Wednesday, December 25, 2013

Miracles Can Happen for Your Aging Parent

More candles burn in churches in December than at any other time of year.  I haven't done a scientific survey.  It's simply my educated guess.  It seems like during these dark-filled days, everyone needs a miracle.  Our aging parents are no exception.

As our parents' lives flicker, the miracles they seek may seem impossible.  They hope to reconcile with a family member.  They dream of experiencing peace.  They long to heal from a traumatic past. 

Wonder of wonders, those miracles can--and do--happen.  Yet the storyline usually doesn't play out the way we'd plan it.  It's wrapped up in simplicity.  Good people, doing good things, partner with God in creating change.

In my work with Boomers in finding housing and care for their parents, I meet some wonderful people.  And yes, I witness healing and hope.

Janice came to me on behalf of her 96-year-old mother, Myrtle,  who needed to move to an adult family home. As Janice, her sister, and I met to discuss the qualities they wanted in the home,  one sentence kept being repeated.  "More than anything else, we want our mother to feel safe."

All during childhood, Myrtle had suffered abuse.  In adulthood, she married an abuser.  Even at the end of her life, after her spouse had died,  she continued to be plagued by anxiety and to experience nightmares. 

At the third adult family home we visited, Olga Muresan greeted us.  The owner and provider of services, Olga is the epitome of motherhood.  She exudes hospitality.  The elders in her care are clean, well nourished and content.  Janice and her sister chose the home, hoping their Mother would fit in.

Two days after Myrtle moved in, I came to deliver a move-in gift of chocolate, and she was all smiles. She was already starting to talk with her housemates and joke with Olga. She died unexpectedly 2 1/2 months later.  When I called Janice to express my condolences,  Janice said, "Olga tucked my mother in bed every night.  She sung her lullabies. I know my mother is at peace." 

"My mother told me many times, 'I finally feel safe.'"

A miracle?  I think so. What do you think?

Tuesday, December 17, 2013

Eldercare Question: Dementia or Depression? Alike, Yet Vastly Different

Dementia is one of the most misdiagnosed diseases.  So says Jerry Mixon, MD, and Founder of Longevity Medical Clinic in Seattle.  And Mixon is not alone in thinking so.

If your aging parent begins to forget things or have trouble concentrating, he or she may may not be suffering from dementia.  Instead,  depression might be the culprit.

It's easy to mistake Dementia and Depression.  They have the following symptoms in common: 

  • Sleep disturbance
  • Loss of interest
  • Poor concentration
  • Loss of appetite/weight
  • Agitation
  • Irritability
  • Memory impairment
There are differences, though.  

Depression can cause:
  • Loss of energy
  • Feelings of guilt/regret
  • Thoughts of suicide
Dementia can cause:
  • Difficulty organizing or losing things
  • Language difficulty
  • Incontinence
If in doubt, take your aging parent to his or her physician.  A correct diagnosis is the first step toward treatment.  

Saturday, November 30, 2013

Eldercare Q-A: My grandma can't live on her own. How should we look for retirement communities?

My readers are getting younger all the time.  So are my clients.  It's not unusual for a grandchild to look into retirement or assisted living for Grandpa or Grandma.

Whether you're a Milllenial, a Gen Xer or a Boomer,  the information you'll need to help your aging loved one is the same.

You may be familiar with the SWOT analysis used by businesses in strategic planning.  S stands for Strengths, W for Weaknesses, O for Opportunities and T for Threats.  Apply that analysis to your loved one.  The following are sample responses; yours will be unique, guided by your knowledge of your parent or grandparent.

STRENGTHS (These are positive things about his or her living situation.  Here are some sample items)
  • Grandma has a strong support system of friends and relatives.
  • Grandma has a positive outlook on life.
  • She has been generous and hard working.
  • Her hobbies include knitting, reading and singing.
WEAKNESSES (These are things that need improvement.)
  • Grandma has lost weight and is eating poorly.
  • Since giving up driving,  Grandma has become isolated and seems lonely.
  • Grandma suffers from short-term memory loss.
  • Grandma is reluctant to take a bath, because she is afraid of falling.
  • She has fallen several times in the last six months.
OPPORTUNITIES (If positive change occurs, these are possible outcomes)
  • In a retirement community, Grandma will have a chance to meet people her own age and make friends.
  • In her new setting, she can enjoy meals in the company of others.
  • Structure to her day, such as exercises, meals, movie times, etc., will make her feel more secure.
  • Staff can offer support with bathing and with medication administration.
THREATS (What might happen if she remains in her current situation.)
  • She could continue to lose weight and become weaker.
  • She could fall and could lie on the floor for hours.
  • Her short-term memory loss could cause her to fall to prey to financial scams.
As you do the SWOT analysis, involve your parent or grandparent as much as possible.  As you look for a community, you'll want to find one that will play to her strengths, buoy her up in her weak areas, and give her new opportunities. 

You'll also want to think through key things such as location and affordability.  As you shop for communities, both online and in-person, use the information gathered in your SWOT to help make the best choice possible.  Good luck!

Wednesday, November 27, 2013

Eldercare tip: Prayer is Just What the Doctor Ordered, for You, for Your Aging Parent

Facing struggles relating to our aging parents can drive us to our knees.

Difficult decisions, hard transitions, thorny relationships.  The storms of life can call us to the place of prayer.  We pray for wisdom for ourselves, for peace for our aging parent, and direction for the situations we face.

Prayer isn't just for churchgoers.  Nonbelievers pray, including Will Schwalbe, author of "The End of Your Life Book Club."  The book chronicles his mother's struggles with pancreatic cancer and tells of their book-club for two which met in various doctor's waiting rooms.  Mother and son read lots of books, including The Bible.  Schwalbe was a self-confessed atheist; his mother, a Christian.

