Wednesday, December 26, 2012

It (2012) was a very good year for reforms in senior care referral agencies

Many senior care referral agencies do great work.  These caring professionals help ease difficult transitions to home care, assisted living and adult family homes. They provide education and outline available options to help consumers make informed decisions. They're upfront about how they're paid:  generally by the care provider, not the senior or their family member. Bottom line: they care.

Some agencies weren’t measuring up, though.  So, Washington State passed legislation that went into effect January 1 of this year, to put referral agencies under increased scrutiny.  The Elder and Vulnerable Adult Referral Agency Act came about in part as a result of public outrage beginning in 2010 over media coverage of referral agencies referring elders to care providers who had documented cases of neglect and abuse. 

At year's end, I can say the wake-up call sounded January 1 was good. If you're looking for in-home care, assisted living or adult family homes and use an agency, the law gives you and your aging parent added protection. For example, the law mandates that if an agency refers you to a care provider, within 30 days of the referral, they must have checked the Department of Social and Health Services website for assisted living and adult family homes or the Department of Health website for home care.  The agency must look for State Enforcement letters (letters that point out violations, fines and stop placement orders), and give you copies of the letters.  In addition, referral agencies need to keep detailed information about every provider they refer to and update it at least annually.

There are other provisions that protect you, the consumer.  Each agency must have $1,000,000 worth of professional and general liability insurance.  And agency employees are "mandatory reporters."  This means that if they witness or suspect any abuse, neglect or financial exploitation they must report it to the appropriate authorities.

A key provision of the law requires an extensive intake of the elder which includes questions on diagnoses, medications, daily routine, food preferences, allergies, personal care needs and more.  When done well, the intake helps a provider determine whether he or she can meet the elder's needs. The law also requires that confidential health care information be treated the same way your doctor treats it.

I work for a housing and care referral agency called Silver Age. I'm proud of what we do to help families, and proud of the protection the new law has given to vulnerable adults.

Bottom line:  the law was needed, both to protect elders from abuse, and to keep all referral agencies accountable. That's good for you and your aging parent.

Tuesday, December 18, 2012

Your Parent Has Early Dementia? Ways to Grow Your Support System

Does your parent have early dementia?  Michael Bower, of the Alzheimer's Association, Western & Central Washington State Chapter, advises: this isn't the time to dig in your heels in "Remember the Alamo" fashion, shouldering the whole load.  Ditto if your parent's spouse is the caregiver, and you're helping out.

"Take 'No' out of your vocabulary," she told caregivers at the Northshore Senior Center in Bothell, Washington. "Practice 'Yes.'"

How does that translate into practical terms?  Bower, an Education Coordinator and daughter of a mother with dementia, offers the following ways to grow a support system.

1.  In your purse, pocket or planner, keep a list of tasks others can do for you.  Your list might include doing the grocery shopping, vacuuming the house or watching your parent for an afternoon so the caregiver can get a break, etc.  There are two reasons for doing this, Bower says.  "If you keep saying 'No,' they'll quit offering.  When you really need help later, they won't be there. Another reason to ask for help early is to get your loved one used to other people helping."

2. Educate yourself on the disease and other family members about the disease, including those far away.  They can help you with specific tasks when they visit, and can do others from afar.  Many out-of-state children take over finances for their parent with dementia, for example.  They can do preliminary online research for care providers. The more involved they become, the more they'll understand the work you do.

3.  Consider joining a local support group.  Many are sponsored by the Alzheimer's Association.  Being in a support group can help you deal with the emotions of caregiving, and offer ideas on coping.  I've walked by a support group at Warm Beach Senior Community many times.  Even with the closed door, the laughter was audible, as people shared moments which were humorous only to others who experience similar moments day after day.  Laughter is great medicine.

If your parent has dementia, can you think of other ways to grow your support system?

Friday, November 30, 2012

Self-Compassion? It's the Key to Coping With Your Aging Parent

Today caps off National Caregiver Month.  All month long,  senior centers nationwide have offered workshops, including one I attended  November 5 at Northshore Senior Center in Bothell, Washington. "Self-Compassion for the Caregiver" explained self-compassion and offered tips to achieve it.  In my view, it's a great subject for us who care for our aging parents.

What is self-compassion?  Workshop leaders Janet Zielasko and Jeannie DeSmet cited the work of Dr. Kristin Neff, author of "Self-Compassion:  Stop Beating Yourself and Leave Insecurity Behind."  According to her, self-compassion involves viewing ourselves kindly, offering the same level of support and understanding we would give a friend.

If you care for your aging parent--either full or part-time--you can't do everything perfectly.  You're human, and you have too many things to do.  But Neff's research suggests that all of us, including caregivers of aging parents--can be healthier, if we accept our weaknesses and give ourselves a break.  Preliminary data seems to indicate that people who score high on tests of self-compassion have less depression and anxiety.  They're happier and more optimistic.

So how do we do it?  Zielasko and DeSmet gave three keys to self-compassion to workshop participants, who were mainly caregivers.

1.  Cultivate self-kindness.  Western culture stresses kindness to others, but not too ourselves.  When you get angry with an aging parent, your first reaction might be, "I should be more patient.  I shouldn't get angry."  But then you get angry with yourself for getting angry.  Self-compassion asks you to remind yourself that you are human and the situation is difficult.  DeSmet suggests actually comforting yourself when you don't measure up to your own standards, and giving yourself tolerance and forgiveness.  "Make a peace offering to yourself of warmth and empathy."

2.  Recognize our common humanity.  When we're in a difficult situation, it helps to be around others who, too, may be struggling in some way.  Support groups, either online or in person, are one way we can find strength to be kinder to ourselves.  So can church groups, going out to coffee with friends, and jogging with a neighbor.  One of the best benefits of being with people, in any setting, is laughing at the situations we find ourselves in.  That's a bonus all in itself.

