in excess, setting you up for illness.

How do you combat burnout? Rob Luck, Director of Social Services and Special Programs for Providence Hospice of Seattle, addressed this earlier this year at Seattle Senior Care Coalition, a group of professionals serving seniors and their families. He offered these suggestions.

1. Maintain boundaries. The Bible says it this way: "Let your 'yes' be 'yes' and your 'no' be 'no.' Set limits on your time, your work, your thoughts to keep balance in your life.
2. Create a written plan of care for yourself. Luck suggests we develop a personal mission state which includes four or five key values, such as intimacy, self care, spirituality, etc. For each value, plan daily activities. Exercising at the gym and scheduling doctor's appointments fall under self-care. Spending time with a spouse and children go under intimacy. For more help with mission statements, see Stephen Covey's Seven Habits of Highly Effective People.
3. Foster some sort of spiritual center, however you define it. Luck says that tapping into something bigger than ourselves will give us strength to work for our parents and still keep other parts of our lives intact. "The work we do (with our parents and our clients) is sacred," says Luck. "But so is caring for ourselves."

Do you have any suggestions for avoiding burnout?

Your Aging Parent Has Two Developmental Tasks

2010-10-18T19:29:00.000-07:00

A toddler's "No!", a teen's rebellion, and your aging parent's attempts at control are all related to developmental tasks we tackle at key stages in life.

David Solie's well-written book, How to Say It to Seniors, discusses two main tasks of elders that are at once conflicting and potentially frustrating to us. Understanding our parents' developmental challenges, he says, will enable us to improve our communication and our relationship.

Your parent's first goal, says Solie, is to maintain as much control as possible, in the face of a litany of losses: of physical strength, friends and financial status, to name a few. Piled on top of each other, these losses often prompt him to cry, "No!" in toddler-style, figuratively stamping his feet, even to ideas that seem reasonable. Meanwhile our developmental agenda compels us to get things done, make decisions and act on them. As Solie says, "Our drivers can clash with theirs that compel them to hang on tight and to reflect."

The best tact is to avoid power struggles and to go with our parents' wishes whenever possible. If they are firm about wanting to stay in their home, for example, we may need to orchestrate an array of services to make that happen. Assuming that's possible.

Sometimes just giving our parents space and grace will enable them to make an informed decision that's right for them. Not long ago I met a 90-year-old woman who struggled with hoarding. Her home and furnishings were growing mold, with possessions and paper piled everywhere.

"By winter the house won't be inhabitable," her son said. Another issue: her failing memory. But Mom dug in her heels when he mentioned moving. A few months later, given time, patience and numerous visits, she called me: "I've decided to move into the apartment you offered."

Your parent's second developmental task is to preserve a legacy. "Every day, every hour, whether they mention it or not, the seventy-plus age group is reviewing their lives," Solie says. Consciously and unconsciously, they ponder how and by whom they would like to remembered. They repeat the same stories again and again in great detail, not so much for the facts as for the inherent values. And they often take a long time to make a decision.

Solie's biggest piece of advice is so listen to our parents. Really listen. If we do, we may pick up on what values they cherish. We may have the opportunity to watch the unveiling of a legacy right before our eyes.

Eldercare Blog Celebrates the Big 50--Posts, That Is

2010-10-11T15:44:00.000-07:00

Whoo Hoo! On September 27, Boomer's Guide to Eldercare passed the 50-post mark.

I started in February with one goal--to provide help and hope to Boomers as they relate to their aging parents. This first "season," if you will, has stretched my mind as I've researched, interviewed experts and tapped into my 14-plus years in the eldercare field.

But blogging isn't about me. It's about you and your needs for help as you care for your aging parent.

According to Google Analytics, your favorite posts are:

1. How to Sell Your Parent's Home in Seven Days

2. Help! I've Lost My Way Searching for a Place for Mom

3. Three Kinds of In-Home Care

4. Can Your Parent be Happy in a Nursing Home?

5. Eldercare Dilemma: In My Aging Parent's Eyes, I've Failed

Check them out, if you haven't read them yet.

Got any ideas for further topics? I'd love to hear from you. In the meantime, I'm ready to tackle another go-around: learning about how to understand our aging parents and ourselves, how to better communicate, and how to advocate.

Eldercare Tips: Finding a Great Adult Family Home

2010-09-27T08:13:00.000-07:00

Adult family homes, also called group homes, recently took a hit in the press with Seattle Times' "Seniors for Sale." The five-part investigative report released in February and Sept. 4 and 5 uncovered widespread abuse and neglect in this ill-regulated and rapidly growing industry. My previous post examined the findings.

What does this mean for you if your aging parent needs care, and you want a small, homelike setting? Excellent adult family homes do exist, provided you do your homework.

Some ideas:

1. Once you find your desired location, do an Internet search to find several addresses. Or ask friends or associates for referrals. Drive by each home and look closely. Is the home in good repair? Is the grass mowed? Little things count.

2. Visit each home several times, at least one announced. Try to arrive at mealtime to observe the quality and quantity of the food. Are staff and residents enjoying one another? Or do residents seem stressed? Does the home look and smell clean and fresh? What about activities? Music? Look at the entire home, staff and program in the light of your parent's needs.

3. Ask the owner, manager or other representative to show you the most recent state inspection report. If you need help interpreting it, ask a friend in the medical field.

4. Call the Long Term Ombudsman in your area to see if any complaints have been filed recently against the home. Ombudsmen work to resolve problems of individual residents and to work on the local, state and national levels to improve care.

5. Contact the Better Business Bureau to check out the home's record.

6. If these steps sound like too much work, consider contacting an eldercare referral agency or a geriatric care manager. Both can be of help in locating a good fit.

Do you have personal experience with a good group home or a bad one?

Eldercare Tip: With Adult Family Homes, It's 'Buyer Beware'

2010-09-20T20:59:00.000-07:00

Choosing an adult family home, or group home, for your aging parent can be dicey. Nationwide, this 20-year-old phenomenon is touted as cheaper and more homelike than a nursing home. But better?

That depends. Clean and comfortable, a well-run adult family home is staffed with consistent caregivers who love and understand the elderly. In such an atmosphere, music, nutritious meals and activities will fill your parent's day.

Finding such a place requires diligence. State regulators can't keep up with the pace of this rapidly growing industry, making it easy for ill-trained, money-grabbing owners to exploit the elderly and their families.

So says The Seattle Times. Last week it published the fourth and fifth segment of the investigative series "Seniors for Sale," a critical examination of adult family homes in Washington State. Earlier segments ran in January.

In reviewing years of state records, the reporter, Michael Berens, noted that of the 11,200 residents living in the state's 2,843 homes, thousands have been exploited financially or harmed by unqualified caregivers. He reported accounts of victims imprisoned in their beds at night, strapped to their chairs during the day or left without proper medical treatment for weeks.

In scores of cases, the report continued, owners collected monthly payments while playing the miser. They eliminated meals, turned off heat or left residents in soaked clothing for days.

The abuse and neglect mentioned above, as awful as it is, doesn't tell the whole story. Earlier this year I met an 80-something man named Paul at Northshore Senior Center. He lives in one of three adult family homes in the Shoreline, Washington, area, owned by Laura Cirves, RN. They're called For Senior's Sake.

Once a week Paul goes dancing at the senior center, thanks to transportation provided by the adult family home. Other times he and the other residents go out to lunch and attend baseball games. They receive manicures and permanents. Live musicians perform weekly.

Laura's homes are licensed for residents with dementia and mental health issues. Despite their medical diagnoses, the residents get every chance at life possible.

"My mission is to increase the quality of the lives in my care," Laura says.

The next post will give some guidelines in choosing an adult family home.

Eldercare Dilemma: Grandpa Tells the Same Stories Over and Over

2010-09-12T20:52:00.000-07:00

Does your aging parent lapse into stories at the drop of a hat? And does he or she repeat the same ones again and again, in great detail?

Grandpa Jake certainly does. When he tells of receiving his first pony, a Shetland named Bill, on his fourth birthday, he travels back in time. From that day on, Jake and his pony were inseparable. "A silly name for a horse," Jack recalls. "Lightening would have been better."

Jake has told this--and other stories--so many times that his family is not only bored; they're worried. Do repeated stories signal dementia? Or an unnatural drawing inward that is unhealthy?

Not so, says David Solie, author of "How to Say It To Seniors." He contends repeated stories are a vehicle for completing a key developmental task: the building of a legacy.

At the end of life, people want to be remembered for their time on earth and cherished by future generations, Solie says. They review the happenings of their lives and consider how those events figure into the way they want to be remembered.

That's where the repeated stories come in. And the detailed rendering of the events, Solie says. More important than the facts are the underlying values--building bricks of their legacy.

In Grandpa Jake's story, the thrill of receiving his horse may have explained his value of gratitude--both as a child during the Depression, and during the rest of his life. A lifelong love of animals may have caused Jack to repeat the horse story again and again. As the story is repeated, other life values may surface, evident to him and his family.

Bottom line: When our aging parents repeat stories, they are in the process of creating a legacy. We need to listen respectfully not just for the facts but for possible themes.

"Tell a similar story from your own life," Solie also suggests.

Connection is everything.

Does a senior in your life tell the same stories again and again?

Eldercare Jargon Translated Here

2010-09-05T21:23:00.000-07:00

Eldercare jargon is alive and well on Planet Earth--unfortunately. Senior Care Professionals often sprinkle their conversations with words which carry no meaning to you and me.

An elderly woman commented recently on the brochure I sent her about retirement living: "I have one question. I'm not sure what 'congregate living' means. Does it have to do with religion?"

Oops! I thought to myself. The word "congregate" is a little like the word "congregation." But that's not what I had in mind. In my brochure I'd committed the unpardonable sin of slipping into eldercare jargon without thinking. After owning my misdeed, I translated: Congregate living is retirement living offering meals, housekeeping, transportation and activities.