One day Schwalbe announced, "I'm going to pray.  Well, not in a church.  But I'm going to pray." His mother beamed. That night, and in the nights to come, he did pray.  He used a devotional book of autobiographical essays by Anne Lamott called "Traveling Mercies: Some Thoughts on Faith."

Lamott said the two best prayers are:  "Help me, help me, help me,"  And "Thank you, thank you, thank you."  Schwalbe tried those prayers, sometimes emphasizing the "Help me, help me, help me" and other times the "Thank you, thank you, thank you."  Sometimes he alternated; mostly he used both.

I've thought a lot about those two prayers, particularly as we face struggles related to our aging parent.  Tomorrow, on Thanksgiving,  we can pray "Thank you, thank you, thank you." Goodness knows, in the days ahead, we'll be praying "Help me, help me, help me."  And that's a good thing, too.

Tuesday, November 19, 2013

Eldercare Tip: When Crisis Comes to Your Aging Parent, Try Prayer

"Whisper a prayer in the morning..."

In the sixties I first sung these lyrics as a teenager in church youth group. Every Sunday someone would request it. Over the decades, as I grappled with life--including struggles with my aging parents--that chorus came to me again.

"Whisper a prayer at noon.  Whisper a prayer in the evening, t'will keep your heart in tune. "  Though simple, that song has meant the world to me, especially at life's crossroads.  Particularly as my siblings and I faced difficult decisions dealing with Daddy and Mother.

Daddy struggled with Parkinson's.  A few months before he died, my brother, sister and I were forced into a corner.  Daddy had contracted pneumonia due to aspiration.  His doctor said he might be able to prolong his life somewhat--and the key was somewhat--by installing a feeding tube.  But was it worth the effort? I remember feeling helpless, torn over what to do.

Perhaps you've felt a bit like this.  We all seem to be caught off guard when we suddenly must make decisions for our parents that are so hard, and it many cases, so final.  In my case, I struggled.  I agonized, and finally, I prayed.

I had no magic words.  Or barely any words at all.  But I'd been taught by my father and mother to pray early on, so pray is what I did.

Sitting in the presence of God and advocating for my parents was scary, at first.  I fidgeted.  I daydreamed, but finally I began to "get it. " Hadn't we been advocating with doctors, nurses and other authority figures on our parents' behalf?  And wasn't God more reliable than these flawed humans?

Lifting up my parent to God's loving care was better than magic.  We kids didn't have to play God or make faultless decisions.  Our role was to be God's instruments, used by Him and guided by Him.

We decided to consult Daddy about the decision.  Jim, my brother, told him about the procedure, and said, "We want you to help us decide.  Do you want the doctor to do this?"  Daddy nodded.

Prayer may not have changed the outcome;  Daddy's life was probably not lengthened by much.  But the practice of giving God my parent--and realizing that my brother and sister were doing the same, made all the difference in the world.

Tuesday, October 29, 2013

Eldercare Tip: 'Respite' Can Save a Caregiver's Life

Caregiving day in, day out, is a recipe for stress.  If you care for your aging parent, you know firsthand.  Ditto if you watch one parent caring for his or her spouse.

Taking a "respite" is essential.  The word literally means a rest.  Today that rest can take several forms:

1.  Every day respite:  Breaks--for several hours at a time or even a day here and there--are critical for the caregiver to survive.  Family members or paid caregivers can come to the rescue.  So can adult day centers, or home care providers.  You can find respite type resources at local senior centers.

2.  Longer chunks of respite time:  The caregiver may need or want to take a vacation.  Take one of my clients, Mary.  She had cared for her husband, who had suffered several strokes, for a decade.  This last summer she had a chance to go to Canada on a "girls retreat" with her daughters, granddaughters and her sister.  But what to do with her husband?  She moved him into an assisted living community under "respite" status.  In this case he stayed for a week.  (Respite stays are typically up to one month.) She returned rested and with many stories to tell.  The bill for his care was $200 a day; the whole family said it was worth every penny!

3.  Extended respite at home:  Sometimes it's easy for an ill parent to stay at home with a paid caregiver.  Home is familiar, and possibly the best place for him or her to stay while their spouse is away.  This option is the most expensive, however.  Home Care agencies charge about $300 a day for live-in caregivers.

There are other creative alternatives that can help bring respite to the caregiver.  Family members can pitch in to care for Dad or Mom for a few hours--or a few days.  Or mix paid and unpaid help to relieve the caregiver.  Do whatever works.

Tuesday, October 22, 2013

Eldercare Tip: Stop, Look and Listen for Better Visits With Your Parent

Sometimes focusing on the simple is best.  Especially when we're visiting our aging parent.  Our goal in a visit is to communicate love and acceptance and to discern any changes that are going on in their lives.  We want to help.  Sometimes that's hard to do.

I'm hoping these simple ideas will spark others that will help you as you visit with your parent.

Stop.  In many ways, we Boomers run at warp speed. We cram a million things (it seems) into a day.  Our aging parents, on the other hand, focus on one or two main tasks.  We walk faster; we talk faster; we think faster (not necessarily better, just faster.)  We're the hare; they're the tortoise.  Our communication works best if we slacken our pace to match theirs.  Simple things can make them feel at ease.  Talk a little slower, for example.  Avoid multiple questions and instead stick to one subject. When we walk with them,  dropping our speed allows them to keep up with us.  That's key to their self esteem.

Look.  Be aware of changes that are taking place in your aging parent.  If your parent has always resembled the crumpled Oscar Madison in "The Odd Couple," a messy house is part of his character and DNA.  But if he had prided himself on majoring in "House Beautiful," a sudden change in housekeeping might mean he's slipped into depression.  Look for other things that signal that a change:  the refrigerator growing indoor green plants, or your parent wearing the same clothes day after day.  When you gather facts that don't add up, you'll want to talk to someone, and at some point approach your parent with your concerns.