3.  Be mindful of your situation.  Mindfulness is holding our experience in balance, neither exaggerating it or denying it, says DeSmet.  "When we're mindful there's less need to escape a painful situation.  Our motivation is to 'care,' not to 'cure.'"  Happiness stems from loving ourselves--and our lives--as they are, she adds.  One way to aid in mindfulness is to practice deep breathing, which anchors our minds.  As we do, we can stop, look and listen, observing our emotions and paying attention to them.

How are you doing with self-compassion?  Would you like to talk about it and how it might help your relationship with your aging parent?

Monday, November 19, 2012

Holidays Made Simple: For You and Your Aging Parent, Part Two

This updated post originally ran in 2010.  

With your aging parent, simplicity is the key to the holidays. Even if your parent is homebound, he or she may enjoy decorations, holiday music, movies and family recipes. To capture the "good old times" your parent may remember, try one or more of these simplified traditions.

1. If your parent enjoyed attending the Nutcracker, the Messiah or other live musical performances long ago, listen to CDs or DVD's of these favorites together.
2. If your parent hosted family and friends during the holidays in times past, give him or her a guest book and a tin of cookies or other treats for people who drop by.
3. If she sang in a choir, or just enjoyed holiday music, hold a sing-along, even if there are only a few of you.  Use recorded music to help you, if needed.
4. If he or she faithfully chopped down and/or decorated the family Christmas tree, take a drive through a lighted neighborhood, stopping for cocoa afterwards.
5. If she filled your Christmas stockings to the max in days gone by, provide some wrapped candies she can give to the grandchildren and great-grandchildren.  My daughter, now a mother of three, has fond memories of her Great Grandpa Bill, who stashed peppermints in his shirt pocket.  When kids sat on his lap, they knew where to look.
6. If she baked traditional breads or holiday cookies, hold a family baking session, using her recipes and encouraging her to help, if possible.  Be sure to tell the little ones that, “These are Great-Grandma’s cookies that she baked for your Grandma when she was a little girl.”
7. If he or she loved watching football during the holidays, you don’t have to simplify this tradition at all.  It’s already simple:  Gather the family and friends, provide food and turn on the TV.  One football tradition in our family involved the “Pancake bet.”  For years the three men in our family (my husband and our two sons) placed bets on the score of the upcoming Husky game.  After the game, they revealed the bets.  The person whose bet was farthest off the actual score had to make pancakes for breakfast the next Saturday.

So the key to holidays with your aging parent isn’t expense in time, money or stress.  It’s connection. And simple is often better.  The words of Henry David Thoreau ring true:  Simplify, Simplify.

Can you think of other ways to simplifiy the holidays for your aging parent?

Saturday, November 17, 2012

Holidays Made Simple: For You and Your Aging Parent, Part I

I've updated the following post on Simplifying the Holidays for Your aging Parent.  The original ran in 2010. 

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.  The little girl or boy inside your parent is still very much alive, and that inner child can appreciate the goodwill these special days offer.  The key, though, is more with less.  More joy for all of you, including your aging parent, with less work.  More wonder with less stress.  More love with less money. But how does that all happen, given your limits on time, energy and funds?

First, you may want to start a conversation with your parent.  Ask him or her, "What is MOST important to you during the holidays?" Just having the discussion honors your parent and will enlighten you.  Don’t be surprised he or she starts traveling down memory lane, sharing childhood memories of a Christmas stocking filled with an orange, a bright red ball, a candy cane, and a new pair of socks.  Oh yes, and a new pair of roller skates?  That’s half the fun of this conversation.

Together, when you’ve finished  the “What HAS to be part of the holiday season?” discussion, narrow the list of favorites to a few activities that can be done with help from you and your family.

My dad, a retired pastor, loved writing family Christmas letters. When he moved to a nursing home with my mom, he wanted to continue his favorite tradition. Parkinson's had robbed him of his ability to write. Fortunately, my younger brother Jim came to the rescue.  Together they discussed the contents.  Jim wrote and edited the letter, with Daddy’s approval.  Later Jim's wife and kids were enlisted to type, photocopy, address envelopes and take them to the post office.   For Daddy, those letters were the key to the holidays, allowing him to relax and enjoy the season.

Your parent's list of favorite things will be unique.  In the retirement community where I worked until recently, several residents of German descent make traditional filled cookies every year.  I remember well George’s painstaking efforts to measure the ingredients, bake the cookies, and fill them, standing for hours, despite back pain.   I also remember the smile on his face when others commented on his creation.  It was a community effort:  his adult children provided ingredients.  His neighbors in the community complimented him on his good work.  Others in the community had their own favorite traditions, including attending “The Nutcracker” as a group.  Still others enjoyed Christmas caroling for the nearby nursing homes, senior apartments and an architectural firm!

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

The next post focuses on specific ways to simplify holiday traditions with your aging parent.

Sunday, October 28, 2012

Vigilance is the Byword for Keeping Your Aging Parent Safe

Vigilance.  That word keeps running through my mind.  To keep your aging parent--and other vulnerable older adults--safe from neglect and abuse, it takes a united front.

The need for resolve, consistency and cooperation in keeping elders safe struck home with me just days ago.  Earlier this month a 29-year-old owner of a Bothell adult family home was arrested for burglarizing 8 banks between January and September.  His heists were coined the "Tour de Banks," since he rode a bicycle for his getaways. His proceeds went to paying gambling debts.

