Eldercare Resource: Gale Wald, RN, Senior Transitions Specialist

I’m always looking for my “pot of gold” people.  They have hearts of gold and an abundance of wisdom they use to help seniors in a specific way.  People like your aging parent.

Gale Wald, RN, is one of those persons.  Holidays are especially busy for her, but she works hard all year long.

 Besides being a nurse for 25 years, Gale is a flight attendant with 10 years of experience.  The combination of skills she has honed in those professions makes for one gifted person.   Gale makes flying easier for vulnerable adults and their families.  Her business is called Senior Transitions.

Does your aging parent or loved one want or need to travel by air but can’t safely fly alone?  Gale can help. Or perhaps they can fly alone but need to be picked up at a distant location and delivered to you?  If your schedule makes those situations difficult, Gale can assist you.

She tailors her services to families, and can anticipate and respond their needs as well as the needs of their loved one.  Senior Transitions can:    

·         Provide a professional and trusted air travel companion.

·         Make travel arrangements.

·         Provide door-to-door ground transportation if needed.

·         Meet and greet you at the departure airport.

·         Guide the traveler through check-in, security and customs.

·         Assist with purchasing meals before, during and after a flight.

·         Handle the situation when scheduled flights are changed or canceled.

·         Keep family informed of departures and arrivals.

Gale started her business 12 years ago when her friend’s elderly dad wanted to visit his sister in Seattle.  He lived in Calgary, Alberta, and because of the distance and his frailty, he hadn’t been able to make a flight.  Gale stepped in, and has been reuniting families ever since. 

Gale also does adult family home care assessments. For more information, contact Gale Wald at 206-755-3636 or stransitions@gmail.com.

 

 

 

Nonprofit Retirement Communities: Frequently-asked Questions

In many parts of the country, nonprofit retirement communities abound.  If you're looking for housing and care for your aging parent, you'll see them.  So what's the difference between the nonprofits and the profits?  Take a look below:

1.  Are for profit retirement communities more profitable than nonprofits? 

Not necessarily.  There are for-profit senior communities that are weak financially and others that are strong.  The same goes for not-for-profits.   There's an old saying that rings true when it comes to nonprofits:  "No margin, no mission."  Financial stability is crucial for both groups to serve their residents and communities well.

2.  What does each group (nonprofit and for-profit) do with profits they make from their organization?

For-profits pay their investors and owners, both at the building level and at the corporate level. Non-profits must be socially accountable, investing in programs which will benefit those they directly service and the community at large.  Many nonprofit senior communities set aside monies for a benevolence fund for elders who run out of money.  Other nonprofits offer specialized training and scholarships to their employees.  Still others sponsor volunteer programs to reach out to those in need in the community.

3.  Are nonprofit retirement always faith-based (sponsored by churches)?

Many are church affiliated, but others are connected with lodges, hospitals or charitable foundations.  They are governed by volunteer boards, generally composed of people with expertise in a variety of fields which will be helpful to the community.

4.  How do charitable contributions help the nonprofits?

Individuals are able to give money to the retirement community, usually through a foundation or department of development.  They can deduct these contributions from their taxes.  In addition, in many states, nonprofit retirement communities are excerpt from a portion or all of the campus' property tax.

5.  Are monthly fees more or less at for-profits than at their nonprofit counterparts?

There are nonprofits offering affordable communities, and others that charge much more because of their luxurious lifestyle.  The same is true for for-profits:  varied price points, depending on their location and their prospective residents.

Senior Care Professionals: Some Words to Live By

I'm a blogger with two audiences.  Most of you read because you have an elderly parent or loved one, and you're grappling with a particular issue.  The rest of you read because you work in the senior care field.

This post is for professionals.  It's my opportunity to share some unsolicited advice, not because I relish doing so, but because it's needed.  I've seen the need staring at me and others over the course of 20 years in the senior care field. 

As my minister father used to say from the pulpit: "I'm preaching this sermon as much for me as for you."  My three-point sermon is directed at you, me, and all of us working with seniors and their families.

