Sunday, December 28, 2014

Untangling the Senior Housing Maze? Here's Help

Look in a directory of senior and care housing options, and you may get lost in the words.  So many options it's a little like a toddler in a 31-flavor ice cream store.  The good news is that there's an abundance of help for your aging parent, whether you're looking for the future, or for next week.

There are many options besides a skilled nursing facility.  Here's a list.

1.  In-home help--Home care agencies provide a gamut of services, from housekeeping, home maintenance and yard care, to companionship and help with personal care, such as bathing and dressing.  This help typically runs about $25-$27 an hour, and works if the senior has scheduled needs. 

2.  Senior housing--This is for very independent seniors.  There are usually no services or care, just a group of older people living together in community.  Often they're located near senior centers or other community resources.  Pricing varies widely.  Samples:  HUD Housing (for very low incomes), Affordable Housing (for low to moderate incomes), Senior Condos, 55 and older apartments. 

3.  Retirement communities--Meals, housekeeping, activities and transportation are routinely offered as part of the monthly fee.  If seniors need help with bathing, dressing or medications, they typically contract with a  home care agency.

4.  Assisted living communities--In addition to services of a retirement community, assisted living communities provide 24-hour emergency and personal care help. There is a huge variety in programming.  Some are premised on a social model, emphasizing activities and others on a medical model, offering very heavy care.  In many states, assisted living communities can perform duties that once were only available in a nursing home, such as two-person transfers (when your parent needs two people to get him or her out of bed or out of a chair), and diabetic insulin care.   
5.  Retirement/assisted living communities--This type of community is a combination of the two previous options, allowing residents to move in when they are still quite independent and "age in place," receiving more services as their needs grow.

6.  Continuing Care Retirement Communities--These often require an entrance fee of anywhere from about $100,000 to over a million dollars. Some entrance fees are wholly or partially refundable. Monthly fees are usually lower than in a rental retirement community. Seniors moving in are generally younger and more active.  As their needs change, they can move to other sections of the community for assisted living and nursing care.

7.  Memory Care--Some assisted living communities have a special section to residents with moderate to severe memory issues.  Other communities serve only people with dementia.

8.  Adult family homes--This type of care is not available throughout the nation.  In Washington State, these homes can serve at most six residents.  Usually two caregivers are on site to provide care.  Adult family homes can offer virtually every type of care provided by a nursing home, with the exception of IVs and ventilators.   Because the house is small,  this setting is particularly good for those who need 24-hour direct supervision.

Good luck in untangling the senior housing and care maze!  If you need help, post a comment below, and I'll contact you.

Saturday, December 20, 2014

How Your Aging Parent Plays the Holiday Waiting Game

Everyone waits during the holidays.  But especially your aging parent.  You wait for the crowds to dissipate and the to-do list to be checked off.  Your parent's waiting is often darker.

Perhaps he or she longs for a body to mend.  Or a family relationship to heal.  Or the constant loneliness and depression to go away.  And often that waiting makes the days seem long and the nights even longer.

My dad died in 2003.  During the holidays, and at other times during that last year, his waiting was plagued by doubts--about himself and about his relationship with God.  "I don't see how God could ever forgive me," he'd say, and "I'm good for nothing." Funny, since he'd been a pastor.   I wish I could have chased those blues away, but I couldn't.  I could only say, "I'm so sorry.  I'm really so sorry." 

I did remind him of something he'd told me all my life.  "Nothing can ever separate us from the love of God."  Looking back, I wish I'd reminded him of a holiday story straight out of the Bible, in Luke 2, of two elders who knew all about waiting.

Simeon, an older man, visited the temple in Jerusalem every day, waiting for the coming of the Messiah.  One day he was led to go to the temple where he spotted Mary, Joseph and baby Jesus.  Immediately he recognized that this child was no ordinary baby.  He blessed Jesus, and said to God, "...Let your servant go in peace, according to your word, because my eyes have seen your salvation."

Anna, another elder, was an 84-year-old widow, who never left the temple.  Daily she prayed, fasted and waited on God.  The day Jesus and his parents showed up to see Simeon, she approached and immediately knew this was the Christ she had waited for.

Besides the shepherds, these elders were the first to see Jesus.  In their frailty, they could relate to the tiny baby who was their Savior.  I have an idea God didn't take away any physical pain they had, or give them a perfect life.  But He gave him a glimpse of Himself, which is what all of us--old and young--want and need. 

Waiting is hard--for all of us.  But it's good we don't have to wait alone.

Tuesday, November 11, 2014

Is Your Parent a Vet? And Caring for a Spouse? VAA Program Can Help

For years I've joined senior care professionals around the country in touting a national program called Veterans Aid and Attendance.   It targets wartime vets, now age 65 or over, who served in World War II, the Korean Conflict and the Vietnam War,  (also the Gulf War), helping them pay for personal care at home or in group care settings.

It's a laudable program which helps many vets fill in the gap between the high costs of medical care and their fixed incomes.

Just yesterday, though, I discovered a wrinkle in this program.  And a great one.  The spouse of a wartime veteran can also get financial help for medical expenses, to the tune of as much as $1348 a month.

The idea makes sense:  Helping the spouse aids the caregiving vet in battling the stresses which accompany that difficult role.