Cooperation between police, bank officials and the adult family home employees was key in solving the crime.  Little things--like his employees noting they suddenly received their pay in cash, rather than by check, prompted suspicion.   So did his cell phone records, which pinpointed his location near the banks in question at the times of the robberies.  His bank deposits posed questions, too. As did his withdrawals.

Fortunately, the adult family home residents have been placed elsewhere, and the home shut down. Here is the Seattle Times story:

The case is closed, except for the trial, but the question remains:  How can we as senior care professionals and as sons and daughters of the frail elderly, keep our elders safe?  Senior care professionals are mandated reporters: if we even suspect abuse, abandonment, neglect or financial exploitation, we MUST report it to the DSHS hotline, for those living in assisted living or adult family homes, or to Adult Protective Services, for those living at home.

Adult children are also encouraged to report suspected abuse.

It takes a united effort to keep elders safe.

Tuesday, October 9, 2012

Eldercare 101: Tips on Talking With a Parent Who Has Dementia

Your parent has dementia.  And you may be scratching your head, wondering how to communicate.

Last week I attended a "Dementia Specialty Training," taught by Jeannine C. White, RN, MSN.  She offered guidelines that are as applicable for adult children as for full-time caregivers.  Try some of these ideas.

1.  Present one question or statement at a time.  If necessary, repeat the question or statement, using the same words and tone exactly.

2.  Keep questions simple.  Ask one-part questions such as, "Do you want tea?"  Do not ask open-ended questions like, "What do you want to drink?" or multiple-choice questions:  "Do you want tea or coffee, and do you want it now or with dessert?"  Eventually, even questions that can be answered by "yes" or "no" may be too hard.

3.  Speak slowly and clearly, in an adult manner.  Allow your parent time to think and respond.

4.  Talk about concrete (real) action and objects.  People who have a dementing illness cannot deal with non-concrete ideas, such as planning for a future birthday party or wedding or voting in an election.

5.  Use nouns or names, not pronouns.  For example, say, "Fred is coming today," rather than "He is coming today."

6.  Use positive statements.  For example, say, "Please stay in the house," rather than "Don't go outside."  People with impaired memories can better understand what you want them to do than what you do not want them to do.

7.  Use gestures and visual aids. Objects such as a toothbrush or comb can help identify activities.  Pictures of objects also can be used to convey ideas.

8.  Use touch, as appropriate.  Holding hands, hugging or combing your parent's hair shows warmth and affection, even when words don't do the job.

9.  Respond on a "feeling" level.  For example, if your parent says, "You stole my purse," respond by saying, "I know you are upset because you cannot find your purse.  I will help you look for it."  This kind of statement reassures your parent that you are there for them.

Can you think of other tips that help adult children speak with their aging parent who has dementia?

Thursday, September 27, 2012

Eldercare Q-A: How Can I Help My Aging Parent Build a Legacy?

My short baseball career began--and ended--in second grade.  A fly ball smacked me in the face.  Specifically in the nose.  Years later, though, I found myself editing a book on teaching baseball techniques to children.  How did that happen?  My husband's elderly uncle decided to build a legacy.  And I wanted to help.

Your aging parent is also involved in building legacy, says author David Solie of "How To Say It to Seniors."  It's his or her developmental task.  ""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.

For Uncle Dale, the legacy idea was simple.  He wanted to publish a book that would help children master the fundamentals of baseball.  He also wanted to honor his own grandchildren's accomplishments in the sport.  So he gathered together a team that would help him with the task:  sportswriters, baseball players, a graphic artist and more.  Like all seniors creating a legacy, Uncle Dale is doing this in his time and in his way.  When the product is finished, it will have his indelible stamp on it.

Unfortunately, we adult children can miss the signs when our aging parents are trying to build a legacy.  I know.  My dad was a minister.  After retirement he would "hint" from time to time that parishioners had suggested he publish his sermons.  He suffered from Parkinsons and depression, though, and his inner voice was weak enough that we kids didn't get the message.  His disparaging comments, "Probably no one will read them," didn't help the project to gather steam.  Unfortunately, the sermons never were published.

As I grow older, I'm trying to listen for the sounds of legacy.  For example, my friend Don, in his mid 80s, has been writing letters to his grandchildren for years.  "I write about what is important in life, and I encourage them to make good decisions," he says.  Another friend, Tillman, builds legacy by reviewing slides of his years as a missionary to Zimbabwe, and telling stories of God's work in that land.

When seniors create legacy, they repeat the same stories again and again in great detail, not so much for the facts as the inherent values.  Solie urges us as their children to listen, really listen, and help, if we can.  Even if we know more about commas than baseball.

Have you picked up on your aging parent's desire to create a legacy?  How have you been able to help?

Monday, September 24, 2012

Eldercare 101: A Hands-on Primer on Washington Adult Family Homes

Question: What eldercare option is growing by leaps and bounds in Washington State?  
Answer:  Adult family homes.

King County alone has more than 1065 homes.  No wonder they're springing up everywhere.  Adult family homes cost one third to one half of a nursing home.  They provide a more homelike setting. All in all, adult family homes are worth considering if your aging parent needs considerable care.

These homes usually have six residents cared for around the clock by trained caregivers. But is the right one hard to find?  One that will fit your parent's needs?

Last week I began checking them out in Bothell, my hometown.  I wanted to experience the "hunt," and offer a few tips to you and others who might be looking for your aging parent.  Here are some things I discovered.

1.  Washington State's DSHS website has a page devoted to finding adult family homes. Other states have similar listings.  I did an advanced search for the three Bothell zip codes.  My printed list included 84 homes.  In my zip code alone there were 24 homes.  Quite a few, all within a mile or two of my house.