1.  Be nice.  Your clients may be crabby, unreasonable and once in awhile, outright mean.  But we need to remember that they are the customer.  We are not.  And they may be facing one of the biggest challenges of their lives with an issue--or multiple issues--relating to their aging parent. 
Because of that stress, they may doff their usual persona and become Mother Bear or the Drill Sergeant.  We, on the other hand, need to act like grownups, even when we're peopled out by the end of the day.  Remember the old television show, Candid Camera?  And the surprising line, "Smile, you're on candid camera?"  Corny but true, a smile will do wonders for our customers, especially those who are hurting.

2.  Speak the truth in love.  Actually, those words are found in the Bible.  Sometimes it's easy for us to withhold information which is needed but is hard to swallow.  For example, in my line of work, I deal with children who think their parent will live in a spacious private room in a modern adult family home on Medicaid.  But that's not the case.  I need to empathize with their disappointment at the disparity between their ideal and reality.  Another truth:  If we don't have enough information to explain the "why's" of a particular situation,  we need to educate ourselves or find someone more knowledgeable.

3.  Say 'Yes' more than you say, 'No.' Sometimes "No" may be technically the right answer, but rephrasing the statement to emphasize the positive works better.  Telling a resident, "No, you can't leave the community by yourself," may be true.  But saying something like, "This is a good place for you to become healthier and stronger.  We want you to stay for that reason," may work better. 

Medicaid Jargon Made Easier

Let's face it.  Learning the complexities of Medicaid is tough.  If your parent is running out of money, you'll need to know the meaning of the following words.

A little introduction.  To be eligible for Medicaid, your aging parent has to qualify two ways:  first, financially, and second, medically.  Each state has its own program.  The basic rules are similar, but dollar amounts on income and assets can vary. 

Most people these days in Washington State are applying for a Medicaid-waiver program called COPES (Community Options Program Entry System) which offers people care in their homes, in assisted living communities and in adult family homes.  Traditional Medicaid refers to care offered in a skilled nursing facility. 

Step One:  Financial Qualification--words you'll need to know:

1.  Income cap--this is the limit on monthly income your parent can have and still qualify for COPES.  In Washington State, the income cap is currently $ 6381.  If your parent seeking COPES help is married, his or her income in their own name cannot exceed this amount. 

2.  Asset cap--in Washington State, and in many states, the limit for resources (assets, property and savings) is $2000 for a single person.  In the case of a married couple in which one spouse applies for COPES, they can have $56.726. 

3.  Exempt resources--These are resources that don't count toward the $2000 limit.  They can include a home (under certain conditions including when one spouse continues to live there when the other goes on COPES), household goods and personal affects, some real estate contracts, a car, life insurance with a face value of $1,500 or less, most burial plots and prepaid burial plans.

Step Two:  Eligibility Due to a Need for Help with Activities of Daily Living--more words

1.  Comprehensive Assessment--a social worker will assess your parent's needs for help with such things as eating, bathing, transfer (e.g. moving from a bed to a chair), bed mobility (positioning), locomotion (walking and moving around), using the toilet and medication management.  A person can run out of money and still not qualify for Medicaid if he or she is still independent or needs very little help.

2.  Award letter--This letter is the official approval for COPES help.

3.  Reimbursement rate--If your parent is applying for care in an assisted living community or adult family home, DSHS will set a daily rate that the State will pay for your parent's care.

4.  Participation--This is the amount your parent will pay toward the cost of the care.  Generally, a person "contributes" his income toward the care, minus a small amount for personal expenses.

Much of the above is excerpted from a publication of Columbia Legal Services, Questions and Answers on the COPES PROGRAM.

Book Review: 'Activities to Do With Your Parent Who Has Alzheimer's Dementia'

Judith A. Levy is an occupational therapist.  For more than 40 years she has worked in geriatric care centers, hospitals and home-care programs.  She has helped people of all ages get well.

 In 2013 she wrote a book, with another audience in mind:  children of people with dementia.  At the time Judith had been caring for her 97-year-old mother for nine  years.  Clinical knowledge was one thing.  Having the responsibility of another life--that if her parent--was quite another.

"I cannot go home at the end of the day and leave it all behind.  Now I am the child, and this is my parent.  I'm no longer the professional.  I have no choice but to adjust to the changes."

Judith's book,  'Activities to Do With Your Parent Who Has Alzheimer's Dementia,'  has simple, meaningful activities that will stimulate the long-term memory and bring enjoyment to you and your parent. 