Listen.  When another Boomer asks, "How are you doing?"  your automatic answer is probably, "Fine," even when you're not so fine.  Your aging parent has removed his or her social filters, though, so when you ask that same question, "How are you doing?"  be prepared to listen carefully to several minutes of medical issues such as medication changes, upcoming surgeries, and a litany of aches and pains.  Your parent is focused on the physical, understandably, and that probably won't change. The best thing we can do is to really listen, even when we're not excited about the topic.  Forget the I-Phone, the clock on the wall or the television screen.  Focus on him or her.  When you do, surprises sometimes happen.  Stories emerge, entertain, and excite.  Happy listening.

Wednesday, October 16, 2013

Eldercare Q-A: My Parent is Very Sick, Maybe Dying. What Do I Say?

Your parent has heard some grave words from the doctor.  Life threatening words. You want to be supportive.  But how?

Will Schwalbe, author of  "The End of Your Life Book Club," wrestled with that dilemma.  His mother was struggling with pancreatic cancer.  As they sat in the waiting rooms together, they talked about the books they were reading. And a book club of two was formed.

One book they read was "The Etiquette of Illness," by social worker and psychotherapist Susan Halpern.  Schwalbe says about Halpern's book:  "It's really about what to do when you feel scared that doing something, if it turns out to be the wrong thing, might be worse than doing nothing at all."

After finishing Halpern's book in the middle of the night, Schwalbe scribbled down on a scrap of paper three things he didn't want to forget.  The next morning he began using them with his mother. Perhaps they'll be helpful as you support your parent.

1.  Notice the difference between "How are you feeling?" and "Do you want to talk about how you are feeling?" The first approach is intrusive and demanding, the second gentler, Halpen says. Your parent may not want to talk about how he or she is feeling for a number of reasons:  possibly he or she is having a good day and doesn't want to be the "sick person."  Or maybe it's a bad day and he or she wants to be distracted by talking about something else.  Or maybe your parent is getting tired of answering the same question all day long.  Giving your parent a choice about conversation is empowering.

2.  Don't ask your parent if there's anything you can do.  He or she may not want to burden you.  Or your parent may find that thinking of ways for you to help is more trouble than it's worth.  Instead, suggest things, or if it's not intrusive, just do them.

3.  You don't have to talk all the time.  Sometimes just being there is enough. Depending on their preference, you might touch their shoulder or hold their hand.  Sometimes reading their favorite Scripture or poetry aloud is good.  Bottom line, trust your knowledge of your parent.

I'm still reading "The End of Your Life Book Club."  I'll keep you posted on any other tips I discover. Can you think of any other tips for communicating with parents who face life-threatening illnesses?

Wednesday, September 25, 2013

Eldercare Truth: When Making Decisions for Your Parent, Trust Yourself

Decisions, decisions.  If you care for an aging parent, you've got so many decisions.  In-home help vs. retirement living, assisted living vs. an adult family home.  It's enough to drive you nuts!

I work with adult children who make huge decisions on behalf of their parents.  Usually, I'm helping them find an assisted living community or an adult family home that will provide comfort and care.  I listen to their desires, their parent's needs and wants, and of course, we talk about money and location. Then we tour.  More questions surface, and sometimes the "deal breakers"--the things that initially seemed so important--drop off as we see various options.

Often my clients will ask, "If this was YOUR mother, which one would you choose?"  Good question, except I can't answer it for several reasons.

First, my mother has been dead for nine years.  But more importantly, mothers and fathers differ widely in their tastes.  If your parent typically vacationed in a tent when you were growing up, he or she might not feel comfortable in a posh assisted living with all the bells and whistles.  Some elders love communities that remind them of cruise ships on land; others prefer those that resemble country lodges, and still others opt for the bed and breakfast type.

So how do I answer that question, "If this was YOUR mother, which one would you choose?"  I say something like, "Only you can answer that question.  But as you look around enough, you'll know.  You'll be able to picture your parent in that place."

And you know what?  It works.  At least almost all the time.

Monday, September 23, 2013

Eldercare Resource: Support Groups Need These Things to Work

If you care for an aging parent, a support group could help.  Support groups bring people together who might not otherwise know each other, for the purpose of offering specific assistance and encouragement. Effective groups have:

1.  A purpose or purposes--Some focus solely on encouraging members to share their journey with their aging parent or loved one.  That means expressing their feelings, and discussing the direction they see themselves going. The Biblical phrase: "Rejoice with those that rejoice and weep with those who weep," describes this group. Other groups allow members to give feedback to the person who shares.  Still others have an educational thrust, offering information about aging, the disease process, and specific community resources available to caregivers.

2.  A leader who combines strength and compassion--He or she knows the group's purpose and invites participants to join in. When someone speaks too long, monopolizing the group's time, the leader gently yet firmly insists that the person stop so everyone can speak.  I've led support groups, and I know that a leader sometimes breaks the rules effectively.  When a member was suffering with fresh grief,  perhaps having just heard a difficult diagnosis, or having recently placed a parent in a nursing home, I knew they needed more of the group's time to process their feelings.

3.  Defined structure--Support groups work best when they meet at least once a month, at the same time.  Generally an hour to 1 1/2 hours works best. Depending on the group, members may want to exchange email addresses and/or phone numbers, so they can check on each other in between sessions.

You'll note I didn't require that the group leader have an advanced degree in social work.  That preparation would be nice, but effective group leaders often have backgrounds in teaching, nursing, or other types of "people work."