The program has limits on income and assets.  In addition, the disabled vet or spouse must need help with activities of daily living, such as bathing, dressing, eating, etc. 

Pass the word along:  to any older disabled vet or an able-bodied vet caring for a spouse.  Perhaps your parent could benefit. For more information, contact

Sunday, November 2, 2014

Touring Assisted Living: Tips to Make the Minutes Count

You're busy, but you've got a job to do:  find assisted living for your parent that is affordable, comfortable, and hopefully filled with fun people, staff and residents alike.

This is a big ticket item, both financially and emotionally.  And you have the idea that seeing is believing.  And rightly so. So you tour. But you don't have to drain yourself doing it.  Here are some time and energy savers to make touring more productive.

1.  Do some research beforehand:  Online information is heavy on marketing, not so much on practical information or pricing. Community websites do, however, give you some sort of feel for whether your parent might feel comfortable there. Another source is the company's brochure with pricing.  Consider calling to request it.  Some communities are averse to giving out pricing information without a visit.  Try anyway.  The only potential downside to giving them your address is that the company may add you to their mailing list.

2.  Make a wish list of the "deal breakers,"  things that your parent and you must have.  Thirty minutes from your work or home? Pet friendly? Anytime dining? Within your proposed budget? These are suggestions; your list will be unique.

3.  If possible make appointments with the marketing representatives.   This doesn't rule out dropping in, just to get a feel of the building, the people and how things work,  but a specific appointment time will usually give you a better experience.

4.  Make sure you're well rested.  Tour when you're feeling the best, often morning or early afternoon.  In assisted living communities you may see more activities happening in the morning; many residents are into siesta mode in the afternoon.  Another tip to keep you from tiring:  visit one or two communities in one day.  On average, each community will take 60 to 90 minutes to tour.

5.  Keep hunger and thirst at bay.  If you have the time, ask to include lunch with the tour.  You can sample the food and watch and listen to the residents in the dining room.  If time is limited, bring water and snacks to keep your brain and body working well.  Touring is hard work.

6. Come a bit early and linger in the lobby.  Engage the residents; it's easy to do. Many will tell you exactly how they feel about living there.  Pluses and minuses:  food, care, activities, everything. Sometimes you'll run into a daughter or son, whose parent lives there.  Their words are worth far more than that of a paid employee's pitch. 

Have you heard of other tips to make touring assisted living communities easier?

Tuesday, October 14, 2014

Eldercare Options: The When's and Where's of Moving From Home

When does your parent want to move from his or her home?  Nationally, more than 90% of seniors say, "Never."  Yet that ideal doesn't always work out.  So how do you begin a conversation about housing and care, knowing there's a possibility your parent might need to move? Sometimes framing the subject of moving in terms of options allows your parent to think of it in a different light.

Many things:  health, home upkeep, finances, loneliness can affect the timing of a senior's move. Here are some scenarios to run by your parent.  Possibilities, if you will.

1.  Some people stay put and hire in-home care.

2.  Some seniors move soon while they're in good health and can enjoy the amenities, knowing health care is available later if and when they need it.

3.  Some people who care for their spouse find relief by moving to a retirement community. They receive help with domestic duties such as cooking and cleaning, and the staff can help their spouse with personal needs such as bathing and dressing.  The caregiver-spouse drops the title of caregiver, and is free to be the spouse.

4.  Others move when the cost of in-home care exceeds the cost of assisted living.  In-home care runs about $25 an hour or more in many parts of the country.  Often six to eight hours of care a day will cost as much or more as assisted living.

5.  Still others move following a medical emergency such as a hospitalization, or because a physician says 24-hour care is needed.

6.  Others may not have to move at all!

There's no magical time, but circumstances and key people in your parent's life will help him or her determine when the time is right.

Tuesday, September 30, 2014

VARIETY sums up today's assisted living choices

If your parent needs assisted living today, and he or she lives in a city or suburbs, there's one word that describes what you'll see.  Variety.  Take Bellevue, Washington, for example.  The following assisted living communities differ in size, ambiance, pricing and care.  In many US cities, you'll find similar range of offerings.

The Bellettini--Situated in the heart of the city, this posh building is home to approximately 150 to 170 residents.  High ceilings, chandeliers and huge windows add to the hotel-like ambiance. The daily schedule rivals that of a cruise ship and includes outings, travelogues, exercise classes, personal trainers, art shows and culinary demonstrations. Speaking of food, dining options include two restaurants, which are open to the public.  In The Panini, a bistro, residents can watch the chef prepare their food to order.  The Bellettini caters to people who enjoy gracious living.  They tend to be independent, but have the reassurance they can receive more care if they need it.  Apartments range in size from the compact studio to the spacious penthouse.  There's a big range of pricing, too.

The Gardens at Town Square--Gracious living is a good way to describe this community, owned by Era Living.  For more than 20 years, Era Living has partnered with the UW School of Nursing to produce active aging and wellness programs.  Residents at The Gardens at Town Square can hear up-to-the-minute research on timely topics relating to health and other subjects.  Those might range from history to horticulture, from geneaology to astronomy, all delivered by experts in the field. The UW connection also extends to the Department of Social Work.  Residents here can join support groups and receive counseling with transition issues, thanks to this program.  One favorite feature of Era communities is the quarterly art show, showcasing work of residents and local artists.  When memory issues become challenging, care is provided in a specialized memory care unit. 