Here are other examples of eldercare jargon you may hear as you care for your elderly parent.

ALC--After 14 years working in this field, I heard this recently from a professional. "I often give talks in ALC's on veterans' benefits." When I asked the meaning of an ALC, she said, "ALC is an assisted living community." Really!

Interdisciplinary Assessment--It's a nursing home term. During the first 14 days of residency in a nursing home, all departments come together to report on the new resident's needs and determine how those will be met.

Transfer--This has two meanings. The first obvious meaning refers to an elderly person moving from one care setting to another, such as from an assisted living community to a nursing home. Transfer also refers to the process of getting up from a sitting or reclining position. If your parent is a two-person transfer, he needs two other people to help him get up.

Respite--In a broad sense, this word means "rest," usually for a caregiver. This usually takes the form of bringing their loved one to a care setting temporarily, so the caregiver can take a break.

Discharge--No, this doesn't refer to bodily fluids. It has to do with leaving a care setting, such as being discharged from a hospital, a rehab center or a nursing home. Sometimes discharge happens because the person needs more care; sometimes because the person's health has improved.

Spenddown--This occurs when your parent's limited funds are paying for health care and will soon run out. Yet he or she is not yet eligible for Medicaid. Each state has rules about how funds can be spent during this spenddown period.

Have you encountered other examples of eldercare jargon? Please share.

Eldercare Dilemma: In My Aging Parent's Eyes, I've Failed!

2010-08-31T07:33:00.000-07:00

Raise your hand if you've...

Failed to keep a promise to your aging parent.

Forgotten their birthday or anniversary.

In frustration, said words you wish you could eat.

I raised my hand more than once. For many reasons--commitment overload, personality differences and the human condition--we Boomers do and say things to let our parents down.

Ten years ago I opened my parents' apartment door to pick them up for a doctor's appointment my sister had set. Daddy, who had Parkinson's Disease, was dropping pounds as if he'd won the "Biggest Loser" competition. My sister forgot to tell them about the appointment. I showed up on their doorstep.

"What's this about going to the doctor's?" Daddy snapped. "Why didn't anybody tell me? If I do see the doctor, you're not coming in!"

A simple misunderstanding, in most people's eyes. But to him, we'd failed, miserably.

Several months ago I listened to Stephen Towles, an ordained minister and elder care advisor with Choice Advisory Services. He spoke to a group of 80 Seattle area professionals in the senior care field. Besides working with elders daily, many of them struggle with communicating with their own parents.

Our first reaction, when we fail, or when someone (like our parent) thinks we fail, Towles said, is to self-deprecate (the I'm no good, nobody loves me, I'm going to eat some worms mentality) in which we ruminate over our failure, playing it again and again. Or we blame the other person for our mistake. Either tact, while understandable, doesn't help. We wallow in our humiliation and are stuck, like Winnie the Pooh, in a hole of our own making. Have you been there? I have.

A better way to react, Towles said, is to calm ourselves and realize that "No one or nothing is against me. That means everything is for me." I found a similar thought in the book of Romans in the New Testament, where the Apostle Paul writes, "Nothing can separate us from the love of God." Towles said when he failed a key person in his life, just thinking about the truth that no one was against him transformed his perspective.

Towles says this exercise moves us from self-focused humiliation to other-centered humility. Instead of beating ourselves up when we fail our aging parent, we ask, "What can I do to repair this situation?" That change in thought pattern propels actions which may include apologizing and making amends.

With my dad, I first calmed myself, and later him. And yes, I got to accompany them into the doctor's office, thanks to a kindly nurse.

Do you have a story of a time when you've failed your parent and worked through the process from humiliation to humility?

Ready, Set, Go: Tips for Moving Your Parent Close to You, Part 2

2010-08-21T21:24:00.000-07:00

If you're moving your aging parent close to you, there are endless details to address. The last post discussed some medical and insurance issues.

Here are a few other concerns:

1. If your parent moves across state lines and needs Medicaid services (in-home care, assisted living, adult family homes or nursing home), he or she must establish residency in the new state before applying. In other words, even if your Mom or Dad lived in a Medicaid-funded facility in Idaho, he or she can't check into a similar care center in California and expect Medicaid to pay from day one.

To work through this, some children bring their parents into their own home temporarily, filing the Medicaid application as soon as their parent arrives. Once the application is approved, they admit their parent to the health care center. Other children bring their parent to the health care center upon arrival in the new state, applying on that day and paying privately until funding is obtained. If you're relocating your parent across state lines, the federally-funded Eldercare Locator program may offer help and advice. Trained telephone counselors have many resources. Or google Medicaid (your state) for specifics.

2. Powers of attorney and advance directives are worded differently from state to state. A visit to an attorney in your state is a good idea, so you and your parent can make changes if needed.

3. To help your parent establish a social network in your area, do some homework (or delegate this to other family members.) If he's a bridge player, check out opportunities at the local senior center. If she has attended a church or other religious group, find a similar congregation locally. Other associations your parent has had in the past: garden clubs, the Elks, Rotary, etc., may be available in your area.

What other steps would you advise other Boomers to take to help their parent make a good transition to their new home? I'd like to hear from you.

Ready, Set, Go: Tips for Moving Your Parent Close to You, Part 1

2010-08-19T21:06:00.000-07:00

Miles--and even states--may separate you from your aging parent. That distance may not have posed a problem until now. But recent falls, depression, dementia or other issues are sending a clear message. Your parent needs to move close to you.

Once you and your family decide on where Mom or Dad should live, and who will sell the home and sort through the "stuff," you'll encounter other issues.

1. If your parent has straight Medicare coverage, the good news is that it is portable throughout the country. The bad news is that fewer physicians are accepting new Medicare patients than in the past. A call to your own doctor may help you locate one. If you're moving your parent to an assisted living facility or nursing home, the admissions staff can usually provide referrals.

2. Medicare Advantage plans, a specific type of managed care, operate in a limited service area. If your parent is enrolled in such a plan, see if it offers coverage in your locale. If not, you'll disenroll your parent from his current plan, and enroll in a Medicare Advantage plan near you. Touch base with customer service representatives from both companies to assure a smooth transition.

3. Once you've chosen a new doctor, ask for your parent's records to be transferred. As soon as possible, schedule a visit with the new physician. If you're moving him or her to an assisted living, adult family home or nursing home, the physician will need to see your parent before he or she can move in.

More tips for moving your parent close to you are in the next post.

Can Your Parent Be Happy in a Nursing Home?

2010-08-09T06:50:00.000-07:00

Looking for long-term care for your aging parents? Of course you want the best. But perhaps, due to Medicaid issues or heavy care needs, the only answer is a nursing home.

No need to feel guilty, says health writer Paula Span in the August 6, 2010 issue of the New York Times. Her article, "Finding the Right Home and Contentment, Too," suggests that the type of facility our parents live in might matter less than we've thought.

Quality of care, a pleasant environment, and responsive staff are essential, she says. But a posh facility with all the bells and whistles may not be where your parent wants to live. The brand-new assisted living decked out with a bistro, gourmet meals and a spa may not be a great improvement over a nursing home.

Span sites a study in the Journal of Applied Gerontology which surveyed 150 Connecticut residents of assisted living, skilled nursing facilities and adult care homes. Researchers from the Connecticut Health Center asked residents questions about their quality of life, emotional well being and social interaction.

Initially, assisted living residents were less likely to be bored or lonely and scored higher on social interaction. But when researchers considered other things, differences eroded.

A resident's well being is the sum total of several factors, says lead author, Julie Robison, associate professor of medicine at the university. "It's the characteristic of the specific environment they're in, combined with their own personal characteristics--how healthy they feel they are, their age and marital status."

An elderly person reporting being in poor health might be as depressed living in an assisted living facility as in a nursing home.

Residents who had input in the moving decision and who had lived there long enough to adapt did equally well in all care settings.

Bottom line: If finances or health issues necessitate a nursing home for your parent, don't feel guilty. Do your best in seeking a good, supportive facility, with friendly, competent staff. And involve your parent in the process--after all, it's his or her new home.

To see the entire article, go to "Finding the Right Home, and Contentment, Too," Paula Span, New York Times, August 6, 2010.

Questions About Your Parent's Insurance? National Program Offers Free Help

2010-08-05T22:28:00.000-07:00

Good help is hard to find. Especially if it's free.

When it comes to our aging parents' insurance--Medicare, Medicaid, long-term care or life products--we Boomers may need help to understand the benefits and clarify the issues. All the better if the advisor is well trained, doesn't charge a fee and won't try to sell us something we don't need.

Such qualified, impartial advisors are just a call or a visit away, thanks to a nationwide government-funded network called State Health Insurance Assistance Programs (SHIPS). Specially trained in senior health insurance issues, the counselors can answer your questions and help you understand your health care choices.

Besides consulting one-on-one on the phone or in person, they also give group presentations on insurance-related topics.

You might call a SHIPS advisor if you're:

1. Choosing a Medicare policy for your parent and need advice.

2. Considering purchasing a long-term care policy for your parent or yourself, and wonder what questions to ask.

3. Purchasing a Medicare Part D Prescription Drug Plan and need help comparing the various plans.

4. Having trouble making sense of your parent's Medicare statements and medical bills.

SHIPS operate under slightly different names in all 50 states. In Washington State, for example, the program is called Statewide Health Insurance Benefits Advisors (SHIBA). For information on a program in your state, visit the SHIPS page on the Medicare website.

Eldercare Tip: Making Visits to the Care Center Memorable

2010-07-28T20:51:00.000-07:00

When you visit your aging parent in a care center, the cat can get your tongue. First, the pleasantries. Then the silence. What happened to those '80s platitudes about 'quality time'?

Fortunately we Boomers are creative. Here are 10 simple activities that may add zip to your visits. Most are geared for elders who are alert and oriented. Others may stimulate those with dementia as well.

1. Bring a loved one. Two is company; three or more is a party. Just the presence of another will brighten the visit and lighten your emotional load.