2.  The DSHS website lists key items for each home including
  • Enforcement letters.  These are letters the State issues the home for violations of statutes.  They can be for anything for failing to pay the annual required fees to not reporting an emergency in a timely manner. 
  • Medicaid acceptance.  This is more than a little tricky.  Most homes say they will accept Medicaid but require between 18 months and 3 years of private pay before a resident can convert to state assistance.
  • Specialties.  Most adult family homes specialize in caring for residents with dementia and/or mental health issues.  A few also accept developmentally disabled residents.
3.  In my ongoing visits, I've found.
  • Diversity.  Two homes only take Russian-speaking residents.  One home I visited specializes in older developmentally disabled males.  Other homes desire females only who are frail. Most homes cannot accept exit-seekers--residents who continually try to leave.  Yet other homes with locking devices feel comfortable with these types of residents.  Still others take on pretty much any kind of a challenge, from post-strokes to recovering hip fractures to dementia in its many stages.
  • Somewhat uniform pricing.  Older homes may have a smaller price tag than newer ones, but not by much.  Generally adult family homes start at $3500-$4000, with higher fees for residents with greater needs.
  • Visiting is important but wearing.  Family members may want to trust a professional, such as a senior housing specialist or a geriatric care manager, to help them with the hunt. 
Have you looked for an adult family home for your aging parent?  If so, what has helped in your search?

Friday, September 14, 2012

Eldercare Dilemma: I don't want Mom to Have to Move TWICE!

"I definitely want to move Mom only once."  After all, moving is hard on elderly parents, and it's not easy on children, either. So how can you make sure you won't be carting Mom, her possessions and furniture to a new community months or years from now?

What about dementia? A marketing representative told my client, "Our community can take care of your mom for the rest of her life!"  A problem:  his mom had early dementia.  She was engaging and cogent for fifteen minutes or so, until she began her pattern of repeating questions and phrases. Her short-term memory was zip. For now, her needs were simple: friendly staff directing her to meals and activities, and helping her bathe and take her medications. Later, though, problems could arise. Depending on the progression of her disease, she might begin to wander or yell at residents or staff. Because the community had no memory support area, with specially trained staff, she could be asked to leave. The implied promise of "taking care of Mom forever" wouldn't hold water.

What about other progressive diseases?  George lived for five-plus years at the assisted living where I worked.  He made friends, was the star of the art group, and every Friday toasted with four men in an informal "Happy Hour."  Eventually, though, as he approached 100, he became weaker.  It took two people to get him out of bed. We could no longer meet his needs. George had to pull up stakes and move to a heavier care assisted living. Another potential move-out criterion is diabetic care. If your parent needs sliding-scale insulin, he or may need to move to higher care.

What can you do? No one has a crystal ball, but it's good to be prepared for the possibility of a second move. The community you're choosing now may be perfect today. When your parent's needs increase, an adult family home, a heavier care assisted living community or one with memory support might work better.  If funds aren't an issue, you have more options from the beginning: move Mom to a more expensive community with progressive care and specialized wings. When her needs grow, you simply move her down the hall.  Another option, especially if your parent has extensive needs, is to bring in extra home care staffing to assist the assisted living staff in caring for your parent.

Is this easy?  No. The Boy Scout motto makes sense here:  Be prepared.

Do you have any other ideas concerning a "second move"?  Or stories of your own experience with this?

Wednesday, August 29, 2012

My Top Picks for Eldercare in Washington State

Given the many great eldercare options in Washington State, it's hard to choose the "Best of the Best."  So I won't try.  But I will give you three of my favorites, based on my 16-plus years in this field.

The following three rate an A-plus not because they're the most luxurious or have the best food or even the best location.  They're excellent because they succeed at their mission:  providing an abundant life for the seniors in their care, and encouraging their employees to do their best every day.

Warm Beach Senior Community, Stanwood--Started in 1967 as a ministry of the Free Methodist Church, this community has housing that ranges from very independent manufactured homes and cottages to smaller apartments, assisted living and skilled nursing. Besides the continuing care, a huge plus is the scenic setting, amidst cedars and Douglas firs, next door to Warm Beach Camp and Conference Center.  Eagles fly overhead, and deer scamper across the lawns. Residents are active here, and their volunteer efforts include running a thrift shop, hosting an annual bazaar, plus visiting the sick. I visited there on the community's 45th anniversary last month, and found many employees who had worked there for well over a decade. Best of all, residents were all smiles.

Foss Home and Village--Located in North Seattle, this Lutheran-sponsored nursing home and assisted living has weathered the test of time, in operation since 1929.  Foss is known for excellence and innovation. An example is Foss Home's Village, one of North Seattle's earliest assisted living programs which opened in the early 1990s.  Today the organization can be proud of a rehab program that is recognized by doctors, therapists and others as one of the best around, and a volunteer program and development efforts that enrich the lives of residents. During the time I worked at Foss in 2008, my best memories were of staff and management enjoying their work. Today of 370 employees, 100 have served a decade or more. There is a fun, upbeat atmosphere at Foss, and the residents see and hear it:  through jokes, smiles, and banter that make the day happier.

Providence Mount St. Vincent--West Seattle--The Sisters of Providence founded Providence Mount St. Vincent in 1924.  Through the years, it has been much more than a place to care for the aged, offering nursing home and assisted living care. Their health care center was one of the  first in Washington State to create smaller neighborhoods, where residents could forge friendships, celebrate birthdays and decorate the halls. Mount St. Vincent has also been at the forefront of programs including Person Directed Care, which looks at every area of nursing home life to ask, "Is this what the residents want?" Another plus about Providence Mount St. Vincent is its intergenerational program, allowing children and elders to enjoy each other every day.

Do you have experience with any of these eldercare facilities?  Or do you have another favorite, and if so, tell us why?