Some principles for doing activities with someone with dementia:

1.  Morning works best.  People with dementia are mentally sharper then.  As the day goes on and draws nearer to dusk, "sundowning" occurs, bringing with it increased confusion and agitation.

2.  If the activity produces frustration, stop and move onto another one.

3.  Do all the tasks at the same place each time.  Choose a well lit table; make sure your parent's chair is comfortable.  Spread out any "props" and clear the tabletop of other objects.

The 57 activities are presented in alphabetic order and include:

• The Alphabet--Using colored alphabet letters, sort the letters by color and count each group to see which color has the most letters.  Other ideas:  "The letter A is yellow; can you find it?"  "Tell me a word starting with the letter A."  And of course, sing the Alphabet Song.
• Baking--It's structured, sequential, time limited and satisfying.  Baking can get your parent to talk about favorite foods, childhood holidays and an event in the past at which a special food was served.  Depending on your parent's ability, he or she can help assemble ingredients, stir the batter, and wait for the timer to go off.  Baking and decorating cupcakes are especially fun.
• Crossword Puzzles--Books in the grocery store have puzzles that may be doable if you work together.  You can give clues that will help him or her succeed.

A great book, with practical activities and conversation starters.

Eldercare Info: Myths About Hospice Dispelled

Chances are, you've heard the word "hospice" coming up in conversation lately. Stephanie Mehl, RN, of Providence Hospice of Seattle explains why.  "End of Life conversations are the equivalent of sex talks in the 70s," she says.  Boomers are facing these issues with their parents, and looking ahead to their own future. 

Mehl says that many people know that hospice is a supportive type of care available to people with a prognosis of six months or less.  They may not understand the myths related to hospice.

1.  MYTH 1: Hospice care is very expensive.  The truth is that Medicare covers all hospice services, medications and equipment.

2.  MYTH 2:  If my loved one or I go on hospice, we'll get 'sent' somewhere.  People hardly ever go to a special free-standing hospice building, Mehl says.  Instead, hospice services can be delivered in a person's home, in an assisted living or adult family home or in a nursing home.  Hospice care doesn't cover room and board, though.

3.  MYTH 3:  People on hospice die sooner than they might otherwise.  Hospice doesn't hasten death, Mehl says, citing a study which followed lung cancer patients.  Those on hospice lived on average 26 days longer than those not on hospice.  Good nutrition, hydration, pain control and attention to the whole person likely make a difference.

4.  MYTH 4:  Hospice professionals hang around all day long.  The purpose of hospice isn't to do 24-hour care.  Hospice professionals come in regularly to provide pain control, help with bathing, and support the patient and family.  They are not full-time caregivers. Hospice can be utilized for bereavement care as long as 15 months after the death.

5.  MYTH 5:  If my loved one or I go on hospice, we'll have to change doctors.  A hospice patient can keep his or her existing doctors.

This information was taken from a talk Stephanie Mehl, RN, gave to a group of senior care professionals called COPS (Coordinators of Patient Services) in Bellevue, Washington on September 16, 2015.

Free Counseling Progam for Caregivers Still Going Strong in King County, WA

Do you provide transportation for your aging parents?  Clean house or prepare meals in an effort to keep them independent and safe?   Do you monitor them from far away? Any of these tasks can qualify you as an unpaid caregiver.

Over time, caregiving is a recipe for stress.  If your loved one lives in King County, Washington, you may qualify for six free one-one-one counseling sessions through a program begun in 2013.

There's no income qualification.  And  you don't have to spend 40 hours a week doing caregiving tasks to be eligible for the program. Caregivers can be spouses, adult children or friends and they don't need to live with the vulnerable adult.

Sessions often take place at coffee shops; that's why it has been called "Starbucks Therapy." A home setting works well for others.  The program emphasizes problem solving, self-management and positive change.

One change was made this year.  The vulnerable adult must be living in their own home, the home of a loved one, a retirement community or senior independent housing.  He or she can't be living in an assisted living community, an adult family home or a nursing home. 

Seattle-King County Aging and Disability Services funds the program and Evergreen Health sponsors it.

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

Eldercare Q-A: Is it possible to save money on Mom's care?

Can your elderly mother save money on health care, even when her care needs are rising?  Money is often a huge challenge for families looking for in-home care, assisted living or adult family homes.