Do you have any experience with caregiver support groups you'd like to share?

Tuesday, September 17, 2013

Dementia Tip: Your Loved One Jumbles the Facts? Slide Back Your Chair

If your parent has dementia, it can be tricky when a care provider asks him or her direct questions.  The nurse says, "Do you have times when you can't make it to the bathroom in time?" Your parent answers, "No."

You know otherwise. So how do handle the dementia version of the facts?  Two responses immediately spring to mind.  Contradicting your parent in front of an authority--even if you're right--doesn't work.  It sets off a chain of defensiveness.  A better way is to wait until after the formal conversation is finished to correct the mistakes in private.

Often my clients teach me things I'd never know otherwise.  Not long ago I observed a third way to handle skewed facts caused by dementia.  An adult child sat next to her father, who had Lewy Body Dementia. Across from them sat a social worker who did his "intake":  a series of questions designed to pinpoint care needs.

As the social worker began to ask questions, it became apparent that the older man's answers didn't match the reality. For example, when the incontinence question came up, the parent shook his head.  "No problems."

His daughter quietly slid her chair back a few feet.  Because of his diminished peripheral vision, caused by dementia, her parent could no longer see her body language.  She "corrected" his answers, simply by nodding or shaking her head, and taking notes on certain points that needed explanation later.

Who would have guessed that simply sliding a chair could have made such a big impact in ferreting out the truth while maintaining an elder's dignity?  We listen.  We learn.  We grow.

Thursday, August 29, 2013

Eldercare Resource: Why Support Groups Work

Never underestimate the power of a listening ear.  Whether you care for an aging parent, or support a parent who is caring for a spouse , you may need someone to hear you out.

"The greatest gift you can do for a caregiver is to listen to them," says Jane W. Barton, educator and consultant on aging issues.

Last spring our church, Seattle First Free Methodist Church, began a caregiver support group, which aims to bring listening to the fore.  I have the privilege of leading it.  The group is composed of a handful of women who care for a loved one.  For an hour or so, once a month, they become "sisters."

They tell their stories and catch up on their latest adventures in caregiving. They speak of grappling with the grim realities of Parkinson's, cancer and dementia. Group members offer advice, but only if requested.  Most important, these heroines share laughter and tears, serving as each other's cheerleaders.

Because we're part of  a church, we pray aloud for each other.  That's my favorite part.

My job is easy.  I keep order, making sure that someone doesn't monopolize.  That really doesn't happen.  I also remind everyone, including myself, of the importance of confidentiality.

Caregiver support groups are also found in senior centers,  at home care agencies and at hospitals. Wherever they are, you'll find smiles and laughter, and yes, some tears.  Listening makes the heart grow lighter.

Tuesday, August 13, 2013

Eldercare Truth: When we come up short, God makes up the difference

Ten years ago today, 10 days after his 77th birthday,  my dad died from Parkinson's. Like many other adult children,  in the weeks before and after, I suffered from the "guilties."

A chain of thoughts, common to you or others who've lost parents, or are walking with them through the end of life stage, ran though my head:

"If only I'd been able to see him one more time."
"I wish I could have done more for him."
"If only I'd been able to visit more often."

And the final and critical "If only""
"If only I'd been able to be there when he passed."

Due to a series of communications gaffes, I wasn't notified until the day Daddy died. My brother and sister didn't receive the news, either. Daddy died without family at his side.

In the midst of my "guilties" as my husband, daughter and I flew to Wisconsin for the funeral,  something interesting happened.  My grief was interrupted by a phrase that my dear friend Lupe had used years earlier to reassure me when our unruly teenage sons had pulled shenanigans. (They've since grown into responsible dads.}

I'd agonized over being a good mother back then.  And I kept being stymied at our sons' antics. Was I doing something wrong?  And how should I respond to this behavior?

Walking together through our neighborhood, Lupe reminded me that things would be okay.  God would use even my missteps for good

"God makes up the difference," she would say.

As I landed in Wisconsin and visited  the nursing home where Daddy spent his last days, the truth of Lupe's words rang true once again.  The nurses reported:. Several days before Daddy died, the staff began playing hymns all day long.  They read cards sent by some 40 members of the various congregations he had served as pastor. Many parishioners thanked him for his contributions in their lives. One card contained a photo of a handsome man in his forties.  "Who is this man?" his nurse asked.   "Me," he said with clarity.

We heard more about God's working through the nursing staff on behalf of Daddy.  They prayed aloud with him and rubbed his shoulders. They held his hand and reassured him of God's love.

No, Daddy was not alone when he died.  What we children couldn't do, others could do and did. I am incredibly grateful and assured that when we can't do our part, or when we do it less than perfectly, God makes up the difference.

Can you think of times in your relationship with your aging parent when God made up the difference?

Tuesday, July 30, 2013

As Your Aging Parent Faces Death, Four Things Matter Most

As life draws to a close for your aging parent--or for any of us, for that matter--the complex becomes simple.  Dr. Ira Byock, MD, author of "The Four Things That Matter Most," boils down the essence of end of life into four sentences:

1.  Please forgive me.
2.  I forgive you.
3.  Thank you.
4.  I love you.

Notice the order.  Forgiveness comes first. Not terribly surprising.

Dr. Byock's preface contains a meaningful quote by theologian Paul Tillich about forgiveness.

"Forgiving presupposes remembering.  And it creates a forgetting, not in the natural way we forget yesterday's weather; but in the way of the great 'in spite of' that says I forget although I remember: Without this kind of forgetting no human relationship can endure healthily."

Our job is to listen, support and affirm.  And  forgive.  As we hear these four sentences--either audibly or nonverbally--we enfold our aging parent in love.

Are any of you supporting your aging parent as life draws to a close?  How do you describe your most important role?