Evergreen Court--Homelike.  Friendly.  Affordable.  Those words describe Evergreen Court. This community features lots of trees, and every resident has personal access to the outdoors by either a patio or a deck. A long time ago Leisure Care, a national retirement community chain, owned the building.  But now it's owned by a not-for-profit called DASH (Downtown Action to Save Housing). Independent residents at Evergreen Court meet income qualifications to live here.  Apartment rents are the lowest in the city, and they come with three meals a day, weekly housekeeping, and a wonderful activities program.  With 84 total apartments, everyone knows everyone else.  Residents are active in helping plan programming, and they volunteer as they can.  Assisted living is offered in a section of the building, and there are some Medicaid-funded apartments.

Variety is the spice of life?  In assisted living, it appears to be just that.


Tuesday, September 16, 2014

Decisions, Decisions: How to Help Your Aging Parent Make Them

Giving up the car?  Moving to an assisted living community?  Eating a healthier diet? Whatever the decision your aging parent faces, there's ambivilance. Through a process called "Motivational Interviewing," you can help your parent resolve the vacillation and commit to change.

"There are pros and cons for every decision we make," Carilyn Ellis says.  Ellis uses motivational interviewing in her work with veterans who are grappling with issues including drug and alcohol abuse.  Some are seniors. She contends that the same principles she uses as a clinician can be used by family members and others in helping seniors make decisions.

In a nutshell:  "Motivational Interviewing is collaborative conversation that strengthens someone's own motivation for and commitment to change."

Words that describe the process, according to Ellis:

  • Collaborate--rather than confront or be authoritative.  You let go of the outcome, but focus on your parent and how you can work together.
  • Evoke your parent's motivation--Discover what he or she wants, rather than attempting to persuade him or her of  your point of view.
  • Honor your parent's independence and autonomy in making decisions for their own lives.
Principles of "Motivational Interviewing":
  • Express empathy.  Use phrases like "This is really concerning to you."  "It's a hard decision."  And if your parent dismisses the difficulty, say something like "I know what you're saying.  I still think it is hard."
  • Normalize their feelings.  You can say something like "What you're going through is normal. To think about what's important to you is always OK."
  • Summarize their words.  You might say, "I think I'm hearing you say...Am I right?  Please correct me if I'm wrong."
  • Support self-sufficiency.  They need to believe they're able to make the change.  You can help by validating the steps they've already taken or validate their successes in life.  Remind them of how they overcame obstacles.
  • Roll With Resistance.  Don't argue.  If a tug of war ensues, go back to empathy.
Developing Discrepancy:  
  • The goal is for your parent to initiate the "change talk."  How can you recognize this "change talk?" Instead of using phrases like, "Living in a retirement community is good for some people," he or she might say, "I want to visit one to see what it's like." 
  • Ask evocative questions.  Some possibilities: "Let me ask you, what if you chose not to..."  Or "What if you decided to continue..."  Or "On a scale of 0 to 10, where 0 is absolutely not and 10 is absolutely committed, where would you put yourself right now?" If he or she answered, 5, you could ask, "What would it take to move you from a 5 to a 6?"
  • Ask, "What are your top three values and why?"  How does your current situation/behavior fit with these values?  Since you know your parent well, you probably won't have to ask his or her values, but say something like, "You know I know you well, and it seems to me like family (or saving money, or friendship, or...) is a huge value for you.  Right?" 
Use a gentle, supportive tone, Ellis advises.  

Much of this information was taken from Carilyn Ellis' presentation to the Certified Senior Advisors.  It was entitled "Motivational Interviewing:  Tools for Fostering Improved Motivation in Your Clients to Make Decisions and Achieve Their Goals."

Tuesday, September 9, 2014

Medicaid Myth: Spend Down Your Money and Presto! Instant Medicaid

A note to you regarding your aging parent: Running out of money doesn't necessarily translate into Medicaid eligibility.

A few weeks ago an Executive Director of a nearby retirement community emailed me.  A woman in his community we'll call Sally had lived there at least five years.  She was nearly broke.

The community had a "spend down" policy of allowing people to convert to Medicaid funding after four years of private pay.  Since Sally had lived there more than that length of time, she'd be eligible for Medicaid, right?

Wrong.  Medicaid eligibility is two-fold:  financial and medical.  Sally is totally independent, taking her medications, dressing and bathing herself, and managing her activities of daily living.

Unfortunately, she has no medical need and flunks the Medicaid test.  Sally will need to leave her current community and find low-income housing.  Unfortunately, that option generally involves long waiting lists.

The moral to the story?  Don't assume that if your parent exhausts his or her funds,  Medicaid is assured.

Wednesday, August 27, 2014

Eldercare Helps: The Other 'D's That Aren't Dementia

Dementia, the dreaded "D-word," has copy cats.  As you monitor your aging parent's health, you may encounter one or more of these.  They all begin with D, and their symptoms are similar to dementia.