2. Add a child or more, preferably a grandchild or great-grandchild, and your group will gather a following. Add a baby and presto! Your aging parent will go gaga.

3. Bring small items to entertain the little ones--bubbles, balls, crayons and color books. Don't forget toy cars and dolls. Watching the little ones play will engage your aging parent.

4. Let your elderly parent play the host (or hostess.) Purchase a guest book and invite everyone who visits to sign and date it. That includes care staff workers, clergy and children. When you come again, open the book and ask about recent visitors.

5. Have a family sing-along. Try almost anything from "Row, Row, Row Your Boat" to "Let Me Call You Sweetheart" to "Amazing Grace." The public library and the care center's activities director may be able to provide CD's to help. My most treasured memory of Grandma Ethel was hearing her sing "Jesus Loves Me" long after she ceased to recognize us and after she had stopped talking.

6. Bring in your aging parent's favorite food,either home-cooked or takeout and eat together in the family visiting room. Better yet, plan a family potluck in which members all prepare Grandma's family recipes. As you eat, share memories revolving around the special dishes.

7. Root, root for the home team. Watch your favorite Major League team in your parent's room or apartment. Don caps and other sports regalia and call on the little ones to serve as pint-sized cheerleaders. And be sure to sing "Take Me Out to the Ballgame."

8. Get glued to the tube. Watch television classics together, whether "The Lone Ranger," "Mickey Mouse," or movie-length blockbusters like "Sound of Music" or Shirley Temple flicks. Bring popcorn, soda pop and movie candy.

9. Take a walk outside. The sunshine is a wonderful boost for a loved one spending day after day in a care setting.

10. Pray together. Everyone can take a turn, thanking God for the many blessings.

Can you think of other activities which have made your visits memorable?

Eldercare Help: Three Kinds of In-Home Care

2010-07-18T22:14:00.000-07:00

"I'm staying home until the undertaker takes me out."

If similar words have popped out of your aging parent's mouth, he or she is in good company. Until recently 85% of seniors said they wanted to remain home until they died, according to senior care national statistics. Today that number has swelled to between 91 and 92%.

Multiple reasons make "home sweet home" a natural choice. There's the draw of the familiar house, neighborhood, social connections and services. Add in other factors: new technology, a slow economy, and the availability of in-home help, and voila. A recipe for "staying home for life."

As your parent's health wanes, in-home help may become necessary. The dizzying array of choices falls into three types:

Chore Services--Yardwork, housecleaning, shopping, cooking and transportation all help seniors stay independent. These basic services cost relatively little--approximately $10 to $15 an hour. Sometimes there's no cost. In the Seattle area, Catholic Community Services trains volunteers from congregations to help low-income seniors remain at home. The program is called Volunteer Chore Services. Seniors of all incomes in the Greater Issaquah and Sammamish area are helped at no cost by another volunteer-based organization, Faith in Action. Other similar programs operate throughout the country. Related to Chore Services are Companion Services which provide a "watchful eye" to seniors with memory deficits.

Home Care--Trained caregivers help with bathing, dressing, grooming, toileting and other personal needs, as well as providing light housekeeping, meal preparation and chore services. These agencies employ their staff and provide benefits and training. The average hourly charge is between $20 and $25, and often there is a four-hour minimum charge. Home care agencies differ in the kind and amount of training they give workers and in the experience they require for hiring. Seniors Helping Seniors, a national company, hires only people age 50 or over.

Home Health Care--This is the highest level of in-home care. Home Health Care services are provided intermittently as needed by licensed nurses, physical therapists, speech therapists, medical social services, etc. A physician must write orders and people must be homebound. Medicare and insurance plans cover these services. People can also pay privately.

Have you had a positive--or negative--experience with in-home care services? Tell us about it.

Eldercare Tip: When Choosing a Nursing Home, Be Wary of Advice

2010-07-10T15:33:00.000-07:00

Choosing a nursing home is a race against time. In "The Greatest Race" style, the hospital social worker sets the rules. From the crack of the gun (not literally), you have one or two days to look for clues and find the right place.

How do you choose a good nursing home for your aging parent? Following a friend's advice may work. But don't take it as gospel truth without investigating, especially if his or her report isn't recent. Neither can you assume the nursing home your parent used for rehab three years ago is still a good choice.

Claudia Kelley, an occupational therapist with the State of Washington, spent more than a decade working in health care centers. But she admits she was caught off guard when her grandma was hospitalized for the second time. The family had been pleased with Grandma's earlier rehab experience at Nursing Home A, so they automatically chose it again.

"I couldn't believe the difference. You'd hardly know it was the same building," Claudia said. Between Grandma's two stays, administrators had changed. Organization plummeted, and staff now spent more time gossiping than caring for residents.

How do you check on a nursing home that you've been pleased with in the past or a friend has recommended? Some suggestions.

1. Call the nursing home and ask, "How long has your current administrator been working there?" or ask, "Is Administrator Jones still overseeing care?"

2. Double check your experience or your friend's recommendation by visiting the Medicare website which rates nursing home quality.

3. A personal visit is always a good idea, if possible.

Do you have any other suggestions for choosing a nursing home?

Eldercare Truth: All of Life is Junior High Recycled

2010-07-07T11:50:00.000-07:00

Granted, elders are each unique. But as Art Linkletter says, "They say--and do--the darndest things."

See if you recognize your aging parent in any of the following:

1. Elders can be unpredictable. Cupid can strike willy-nilly, turning widowed 80-somethings into old versions of love-struck teens. At our retirement community we witnessed three marriages in one year. Sweet-talking and hand-holding led to quickie marriages, with grown children reeling in shock, initially. "It was sort of like a shotgun wedding without the baby," one Boomer said. Everyone adjusted, though, and it was fun to see the newlyweds coo and glow in their newfound love. But definitely unpredictable.

A different example of unpredictability involves autos. One day 96-year-old Ethel announced, for all to hear: "Alice, I have a surprise. Can you guess what it is?" I wondered. Had Ethel's car suffered one more owie? Her nephew had tried for years to convince her to give up driving.

"I've decided to contribute to the public good, to do my duty to my community," she said with a smile. "I won't be driving anymore." Who could have predicted her sudden change of mind? Her decisiveness reminded me of my two-year-old son who potty trained himself after months of my coaxing and "training." Unpredictable? Ya betcha!

2. Seniors sometimes see themselves as invincible. One morning I walked outside our community and spotted a 92-year-old resident standing on the top rung of a ladder which leaned against his cottage apartment. Tempted to yell, "Get down right now!" I tried to collect my thoughts before asking, "Are you OK? I get scared when I see you up there. You could fall." What was he doing? Watching a workman repair the roof on the sunroom. This elderly macho man assured me he was safe. After all, he had experience with ladders--40 years ago.

Ditto for the invincible elderly golf cart enthusiasts who began zipping down the sidewalk next to the nursing home. Picture the glee in their eyes as they zoomed around the corner. Staff, and frail residents with walkers, were not as entertained.

3. Our elders give us great stories to tell. You have your own sagas starring your elderly parents. Heartwarming, touching, hilarious, your stories can bring you to tears--or to laughter--when you share them with others, especially your kids and grandkids. Such tales bond generations.

Is life like junior high recycled? Or toddlerhood replayed? I think so. These periods of life revisit us unbidden, whether we're 14, 40 or four score and 10.

Do you have any stories starring your aging parent you'd like to share?

Your Aging Parent Needs a Great Advocate: You!

2010-07-01T10:50:00.000-07:00

Everyone needs an advocate. Especially your aging parent.

The value of advocacy hit home with me a decade ago. Home alone on a Saturday, I slipped down the stairs while attempting to carry out the trash. Boom! A broken ankle. The four-hour wait in the emergency room was easy street compared to Monday morning when I phoned for a referral to an orthopedist.

"The referral manager doesn't work Mondays," said the young woman. The Vicodin had eased my pain but muddled my brain. I was a health care professional, but the words I needed escaped me. Finally I blurted out:

"Someone in your office should be able to facilitate referrals, even on Monday."

Hours later, after many phone calls, I sat in the orthopedist's office, thinking to myself, " I really need an advocate."

So do our aging parents, on an ongoing basis. We interpret life, speak for them to authorities and serve as their cheerleader. Several qualities will help us do our best in the advocacy role.

1. Compassion. Good advocates place the welfare of their parents above everything else. Money, power and selfishness are cast aside. That doesn't mean we don't make mistakes, get tired of the role, or sometimes wonder, "How did I get into this?" But our mission--to help them finish life well--enables us to advocate well.

2. A Desire to Learn. There are so many bodies of knowledge to master: legal, financial, medical. The more we know, the better questions we can ask of the doctors, financial planners, lawyers and others in our parent's lives. The more we know, the clearer we can communicate with our parents.

3. A strong sense of ourselves. This is not to be confused as selfishness. But knowing who we are will keep us from being stepped on by others, including our siblings or our parents.

4. A willingness to ask for help. Advocacy sometimes is more than one person can bear. Finding partners--paid or unpaid--to share the load eases our burden. In addition, taking a break--for a few hours, a few days, or even a few weeks--can help us come back to our parents refreshed and renewed.

These qualities don't come packaged for us to unwrap. We develop them by seeing other advocates, and by doing the job ourselves. As our mothers said, "Practice makes perfect."

What is your most difficult task or role in serving as an advocate for your aging parent?

Eldercare Tip: Medicaid Q-A

2010-06-25T20:06:00.000-07:00

Perhaps, like many Boomers, you worry about money. Especially when your aging parent's health begins to fail. Medical bills soar. The bank account drains. You may ask: Will my aging parent's money run out? And if we apply for Medicaid, how can we assure that Mom or Dad won't have to move?

First the question: "Will my aging parent's money run out?" We don't have a crystal ball, nor do we know if your parent will be the rare person who lives to be 105. But some figures may help. An average assisted living community charges roughly $4000 to $5000 a month; approximately $48,000 to $60,000 or more annually. Private pay skilled nursing costs on average $100,000 yearly. Wow!