Ask Rose and her son and daughter. .I met them several weeks ago. Her daughter said, "Mom has been in her home for fifty years, and she wants to stay there.  But the cost of in-home care is so high."

In this case, "high" meant $365 a day for around the clock caregivers, or nearly $11,000 a month.  There were other expenses, too, like the caregiver's groceries and household utilities.  Could we come up with care that was more affordable, but still high quality?

"Give me your wish list,"  I asked them. 

"A home filled with light."

"A large bedroom, with a private bathroom or least a bathroom nearby."

"Qualified, competent caregivers that speak excellent English."

"At least a couple of residents who enjoy conversations."

As we toured, we looked at the wish list.  And the cost. In an upscale neighborhood of Seattle, we found two homes with lots of light and gorgeous views of mountains and water. They had everything on the family's checklist. Price tag:  $8000 and $8500 a month.

Moving farther north to a nearby suburb, we toured a home that worked except for the size of the bedrooms.  Price tag:  $7000 a month.

About two miles north of the county line, but still within easy driving of Seattle, we found a home that met all the family's desires, and the bedroom was huge!  "We really enjoyed the caregivers," Rose's daughter said.  Price tag:  $5500 a month.  SOLD!

A savings of $5,500 a month, not counting incidentals.  Such a deal!  Moving to an adult family home, with two caregivers and four other residents, might not work for everyone.  Or it might not save as much money as in this case. But for Rose and her family, an adult family home worked well, saving in time as well as money.

"No more shopping for groceries, no more ordering medications, and fewer bills to write," said her daughter.  "Now we can spend time with her rather than doing things for her."

Forgiving Our Parents: My Story

"I think I can.  I think I can."  Those words of the Little Blue Engine from the children's story book have resonated with me throughout life.  Especially as I  thought about forgiving my aging parents.

In my late-forties I examined my life. I didn't like what I saw.  Like everyone on the planet, I was raised by imperfect parents.  Yet in my case, my childhood losses spilled into adulthood,
rooting themselves inside me  They bore a crop of anger, resentment and people pleasing.

Surprisingly, my work in a retirement community with seniors and their families set me on a journey toward healing.  Daily I witnessed seniors as they literally, sometimes figuratively, climbed the steep mountains at the end of life.  Their burdens often seemed insurmountable.  Loss of health, friends, life itself. 

I also saw their adult children.  Many had taken the path of forgiveness.  Stripped of resentment, they valued their parents and spoke openly about the their parents' struggles.  They showed love through kind words, hugs and laughter.  And they served as cheerleaders as their parents endured life's trials. Could I do the same?

I couldn't forgive in a vacuum.  I needed people.  I joined a support group. As we sat in a circle, we shared our stories.  Those stories were sacred; so were our laughter and our tears. I remember one night thinking as I drove home, "I didn't have to look over my shoulder.  I'm beginning to feel free."  The group brought to mind Fred Rogers' words, "I like you just the way you are."

One night I left the group and a friend stopped me.  "Alice, I will be praying for you, that God will show you who and what you need to forgive," she said.  "And one more thing. That God will show you how much He loves you."

I began writing out my losses:   A big discovery: Prayer not only enabled me to list and forgive those hurts, but it  showed me my faults.  I needed to forgive myself.  I needed to ask forgiveness of others. As I grieved and let go of the hurts, I started recalling the good things my parents had given me.  Faith in God and reassurance of Christ's unconditional love.  The importance of community and reaching out to others.

As I weighed my life in the balance,  the blessings loomed large.  The forgiveness I had received from God and others allowed me to forgive, as well.

I'd like to say that I suddenly felt warm and fuzzy inside afterwards.  But I didn't, at least not immediately.  I felt sapped.  Like I was standing still.

Not long afterward my sister Carol wrote me with a request.  Daddy and Mother's 50th wedding anniversary was coming soon.  Carol had planned a surprise anniversary party.  She asked everyone attending to write a letter thanking Daddy and Mother for their positive influence on the lives of so many people.

I stalled.  I'd done the forgiveness but my feelings hadn't caught up with my thoughts.   I found a devotional by Melody Beattie, in the "Recovery Devotional Bible,"  that spoke to me.