Delerium--This has a rapid onset of hours to days.  The person becomes confused and disoriented, with impaired memory and possible hallucinations and mood fluctuations.  Delerium is not a disease in itself, but is a syndrome or combination of symptoms.  Delerium has a medical cause.  In elders, it's often a result of a urinary tract infection, or possibly a reaction to a drug.  Once the basic medical problem is treated, the delerium goes away.

Depression--If your parent is experiencing lack of energy or motivation, or confusion or a slowing of thought, he or she may appear to have dementia.  But the cognitive loss could be due to depression. Elders often present with different depression symptoms than do younger people. Your parent may not use the word "sad," for example, but he or she still could be depressed.  Again, this is treatable.

Damaged Brain--If someone falls--and many older adults do from time to time, they can damage their brain, leading to confusion and slowing of thought.  For awhile, they may seem demented.  Usually over time, things get better.

Developmental Delay--Elders with developmental disabilities may think slowly, speak slowly and act as though they have dementia, when they may not.

Deficient Education--If an elder only finished sixth grade, he or she may have difficulty processing language.  The slowness of thought could be confused with dementia.

All of these D-diagnoses impact cognition.   But only one is dementia.

Carilyn Ellis, MA, discussed these in a presentation for Certified Senior Advisors called "Understanding Assessments, Determinators and Diagnoses--and Challenging Doctors When Needed."

When presented with a dementia diagnosis, Ellis advises to ask the doctor, "Is there anything else it could be?"

Wednesday, August 20, 2014

"She's NOT my mom! " Tips on advocating for other elders in your life

Do you have any of these elderly "non parents" in your life?
  • A widowed or divorced aunt who never had children and whose health is faltering.
  • An aging uncle who never married.  He needs care and support.
  • A relative with failing health who has no support system except you.
Advocating for an aunt, uncle or other relative often feels different than doing the same things for your parent.  That's because the bond with our "non parents" is generally more tenuous.

Sometimes our aunts, uncles or other relatives are like clay in our hands, willing to comply because they trust us. But often they don't, chiefly because their fierce independence has propelled them through life, and they're not about to give it up. We do more second guessing of our decisions:  "What if she refuses?"  "How can we persuade her to do the right thing if she digs in her feet?"

Take Aunt Grace, our somewhat eccentric and very independent maiden aunt who lived into her 90s on millet and porridge.  Unfortunately, dementia took hold. She moved from an apartment to a boarding home, accompanied by her cat.  Eventually Daddy was called in to help move her to a nursing home.  "I'm staying put," she said.  "And so is Kitty."

The struggle was ugly.  Daddy enlisted another younger relative to give him some perspective and help. Several days later, Grace, though not happy, moved to her new digs.  The cat found another home, and Daddy came away with a faceful of scratches.

Four pieces of advice if you're in a similar  position:

1.  Seek help from friends who can serve as sounding boards for your frustrations in dealing with the situation.

2.  Consider consulting with a Geriatric Care Manager.  These professionals have experience dealing with difficult family issues and can help you come up with "next steps," even if your relative is unwilling to admit there is a problem.

3.  Be as patient as possible, knowing that your relative isn't about to give up his or her independence without a struggle.

4.  Do your homework so you know the services in your area.  That way, if an emergency arises and you need to act, you'll be ready.

Do you have experiences helping a "non parent"?  Any advice for others?

Thursday, July 31, 2014

Your Parent Has Dementia? Skip the Words; Make Some Music.

Your parent has dementia.  And he or she seems unreachable.  But wait.  The key that unlocks his or her memories and emotions may be as simple as singing a song.

"People with Alzheimer's Disease and other dementias can respond to music when nothing else reaches them," says Oliver Sacks, neurologist, author and contributor to The Oprah Magazine.  "...Musical memory somehow survives the ravages of the disease, and even in people with advanced dementia, music can often reawaken personal memories and associations otherwise lost."

In my own experience working with families and their loved ones with dementia, I've seen the power of music.  The elderly worshipers in a nursing home Sunday service nod off for most of the hour. That is, until, "Amazing Grace," is played.  And miraculously, those who normally have no words can suddenly sing the hymn's lyrics, flawlessly!  In my husband's Grandma's case, Alzheimer's took away her speech, but couldn't snatch the words of "Jesus Loves Me" from her lips.  In her difficult last days, she sang the song.  Those words comforted her, and us, as well.

The Alzheimers Foundation of America offers some suggestions on choosing music to enjoy with your loved one.

1.  Top 10 Picks:  Selections from your parent's young adult years, from ages 18 to 15, offer the most potential for engagement.  Frank Sinatra, Kate Smith, Lawrence Welk, Big Band Music can set your parent's toes tapping.  I remembered one man named Jack whose struggles with memory were forgotten when he attended a weekly dance at the senior center.  Suddenly he was 18 again and the memories flowed. "My buddies and I would drive 100 miles to those dances.  It was wonderful," he said.

2.  Unfamiliar Music:  Because it carries no emotions or memories, this type of music can aid physical relaxation or enhance sleep.  Think soft and soothing.

3.  Late Stage Dementia:  Songs from a person's childhood can comfort, relax, and demonstrate love and caring.  Folk songs in the language the elderly learned them are also powerful.  For those with religious faith, hymns can help them connect with God and with the people they love.

So sing a song.  Even if it's off key.  In the process, you may reach your aging parent in a more powerful way than words alone could do. 