Friday, July 26, 2013

Eldercare Tip: The 'Pregnant Pause' Proves Silence is Golden

The Pregnant Pause.  It's a term used by journalists that can help you communicate with your aging parent.

Reporters use lulls in the conversation to discover new things.  If the person being interviewed stalls or gives only a pat answer, the reporter waits.  And waits. The silence is painful, but often, the Pregnant Pause yields information that is lucid and memorable.  I know. As a journalist I was surprised by truths born out of silence.

Your aging parent will respond especially well to your Pregnant Pause.  That's because with advancing age his or her brain slows in processing information.  Retrieving prior facts and memories takes a longer time, too, as does formulating a response.

Suppose you ask:  "How did you like the last retirement community we visited?"  He or she may give you silence. Or a canned response with no detail: "It was OK, I guess."

Resist the temptation to fill in the conversation void.  Listen! With the extra time, and the trust you've earned in keeping your mouth shut,  your parent may utter something new and vital.

I asked an elderly client a few years ago, "What is the most important consideration in your move to a new home?"  She wisely said, "I need to think about that."  The next day, she called me.  "I've been thinking a lot about what you said.  Wherever I move, I want to be treated with dignity and respect."

The Pregnant Pause paid off.  It may for you, too. Try it with your aging parent.

Monday, July 15, 2013

Eldercare Assisted Living Tip: Good Things Can Come in Small Packages

In college my girlfriends would say, "Good things come in small packages."  Usually they meant a prized piece of jewelry. Especially an engagement ring.  Today when you search for eldercare for your aging parent, you can find hidden treasures by thinking small.

Smaller retirement and assisted living communities may not have the largest buses, or the fullest social calendar.  They may not serve steak as often or bring in live drama. But their small size has other pluses. With fewer people living together, elders often have an easier time meeting others, making friends and building strong relationships with staff.

Here is one of my favorite stars in the world of smaller communities.

The Gardens at Juanita Bay, Kirkland, Washington--With just 48 apartments, this not-for-profit assisted living community is the epitome of friendliness.  Much of that comfortable feeling is due to many staff, including management, working there for years.  Dinner is delicious, by the resident's count, if not very fancy. Pretty much everything is made from scratch, and focuses on American favorites. The outdoor gardens here are beautiful, especially in the summer.  And inside, the light-filled rooms are decorated in interesting themes.  Apartments are small, but residents don't seem to mind; they see the whole community as their home.

Do you have a favorite smaller assisted living community?  Tell us about it.

Tuesday, June 25, 2013

'Spending Down' to Medicaid: Three Easy Tips

Medicaid financial qualifications differ from state to state.  Some states have an income limit; some have an asset limit; and others, like Washington State, have both. If your aging parent needs care, or will in the near future, and funds are low, your first step is to do an online search on "Medicaid qualifications (your state)."

Once you have your state-specific numbers, you can begin to help your parent spend money on Medicaid-allowable expenses. The process is called a "spend down."  Here are some ideas (I'm assuming you have financial power of attorney.)

1.  Spend for your parent's future needs.  If  your parent could use a new television, an easy chair, or some new clothes, now is the time to go shopping.  Once he or she is on Medicaid,  the money will be gone. If it's hard to anticipate future clothing needs today, you can purchase gift cards for use later.  Within reason, you can buy gift cards in small amounts to use for relatives' birthday gifts, going out to dinner, etc.

2.  Plan for your parent's passing.  Most states allow people to purchase burial plots. Many states permit people to buy prepaid funeral plans or funeral trusts.  Check with your local funeral provider to see what type of plan is allowable and how much money your parent can spend and still comply with Medicaid rules in your state.

3. Purchase a small life insurance policy in your parent's name.  Most states allow policies of about $1500 to be paid for out of the spend down funds.

These ideas are starters.  Good luck!

Wednesday, June 19, 2013

Spring Cleaning for an Eldercare Blog? Now Information is Easy to Find

Yay! With just hours left until summer, I finished my spring cleaning.  Not on my closets or cupboards or floors, but on my eldercare blog.  I've added new categories or labels which should help you locate the information you need to grapple with issues relating to your aging parent.

Here are new categories that reflect my research over the last three plus years.

1.  Adult Family Homes--This label discusses one of the fastest growing senior care options, especially helpful if your aging parent is very frail.

2.  Affordable Housing--This label explains the types of low-income senior housing, how to apply and why these options are workable for seniors with limited means.

3.  Assisted Living--Another  popular option, that has pluses for many elders, but minuses for others.

4.  Caregiver Helps--Many of you are caregivers for your parent, either part-time or full-time.  Or you have one parent caring for a spouse.  Either way, you need support and encouragement. These posts offer that.

5.  Dementia--This label discusses various issues related to dementia, such as how to communicate with someone who has dementia, how to find care for them, etc.

6.  Eldercare Referral Agencies--This is a rapidly growing service which offers free help to families looking for care for their loved ones.  There are posts on questions to ask if you interview a referral agency, on explaining the new rules in Washington State governing such agencies, etc.

7.  Medicare/Medicare--Posts explain the difference between the two.

Let me know if these categories make it easier to access the help you need.

Friday, May 24, 2013

Caregiver Tip: Five Minutes to Sanity, From One Who Knows

Caregiving for a parent or spouse is a recipe for stress.  But the last thing you need if you're in that role is another piece of advice on caring for yourself.  No matter how well intentioned, that suggestion can sound like an assignment. Or an order. Unless it's from someone who knows your pain.

Two days ago I heard about the "Five Minute Plan" created by a caregiver named Sammy. Jane Barton, who speaks to caregivers and senior care professionals nationwide, told Sammy's story. One day after a speech,  Sammy came up to Jane. Sammy was the picture of vibrancy, with bright red hair and a knockout smile.