If you know your parent's net worth, you can estimate a range of how long the money might last, barring some financial catastrophe. Long term care insurance helps the nest egg last longer.

Second: "How do I find assisted living, adult family homes or skilled nursing facilities that accept Medicaid?" Eldercare Locator, a national website sponsored by the United States Administration on Aging, offers a data base and phone line with a trained professional on the other end. Or you can obtain a list of Medicaid certified facilities from your local senior center, hospital or Department of Social and Health Services.

Third: "My parents can pay privately for a few years before needing Medicaid. Can they move into assisted living, and remain there after they run out of money?" It depends on the community. Some assisted living communities accept private funding only. When residents can't pay, they must leave. Other communities require new residents to pay privately for a specified length of time--often a year or two-- before switching to Medicaid. They can then stay. Other communities accept Medicaid funding from day one.

Fourth: "How available are Medicaid openings?" The majority of skilled nursing centers nationwide accept Medicaid and have openings. Availability of Medicaid openings for assisted living and adult family homes varies from state to state. In Washington State, it is easier to find an adult family home accepting Medicaid than an assisted living facility. Early research will help as you seek to find a good place for your aging parent. So will flexibility and an openness to accept a good community that may not be in your back yard.

Can you tell us about your search for a Medicaid-funded community for your aging parent?

Help! I've Lost My Way Searching for a New Place for Mom

2010-06-21T21:11:00.000-07:00

Something is not right. Those words from Miss Clavel, the stern schoolmarm in the Madeline children's storybooks, may describe your aging parent. He or she needs eldercare NOW, and you don't know where to turn.

If you're like many Boomers, finding the right home for your aging parent quickly is akin to strolling into the casino at Monte Carlo with a fistful of Euros, hoping to hit the jackpot.

You don't have to go it alone. Free help is available nationwide through a myriad of senior care referral agencies. These organizations help families find the right level of eldercare that will match their parent's needs: home care, retirement or assisted living, adult family homes or nursing facilities. Once the family signs a contract and their loved one moves in or receives services, the provider pays a referral fee.

To find these organizations, look in the phone book or online for "senior care advisors," "eldercare advisors" or "eldercare referral services." Some are affiliated with a national organization, such as A Place for Mom. Others operate in a designated region, such as CHOICE Advisory Services,concentrating in parts of Oregon and Washington. Still others, like A Change is Afoot, focus locally, serving families in Northwestern Washington.

How do these agencies work? Some eldercare advisors work exclusively by phone. For example, suppose your mom is in a nursing home for rehab, needing to move to assisted living. You inquire by email or by phone. The organization hooks you up with a local advisor, who phones to chat about your mom: Her needs? Interests? And what about your specific wishes?

The advisor chooses as many as a handful of communities which might work. Marketing reps from the selected communities contact you to set up appointments. You tour and choose the winner. (It's a bit like The Batchelor!) The goal of the phone technique is to give you several tailored choices so the process becomes easier.

Other eldercare advisors work face to face. After their initial phone visit with the family, the advisor schedules an in-person visit, bringing together as many family members as possible. Once all needs are out on the table, the eldercare advisor will accompany the family to several selected communities, taking time afterwards to ask, "What did you like best?" "Did you notice this?" "How would you compare the strengths of community A with community B?" He or she will not tell you what to do, but will guide you in making an informed choice.

Does this type of service work? As a marketing director at Evergreen Court Retirement and Assisted Living Community in Bellevue, Washington, I've worked with some great eldercare advisors. One helped a woman who had few assets. Since she was most concerned about affordability, he took her to three budget-priced communities. Afterwards he developed a spreadsheet to help her in making the decision. The woman is moving into our community within two weeks. Best of all, she's happy with her choice.

I definitely prefer the in-person approach. With both methods, you'll find many eldercare advisors who shine, while a few lack follow-through. As a whole, though, these professionals provide a helpful service to families.

Before investing your time with a senior care advisory organization, check out their reputation with the Better Business Bureau.

Do you have an experience with a senior housing and care advisor? Tell us about it.

How to Sell Your Parents' Home in Seven Days

2010-06-16T21:03:00.000-07:00

By Susan Peters, Guest Blogger

Susan Peters has more than 20 years experience selling real estate in the greater Seattle area. Like many realtors nationwide, she has developed an interest in helping seniors and their families market their home. Here is a true success story.

My clients were recently faced with the challenge of placing their parents in an assisted living facility and selling their home. This is how we did it, step by step, in seven days. (From the time we listed it!)

1. The adult children moved their folks into the assisted living facility before they even talked about selling the house. This is the most important part! Having your house on the market is stressful for anyone, but there is nothing more distressing for elderly sellers than having strangers tromp through their house day in and day out.

2. We set a budget of $15,000 for improvements that would give the best return. This included: paint, refinishing hardwood floors, new sink and counter tops in the kitchen, some new lighting fixtures, and a ton of yard work.

3. After the work was done, I brought in furniture, artwork, and accessories and then staged the living daylights out of it!

4. Instead of using my traditional real estate sign, I had a custom sign made that mimicked my flyer. On Sunday afternoon, over 200 people came through my open house. By Sunday night, we had a full price offer and we closed in 30 days.

The photos above show the biggest improvement: painting out the fireplace. Lightening up the drab green wall color paint helped to wake up the entire room.

If you'd like to sell your parent's home in seven days, give me a call!
The Better it Looks...The Better it Sells!

Susan@SusanPeters.com
206.781.1724

Eldercare Tip: To Your Aging Parent, the Written Word Has Power

2010-06-09T19:09:00.000-07:00

Perhaps you've heard your aging parents say, "Put it in writing." You know they love your voice. But often they want to see your message written across the page.

Seniors' preference for the written word stems from many sources. Our parents' brains processing speed is diminished. So they compensate. To prod their memories, they scribble notes to themselves. To tackle technical information, they revisit words again and again. Those with hearing loss have another reason to prefer the written word. It fills in the gaps left by unheard verbal messages and opens up new horizons!

Seniors share a culture that honors reading and writing. They are among the most devoted readers of daily and weekly newspapers. Over the years, many elders enjoyed Time Magazine, Saturday Evening Post and Readers' Digest condensed books. They wrote love letters, corresponded with friends and penned letters to the editor.

How does this affect your relationship with your parent? If you're discussing new and/or difficult information, it's great to write a synopsis of what you covered. And when it comes to showing your affection, thank-you cards, birthday cards and even handwritten letters pack lots of power.

When my father-in-law was dying of cancer, friends and relatives sent cards and messages of support. And in the aftermath of his death, sympathy cards arrived. I remember many times walking into the house to spot my mother-in-law, her lap filled with an overflowing basket of cards. Reading them brought comfort.

Words. They're powerful. And writing them often helps.

Has the printed word been a tool for your relationship with your aging parent?

Eldercare Tip: Your Aging Parent Won't Budge? Try Plan B

2010-06-05T21:15:00.000-07:00

My friend Terri wrestled with a problem common to Boomers with aging parents. "My parents are accidents waiting to happen."

Indeed. Her dad, a 92-year-old cardiac patient who popped nitro as if it were candy, knew the hospital emergency room personnel by name. To add to his stress, he cared for Terri's mom, who had dementia. Their home had several flights of stairs.

"I brought up the subject of retirement and assisted living facilities, time and time again," she said. But her dad's answer was always: No way, no how.

Are you dealing with aging parents who need care but won't admit the problem? Instead of wringing her hands, Terri wisely came up with Plan B. See if her steps might work for you.

1. Think through the legal issues. Terri was able to convince her parents to execute a durable power of attorney, a legal document that gave one of their children authority to make financial and health care decisions for them, if they became incapable. Her parents also executed advance directives, spelling out their wishes for end-of-life issues. Even the most stubborn parent will usually understand the importance of making these decisions ahead of time. Offer to go to an attorney with them.

2. Research options. Even if your parents won't budge now, that doesn't prevent you from visiting possible retirement or assisted living communities or checking into home care, if you think that would work. Terri did her homework and told her parents about her research "for the future," or "in case you might need care sometime." She invited her parents to come along, too.

3. Avoid power struggles. Don't hammer your point into the ground.
And when you do bring up your concerns periodically, use "I-messages," such as "I'm worried that you're not eating properly" or "Those stairs are so steep; I would feel badly if you fell and hurt yourself." Discuss interim steps such as installing a pendant-type emergency response device or a sit-down shower stall.

4. Implement your plan. Work together with your siblings so everyone is on board. And then sit tight, knowing you've done your best. Later if an emergency arises, or if your parents change their minds, you'll be ready.

Have you developed a "Plan B" you'd like to share?

Eldercare 101: Boomers' Questions on Medicare

2010-05-31T15:11:00.000-07:00

In 14 years working with Boomers and their aging parents, I've heard many questions about Medicare. These three are among the most frequently asked.

Q What part of Medicare covers assisted living?

A None. Assisted living is long-term supportive care. Medicare only covers acute care, such as hospitalization, or periodic outpatient events, such as doctor visits.

Q My dad is in a rehab receiving therapy for a fractured hip. Will Medicare pay 100 days of nursing home care?

A Not necessarily. One hundred is the maximum number of nursing home days allowed under Medicare A. When a patient reaches his potential, or stops improving, his Medicare time ceases. Very few people stay on Medicare A the full 100 days.

Q What about home care? Does Medicare pay for that?

No. Home care is not tied to a medical condition and is not covered under Medicare.

In a nutshell, Medicare's four parts include:

Medicare hospital insurance (Part A) provides basic coverage for hospital stays, post-hospital nursing home stays and home health care.

Medicare medical insurance (Part B) pays doctor and lab costs, and some out-patient medical services (i.e. medical equipment and supplies, home health care and physical therapy.)