Thursday, July 17, 2014

Medicaid 'Surprises' You May Encounter

Your parent has been approved for Medicaid.  Now what?  He or she will receive care in the home, assisted living, adult family home or nursing home.  Chances are, though, you'll encounter some surprises.  Here are a few:

1.  Your parent could get a roommate.  In most states, the Medicaid program is obligated to provide a shared room if available.  That isn't always possible, though.   In Washington State, many adult family rooms have only private rooms, so when a resident converts to Medicaid funding, he or she gets to stay put.  If your parent happens to be assigned to a shared room and a private room is available, it's sometimes possible for you (the family) to pay the difference between the shared rate and the private rate.

2.  Medicaid covers the basics.  The emphasis is on the basics.  The good news: Medicaid will cover physician services, prescription drug and home health services and also Medicare copays.  Supplies like incontinence products and toilet paper are covered.  Other things aren't paid for in most states such as dental care and transportation to medical appointments, except in limited instances. Many adult family homes, assisted living and nursing homes do have "in-home" physicians who come in on a routine basis to see the residents. Some facilities also have podiatrists coming in, and mobile laboratories for blood draws.

3.  Mom gets an allowance.  Remember when you received one as a child?  Your parent on Medicaid will get a similar monthly personal needs allowance. In Washington State, it's $62.70 for an assisted living or adult family home resident, and $57.28 for a nursing home resident.  Not very much and certainly not enough to cover going out to lunch, buying new clothes or springing for birthday gifts for the grandchildren.  That's where you come in.  You can pay for outings and buy gift cards, clothing or other items.  But you can't legally give your parent large sums of cash, as to put them over the asset limit for Medicaid.  That's $2000 in many states, including Washington.

Note:  Medicaid coverage varies from state to state.  Check out your state's website by googling Medicaid (your state).  Washington State's Medicaid website is found at

Monday, June 30, 2014

Eldercare Tip: When It Comes to Your Parent's Meds, Less is Best

Just say ''No.'' Nancy Reagan's slogan for her anti-drug campaign rings true today.  Especially for your aging parent.  The wrong drugs, the wrong dosage, the wrong combination of drugs can do a number on your parent's health.

"The general rule of thumb is 'Less is Best,'" says Grace Gana, Clinical/Geriatric Pharmacist with Elim Pharmaceutical Consultants, LLC. Grace visited our team meeting at Silver Age Housing and Care Referrals last month.  Medications that purport to heal can do more harm than good, she told us.

Inappropriate Drugs for the Elderly--Drugs affecting the central nervous system, either directly or indirectly, have potentially serious adverse effects on the elderly.  The biggest offenders are

  • Sedatives/Hypnotics (eg. Ambian, Sonata) 
  • Antipsychotics (eg. Seroquel)
  • Benzodiazepines (eg. Xanax, Ativan)
  • Antihistamines (eg. Hydroxyzine) 
  • Tricyclic Antidepressants (eg. Amitriptyline)
These drugs are associated with falls/fractures, dementia/cognitive impairment, delirium, insomnia, kidney disease, GI bleeding, chronic constipation, etc.  

Drugs that especially need monitoring--Perhaps your parent is taking a psychoactive drug, one which chemically alters brain function, causing changes in behavior, mood and consciousness.  These include antidepressants, antipsychotics, drugs used for ADHD and for dementia.  Those should be routinely monitored for safety and effectiveness, and adjusted/discontinued as necessary, says Gana.

Count your parent's medications--The more medications, the greater the possibility of negatively reacting with each other.  Consider the possibility of asking your parent's doctor to discontinue any medications that are not necessary.

Thursday, June 12, 2014

Give Your Aging Parent Permission to Bless You

Long ago and far away, elders were called patriarchs.  Their names are familiar: Abraham, Isaac, Jacob. And their stories, told in the Bible, loom larger than life.  These men made the nation of Israel out of nothing.  At life's end, they gathered their extended family around for possibly their biggest accomplishment of all:  the blessing.

The elder addressed each grown child by name,  listing strengths and weaknesses, and foretelling what God would do in that person's life.  Today your aging parent has that same opportunity.  He or she has blessings to bestow on you and the rest of your family.  But it may take a little coaxing to persuade your parent to talk about faith and his or her dreams for your family.

Seniors are the most religious group in our nation.  According to Jane W. Barton, MTS, MASM,  an instructor in the national Certified Senior Advisor Program,  seniors attend religious services more and volunteer more than other age groups. The church is second only to the family in its influence on seniors.

Yet elders differ in the ways they share their faith and offer blessings to the younger generations. For every evangelistic one, like my Grandpa Harley, who prayed aloud so long that we kids made sure we visited the bathroom before he started so as not to have an accident, and whose last day on earth was spent mowing the church lawn and praying for his pastor, there are countless quieter folks. "Guideposts," a well-known national inspirational magazine, ran a feature for years called "Quiet People." These people stand in the gap, helping in those in need, with prayers, hugs, conversation and sweat and little fanfare.

In our home, my parents' periodic visits offered opportunities for them to bless us.  One August, a few weeks before school started, Daddy walked with 10-year-old Timothy to the new school being built near our house.  This would be Timothy's first year in public school.  As we walked the empty corridors which soon would be filled with laughing children,  a thought came to mind.  "Daddy, could you pray for Timothy's school and all it represents:  the learning, the friends, the good times?"  We stopped.  Daddy placed his hand on Timothy's head, and blessed him.