 "Sometimes, to get from where we are to where we are going, we have to be willing to be in-between. ...Being in-between isn't fun, but it's necessary.  It will not last forever."

The writer's block resolved.  I might have been influenced by the words of  Melody Beattie.  Or maybe the words of The Little Blue Engine, "I think I can, I think I can."  

In the years to come, my siblings and I would help Mother and Daddy make difficult decisions regarding their health and end of life.  Forgiveness made all the difference.

Medicaid 101: Mom's on Medicaid. How Can I Help?

Fifty dollars a day.  Could that buy you a place to sleep and three meals?  A budget hotel would eat up the fifty dollar bill and then some.  Add breakfast, lunch and dinner at a bargain restaurant, and the total could easily jump to $100.00. 

And suppose you need care--the kind your elderly parent might need.  Help with bathing, dressing and medication reminders?  It's not hard to see that $50.00 a day doesn't go very far.

Welcome to the world of Medicaid.  For a light care resident in a Seattle adult family home, the State of Washington pays the provider $47.59 a day.   Less than $50.00! The rate goes up as the care needs increase, but the highest rate is $163.59.  Translated into monthly rent and care, we're looking at between $1428 and $4920.  Very few residents are assessed at the higher rates.  Those that are assessed higher are usually bed bound, can't feed themselves and need heavy attention by caregivers.

Assisted living providers are paid a bit more for Medicaid residents.  And this year, they got a long-deserved 2.5 per cent raise.  They are now paid between $67.22 and $163.89 a day.

If your parent is on Medicaid, or about to convert to Medicaid funding, you'll need to face some grim realities.  Then you'll see what you can do to help..

1.  Choices for Medicaid residents are shrinking.  Your parent's doctor may say, "Your mother needs memory care," and you think that translates into an assisted living community with a specialized memory care unit.  One problem:  Medicaid. funding.  In the Seattle area, there are only three communities that offer Medicaid in their memory care area, and that is only after two or three years of private pay.  In Washington State, Medicaid residents, whatever their cognitive state, generally go to adult family homes.  Many of these work out well.

2.  You may need to adjust your expectations.   If you know your parent will run out of money in a year or so, it's a good idea to search out places that take Medicaid and move your parent sooner rather than later.  Why?  Because providers often require a certain number of months of private pay before a resident switches to Medicaid.   Offering a provider some private pay months up front will give you more choices of homes.

3.  You can help provide extras for your parent.  Once your parent is on Medicaid, he will be contributing his income toward the cost of the care.  He will get a small monthly allowance, but that won't pay for everything,  You can buy clothes, pay for haircuts, purchase supplies, and even favorite foods that aren't on the menu.  Medicaid providers are often operating on a shoestring, and will appreciation your lending a hand.

Is your parent on Medicaid or transitioning to Medicaid?  Do you have any observations you'd like to share?

Dementia 101: How Mom's Kitchen Can Be a Dead Giveaway

Lucille, 85, loved her house, and especially her kitchen.  But recently that favorite room began taking on some strange sights and smells.  See if Lucille's story parallels your aging parent's in any way.

No fresh fruits and vegetables in the refrigerator.  Unless you count the green things growing from leftovers.   A check of the freezer revealed TV dinners, and ice cream--of various flavors. But nothing else.

Lucille had early dementia.  Her kitchen mishaps--bringing home way too many groceries and keeping cans and jars from 2000, were at least partially due to memory loss.  Items were jumbled here and there in her cupboards in no logical order.  Opening the kitchen pantry brought an array of random things:  toilet paper, panties, a sewing kit. Sometimes Lucille "cooked," but following a recipe was next to impossible.  She tried, anyway.  And her family noticed that her dishes didn't taste the same as they used to.

There are lots of Lucilles around the world.  In her case,  she absolutely refused to leave her home.  So her family compromised by hiring a caregiver/companion named Jane from a home care agency.  Jane came into the home twice a week at first to help with transporting Lucille to appointments, shopping for groceries, going out to lunch, and making and freezing meals.  The family called Jane a "personal assistant," and that's exactly what she was.

As Lucille's disease progressed, Jane came more often, reporting to the family on what they did together, and anything unusual--positive or negative--about Lucille's behavior and demeanor.  They also talked about assisted living as a next step.  When the family broached the subject with Lucille, Lucille asked Jane, "Do you think I should do this?"  Jane had become a trusted friend.