Friday, August 24, 2012

My Sister Drives Us Siblings Nuts! We Can't Agree About Dad's Care

Linda called me on the phone from Oregon.  "All of us siblings want the best care for Dad. We all agree on the right course. Except my one sister who refuses to listen."  I could hear her voice crackle as she continued.  "She drives Dad crazy, and he'll do anything to get her to go away, including agreeing to things he'd never say yes to otherwise. What do we do?"

Linda isn't alone.  Perhaps you have a sibling from Hades.  She is sure about the RIGHT way to care for your aging parent, be it home care, assisted living or other care. No one else in your family agrees with her plan; but that doesn't stop her from using anger to try to convince you. Whether it's mental illness, a major case of selfishness, greediness, or leftover sibling rivalry from long ago, something is keeping your sibling from rational thinking, from the give and take that brings solid solutions.

Over the years I've picked up these tips from adult children who make decisions about their parent's care while grappling with a difficult sibling.

1.  Realize issues with your sibling will continue.  He or she didn't just wake up one day recently wanting to micromanage things.  That behavior has likely been around for a while.  One game plan is to avoid talking one on one with your sibling about the "health care topic."  You can say something like, "It's really important for us to talk about Dad's care.  I want all of us to have input so we can make a joint decision."  If she keeps talking about the subject, you might say, "I feel uncomfortable discussing this until we can all get together."

2.  Call a family meeting.  Linda's brother and sisters did this.  Everyone came, including the difficult sibling. One sister with business acumen chaired it and kept order.  All parties had a chance to speak about Dad's health care. At the first meeting, they didn't come to a firm conclusion, but everyone aired thoughts and feelings. They also spoke about Dad's wants, and how due to his dementia, those desires might not be realistic.  At their next meeting, they agreed to have a nurse join them

3. Enlist a professional.  Many nurses, psychologists and social workers specialize in helping families of the elderly sort through issues.  They're called Geriatric Care Managers.  Linda's family met with a nurse who sorted out their dad's needs as well as those of the family.  Adult children were given a "to-do" list.  The presence of a professional often tames the crazy behavior of the difficult sibling, at least until a definite plan can be agreed on.

Do any of you have a sibling that makes it difficult for you to make decisions regarding your aging parent's health care?  How have you handled it?

Thursday, July 19, 2012

Eldercare Q-A: Help! Mom Needs to Move Now! What to do?

Nobody plans for their aging parent to suffer a stroke.  Or careen down the dementia road so quickly you can't see the crisis coming.  Or fracture a hip.

Perhaps your aging parent has fallen into one of these--or a sundry other--eldercare crises.  You want to find a safe, comfortable, affordable new home ASAP. But you're short on two things:

You're long on one thing: stress.

An eldercare housing specialist could be the answer to your prayers. Also called senior care advisors, they are becoming a growing choice nationwide. Eldercare housing specialists use their knowledge of retirement, assisted, and other residential care options to help you find the right fit. They don't charge clients fees for their service. Instead, the community pays the eldercare referral service a commission on move-in.

Jean and John are sold on this option.  One night they received a call from the Tacoma police.  John's mother had driven from her home--some 35 miles away--into the city, running out of gas. What was she doing there? She hadn't a clue.  "It was obvious she couldn't live safely in her home," Jean said. They called Heidi Sheldon of Options for Elders. Heidi showed them several care and housing options; the family chose their favorite. Soon John's mom was tucked in, safe and sound, in her new adult family home.

Another success story: Bertha's dementia was evident to the staff at the retirement community where she lived. She did OK until the administration realized that her hoarding was a fire hazard. She had to move ASAP.  Her son called a local senior housing specialist. Together they viewed options and quickly settled her into her new home: an assisted living community with specialized care.

Not every story ends so happily.  In Washington, two years ago the Seattle Times published a series of articles, "Seniors for Sale," which documented instances of senior care referral agencies placing residents into adult family homes with documented records of abuse and neglect.  That series spawned a public outcry which eventually led to new legislation regulating senior care referral agencies.  It went into affect January 1.

Thursday, July 12, 2012

Eldercare Q-A: Retirement or Assisted Living--What's the Difference?

What's the difference between retirement and assisted living?  I'd love to have a dollar for every time a Boomer asks that question regarding his or her aging parent.  See if your parent fits into one of the following.

1.  Does he or she need meals, housekeeping, transportation to doctor's, grocery stores, etc., and activities but is pretty independent otherwise?  If you answer yes to several of these, a RETIREMENT COMMUNITY is probably a good fit.  In this type of living situation, your mother or father receives lots of support--physical and emotional, but no personal care from the retirement community staff.

2. Does your parent need all of the above plus help with bathing, dressing and/or medication setup?  If his or her personal care needs can be scheduled--showers on Tuesday and Thursday, for example, one option is to hire a HOME CARE agency to come into the retirement community. Often, but not always, this is cheaper than moving to an assisted living community.

3.  Another option for personal care is moving to ASSISTED LIVING.  This offers all the benefits of a retirement community, plus on-site staff.  They can help with a wider range of needs, many of which can't be scheduled.  Some examples:  cuing and reminding for someone with dementia, incontinence care, and medication assistance. Assisted living communities differ widely on the scope of care they can provide.  So ask lots of questions if you go that route.

For years I've described retirement community residents this way: they paddle their own canoe.  Sometimes they get tired and need help from children to stay independent, but generally they know how to move forward. Assisted living residents need life jackets and others to paddle (figuratively) due to cognitive, emotional and/or physical needs.  General statements like these don't always hold water, but hopefully you get what I mean.

Thursday, June 28, 2012

Assisted Living Food: Suddenly Your Aging Parent Hates It!