Fast forward many years to a nursing home in the Midwest.  Daddy was dying. Many of our family had gathered. "Daddy, who do you want to pray?"  I asked.  No answer.  I began to pray, naming each person in the room by name.  Daddy uttered a rasping noise and turned his head toward my "baby" brother Jim. "The boy. The boy,"  Daddy said. I got it.  Daddy wanted Jim to pray. Jim choked up but he did it.  What a blessing.

I can't give you a "how to" on coaxing your aging parent to bless the younger folks.  I certainly have missed some cues.  But it seems to me that the keys to hearing, seeing and experiencing their blessing is to value them, ask for their input and pray.

Happy Father's Day!

Thursday, May 29, 2014

Eldercare Tip: Three Things Your Aging Parent Needs Most

Your aging parent doesn't need a closet full of clothes.  Or a five-pound box of candy.  More than anything, he or she needs three things:

1.  To BE LOVED.
2.  To BELONG.
3.  To BE BRAVE.

Abby Durr, owner of Silver Age Housing and Care Referrals, expressed those thoughts not long ago. They guide our company as we work with families in finding housing and care for their loved ones. These principles can also apply to your relationship with your aging parent.

1.  YOUR PARENT NEEDS TO BE LOVED:  Love is expressed in many forms: sharing family photos and memories, paying and receiving compliments, and reminding our elders of their value as people created by God.  When they need care, in their home or in assisted living or an adult family home, pay attention to the caregivers.  Do they show love by making eye contact with the elders?  Are hugs, touches on the hand or shoulder or high fives a part of their day, assuming the resident wants that?  Do they know the residents' favorite foods and those they can't stand?  Asking questions and closely observing the caregivers'  behavior will help you determine whether they love what they  do, and the elders  they serve.  Love counts!

2.  YOUR PARENT NEEDS TO BELONG.  Being part of something bigger is an idea your aging parent understands.  He or she has survived The Great Depression, World War II and more. Camaraderie and sacrifice are more than words; they're etched into the character of this generation. Today your aging parent still wants to fit in.  In your family gatherings, that means taking time for conversation and encouraging contact with children and grandchildren.  In an adult family home or assisted living,  activities like sing-alongs and picnics can build community.  When people talk to each other, meals can feed both body and soul.

3.  YOUR PARENT NEEDS TO BE BRAVE.  Everyone wants to be able to do good for others.  Yet when elders are frail and need lots of help, it's easy for them to say, "What can I do for anyone?  I need someone to do the simplest things for me."  Abby's grandmother said those very words.  She suffers from Parkinson's and is growing increasingly dependent on others.  Abby wisely said, "Grandma, you have something we don't have:  time.  You can bless others by using your time to pray for your children, your grandchildren and your great-grandchildren."  Despite frailty, elders can help in their own way. In group living settings, I've seen residents fold towels and help caregivers measure ingredients for making cookies.  Others make homemade birthday cards for other residents.  When they give, they receive a bigger gift:  joy.

Thursday, May 22, 2014

Eldercare Safety Valve: How APS Can Keep Your Parent Safe

Last month I hit a milestone after working in the eldercare field for 20 years.  I picked up the phone to make my first Adult Protective Services report after suspecting that an elderly woman was being neglected.  An investigation ensued, and afterwards, I was firmly convinced that APS plays a vital role in keeping our elders safe.  Including your parent.

Anyone who suspects abuse or neglect of what Washington State law calls a vulnerable adult can report to APS.  But some of us are called Mandatory Reporters.  Social workers, law enforcement, employees of nursing homes and health care providers are included in this group.  As a senior care referral agent, I, too, am required to report.

Yet I must admit when I called the Agency, I was more than a little nervous.  A little voice inside my head kept telling me, "You're making too much out of this."  But after rereading the law and my responsibility, I had to report.

The first person I met over the phone was an Intake Officer.  He was congenial and helpful, taking my report which sounded like this:

Karen, a middle-aged client of mine from out of state, told me her story.  She was in Washington visiting her mother.  Mom lived in an apartment with the other daughter who was an alcoholic.  Mom paid the rent in exchange for help with measuring her insulin,  monitoring medications and transporting her to the Kidney Center.  Also on the daughter's to-do list was shopping, cleaning and preparing meals.  Yet none of this was being done.  And Karen suspected that her sister was taking her mother's pain pills.  "This place is a pit," she said. "And I know my mother isn't eating right."

She also said her sister was using lies and manipulation to keep her mother from obtaining home care or moving to assisted living.

A Female Investigator was assigned to the case, which was given a number.  Karen's identity was kept confidential.  The officer paid a personal visit to Karen's mother's home to discuss the situation.

Afterwards,  she reported that the mother seemed to want to be in the situation, and there was not enough evidence of abuse or neglect to move forward with the investigation.   I was glad the situation was laid to rest.

I have other friends who have been in my shoes, reporting abuse or neglect.  One friend, who works at an assisted living community, walked into a female resident's room, only to find a male caregiver pulling down her pants.  For no good reason.  She called the hotline.