A crazy kitchen doesn't always spell dementia.  But it's an indicator that something might be awry and worth checking into.

Advocacy 101: When it's time to spill your guts!

Stepping into the role of advocate for your aging parent is hard.  Duh! As an advocate you speak and act on behalf of him or her.  You may choose assisted living or nursing care, discuss medical issues with providers and settle issues with caregivers.

You'll meet authority figures:  doctors, lawyers, social workers, nurses and more.  If you're like me, you'll be tempted to see yourself as less able, given their higher level of expertise.

Remember this: You are the authority on your parent.  Don't ever forget the power your knowledge and experience gives you.  Working together with professionals, you can get good outcomes.  And especially if you know when to spill your guts and when not to.

Spill your guts when...the professional needs as much information about your parent as possible
to help you reach your goals.  I work as a senior referral agent with Silver Age Housing & Care Referrals, helping adult children find the right assisted living, adult family home or in-home care for their parents.  I ask family members, "Tell me about what's going on with your parent?" "How are you coping with the situation?" and "What are your parent's hobbies and interests?"  I feel privileged to listen to the long version. The more I hear, the better I know the older adult and the family.  That knowledge helps me to find excellent care options.

Another place that's safe to spill your guts is in a caregiver support group.  You don't have to worry that if you vent, people will judge you.  They absolutely won't.  Group members are all in the same boat. They can laugh at situations others would find deplorable.  And if you talk too long, the leader will gently ask you to wrap it up so others can speak.

Don't spill your guts when...the professional needs the short version.  Doctors only have 10 or 15 minutes to solve your parent's problems, so it's best to discuss only the most pressing concern.  If you do need to talk about other things, make a list and speak briefly about each item.  Of course, there are doctors who do allow you to spill you guts, but do so sparingly.

Over time you'll know which people can take the long version and which need the condensed version of your parent's story.  But remember, no matter what initials are to the right of his or her name, you have a Doctorate in Parentology.  Use the knowledge wisely.

Mourning After Mother's Day; Why the Tears?

It's the morning after Mother's Day.  The flowers are beginning to fade, the goodies are gone, and the rest of the holiday's trappings set aside.  But today, when everything is supposed to be returning to normal,  you may feel empty. You may be mourning the loss of your mother.

Perhaps your mother has passed and you long for her presence. Whether it's been a decade or a month, there's a hole in your heart that may never totally be repaired.  So you cry, with good reason. Or, perhaps you are grieving for the mother whose inner strength has been stolen from her through dementia, mental illness or other debilitating disease. She can't be the nurturer, the encourager and the cheerleader.  You feel sad--for you, for her, for her other loved ones.  That sadness is normal.

Mother loss is hard.  My mother died in 2003, but mental illness took away her vitality decades earlier.  Years of  heavy duty psychoactive medication left her flat, unable to initiate contact, and barely able to respond.  I remember hearing my six-year-old son say to me," Why does Grandma look mean?  Is she mad at me?"  I tried as best I could to tell him, "Grandma loves you, but she has a sickness that makes her sad." 

My clients tell me of similar experiences.  A mother who used to be the life of the party but now isolates due to dementia. A mother whose mental illness causes her to be incredibly needy and unable to see others' points of view.  A mother who used to recognize the family but no longer does.

I wish I could change those situations but I can't.  I can tell you what Msoshi, a friend who'd immigrated from the Congo, said to me when I told him about the loss of my mother.

"Je suis une orpheline, " I told him.  That's French for "I am an orphan."  The two of us could speak in French about things I'd never say in English.  "Ma mere es morte et je suis triste" (My mother died and I am sad.) 

He looked at me and said nothing for a while as I fought back the tears.  Then he said something that I'll never forget.  "Vous avez un Pere en ciel.  Dieu est votre parent."  (You have a Father in Heaven.  God is your parent.)

The ache in my heart didn't go away.  But it was made bearable by a truth that I'd known in my head but now experienced in my soul.  God would carry me though.  He was--and is--my loving parent.

Have you experienced mother loss?  And if so, what comfort have you found in the midst of grief?