Assisted living cuisine can turn sour in the blink of an eye. One day, your aging parent will give the assisted living dietary staff accolades for their well prepared meals served in a timely manner.  But suddenly, the story changes. You hear mantras that remind you of  Goldilocks: "It's too hot."  "It's too cold." But rarely, "It's just right."

Your aging parent may complain about things like: Residents wait too long to be served.  The kitchen runs out of resident favorites.  Eggs aren't cooked to her liking.

So what do you do? Here are some ideas I've seen adult children use over the years in addressing food issues in their parent's assisted living communities.

1. Give the situation some time to resolve. Cooks at assisted living communities quit.  So do servers.  When that happens, it's easy for everyone to go into a frenzy, at least temporarily. If staff, families and residents can sit tight during the hiring process, things may work out.

2.  Eat in the dining room with your parent more often.  Note positives as well as negatives. Use the comment cards located in most dining rooms to jot down suggestions for improvement. Your comments will carry at least as much--if not more--weight than those of your parents.

3.  If your parent is competent, encourage him or her to voice concerns, either in writing or through the Resident Council.  At most assisted living communities, management wants to create a pleasant dining experience for residents. During difficult transitions, positive ideas can be born to make meals more pleasurable.

4.  Realize why this is such a huge issue for your parent. Your parent can't just drive down the road to a Chinese restaurant.  He can't fix a gourmet meal in his kitchenette. He can't bake a chocolate cake.  So when there's a slip in service, or food quantity or quality in the assisted living dining room, your parent's world is rocked.  Things will likely settle down, given time and patience.  If they don't, discuss the other positive qualities of the community with your parent.  And think twice before moving him somewhere else. Remember the old saying, "The grass is always greener...?"  Another version is, "The food is always better somewhere else?"  Not necessarily so.

Have you and your parent experienced a disappointment in food service in his or her assisted living?  How have you handled it?

Monday, June 18, 2012

Eldercare Dilemma: Mom's Favorite Caregiver Just Quit!

Your elderly parent is fit to be tied. And you're not doing well, either.  Why? Her favorite caregiver quit. Gone is the one who knows Mom loves pink, hates broccoli, and has to be bribed to take a bath. In her place is a stranger.

How do you handle this?  Mike Davis, owner of Always Best Care-Eastside, a home-care agency serving Seattle and East King County, has a definite opinion.  "Caregiver turnover is high, and there's not much we can do when a caregiver quits.  But we can do our best both to feel and mitigate the pain of those involved."

He advocates a "no strangers" policy.  It works like this: If Carol quits as a caregiver for your mom, she or another staff member that you and your mom know will introduce Barb, the new caregiver.  The person who introduces Barb will work with her for a good part of a shift, to teach Barb the ins and outs of your mom's care needs and preferences.

At Always Best Care-Eastside, the agency pays both caregivers during the training period.  The client pays for only one.

I like the "no stranger" concept. If we or others can take the time and care to introduce our parents to new people in their lives, everyone wins.

Can you think of other situations in which you can implement the "no stranger" concept with your elderly parent? 

Wednesday, May 23, 2012

Eldercare Q-A: Mom moved to assisted living, but she's more confused than ever!

A common eldercare situation: dementia causes your aging parent to move to assisted living. Upon the move, he or she is more confused than ever. What's up?  Assisted living offers just what the doctor ordered: structure, supportive staff, meals and personal care. But for awhile, things are topsy-turvey.

Why the increased confusion? Throughout his or her life, your aging parent successfully navigated through change. He or she adapted to new stressful situations, be it college, a first apartment, or a new workplace. During the first few days, things were forgotten--the umbrella, briefcase, or coffee mug. But soon, the short-term memory clicked in, relaying the information about the new surroundings to the long-term memory.

Your parent's transition to assisted living is drastically different. Now, with dementia, the short-term memory is diminished. Before moving to assisted living,  your parent kept things barely afloat by relying on the long-term memory. He or she knew the location of the living room and the kitchen and how to find the bathroom from the bedroom at night.

In assisted living, his or her new home, everything is upside down.  Where's the dining room?  How is the laundry done? Confusion, confusion at every turn.  How do you, your parent, and the staff handle this successfully?

Assisted living staff in Washington State, and throughout the country, are required to take specialized training in dementia. They know that a new resident will need extra time and attention, which may include reminders about wake-up time, escorts to meals, invitations to activities, etc. You can help, too, by setting up the room ahead of time with special furnishings and belongings.  During the first few weeks, make an effort to eat some meals with your parent in the dining room.

The good thing is that generally, the confusion will improve after a few weeks. The new home will seem more like home, and your parent will seem more like himself or herself.

Sunday, May 20, 2012

When I Die...Thoughts on Talking to Your Aging Parent about Death

Death. Have you and your aging parent talked about it? It's difficult, without a doubt. Yet allowing your parent to express his or her end of life wishes can be sacred, for all.

Trudy James knows. A Seattle-based trained hospital chaplain and Episcopal lay minister, James has facilitated end-of-life planning groups for years.

"People can solve their own hurts if they're listened to," says James. "Your job (as adult children) is to listen without talking, allowing them to tell you what they want."

But how to start? Be open-ended so your parent can fill in the blanks with what they desire, James advises. One idea is to ask your parent to complete the sentence, "When I die, I want..."

Typical answers include:

1.  When I die, I want things to be in order. Your parent may be adamant about dressing drawers being straightened, wills being finalized, or dishes, trinkets or antique guns parceled out to children.

2.  When I die, I want my loved ones to be OK.  That may mean adult children and others are provided for financially. Or it may mean a desire for emotional and spiritual peace, with kids getting along.