"I enjoyed your talk, and I learned many things," Sammy said.  "Would you mind if I gave you some feedback?"

"I'd love it.  Tell me about your story first."

For years Sammy had cared for her husband who had Huntington's Disease. Her three children were all at risk for the debilitating disease.  Recently Sammy's mother had suffered a stroke, giving Sammy one more person to care for. To pay for the family's needed health insurance, Sammy worked full time. Her plate was as full as it could be.

"How do you manage all that?"  Jane asked.

"Fine.  But it's because I have the Five Minute Plan."

The Plan goes like this: At 8:00 am Sammy locks herself in the bathroom.  Pulling out her I-Pod and earphones, she listens to inspirational music. She loses herself in the beauty of the sounds and the words.  For five minutes, she doesn't think about doctor visits, or bills, or medications.  She's free.  At 8:05, she faces the day renewed.  "I know I can tackle what I need to do, as long as I have my five minutes."

Jane remembers standing in awe of this woman.  She only had one suggestion:  "As good as you feel after five minutes, do you think you could stretch it to ten minutes?"

Sammy broke into a smile.  "I don't see why not.  I've always been an overachiever."

If you care for an aging parent or spouse, do you have any specific ways you keep your sanity?

Monday, May 20, 2013

Help for Caregivers: Free Counseling Comes to the Rescue!

Attention, caregivers!  If you're not sure whether you fit this description, think again.  Do you provide transportation for your aging parent?  Do you do laundry, run errands, or clean house, so your parent can maintain independence?  Do you monitor your parents long-distance, making sure they're safe?

These are all forms of caregiving,  Day in and day out, these tasks can put you in the danger zone for stress.  Fortunately, though, geriatric professionals across the country are recognizing the need to keep caregivers healthy.

In Washington State,  for example, unpaid primary caregivers living in King County can get up to six in-home counseling sessions free, through a new program funded by Seattle-King County Aging and Disability Services.  The focus is on problem-solving, self-care, stress management and positive change.

Caregivers don't have to put in 40 hours a week to be eligible for the free counseling.  They don't have to live with the friend or loved one they care for.  The elderly person can even reside in an assisted living community or adult family home, anywhere except a nursing home.  There are no income restrictions on the program, either for the caregiver or for the elderly person.

This program is dubbed as "Starbucks Therapy" by Kelly Holiday, LMHC, GMHS and Angela Martin-Davis, RN, MHP, GMHS, Clinical Supervisors of Evergreen Health Behavioral Health Services, which sponsors the program.  Counseling sessions often take place, not at home, but in a relaxing place like a coffee shop.  Sounds like just what the doctor ordered!

Caregivers living in King County can schedule their visits by calling 425-899-6300 or 1-800-548-0558.

Monday, April 29, 2013

Eldercare Tip: Ideas on Writing Thank You Notes for Mother's Day

With Mother's Day approaching, you may be stumped for a gift idea.  Does your aging mother need any more clothes to fill the already stuffed closets?  Or jewelry, or slippers or a robe?  Probably not. How about a thank you note to show appreciation for who she is and what she has done?

Thanking your mom is important.  Why?  She can read and reread the words and be assured of your love, even when you are far away.  A thank-you also shows your acknowledgment of the wonderful things she has done for you and your family, even long ago.

To start, make two lists:  BEING and DOING.

1.  Under BEING, write adjectives that come to mind when you think of her.  Perhaps loving, patient, kind, hard-working, other-centered.  These, and other words you think of, show her essence.

2.  Under DOING, write specific things that she has done for you and for other members of the family.  My mother-in-law's list includes driving an hour to attend all our family functions and making pies, even when she might prefer to retire from the job.

3. Now COMBINE the lists into sentences.  Here's a sample.  I'm going to ask other members of our family--adult grandchildren and great-grandchildren--to write their own.

We don't take time often enough to tell you how much we love and appreciate you, Mom.  You have been a source of loving support to three generations:  your children, grandchildren and now, great-grandchildren.  We love your generous gifts, whether they are afghans for new babies, or homemade jam or pies.  

More than that, though, we have wonderful memories of you rocking babies, attending all our family dinners, and even trying to teach our boys how to make pies.  Hard working, loving and kind are a few words we could use to describe you.  But they don't say it all, by any means.  

Happy Mother's Day, 

Wednesday, April 17, 2013

Eldercare Resource: Finding a Great Senior Care Referral Agency

"I could tell it was going to be a terrible, horrible, no good, very bad day."  These words of six-year-old Alexander in Judith Viorst's read-aloud book ring true for many of us Boomers as we face obstacles relating to our aging parents. We're tempted to say, with Alexander:  "I think I'll move to Australia."

We don't wake up with gum in our hair, or lose our best friend, or get tricked out of our life's savings by a pesky big brother. Instead, we get a wake up call:  our parent has had a stroke, broken a hip, or needs more care.

Pulling the blankets over our heads won't help.  Yet there's no doubt that finding excellent care for your parent is daunting.  In King County, where Seattle is located, there are nearly 1100 adult family homes, plus hundreds of assisted living communities and home care agencies.

A senior care referral agency often will help.  Referral agencies help people find in-home care, retirement or assisted living communities or adult family homes. At their best, these agencies save time, energy and even money. Yet they're not all alike.