Looking for "Treasure" on Your Aging Parent's Dementia Journey

I've worked with aging parents and their families since 1994.  The most important lessons I've learned didn't come from books or seminars.  They came from adult children who faced the difficulties of their parents' journey, even when it involved dementia.

Keith, a friend from church, has a dad with Frontotemporal Dementia.  Here's what Keith said about his dad.

"When people ask how Dad is doing, I have to honestly say that dementia is awful.  There's no doubting that.  I'm learning, though, to look for the small blessings along the way."

Keith mentioned a few:

"I read from the Psalms to dad.  His eyes lit up, and a big smile crossed his face."

"Two friends from his past stopped by.  He recognized them and was glad to see them."

"We found the lenses to his glasses.  No small miracle.  Now he can see!"

"I discovered the nursing home has a barber/beauty shop.  We made an appointment for a much-needed haircut."

Looking for the bright spots along the way isn't easy.  When you find them, though, they're like pure gold.

Can you think of any small blessings you and/or aging parent have experienced recently?

Looking for Free Help on Medicaid? Columbia Legal Services Has It Covered

I live in Washington State.  So do my clients.  When they're understandably stumped about Medicaid for their aging parent, I turn them over to the best free sources around:  publications by Columbia Legal Services.

Contracting with the Department of Social and Health Services, Columbia Legal Services produces documents that are pretty much stripped of jargon.  They're straightforward and easy to understand. Two of them stand out as extremely helpful, asking questions like:  "How much money can my parent keep and still qualify for Medicaid?"  "What kinds of things can be purchased as she is spending assets to qualify?"  and "What is the income limit for Medicaid eligibility?"

The two documents are:  Questions and Answers on Medicaid for Nursing Home Residents and Questions and Answers on the COPES Program.

They answer the same basic questions of how to qualify physically and financially, how the person "participates" in paying for his or her care, what miscellaneous services Medicaid covers, etc.

Today the COPES program is used most often. It's an alternative to nursing home care.  The care under COPES can be provided at home, in an assisted living community or in an adult family home.

So if you might be looking at Medicaid for your aging parent, either now or in the future, I encourage you to start with the COPES publication by Columbia Legal Services.

Have any of you looked at these publications?  Have they been helpful?

Some Good Words for Your Aging Parent at Easter

What does your aging parent want and need at Easter?  Hint:  it's not a chocolate bunny, or a brightly colored egg.  It's not even an Easter lily, as gorgeous as that seems. 

It's love.  But what does love look like, to any of us, at any age?  Christian author Philip Yancey in "Vanishing Grace" writes of being asked the question, "When do you feel loved?"

Here's how he answered.

I feel loved when...

• Someone listens attentively.
• Someone makes me feel important.
• Someone encourages and even challenges me.
• Someone cares for me when I'm hurting.
• When someone gives me an unexpected gift.

These expressions of love aren't bought, generally.  They're demonstrated.  And within each of these categories, we can find examples of "gifts" we can give our aging parent.

In a related quote, also in Yancey's book, Pastor Mark Rutland cited a survey which asked Americans which words they most liked to hear.  The survey came out this way:

In first place: I love you.

In second place:  I forgive you.

In third place:  Supper's ready.

Don't these sound like Easter words?  As you gather around the table, pass the ham or sweet potatoes,  enjoy your aging parent, and the love that binds you together.

Caregivers Carry the Weight of Grief; We Can Lighten the Load

If you or your aging parent is caring for a loved one, you know about stress.  It may seem like your middle name.  It sends your heart racing and your stomach aching. But what about grief?  That set of emotions that we usually connect with death actually comes much sooner.

"Grief starts when the person who takes care of a loved one begins to experience loss," says Carilyn Ellis, PhD, in a seminar for Certified Senior Advisors entitled "The Long Goodbye:  Grief and Caregiver Stress in End of Life Care."

Losses mount over time, Ellis says.  And these impact body, mind and soul. Often a caregiver will experience idiopathic (physical) symptoms such as headaches, backaches or insomnia that seem to spring up suddenly without any apparent reason.  Grief does numbers on our physical bodies.

That's not all.  Caregivers, whether you or your parent, tend to lose social networks as the caregiving role spirals and encroaches into every waking minute. 

Other losses are spiritual in nature.  Often caregivers ask the "Why" questions:  "Why is this. happening? Where are the sources of comfort?"   Grief has psychological implications, as well, as the caregiver experiences sadness and anger.