Medicare Advantage (Part C) Sometimes called the HMO plan, this allows people to receive their Medicare benefits through a private health insurance, rather than through Medicare Part A and B.

Medicare Prescription Drug Coverage (Part D) pays some of the cost of prescription medications.

For more information on Medicare, visit the Medicare website.

Eldercare 101: Medicare, Medicaid Made Simple

2010-05-29T13:40:00.000-07:00

No eldercare blog would be complete without posts on Medicare and Medicaid. Why? Most Boomers mix them up. I did when I entered the senior care field in 1994. These programs sound alike and are spelled alike. But they're as different as night and day.

Your aging parent almost certainly qualifies for Medicare. Virtually everyone over 65 is eligible, since it's funded through employment or self-employment taxes. I'll devote my next blog to explaining Medicare's various parts: A, B, C and D.

Medicaid, on the other hand, covers low-income seniors who have medical needs. Think "AID" for Medicaid. The program is administered by each state; rules and programs differ widely. In many states, a single person can have no more than $2000 in assets. In the case of a married couple, if one spouse needs care, the other spouse can often keep the home and some assets to avoid becoming impoverished.

Programs may include in-home help (i.e. transporting to doctor visits and grocery stores, preparing meals, assisting with bathing), as well as assisted living, adult family homes and skilled nursing homes. In many states, Medicaid covers services and costs Medicare doesn't pay for, including prescription drugs, preventive care and eyeglasses.

If your parent moves to an assisted living facility, an adult family home or a skilled nursing home under Medicaid, he or she will contribute his or her income toward the cost of the care, with the state returning a small amount (approximately $50) for his or her incidental expenses.

For specifics on Medicaid in your state, do a google search of "(your state) Medicaid." Or contact your local county social services, welfare or department of human services office.

For information on Medicare, see my next post.

Is there anything on Medicaid you'd like to add?

Geriatric Care Managers Tackle Eldercare Issues With Grace

2010-05-19T22:10:00.000-07:00

Perhaps you're stumped because...

1. Your aging parent lives across the country. Due to multiple medical crises, you've racked up enough Frequent Flyer miles to purchase a ticket to Fiji.

2. Your siblings and you can't make peace with your parent's care.

3. Demands of work and family overwhelm you, and managing your parent's medical needs seems daunting at best.

Geriatric Care Managers can help you tackle these eldercare issues and more. Steeped in experience and expertise in geriatrics, they generally hold advanced degrees in nursing, social work or psychology. As important, they've listened to problems like yours time and time again.

First, the care manager assesses the "big picture." While he or she focuses mainly on your parent, your needs are critical, too, as are the needs of your entire family.

Next, the care manager writes a comprehensive care plan, which includes a statement of the issues, and "next steps" for implementation. If needed, he or she taps into the services of eldercare attorneys, financial advisors and other professionals.

You can hire a Geriatric Care Manager on a one-time basis--for example, finding an assisting living community or hiring in-home care. You can also call on a care manager continually or as needed, especially if your parent lives far away. He or she can advocate for your Mom or Dad, standing in your place at care conferences, checking in on caregivers, etc.

Geriatric Care Managers charge families by the hour. Before you enter into an agreement, get the rates in writing.

For some Boomers, a care manager can make a world of difference.

Take the partners who lived in New Hampshire, across the country from their parents in Washington State. These Boomers had used up all their sick leave tending to their parents' care. They were exhausted! Hiring a care manager allowed them to breathe a sigh of relief, knowing Mom and Dad were in good hands.

For more information, contact the National Association of Professional Geriatric Care Managers.

Have you worked with a Geriatric Care Manager? Tell us about it.

Does Your Parent Care for an Ailing Spouse? Here's Help

2010-05-15T12:47:00.000-07:00

Emil and Louise moved into our retirement community with one goal in mind: "We want to be together no matter what." Louise suffered from dementia. Emil wanted to focus on his wife's care. This new setting allowed him to do just that, since staff took care of meals, housekeeping and other maintenance. Their daughter gave her full support.

Perhaps one of your parents cares for the other full time. You may be worried, and with good reason. Recent research has shown that the stress of caring for a spouse with a disabling illness can shorten the life of the caregiving spouse. Dr. Nicholas Christakis, A Harvard Medical School physician and sociologist, came to this conclusion in a study published in February, 2006, in the American Sociological Review.

With 518,240 couples aged 65 and older, the study found that the causes of excess death in the caregiving spouse included accidents, heart attacks, lung disease and diabetes.

A woman taking care of a husband with dementia or psychiatric illness was at greater risk than if she were actually widowed, the study said. As an adult child, how can you help the reduce this stress?

1. Discover your caregiving parent's needs. That list may include help with housekeeping and home maintenance, meal preparation and shopping. As care needs increase, the ill spouse may need someone to help with bathing and dressing. And don't forget the caregiver's need for respite and renewal, as well as for friendship and camraderie.

2. Decide which needs you or other family members can meet, and which can be provided by professional service providers, such as home care agencies or adult day programs.

3. Consider a continuing care retirement community. Louise and Emil stayed together in their apartment for several years, thanks to this supportive setting. Toward the end of her life, Louise lived in the nursing home, just steps away from Emil's apartment.

4. Notice signs of stress with your caregiving parent. Some of those include high blood pressure, spiking blood sugars and shingles. Keep in close touch with your parent's physician, who may provide some objective advice. And finally, let your caregiving parent know that it's OK with you to place your other parent in a group home or nursing home, should the caregiving needs become too great.

Is Your Aging Parent's Driving Driving You Crazy?

2010-05-08T15:07:00.000-07:00

My 85-year-old friend Joe saddled up to me.

"Alice, guess what? I got my driver's license."

I knew about Joe's macular degeneration. How could he pass the eye exam in Washington State?

"I'm lucky," he said with a twinkle in his eye. "My cousin is an eye doctor practicing in Arizona. He signed off and I can drive." He added: "Don't tell my daughter!"

Elders will do the darndest things to continue driving. Taking away their car keys seems like cruel and unusual punishment. Yet at some point the safety factor overrules, and we must act.

Is it time for you to have the "Driving Talk"? Consider these tips.

1. Embark on a series of discussions with your parent, advises the writers of "Your Aging Parents: The American Bar Association Guide to Legal, Financial and Healthcare Issues, 2009.' Ask them, "When do you think someone should give up driving?" and "What are alternatives (carpools, public transportation, having a child drive, etc.)? Talk, too, about your own experiences with rude drivers and traffic, and the increasing difficulty so many people have in navigating the roadways.

2. As the talks progress, use "I-messages," such as "I feel worried," "I'm concerned," "I'm scared," says Dennis Gibson in "The Sandwich Years." Instead of "You're dangerous on the road," say, "I'm concerned about your safety because you've had fender benders and I don't want you to be injured!" And acknowledge your parent's feelings of disappointment in thinking about giving up driving.

3. If all else fails, ask a professional for help. Elderlaw Attorney Rajiv Nagaich, of "Aging Options" says that a neutral party, such as a physician or a geriatric care manager, often can help. "Let a care manager have a heart to heart," he says, adding that an intervention by a caring third party can avoid a winless power struggle.

As a last resort, the physician or family can report the senior negligent driver to the department of licensing. Contact your department of licensing, as laws vary by state.

Perhaps you've received some good advice on this subject. Tell us about it.

Mother's Day Gift Ideas from the Pros

2010-05-05T21:19:00.000-07:00

Sees chocolates. A two-pound box, to be exact. For the last three years of my Mother's life, I knew the drill. Forget Godiva, or Russell Stover's, or Dove or Hersheys. Sees made her Queen for the Day, be it Mother's Day, birthday or any occasion.

Not everyone has it so easy. If you're stumped about what to buy your aging mother for Mother's Day, you're not alone. Today I polled professional staff and residents from Evergreen Court Retirement and Assisted Living Community, in Bellevue, Washington. I asked, "What are some great Mother's Day gifts?"

Here they are, in no particular order:

1. chocolate
2. homemade goodies (especially when you prepare their own recipes)
3. flowers (fresh or plants)
4. a cozy throw
5. framed pictures of family members
6. an electronic picture frame
7. DVD's
8. stationery and postage
9. a mini-vacuum

Happy Shopping! Can you add to the list?

Four Myths About Low-income Senior Housing

2010-04-28T14:56:00.000-07:00

"It's as big as our other apartment and it's only $600 a month." Those were my father's words when he and Mother moved into a seniors-only HUD apartment complex.

As a minister, Daddy's retirement was minimal. So this one-bedroom apartment was a real blessing. Besides shelter, the apartment offered opportunities for fellowship with people their own age. The community was located close to the senior center, shopping and parks.

If your parents are struggling financially, affordable senior housing or retirement communities might just fit the bill. But first, here's a look at the myths.

Myth 1: Programs are uniform. Nationwide, various governmental agencies oversee low-income housing for the elderly. The most well-known are HUD-subsidized senior apartments, which give preferential treatment to those with very low incomes (30% of the average family income in the surrounding area.) In other affordable housing programs, for-profit and not-for-profit companies receive tax breaks if they rent a certain percentage of their building to seniors with low to moderate-incomes. Still other programs offer vouchers which seniors use in selected communities.

Myth 2: Affordable senior housing is only for people with practically no resources. Income limits are usually based on the average family income in the area. For certain programs in the Seattle area, single seniors can make $36,000 (60% of the median family income). A couple can make as much as $41,100.

Myth 3: Senior affordable housing consists of apartments with few amenities. Not always. Some have common areas such as lobbies, meeting rooms and game rooms. In addition, there are a few full-service retirement communities serving low to moderate income seniors and offering meals, housekeeping, activities, transportation and assisted living. Evergreen Court Retirement and Assisted Living in Bellevue, Washington, has such a program.

Myth 4: Affordable senior housing always has a years-long waiting list. Not always. My parents were able to move into their apartment near Milwaukee without waiting at all. Today in the Greater Seattle area, some affordable senior apartments have immediate openings. The longest waiting time is for housing serving seniors with very low incomes.