An excellent senior care agency:

1. Thinks outside the box and sees the person as paramount.  Silver Age Housing and Care Referrals, where I work, meets with families in person, including the elder when possible.  Often the question: “What’s going on now?”  unleashes a torrent of response.  Then comes an extensive discussion, about diagnoses, medications and physical needs.  But there’s more.  Your aging parent is far more than the sum of her maladies.  He or she is unique, enjoying things that make life worth living. Not long ago, the daughter of an 93-year-old woman asked Silver Age to find an adult family home in a specific geographic area that would accept a cat, and allow a conversion to Medicaid funding. Very few adult family   homes accept pets, so the search began in earnest. Today, though, both Mother and her cat are now happily settled.  Ditto for a 90-something married couple, who needed assisted living for him, and future memory care for her, in a specific area of Seattle.
2. Pre-qualifies housing and care providers.  Excellent referral agencies are committed to visit adult family homes and assisted living communities in person, and to enter their information into an extensive data base.  At Silver Age, our database contains profiles of 900-plus providers:  home care agencies, retirement and assisted living communities and adult family homes.  It includes licensing and inspection records,  level of care services provided, source of payment accepted, and more.  When a family says, “Mother speaks only Chinese; can you find a place for her on the Eastside?”  we can.  We know which homes accept pets, smokers, and diagnoses with difficult behaviors.
3. Tours with the family and connects them to resources.  Some referral agencies schedule tours with providers and send the family out on their own.  The best agencies make it a practice to accompany clients on visits and provide transportation.  Often the time in the car in between communities or adult family homes is productive for discussing what the family liked, didn’t like and what questions might remain.  Silver Age continues to tour with families until they find the home they like best.  When questions arise during the decision-making and move-in process, we will refer clients to elder law attorneys, movers and health care professionals.

A senior referral agency won't do all your work for you.  But a good one will help tremendously.  Most of all, you will feel less alone.  And less like moving to Australia.  Although maybe that's not such a bad idea?

Friday, April 5, 2013

Two Ideas on Talking With Your Parent Who Has Dementia

If your parent has dementia, chances are you know the frustration of wondering how to communicate. Especially when your parent says something that's simply not true. Or totally unreasonable.  For example, a woman may say, "I'm worried that my husband won't come to pick me up," when her husband has been dead for years. Or she refuses to take a shower, when she's always been fastidiously clean.

Two tactics can help.

Tactic #1:  Refuse to correct.  It's better to be silent than be right, since the conflict you set up in correcting her increases tension between you.  If she believes that her dead husband is still alive and starts looking for him, it's best not to say, "Your husband died."  Even though it's true. That statement can either trigger a resurgence of grief or an argument over whether her spouse is dead or alive. Instead, you can either say something neutral, like "Oh," or "Tell me about him" or "You must love him very much."

If your parent makes a misstatement with a health care provider, resist the impulse to tell the doctor, "It wasn't that way," or "She's wrong about that."  I've seen lots of well-intentioned adult children correct their parent in front of the doctor, only to spark an anger attack because the parent feels disrespected. Doctors and nurses know that the report of a person with dementia isn't going to be 100% accurate.  Not even close. You can make any needed corrections later with the provider in private.

Tactic #2:  Remember the Five Minute Rule.  Caregivers who work with people who have dementia know their memory is often short. That's why they refer to this as the Five Minute Rule. Your parent can refuse to eat, to take a shower or to get dressed.  Rather than fighting, which ups the stress level, it's best to leave and return in a little while to make the request once again. Often time will change their reaction.

Can you think of other strategies for communicating with a parent who has dementia?

Saturday, March 16, 2013

Assisted Living or Adult Family Homes: What's the Difference?

If your adult parent has become increasingly frail and needs a high level of care, there's good news. For the last 20 years, nursing homes throughout the country have been replaced by cheaper and more homelike alternatives.  Those are adult family homes and assisted living communities.

Do you know the differences between the two?

1.  Size--An adult family home cares for as many as 6 residents--a higher number in some states.  At least one or two caregivers are responsible for residents during the day, and one at night.  Assisted living communities often have between 40 and 150 residents and have a lower staffing ratio:  one caregiver to 12 or 15 residents with higher staffing for heavy care assisted living communities. They also have support staff including food services, activities, environmental services, etc.

2.  Cost--Adult family homes in the Seattle area range from $5000 to $7000 or slightly more per month.  Assisted living communities' monthly often start lower:  at about $2000 for a studio plus care, but can go as high as $12,000 for someone on hospice. 

3.  Residents--Adult family home residents are generally frail, in walkers and wheelchairs.  The small physical area is helpful to these elders who would have difficulty navigating the long halls of an assisted living community.  Many residents in an assisted living community often can do much for themselves.  Perhaps they only need medication management, help with a shower, meals and housekeeping.  Some communities allow residents to "age in place," staying there until their growing needs become too great for staffing levels.

3.  Care--Adult family homes often have an on-call Registered Nurse who trains staff to do tasks such as insulin injections and medication administration.  These homes generally offer higher levels of care than assisted living communities, and can often care for residents through end-of-life. Assisted living communities vary widely in what tasks they can perform.  Some can't serve residents who can't transfer by themselves or who need insulin injections or specialized diets.  Other communities offer extremely high levels of care, and some also have a section devoted to memory care for residents with dementia.

4.  Social Activities--Adult family homes generally offer activities tailored to their residents' special interests:  puzzles, books on tape, live music, etc.  A few adult family homes have traveling activity directors who lead residents in tea parties, craft-making sessions, flower planting, etc.  Assisted living communities, with their generally more active residents, offer trips, tours, shopping, church services, etc.

Sometimes a resident could fit into either an assisted living community or an adult family home.  For example, a woman I'm working with lives in an assisted living, and her family wants her to move closer to them.  We thought about an adult family home, since she is 93 and has some dementia.  But she is social, likes to know the news about everything, and enjoys a variety of caregivers and other staffers.  So her family has chosen a smaller assisted living community, one that can offer heavier care when she needs it. 