3.  When I die, I want a peaceful death.  At life's end, your parent may have specific requests such as music playing, scripture being read, an absence of pain, etc.

4.  When I die, I want to know my life mattered.  This statement speaks to the idea of legacy and may take many forms:  verbal or written blessings for loved ones, donating organs for research, giving money for significant causes, etc.

5.  I want my physical body to be laid to rest. Knowing your parent's preferences regarding funerals or cremation, and the specifics of the chosen method, allows you to do everything within your power to implement their wishes.

The sentences above can be boiled down to two basic questions:  "What are your parent's wishes?" And "Who will carry out the wishes?" For specifics on starting the discussion, check out

Trudy James presented this material earlier this month at the Seattle Senior Care Coalition, a group of professionals in the senior care field.

Monday, April 30, 2012

Eldercare Tip: Choosing a Retirement Community is Like Dating, Pt. 2

Choosing a retirement community for your aging parent is like dating.  At least that's what I said in my last post. In both processes, you focus on finding a good fit, looking not only for beauty but also personality and character. And retirement communities have all of these qualities, in one degree or another.  The bottom line is finding something you and your parent can live with, as happily ever after as possible.

One reader, my friend Mark Whitesell, pointed out that a person shouldn't "date" just one facility and call it good. "A person can't make a good choice if they don't know what else is available," Mark said. I couldn't agree more!

The importance of looking at several communities came home to me a decade ago when a 92-year-old woman came into our community with her family.  "This is a lovely place," she said with a twinkle in her eye.  "But I'm just not sure I'm ready to be around these old people."

I asked her family, "What do the rest of you think about Esther moving to a retirement community?" They said she seemed lonely, wasn't eating well, and memory issues were hurting her ability to make good decisions.

"Esther, I want you and your family to feel good about this decision. So why don't you visit a few more communities, and then see what you think?" I could see the stress lift from the woman's face.

A few weeks later, Esther called me. "I want that apartment you showed me!" She'd visited two other communities, and was now ready to make a move. Her family wisely gave her space to process her decision, and opportunities to see what was available.  And bingo, the process worked!

Can you tell me about the process of choosing a retirement community for your aging parent?

Monday, April 23, 2012

Eldercare Tip: Choosing a Retirement Community is Like Dating

When elders and their children visit Evergreen Court, the retirement community where I work, I often say, "Choosing a retirement community is like dating." Both processes are life-altering. And hopefully, the outcome in each will be "living happily ever after." So much for the corny analogy.

Here's how these two are alike.

1. Appearance is important, but it's not the end-all, be-all. Obviously, leaky roofs, unsightly grounds and unwashed windows speak volumes about how a community is run. But beauty, as our mothers would say, can run skin deep. That's true both in romantic interests and in retirement communities. Many communities, while not posh, are nevertheless comfortable and homelike. It's a matter of choice, lifestyle and budget. Marcia Byrd, Executive Director of Patriots Glen Assisted Living in Bellevue, Washington, expressed it this way: "Look beyond the chandelier."

 2. Personality can trump glitz and glamour. As you search for a new home for your aging parent, look for staff and residents engaged in life. Is there a spirit of playfulness? Do residents enjoy chatting in the lobby, curled up near the fireplace? Do the women giggle like sorority sisters while playing bridge? Do the men enjoy swapping stories of war, travel, and their working years? Planned activities can support this active lifestyle, whether it be picnics in the park, trips to the museum, or going out to lunch.

 3. Character also counts. Retirement communities have reputations in the community. Social workers, ministers, Rotary members, and other leaders can offer their studied opinion about various retirement living choices in your locale. Listen to them!. When I dated my husband many years ago, I remember debriefing late at night with my friends in the dorm. "What was he like?" "Was he a gentleman?  Does he seem to be a good fit?" In looking for retirement communities, the bottom line is: What does your parent want and need? What do you need? And is this a good fit?"

Good luck in your search.  Does this analogy work for you?

Monday, April 16, 2012

Eldercare Idea: For Mother's Day, Write Her a Love Letter

Mother's Day is just around the corner. Father's Day is not far behind. So what do you buy for your elderly parent who has everything? Or who says, "You don't have to get me anything?"

A love letter costs nothing except an investment of time and attention. And its value can't be counted, since your parent will read it over and over again. Here are some ideas on how to start.

First, think of three character qualities you admire in your parent. Why, three? Because the number "three" signifies completeness. Two doesn't seem like enough. Three is just right.

Is your parent generous, fun-loving, hard-working? How about family-oriented, intelligent, faithful? Your list will be unique.

Once you've identified three character traits, think of concrete examples which illustrate them.

Here's a sample letter.

Dear Mom,

For a long time, I've been searching for words to say, "I love you."

When I think of you, the word "kindness" springs to mind. As a child, I saw your kindness at bedtime, when you never let fatigue stop you from reading us bedtime stories or answering our questions about life. As we grew into teenagers, we tested your kindness time and time again, with our boisterous and often wayward ways. Today your kindness, developed over the years, radiates from your face.

Another word that describes you is generous. Years ago, I remember the doll clothes you painstakingly made for Carol and me. They were beautiful! Your generosity continues today, with gifts of homemade jam and home-baked cookies.

Faithfulness is another adjective that speaks of you. From my earliest years, I remember watching you pray for all of us, seeking God's will for our family. I know you still do that, and it makes my heart happy.

These are just of the few qualities I thank God for when I think of you. Happy Mother's Day!

Saturday, March 31, 2012

My Eldercare Blog is Two Years Old: Thanks, Readers!

Happy belated birthday to Boomers Guide to Eldercare! Last month the blog celebrated its second year. You faithful readers deserve an applause!