All 50 states have hotlines for reporting abuse or neglect of vulnerable adults.  They're good things for helping keep your parent safe.

If you suspect abuse of a vulnerable adult in Washington State call the statewide abuse hotline number at 1-866-EndHarm (1-866-363-4276).

Wednesday, April 23, 2014

Eldercare Testimonial: Home Care for Mom Saved My Sanity

Early dementia and a stubborn streak.  Not a good combination, especially when it's YOUR parent who refuses to move from her home.  The doctor says she must not live alone, yet she refuses to budge.

In-home care by a professional who understands dementia could just be your answer.  It was for John, who lived in the Midwest, and his brother and sister-in-law who lived in Washington.  For months they texted one another in the wee hours of the night, and during the day as well. "Guess what Mom did now? Her doctor says she makes such a ruckus in his waiting room that she's banned from his practice."  "Mom called 911 again, sure she was dying."  And when dementia caused her to forget to take her anxiety medication--or take too much--all hell would break loose.

Despite her doctor's advice, Mom refused to move.  At this point the siblings determined she was still competent--at least for awhile--so they didn't force the issue.

They did come up with Plan B a few months ago. They came to me, wanting a referral for a good home care agency.  Within days they'd selected an agency which I found for them.  Soon a caregiver came out to meet Mom. At first it was simple:  Her caregiver came in twice a week. She encouraged Mom to take her medications, took her to appointments and out to lunch, went on walks with her, and shopped for groceries and prepared meals, etc.  A great deal of the job was companionship, and also checking in with the family.

"Having structure to her day and things to look forward to has made all the difference," says John. "She seems happier.  And for the first time in several months, all of us are getting a good night's sleep."

John and his siblings know that at some point more care will be needed, either into the home or at an assisted living.  They've already begun planning for that fact.  Yet for now, home care works.

"For us, home care is a great first step."

Do you have any firsthand experience with home care?  How has that gone?

Thursday, April 17, 2014

Kermit the Frog Croaks Out Eldercare Advice

"It's not easy being green."  

Kermit the Frog of Jim Henson's Muppet fame croaked those words long ago.  Yet they still seem timely these days.  Especially for Boomers learning the ins and outs of eldercare.

We're humans, not frogs. Yet we are green  nevertheless. Green in the sense of being over our heads, hopping into newfound territory with little preparation.  How do we cope with our parents' dementia?  How do we understand their physical disabilities?  How do we teach our children about their elders and their needs?

We're green.  Fortunately the green feeling fades--at least somewhat--as we learn.  Knowledge helps, whether it's through friends' telling their stories of what's happening with Mom and Dad, or our looking online at information relating to their specific disease.  But the best source of learning about aging often comes from the elders themselves--our parents, their peers and others.

My parents died in 2003 and 2004, both at 77.  Young these days.  But they taught me many things about aging.  They, too, felt "green."  Daddy's Parkinson's was always giving him new symptoms; just when he got used to a whispered voice, his hands began shaking.  Then later, swallowing presented a problem.

I don't know what issue you're facing with your elderly parent.  Are you tackling the driving issue?  Or a host of medical diagnoses?  Or caregiving?  

We all feel green at different stages of our lives.  As a kindergartener walking into the classroom on the first day of school.  As a junior higher, trying to navigate the halls of a new school building.  And as Boomers now, many of you are wondering, "What happened to the dad or mom I knew for so many years," and "How do I relate to him or her?"

We probably always will feel green on a certain level. Yet being green actually isn't so bad.  It's not easy, Kermit says.  But it shows that we are alive, that we are growing, that we care.

Monday, March 31, 2014

Eldercare Locator: 20 Years Offering Help to Seniors by Phone & Online

Search the Internet for Senior Care.  Then wait for the countless options to appear.  If the process is too complicated, there's an easier way to go.  Simply search for "Eldercare Locator."

Boomers--including me--have been using this site for 20 years.  It's a public service of the U. S. Administration on Aging connecting you to services for older adults and their families.

The site offers information on a myriad of topics:  from financial assistance to food and nutrition, from home repair and modification to housing, and more.  Organizations can't pay to be included in the database.

My favorite part of the service started before the Internet became popular.  Eldercare Locator has a telephone counseling option.  Dialing 1-800-677-1116 will connect you to a trained professional to help you problem solve.

A few weeks ago, I called the number on behalf of a daughter who needed to find low-income housing in the Seattle area for her elderly mother.  A real person answered immediately.  She was courteous and knowledgeable, and suggested my client call the number herself.

The experience was helpful.  It was just as I remembered it 20 years ago, and in the ensuing years.

Eldercare Locator also has options for emailing questions to a counselor, and participating in an online chat.  

Monday, March 17, 2014

Eldercare Tip: When Your Aging Parent Falls, What to do?

"Mom, if you don't quit falling, you'll end up in the HOME."

One of my clients said this to his 83-year-old mother, after her third fall in 9 months.  Ouch!  While his words lacked tact, they certainly rang true.  According to the Centers for Disease Control and Prevention, 20% to 30% of people who fall suffer moderate to severe injuries such as lacerations, hip fractures, or head traumas. These injuries can make it hard to get around or live independently, and increase the risk of early death.