Do you have questions about the difference between adult family homes and assisted living?


Monday, March 11, 2013

Eldercare Book Review: How to Care for Aging Parents

Remember Dr. Benjamin Spock, the child-raising guru?  When baby wouldn't stop crying, we went to Dr. Spock's tome, "Baby and Child Care." Ditto when potty training drained all our energy.

Now many of us care for our aging parents.  The issues are daunting:  medical, legal, financial, and relational.  One great book that covers these issues is Virginia Morris' "How to Care For Aging Parents."  Although the second edition was published in 2004, its main tenets are still true today. Morris' tone is loving, respectful and practical. Another plus:  she sprinkles  anecdotes of real-life situations throughout the book to drive various points home.

"Be Prepared" seems to be Morris' mantra.  She advises, "The most important thing you can do for your aging parent and for yourself is this:  Be prepared for what might come." 

Specifically. she says:  If your parent's arthritis is worsening, talk with him about what he might do if he can't manage alone. 

If your mother has Alzheimers, talk about her wishes for her future and where she will live once the disease has advanced.  And start making plans. 

Morris tackles difficult subjects including dealing with guilt, sibling conflicts, getting Power of Attorney, caregiving from a distance, an explanation of hospice and more.  She even includes a chapter on funeral preparations, and another, for Boomers, on preparing to grow old.

Morris advises adult children and others involved in the care of elders to resist reading the whole book from start to finish. Instead, she encourages readers to use various chapters as needed.

This book is a great reference book for those times when caring for your aging parent has drained your energy, and you don't know where to turn.

Have you found a resource book to help you with your aging parent?

Monday, February 25, 2013

Boomer's Guide to Eldercare Turns Three!

Congratulations, readers!  Boomer's Guide to Eldercare turned three this month. Without your support--and your reading these posts, I would have quit writing long ago.

I've appreciated your cheerleading.  Some of you are paid to work with seniors and their families.  Others are personally grappling with issues related to your own parent. In either case, my goal is provide help and support.

Here are some of the most popular categories, with a sample post:  Enjoy!

1.  Obtaining affordable housing:

2.  Writing a thank-you note to your parent's caregiver:

3.  Using a senior referral agency:

4.  Selling Your Parent's Home:

5.  Understanding Your Aging Parent's Two Developmental Tasks:

Thursday, January 31, 2013

Eldercare Q-A: Mom Won't Take Her Meds: Must She Move to Assisted Living?

Question:  "My 93-year-old mother lives in a retirement community and does everything for herself--bathing, dressing, you name it.  Except she forgets to take her medications.  Must she move to assisted living?"

Answer:  Not necessarily.  If a senior is competent and wants to take their medications, but simply forgets,  there are some wonderful solutions that don't involve moving to assisted living or hiring home care workers.

Picture a pillbox with alarms that can be programmed to remind your parent to take his or her medications.  Some beep, others buzz, still others ring or vibrate.  Some models allow you to record the message in your own voice. And some let you program other messages such as, "Please walk the dog," or "It's time to call your daughter." 

The alarm pillboxes range from about $40 for a simple model to over $300 for one with all the bells and whistles. For many, these high tech wonders work magic.

"This reminder system has enabled my grandma to stay at home," a friend of mine told me recently.

Check out this link, and see what you think:

Saturday, January 26, 2013

Retirement Communities: Why Your Parent Resists Moving

Retirement community. Say these words and your aging parent winces, or goes into a tailspin. Karl Pillemer, Ph.D. and author of "30 Lessons for Living:  Tried and True Advice from the Wisest Americans," speculates why that's often the case.

In researching his book, Pillemer asked 1000 Americans aged 65 and older, "What are the most important lessons you have learned over the course of your life?"  Their answers covered lots of ground, from how to stay happily married, to how to raise children, from how to grow old gracefully to how to live without regrets.

Regarding retirement communities, Pillemer discusses reasons why seniors resist moving from their home.  First, their home is a symbol of independence, one which they sacrificed mightily to own. Second, many seniors fear a loss of privacy, thinking that retirement community living may be invasive. Growing up, your parents' generation typically went from their parents' home into marriage and raising their own children.  As young adults, they didn't usually live in group settings such as dorms, apartments or fraternities like many of us did. So the idea of living in a community seems unnatural.

Around 150 of the seniors participating in Pillemer's book live in senior living communities of some kind.  Even though many were reluctant to make the move, once settled in, they liked it, says Pillemer.

 "With very few exceptions, they described the move from their home to that location as one of the best decisions of their lives."  A supportive setting allowed them more freedom to participate in meaningful activities and build strong relationships.

If you have parents on the fence, Pillemer suggests showing them the following stories.  I've shortened them a bit, but hopefully they'll still be helpful if your parents are undecided.

Edward Horan (not his real name), 77, and his wife discovered new opportunities upon moving to a retirement community.  He says:

We take our meals in the dining room, so we're with other people at least twice a day.  I didn't realize how much I missed the fun of being with people on a regular basis.  Being in community with them, sharing, well, about as many activities as you're interested in.  We have exercise every morning, which is good physically and good conversation.  There's the pool, and billiard players get together each morning, and a bridge group.

Ron Hutton, 90 and widowed, moved to a retirement community and found a new life.  He offers the following advice to his peers who are unsure about moving to a retirement community.

"So I'd say you need to get a life.  Do something.  Take pictures. Oh my God, have something to look forward to.  For example, I'm going to take this painting class.  I've always wanted to take it.  This community does a pretty good job.  I get up in the morning sometimes feeling pretty disconnected and depressed.  I get dressed.  I come down to breakfast, and I don't go back depressed."

Have you talked with your aging parent about retirement communities?  If so, what are their thoughts?

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