To locate affordable senior housing, contact your local senior center.

Do you have experience with low-income housing for your parents or loved ones?

A Quiz: Is Your Parent Ready for a Retirement Community?

2010-04-25T14:47:00.000-07:00

Check to see if your parent might be a good candicate for a retirement or assisted living community.

Does your parent say things like?

"I hate eating TV dinners or in restaurants all the time."

"Shopping, meal preparation and cleanup take too much time and energy."

"I'd like someone else to do the yardwork and housework."

"Asking people to take me places isn't fun."

"I have too much time on my hands."

"I'd like to resume some of the activities I used to enjoy."

"I'm lonely and want to be around people my own age."

"I'd like to simplify my life."

How many of these describe your aging parents? A retirement community isn't the answer for everyone, but a good one will eliminate tedious tasks like grocery shopping, meal preparation and cleanup, plus inside and outside maintenance and housekeeping. An excellent retirement community will provide opportunities for exploring new activities, meeting new friends, and rekindling interests from long ago.

If your parents are very frail and have great physical, emotional or cognitive needs, assisted living may be your answer. It offers all the elements of retirement living, plus personal care and staff that become like a second family. Ask yourself:

"Does my aging parent skip medications?"

"Does my parent need help with bathing or dressing or transferring (i.e. getting out of bed to a sitting or standing position or the reverse)?"

"Does my parent have an incontinence issue that's out of control?"

"Is my parent emotionally needy?"

"Does my parent have great medical needs?"

In-home services are another eldercare option for people desiring to stay in their own home. I'll discuss these in an upcoming blog.

Search and Find a Great Home for Your Parents

2010-04-18T20:08:00.000-07:00

In the best of all worlds, people plan for the future. Perhaps in their 60s or 70s, still in good health, they wake up and see their house with new eyes. They ask, "Is this really the perfect home for our retirement?" And they begin to dream...

This is the REAL world, however. Chances are, if you and other Boomers are reading this, your parents are older and more frail. They probably haven't planned for greater health needs. Now it's up to you. Here are some tips, cultivated from seniors and their families who have grappled with finding the best eldercare.

1. Make a wish list.When possible, involve your parents. Write down their desires, and yours, for their next home, or for fixing up their current home. Examine everything: location, size, meals, housekeeping, transportation? What about proximity to medical facilities and doctors and availability of extra health care?

Think through the things your parents enjoy now or in the past, which they might resume if given a chance. Pets? Gardening? Attending church? Playing musical instruments? Are your parents lonely, isolated?

If your parents choose to stay at home, what services will need to be brought in? And is that a workable solution?

Look through your list, and mark any "must haves," realizing that in doing your research, things will change. For example, Val and Luise, devout Catholics from the Seattle area, were sure they wanted a Catholic-sponsored continuing care retirement community. The good news was they found one. The bad news was it was in Memphis, Tennessee. They settled on a Protestant-sponsored community which proved to be a good fit.

2. Look around.With your list in hand, start your search. Ask friends, your parents' physicians and anyone who works in the senior care field. Check out websites to see if the communities meet your qualifications. Narrow your choices to three or four, and visit.

If possible, take your parents along to your top one or two choices. Nearly all retirement and assisted living communities offer tours with lunch. Some allow residents to stay for a weekend, experiencing life from the residents' vantage point. In the best communities, residents will brag about their home and ask your parents, "When are you moving in?"

3. Move ahead.If your parents stay at home but need help with chores or personal care, they'll experience adjustment to having people in their home. If they move to a retirement or assisted living community, the adjustment will be a bit different. They may mourn over the loss of their home and possessions. Staff will comfort, while attempting to engage them in community life. Within a few weeks, most frail elderly folks start making friends and feeling at home.

If this process sounds too time consuming, there are professionals who can shepherd you through the search process. More about them in an upcoming blog.

Can you think of other ways to help people in this search for a perfect retirement home?

Seize the Day: Celebrate Your Elder

2010-04-13T16:01:00.000-07:00

Daddy's 77th birthday was approaching. And we siblings knew that due to his advanced Parkinson's, it would probably be his last. Sadness hung over our family like a grey cloud.

Then my sister Carol devised a plan. Daddy had been a minister for 50 years, giving his very lifeblood serving his congregations. Carol contacted four of his churches and asked, Would they send him birthday cards?

Some 70 cards flooded in, along with messages that expressed heartfelt celebration and appreciation. The nurses read and reread them to him. One card included a snapshot of a 45-year-old. "Who is that handsome man?" the nurse asked Daddy. He cracked a knowing smile, as she said, "That's you."

Five days after his birthday he died. How thankful I was for those kudos his people bestowed on him.

Celebrating our elder is a wonderful gift. Even in the face of suffering and death, we can offer appreciation. Here are some of my observations:

1. Celebrate milestones.Birthdays, of course. When Lucie turned 100, her family and the nursing home staff granted her wish. "I want a horse," she'd announced. The nursing home activities director procured a miniature horse from a nearby church camp, and a stuffed pony from a local store. Imagine Lucie's face when the miniature horse appeared before her very eyes.

Milestones aren't just birthdays, though. Mabel's family knew she dreaded moving from assisted living to the nursing home. So they gathered the extended family around in a "blessing ceremony," thanking God for the assisted living room that had been Mabel's home for several years. And they annointed her with oil, praying a blessing on her and the new room.

2. Savor life's simple joys.Celebrations don't have to include ice sculptures or high tea. The main thing is connection. Our family gathers for fresh strawberry shortcake, which in Washington, signals the beginning of summer. Others bring their elder to the dock for the opening of fishing season. And of course, there's baseball, possibly the most senior friendly sport of all.

3. Gather the generations. Aging parents seem to love those great-grandchildren! And there's something magical about the unconditional love kids give back. Those folks in between are enriched by their elders, too.

Despite the circumstances, I want to take the time to celebrate our elders.

What are the ways you celebrate your aging parent?

Choosing the 'A-Team': Pros Who Work on Your Behalf

2010-04-08T12:39:00.000-07:00

Remember B. A. Baracus? In the 80s blockbuster tv show, "The A-Team," B. A. led the charge. Buildings caved in, cars exploded and in the end, good triumphed over bad. Boys of all ages loved it!

We Boomers need an A-Team: pros who will charge forth on behalf of our parents, clearing obstacles, ripping through red tape, paving a way for excellence in eldercare.

Whether you're looking for home care, retirement living, assisted living, an adult family home or nursing care, or even in-home electronic devices, the first person you meet--the sales or marketing representative--might end up being a member of your "A-Team."

A great pro, of the A-plus variety will:

1. Put your parent on a pedestal. OK, not literally, but a great marketing rep will be more concerned about your parent's needs than "selling" unneeded services. In a friendly manner, the rep should ask open-ended questions, such as, "Tell me about your mom?" and "What prompted you to seek help?" and "What kind of timetable are you looking at?"

If your parent is with you, the rep should ask her some of the questions directly, and especially, "How do you feel about this?" Other questions will address finances, as well as the needs and desires of the entire family.

Hopefully, you won't feel like you're being grilled--the conversation aims to ferret out all the needs, and maybe unearth some you hadn't thought of earlier. Once everything is on the table, the marketer and you together can determine whether the services they have to offer will work.

2. Answer your questions. You may have questions relating to the quality of their services, such as, What is your caregiver turnover rate? Can I examine your state survey report? How long has leadership worked together in this organization? These are all potential indicators of quality. If the rep doesn't have the answer immediately, he or she should tell you that you'll get a phone call within a few days with the answer. Most important, he or she will keep this promise.

3. Never let "no" be the last word. If this company isn't the right fit for any reason, a great marketer should give you a next step: perhaps two referrals for local organizations that will work for you. And if you happen to see him or her on the street later, you'll receive a big smile, and a question, "How are things going with your mom?"

Have you met marketers that meet A-Team standards? Do you have experiences with others that you'd like to share?

Boomers Bridge the Generation Gap, Part Three

2010-04-01T15:17:00.000-07:00

Boomers are the bridge. We connect people, old and young. But sometimes we feel worn and splintered, walked on from both sides.

We need to stop traffic and repair the bridge.

Sonja Lyubomirsky, a research scientist and author, offers help. In her highly documented and readable book, The How of Happiness, she distills years of empirical research on the science of happiness.

She lists 10 ways to repair our bridges. In the last post, we discussed four. Here are the rest.

Happy people:

5. Take care of their body. When we feel like we're under siege, it's not the time to go for the Haagen Daas.
6. Nurture social relationships.Other people offer perspective, hope and humor. That's the rationale behind the success of support groups for family members of people suffering from Alzheimer's, Parkinson's and other diseases. But most any activity involving community can nurture us, from golfing to auditing classes at the community college to enjoying coffee with friends.
7. Learn to forgive. When we fail to forgive, we're more likely to seek revenge or avoid certain people altogether, Lyubomirsky says. Either option steels joy. Forgiveness involves grieving our losses: the what's, the how's and the why's. And then letting go and seizing happiness.
8. Increase their "flow" experiences. Lyubomirsky describes "flow" activities as those in which we lose sense of time: fishing? sewing? reading? gardening? Whatever floats your boat, go for it. These pastimes soothe our souls and prepare us for the next day.
9. Savor life's joys.Enjoying sunsets, walks with the dog and simple pleasures help us renew and repair.
10. Commit to goals. Keeping promises and seeing things through brings joy and strengthens our foundation.

When you're feeling stepped on by both generations, what do you do? Tell us.

'Honor Your Parents'--But How?

2010-03-30T13:13:00.000-07:00

Every sacred book contains a truth we need to hear: Honor your parents.

This phrase is illuminated in a true story, set outside Jerusalem 2000 years ago. Hanging on a Roman cross, bearing suffering and shame, Jesus looked down at two people He loved most in all the world. His mother and his friend, John.