Even if your aging parent isn't injured, he or she may develop a fear of falling.  The fear can cause your parent to limit his or her activities.  Physical fitness declines.  And the actual risk of falling increases.

Fortunately there are some things you can do to reduce fall risk, even after your parent has taken a tumble.  These are from the Centers for Disease Control and Prevention. 

1.  Encourage your agjng parent to:
  • Exercise regularly. It is important that the exercises focus on increasing leg strength and improving balance, and that they get more challenging over time. Tai Chi programs are especially good.
  • Ask his or her doctor or pharmacist to review their medicines—both prescription and over-the counter—to identify medicines that may cause side effects or interactions such as dizziness or drowsiness.
  • Have your parent's eyes checked by an eye doctor at least once a year and update their eyeglasses to maximize their vision.  Consider getting a pair with single vision distance lenses for some activities such as walking outside.
  • Make their homes safer by reducing tripping hazards, adding grab bars inside and outside the tub or shower and next to the toilet, adding railings on both sides of stairways, and improving the lighting in their homes.
  • Encourage your parent to drink plenty of liquids during the day.  Many falls are due to dehydration.

Has your aging parent fallen recently?  Can you think of anything else to reduce the risk of future falls?

Thursday, February 27, 2014

Adult Family Homes: Why People Don't Chose a Particular One

On the West Coast, adult family homes are especially popular.  Perhaps you're considering this option for your aging parent, especially if he or she has fallen or has multiple medical issues.  Some pluses;  high staff to resident ratio, lower cost than assisted living or nursing care, ability to care for high acuity residents.

Location and price are the top reasons family members DON'T choose a particular home. Here are some other objections:

1.  The rooms are too small.

2.  The residents seem to have more dementia than does my dad (or mom.)

3.  There's no option to convert to Medicaid funding later on.

4.  The yard is messy.

5.  The home isn't clean.

6.  I don't see the caregivers talking and engaging with the residents.

7.  Staff are on-call, but not awake, during the night.

8.  The provider seemed rude and didn't welcome my questions.

Sunday, February 23, 2014

Senior Care Professionals: What happens when YOUR parent has a crisis?

Two groups read this blog:  Boomers grappling with issues facing their aging parents and professionals working with seniors.  And people who fall into both groups.

Perhaps you do.  You've helped adult children deal with their parents' strokes, fractured hips, depression and dementia.  You've supported them and offered the gift of empathy. Now, though, the shoe is on the other foot.  Your parent has the issues.  Your new role feels disconcerting, strange, shaky.

I'm reminded of the Disney musical film, "Alice in Wonderland." I listened to its sound track by the hour as a little girl.  In one song, Alice chides herself for her proclivity to get into trouble, something all of us do from time to time. "I give myself very good advice," she sings, "but I very seldom follow it."

We professionals often know what to do, but when it's our parent, we move from pros to children, to mother bears.  Our protective nature takes over.  Sometimes we rotate the roles.

Take Abby Durr, owner of Silver Age Housing and Care Referrals, where I work. In addition to her professional role, for years Abby has overseen the care of her grandma who has Parkinson's. Members of their large extended family lend a hand, watching Grandma, washing her clothes, cleaning her home.  Their collective goal is to enable Grandma to stay at home as long as possible.  So far, so good, at least until several weeks ago.

Bam!  Grandma tumbled and moved from Home, Sweet, Home to the hospital.  Then came rehab. Abby's advocacy soon kicked into full gear.  "The first night at the nursing home, we ate with her," Abby recalls.  "When the staff delivered her meal tray, the cover was labeled, 'soft mechanical diet,' needed because she has difficulty swallowing.  But when we lifted the cover, the food wasn't mechanically altered in any way. Grandma couldn't have safely eaten it."

Days later, when Abby attended her grandmother's care conference,  the subject of home care came up.  Abby and the rest of the family knew Grandma needed extra care during the hours family members couldn't be there.  "She'll likely need help bathing," a staff member said.

"I can do that," Abby said.  Abby is also a Certified Nursing Assistant.  She could feel herself suddenly go into protective mode.  "I wanted to protect Grandma.  Since I'd done it for quite a while, I knew exactly how she wanted things done.  And I didn't want to give up that role."

Today Abby says that advocating for her grandma in this crisis time, helps her better understand the struggles her clients as they face difficult decisions--and situations--with their loved ones.

Bottom line:  Walking through hard times with our own loved ones helps us understand and empathize with our clients.

Tuesday, January 21, 2014

Free Counseling Continues for Caregivers in King County, WA

Last May I wrote a post on a program offering free counseling to caregivers living in King County, Washington.  It provided up to six hours of in-home one-on-one counseling for unpaid caregivers of senior adults. That included adult children, spouses and friends.

The program was understandably popular.  At the start of the new year, though, I wondered,  "In view of the many budget cuts, will the program continue?"  The answer is "Yes!"

It's funded by Seattle-King County Aging and Disability Services, and sponsored by Evergreen Health. According to Karin E. Taifour, of the Geriatric Regional Assessment Team, there is currently little or no waiting list.

Perhaps you might qualify. 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?

Day in and day out, these caregiving tasks can put you in the danger zone for stress. 

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.

The focus is on problem-solving, self-care, stress management and positive change.  It has been dubbed "Starbucks Therapy." 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.
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