Who are you? You're either eldercare professionals or adult children--usually Boomers--grappling with issues relating to your aging parents.

What draws you to this blog? Of the 112 posts so far, here are the most popular subjects (with a sample post):

1. Finding Affordable Senior Housing--Affordable Senior Housing: Three Models

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

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

4. Writing a Great Thank-you Note to Your Parent's Caregiver--Writing a Great Thank-You Note--Here are Samples

5. Making the Most of Long-Distance Caregiving--Now You See Them, Now You Don't: Long-Distance Caregiving

Do you have any additional topics which interest you?

Thursday, March 22, 2012

Searching for Retirement Living for Your Aging Parent? Three Top Places to Start

Here, there and everywhere. Retirement and assisted living communities, that is. How do you find the right one for your aging parent? According to Steve Wright of Wright Mature Market Services, here are the top three methods Boomers use to begin their search:

1. Referral sources--friends, professionals such as doctors, nurses, social workers and senior centers are all good places to start. Most cannot recommend one community. Instead, they refer. The difference is subtle. "Here's a list of communities you might visit," a social worker might tell you. If you ask, "Are there a few that your clients have had good luck with?" she may point you to her top two or three. Bingo! You've narrowed the field. Another source of information is your friends whose parents live in a community. Hopefully, they're happy with their choice and want to help you.

2. The Internet--Most Boomers do at least half of their search online, before even setting foot in a community, says Wright. They often search words such as "Medicaid," "affordable senior housing," "continuing care retirement community," etc. When I view a website, I look for a "taste" of community life. I pay close attention to testimonials, which are powerful in telling the community's story. I look for photos depicting seniors having fun.

3. Advertisements--this is a distant third. Direct mail pieces, invitations to events, strong signage, all can help you look around to check out the community further.

Can you think of other methods you've used to find the best retirement community for your aging parent?

Thursday, March 15, 2012

Eldercare Dilemma: As the Only Child, You're Stretched Too Thin!

You're the only child of an aging parent. Or perhaps you're just the only one involved, since your siblings can't or won't help. Either way, your role offers double the joy, or double the trouble. Or some of both, depending on the day.

Last week I sat across the table from a devoted--and understandably perplexed--only son of one of our residents. His mom was exhibiting dangerous behavior; assisted living or an adult family home was the answer. But this feisty woman would have none of that!

"I'm not sure what to do," her son said. Our Executive Director started a conversation about behaviors, options, and next steps. At the end of our time together, we had an initial plan that we could come together to evaluate soon.

"If your mom must leave her apartment, I will tell her," our Executive Director said, adding, "You don't need to be the bad guy. Your job is to be the son."

Good advice for any only child--or the only one caring the load. Lean on friends and professionals whenever possible. Shelve the guilt or the martyr role.

That way, you can be what you're destined to be. Your aging parent's child. Period.

Wednesday, February 29, 2012

Budget Housing for Your Aging Parent: Consider Section 8, Pt. 2

Is your parent struggling to pay the rent? And does it get worse every year, as medical costs increase? Section 8 could be the answer.

It was for 85-year-old Helen. Until recently she paid $910 a month for rent and utilities, quite a stretch for her monthly income of $1350. Helen and her family looked into Section 8, a HUD-sponsored program which gives vouchers for rent assistance to low-income seniors.

Section 8 takes two forms: the more common Tenant-Based Voucher, which allows tenants to take their vouchers from place to place throughout their state to Section 8 participating programs. The second form is called a Project-Based Voucher, good at only one location.

Helen's apartment complex had a Project-Based Voucher program. Since the program was new, she was able to stay in her current apartment.

To prove her eligibility, Helen had to document her income and assets, as well as submit to a background check. She also documented her medical costs, such as doctor's and dental visits, Medicare insurance and Medicare supplements.

How did the story end? Happily. Helen's medical expenses of $350 a month were subtracted from her gross monthly income of $1450 (before Medicare is taken out). That resulting number, $1100, is called the gross adjusted income. For seniors on Section 8, their rent portion cannot exceed 28% of that number.

Helen's rent now is $308, instead of $910. Same building, same program, but a huge savings.

Do you have experience with Section 8 you'd like to share?

Wednesday, February 22, 2012

Budget Housing for Your Aging Parent: Consider Section 8, Pt. 1

Is your aging parent stressed over high housing costs? The following quiz may shed light on his or her plight.

1. Is your parent's income less than 30% of the median income in her area? In King County in Washington, that lowest income figure is $18,500 for a single person.

2. Is your parent living temporarily with family or friends until he or she can find something permanent?

3. Is your parent paying more than 50% of his or her income for rent and utilities?

A "yes" answer to any of the above may mean your parent could qualify for Section 8, a HUD-sponsored program that gives substantial rent subsidies in the form of vouchers, usually spendable at a number of housing complexes.

How does the program work? Your parent takes his gross annual income (before Medicare A coverage is taken out) and subtracts medical expenses such as Medicare premiums, insurance, medical appointments, prescriptions, etc. The resulting figure is his or her gross adjusted income.

Dividing that number by twelve gives the monthly adjusted gross income. If qualified for the program, your parent will pay 28% of that amount for rent in a qualifying apartment complex. The Housing Authority pays the difference between your parent's portion and the market rent.

It's a great deal. Just ask some of the residents at Evergreen Court, where I live. Thanks to Section 8, they will soon save lots of money on rent. Their kids are smiling, too.

My next post on Section 8 for seniors comes soon.

Have any of you had experience with helping your parent find Section 8 housing?

Saturday, February 11, 2012

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

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!


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.


Wednesday, January 18, 2012

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

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

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.

Thursday, January 12, 2012

Advocating Tips: When Your Aging Parent Lives Far Away

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.
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