Jesus gazed at his mother, “Dear woman, here is your son.”
And to John, he said, “Here is your mother.”

History records the Apostle John took Mary to his home, where she lived the rest of her life.

Reading John 19:26-27 for the first time brought tears to my eyes. In the midst of incalculable agony, Jesus thoughts turned away from his pain to providing care for His widowed mother, who in that culture had no financial status. This passage tells us two truths: God cares about our parents. And he cares about us.

In today’s busy world, honoring our aging parents can be daunting. Stretched at both ends, distracted by a multitude of duties, we wonder, what does this honoring look like?

To me, it’s a matter of attitude as well as action. We make our parents a high priority; we bestow high standing to them in the family setting and we give respect, above all else.

Honoring includes asking, “How does this particular course of action sound to you?” “How would you like this to be done?” “What can I do to help?” It celebrates their expertise in baking, or baseball, or missionary work in Africa. Honoring can involve physical touch, and so much more.

Some of us honor our parents by bringing them into our home. That was the Apostle John’s way. But it may not be your way. It wasn’t mine. Depending on circumstances such as time and money, our honoring may take other forms: writing letters and making phone calls, if you live far away; or orchestrating home care, assisted living or nursing care. Don’t forget making visits with the sole purpose of saying, “I love you.”

People of all religions are united in loving their parents.

How have you decided to honor your loved one?

Boomers Bridge the Generation Gap, Part Two

2010-03-30T10:01:00.000-07:00

Boomers are the bridge.

I discussed this analogy in the last post. Like any bridge--a covered bridge, the Golden Gate Bridge, a floating bridge--we Boomers connect people. In our families we bridge the gap between old and young. That's a good thing, usually.

Yet there is a darker side to being a bridge. "Sometimes we feel walked on from both sides," Author Dennis Gibson writes in his book, The Sandwich Years. Demands race at us from both our aging parents and younger generations, causing a traffic jam.

Daily we need to stop traffic and repair the bridge. For if we go down, nobody is served.

Sonja Lyubomirsky, a research scientist and author, offers help. In her highly documented and readable book, The How of Happiness, she distills years of empirical research on the science of happiness.

She lists 10 "Happiness Activities" that can help us repair our bridges. Here are four. The next blog will cover the remaining ones.

Happy People:

1. Express gratitude. Thankfulness brings back well being after we experience loss, fatigue and overload. It strengthens moral behavior, enabling us do do the right thing, even when our aging parent might not respond positively.

2. Avoid overthinking. Ruminating about a problem heightens sorrow, impairs our ability to solve problems and saps motivation. Whenever I find myself overthinking, I tell myself, "Stop!" If I'm diligent, the pattern will cease.

3. Suppress negative emotion. Happy people "schedule" their negative emotions. For example, if we feel sadness, we can tell ourselves, "Sadness, I can't see you now. I'll see you after supper."

4. Practice religion or spirituality. Prayerful people tend to live longer. They have higher deposits of hope, gratitude and love. Expecially helpful are prayers that seek God's presence in our lives, Lyubomirsky says.

Do you have any practices you'd like to share that help you "repair the bridge"?

Stay tuned to the next post.

Boomers Bridge the Generation Gap, Part One

2010-03-23T18:01:00.000-07:00

I love word plays, especially describing Boomers.
My favorite: Boomers are the bridge.

I stumbled on this analogy a decade ago in "The Sandwich Years," a book ahead of its time. Author Dennis Gibson coined the phrase. It works for me.

Picture yourself as a bridge: an Indiana red covered bridge, the Golden Gate bridge, a floating bridge, a suspension bridge. In our families, we Boomers are like bridges because:

1. Boomers connect people. We remember endless jello salads filled with fruit and topped with Cool Whip. We recall manual typewriters and telephone "party lines." In our parents' homes, those were part of life. Yet we also share experiences with the younger set: I-phones, Webkins and Facebook. Our breadth of experience allows us to reach out to old and young. In a similar way, we link our parents with medical professionals. When a doctor slips into "Medicalese," we can translate for our parent or ask the physician, "Please rephrase that."
2. Boomers are strong and resilient. Having weathered the test of time, we've survived. Many of us have lost loved ones, endured layoffs and triumphed over other disappointments. No matter how difficult tonight is, we've learned tomorrow brings an opportunity for a new start. That unshakable optimism centers us.
3. Boomers are approachable. Adult children and the elderly tend to be self-focused. The young ones are launching. The older ones are waning. We're the go-to people for both generations. They have faith in us, precisely because we have a solid foundation that will not shake.

Yet there is a darker side to being a bridge. "Sometimes we feel walked on from both sides," Gibson writes. Demands race at us from both the generation above and below us, causing a traffic jam. The bridge is clogged with twenty-somethings and aging parents, screaming and honking their horns (figuratively.)

Periodically we need to stop the traffic and repair the bridge. In the next post, I'll offer some suggestions.

Guilt, Guilt, Go Away!

2010-03-20T20:49:00.000-07:00

Have you ever been "guilted"? I certainly have.

Lupe Maple, Director of Community Support at Northshore Baptist Church in Bothell, Washington, spoke about guilt March 20. Her topic? "Bummed Out Boomers: Dealing With Guilt, Loss and Shame."

Question: What is the source of our guilt?
The sources are many. Your aging parents give you the "look" that says, "You've let me down." Your sibling tells you, "You're not doing enough to help Mom and Dad." But sometimes guilt just pops up unbidden, as we walk the dog or fall off to sleep.

Question: What is it about our aging parent's situation that prompts so much guilt?
Our parents' needs seem like a deep well. We look at the well and think, "How can I do this? I haven't got it to give." We feel guilty when we don't meet all their needs, when in truth, no one person can.

Question: How do we escape the guilt trap?
Setting boundaries on our decision-making process brings relief. Instead of reacting to the huge need and either overworking or avoiding the situation altogether, we can make decisions based on "what I can do," allowing others to share the load.

Question: What is your advice to those with parents whose health is failing?

Choose to be a son or daughter. That is your calling. Take advantage of the many resources to fill in the gap between your parents' need and your ability to help.

Now You See Them, Now You Don't--Long Distance Caregiving

2010-03-20T04:44:00.000-07:00

Your parents may live states away, but you worry anyway. And when you finally see them face to face, you realize why!

The angst of long-distance caregiving came home to me personally when my parents arrived at Sea-Tac airport for a 10-day visit to celebrate too many family occasions: two graduations, one wedding and a surprise celebration for Daddy and Mother's 50th anniversary. Father's Day capped it off.

My first shock came at the gate. Daddy suffered from Parkinson's, and Mother, a chronic illness. I knew his disease was progressing, but on the phone a week earlier, they'd assured me, "We're doing fine." Now, I wasn't so sure. I watched airline personnel push them in wheelchairs, their bodies hunched over.

At home, little details began to tell the real story: Mother's dress was packed unlaundered. Minor medical crises sprinkled every day with surprise. One day Mother tumbled from the car to the front lawn, landing flat on her back. Nothing broken, except her pride. The scene reminded me of a signature commercial, "I'm falling, and I can't get up!" Daddy, frail from Parkinson's, couldn't help me lift this 200-pound woman to an upright position. I managed, but my technique would have gotten me tossed out of a nursing assistant class.

"I need my Fleet enema. I need it now!" Daddy moaned another day. Until then, I hadn't heard of such a thing. But the constipating effects of the Parkinson's medication could not be ignored. I raced to the drugstore.

Daddy's biggest fear was he'd trip down the aisle at the wedding.

He didn't trip, thanks to our son's gentle handling. In fact, the kids all did well caring for their grandparents. But multiple social occasions coupled with unforeseen physical and emotional needs took their toll on us all.

On Father's Day, the day after Shari's wedding, I decided to skip church. Nothing doing. Daddy gave me that, "I'm so disappointed in you," look and I crumbled.

When I left the airport after delivering them to their outgoing flight and kissing them goodbye, I thought about what I'd learned about long-distance caregiving. Some thoughts:

1. Aging parents are notoriously terrible reporters. They don't mean to worry their kids, so they skirt around the truth. When they say on the phone, "We're doing fine," they may mean, "The house hasn't burned down, and we both have heart beats." We children have to do investigative reporting to get the real scoop.

2. A corollary is to listen to tone of voice. If your parents say on the phone, "Things are great," but sound like they're gasping for air, something is not right. Go with the voice, not the words.

3. A corollary to the corollary is, if they say, "I know flights are expensive; you don't have to come," don't believe it.

I'll be writing more about long-distance parenting. Do you have some thoughts or observations?

Free Help Just a Phone Call Away!

2010-03-16T17:26:00.000-07:00

I love the information-laden Internet. But when it comes to receiving comfort, or clarifying meaning, or asking questions, there's nothing like picking up a phone and hearing a live voice. Especially when we need information ASAP to help our parents.

Fortunately, thanks to a nationwide program called Eldercare Locator, help is just one toll-free phone call away. Dial 1-800-677-1116, and you'll reach a trained counselor from your local area who will listen and problem solve, offering resources from a database of more than 1000 services. Some of the topics covered are meals, home care, transportation, adult day health, health maintenance, legal services, housing and assisted living and more.

The program is a public service of the National Aging Information Center. Its goal is to help keep people living safely and independently for as long as possible.

I can enthusiastically recommend the program. Clients have walked into my office in crisis with immediate needs that I couldn't solve. I'd dial the number and put the "phone social worker" on speaker phone. Within minutes, the "next step" was clear. The clients went away lighter.

There's also an online version of the program. Whichever you choose, I'm guessing you'll like it. It's something to keep in your arsenal of information.

Do you have other sources of free information you'd like to share?

Five Ways to Break an Impasse

2010-03-13T12:10:00.000-08:00

Your parent's behavior is driving you crazy. Maybe it's climbing a stepstool to reach the highest kitchen shelf, or driving like Mister Magoo, or refusing assisted living, even though he or she needs care. Whatever the cause, you're at your wit's end.

Joseph A. Ilardo and Carole Rothman discuss how to handle difficult situations with competent and independent but stubborn parents in “Are Your Parents Driving You Crazy?” Often all that's needed to break an impasse, they say, is finding a way for your parents to change their minds without losing face.

The following strategies are pulled from their book. Some of the examples are mine.

1.Alter the cast of characters. Consider bringing in a trusted outsider, such as a friend or minister, to offer a fresh approach. I remember one woman who feared moving to a retirement community. A talk with her pastor eased her concerns. If your parents change their course after a talk like that, they can give the minister credit for the decision.
2.Allow your parents to say no now, which may enable them to say yes later. Suppose your parents aren't managing living independently but refuse to move to an assisted living facility. Don't argue. Let them vent, and just listen. Listening creates a climate of openness, allowing them to hear themselves and reconsider their refusal. Leave information so they can read it and weigh the decision.
3.Accept partial or temporary solutions. I've had successful results when children asked Mom to try assisted living for a month or two, with the promise that they would refrain from selling her home during that trial period.
4.Turn disadvantages into advantages. If you can't prevail, use a statement like, “Mom, Dad, there's really nothing more I can say. You have the right to do what you want. I'm powerless.” This might prompt a generous sentiment. In changing their minds, they could say they “did it for the kids.”
5.Show your parents they really matter to you. If your parents' behavior is repeatedly out of line, consider an intervention in which family and friends confront your parent in love, pointing out how their behavior has affected them.

When Push Comes to Shove...Let It Go

2010-03-09T15:04:00.000-08:00

Your parent needs help. You've presented the facts and offered a solution. Then he or she explodes, acting like an 85-year-old toddler throwing a tantrum in a grocery store. No way, no how. End of story. Or is it?

Certain issues tend to trigger the inner toddler in seniors who are competent but stubborn and fiercely independent. Asking your parent to give up driving, even in the face of recent fender benders, can feel like cruel and unusual punishment. For other seniors, the idea of strangers entering their home to assist with household tasks is out of the question. And what about bringing in help with personal care or moving to a retirement or assisted living community? You have the facts on your side. But your parent says, "Absolutely not."

So what do you do to end this tug of war? Muscle your power, and impose your will over theirs, sure that your course is right? I saw this dilemma play out between mother and daughter 15 years ago at the retirement community where I worked.

Their body language said it all. Sitting with me at the table, the two turned as far from each other as possible. The daughter spoke 90% of the time, despite my efforts to allow Mom to talk.

"I think Mom will really like it here, after she adjusts," she said. The retirement community was affiliated with Mom's church and Mom's sister-in-law already lived there. Mom, meanwhile, sat silent.

The icy atmosphere continued on tour. At one point the daughter whispered to me, "She's always been difficult."

When I asked her mother, "Is this what you want to do?" she said, "My daughter is making me do this."

A red flag went up. New to the industry, and lacking experience, I went against my better judgment. I continued the admissions process, hoping the older woman would eventually settle in.

Mom moved in. For six weeks, she repeated her mantra, "My daughter made me do this," to everyone she met: staff, residents, her sister, her daughter. By the time she moved away, I'd learned my lesson: pushing your parent into a corner is like putting a leash on a cat and expecting it to heel.

A great book on handling difficult situations is "Are Your Parents Driving You Crazy?" by Joseph A. Ilardo and Carole R. Rothman. They point out that, barring an immediate threat to your parent's safety, trying to impose your will on your parent will have one of four effects: 1. Your parents will stop talking with you, 2. They will become even more stubborn, 3. They will comply grudgingly, with anger and resentment, undermining your efforts, or 4. They will surrender and become completely dependent on you. None of these seem particularly desirable.

When you're tempted to push, let it go. In the next post, we'll discuss other better ways to handle these difficult issues.

Do you have any tips to share on handling a difficult situation?

A Way to Keep Your Parent From Wandering

2010-03-05T11:46:00.000-08:00

Wandering can be a deadly word. If your parent suffers from dementia and lives at home with a spouse or caregiver, slipping out the door may spell death.

You've heard the stories: "Mom wandered out into the street, but fortunately a police officer found her." "Grandma walked to the park looking for her granddaughter."

Often one wandering incident prompts the family to place their loved one in a secured memory support community, and understandably so, since safety is a life-and-death matter.

Sometimes a wanderer is otherwise appropriate for living at home, however. The caregiver is handling the situation well. He or she is learning all about the disease and how to manage behaviors. If support is needed, he or she is receiving help with such tasks as preparing meals and cleaning house. So does a wanderer always have to live in a secured unit?

My friend Luise Volta is a wonderful caregiver for her husband, Val. She gave me some clarity on this issue in an email last week:

"I had a scare on Monday night when Val left the house in the middle of the night in his pajamas. I heard the front door and intercepted him out on the sidewalk. Got him back to bed but there was no sleep for me!"

The next morning she found "The Alzheimer's Store" and ordered key pad alarms (pictured above) for both doors by overnight UPS. They are similar to those installed in nursing homes. The device sounds an alarm if anyone tries to exit without punching the right "secret" code.

"I was able to figure them out, install and set them myself. What a relief," Luise added. For her, this system has proved an excellent solution. Living in a rented apartment, she was happy the system used double-sized thick tape, rather than screws, to adhere to the door.

The Alzheimer's Store also sells similar products such as an alarm which sounds in the caregiver's room, rather than at the front door.

Store owner Ellen Warner also suggests a redundant strategy. Besides a door alarm, she advises people to install a chain lock on the door near the knob so that if someone with dementia attempts to exit, the chain will slow him or her.

The Alzheimer's Store also carries information and products related to cueing, bathing, caregiver needs, fall prevention, incontinence management and more.

Need Long-Term Nursing Care? Meet Anna

2010-03-03T12:36:00.000-08:00

If you're looking for long-term nursing care for your parent, you might want to meet Anna.*

It's 7 am. Outside her picture window, blue jays devour their breakfast from a bird feeder. Inside, prayer journals and devotional books sit ready at her desk. After a hearty meal of bacon and eggs, Anna will take a leisurely whirlpool bath in a spa, complete with fluffy towels, lotion and bath salts.

Anna lives at Warm Beach Health Care Center in Stanwood, Washington. It's one of hundreds of nursing homes nationwide involved in a sweeping movement begun in 1991. With names like Eden Alternative, Pioneer Network and Person-Directed Care, these programs aim to make nursing homes more like home.

In traditional nursing homes, residents rise, eat, bathe and sleep in lockstep fashion. Late risers are jolted awake at 6 am whether they like it or not. Night owls are put to bed with the chickens. Times for meals, baths and activities are set for the benefit of staff and schedules, not residents.

In 1991 Dr. Bill Thomas and his wife Judy Meyers Thomas decided, “Enough is enough.” They began with their nursing home in rural New York, determined to eradicate the three plagues: loneliness, helpless and boredom.

Thomas wrote: “We'll bring in 100 birds, two dogs, four cats, three rabbits and a flock of laying hens. Then we'll plow the lawn and start a larger organic vegetable garden outside our residents' windows.”

Eden Alternative was born.

Nursing homes since then have modified the cultural change emphasis to suit their staff, residents and locale. Many leaders have ripped up schedules, flow sheets and the lousy, tasteless menus.

They've introduced pets and plants and built playgrounds for children. And they've divided long stark halls into functioning neighborhoods, where residents and staff laugh and cry with each other.

The Federal Government has even ponied up funds for training nursing home staff in these voluntary programs. Several years ago in Washington State, 33 nursing homes including Warm Beach signed up for the three-year program called “Person Directed Care.”

Now when Warm Beach staff contemplate program changes, they ask, “Is this what the residents want?”

At residents' requests, staff have already remodeled the bathing rooms, added a continental breakfast for early risers, and divided the resident population into “neighborhoods,” with permanent caregivers. Residents choose a name for their neighborhood. They plan baby showers for staff, enjoy take-out Chinese and celebrate birthdays.

The new culture has trimmed staff turnover. Aides enjoy their permanent assignments, since they have five days a week to bond with the residents. Creativity has surged. On a clinical note, pressure sores and falls have decreased.

When I entered Anna's room, she handed me a thick guest book to sign. During our time together, as staff entered the room, she introduced me with comments like, “They're so good to me," and "Dawn puts lotion on my back every morning. It feels so good."

How do you find one of these nursing homes? Sometimes the nursing home's website will list an affiliation. Otherwise, when you visit in person, ask about “Eden Alternative,” “Pioneer Network,” or “Person Directed Care.”

*changed name.

For more information on cultural change, try this link:

Welcome!

2010-03-01T14:01:00.000-08:00

Remember parenting a preschooler? Or if not, were you a doting aunt or uncle? Raising children, or helping nurture those of others, is an incredible roller coaster.

Today many of us boomers are riding another roller coaster, caring for our aging parents. This ride has its own set of highs and lows, but real nonetheless.

My goal is to help my peers deal with their aging parents, as I’ve done for 14 years working in health care settings. And while I know each relationship is unique, I've also observed similaries.

"I slipped into this new role, seemingly out of the blue," one Boomer said. "My mother-in-law, a wonderful home decorator, asked me for advice on a picture frame. I'm not even good at that."

As time passes we move from an influencer to an advocate: one who speaks for our parent when he or she can't.

Is this easy? Not always. Is it frustrating? Yes, for both generations. While it's true we can recycle some parenting lessons we learned long ago, we'll definitely do some tweaking. Our parents are still our parents. End of story.

Dealing with my own parents, who died 6 or 7 years ago, I realized the need for connection. In this blog you’ll hear from professionals. You’ll also hear from those traveling this journey today.

We’ll ask: How can I understand my changing parent? Deal with a difficult parent? How can I advocate well?

I’d love to hear from you. Anything relating to aging parents is fair game.