Caregivers must process the various stages of grief at specific losses:  for example, the loss of roles the ill person played in the family; and the loss of companionship that this phase of life often brings.

"This 'anticipatory' grief is an ongoing process," Ellis says.  "It's grief after grief."

How can we help the caregiver (either ourselves or loved ones)?  Ellis gives the following advice:

ASSESS.  Discover the caregiver's beliefs, values, fears, concerns. 

Ask how the caregiver is feeling:

• Physically.
• Emotionally.
• Socially

NORMALIZE.  Talk about the fact that these feelings of anger, guilt, frustration, etc. are normal and that others feel this way.  And the physical feelings of fatigue, aches and difficulty sleeping are also shared by many people in grief. 

VALIDATE.  Listening is one of the best gifts the caregiver can receive. 

ENCOURAGE SELF-CARE through support groups and supportive friends.

What is your experience with anticipatory grief? 

Adult Family Homes: Commonly Asked Questions

All down the West Coast, and in other parts of the country, adult family homes dot the eldercare landscape.  In Seattle and surrounding King County, there are 1100 such care homes. 

They're little known wonders.  Two years ago I started knocking on the doors of adult family homes in my city.  As I met the providers, observed the caregivers and spoke with the residents, I grew in my admiration for this homelike setting.  I'd worked with seniors and their families for 18 years, but adult family homes were new to me.

Since then, I've spoken with clients who have had the following questions about adult family homes.

1.   Are caregivers in adult family homes adequately qualified?

Caregivers in adult family homes must pass the same basic training classes as those working in assisted living communities.  Those classes include coursework in dementia care, mental health and fundamentals of caregiving.

2.  What is the staffing level in an adult family home?

In Washington, the law requires at least one caregiver for six residents at all times.  However, many if not most adult family homes have two or three caregivers working during the day, with one available at night.  In assisted living communities, staffing levels are on average 12 residents to one caregiver.

3.  Can adult family homes care for serious medical conditions?

Yes.  The Law allows adult family homes to care for nearly every condition that a skilled nursing
facility can handle, with a few exceptions including  IV injections.

4.  Do adult family homes have licensed nursing staff?

Some homes are owned and managed by Registered Nurses.  All adult family homes have Nurse Delegators.  These are specially certified RN's who train the caregiving staff to do tasks that normally an RN does such as medication management, administering of creams and insulin injections.  These Delegating Nurses are on call for the adult family homes to problem solve, consult with physicians, and assess residents' progress.

5.  What type of resident is best suited for an adult family home?

People who are considered "fall risks" because they've fallen several times are particularly suited for an adult family home.  There are no long halls to navigate, and staff members can watch residents closely during the day.   At night, if residents can't push a call button, staff can place a pad with a censor on the floor near the bed.  If a resident starts to get up, the censor goes off quietly so the caregiver can hear and check in.

People with dementia, especially mid to late stage, do well in adult family homes. The quiet atmosphere and caring staff can be soothing.

6.  What elders might NOT be best cared for in an adult family home?

Elders who are cognitively intact and physically able and who crave social activities are better served in assisted living.

Do you have other questions about adult family homes? 

Eldercare Q-A: Mom has a new dementia diagnosis. Will she need memory care?

 Memory care.  When someone is diagnosed with dementia, their family ponders the possibility of the need for such specialized care. Perhaps you're in that situation.

The key is possibility.  Not everyone with dementia needs specialized memory care.

What triggers the need for memory care?  Behaviors like screaming, striking out at others, and behaving inappropriately, such as using a waste basket for a toilet, all indicate a need for memory care.  So does "exit seeking."  That's a term for someone who impulsively and repeatedly heads for the outside door of his home or assisted living community.  Another indicator of a need for memory care?  People with dementia who can no longer feed themselves.  There are others, but you get the idea.

If your parent has just been diagnosed, he or she doesn't likely need memory care immediately.  Often a smaller assisted living community may meet his or her needs during the early to moderate stages of the disease.  Your parent can retreat to his or her apartment when the stimulation of the dining room and social activities gets to be too much.  Caring staff can make his or her days go well.  And if the disease progresses to the point of needing memory care, they should be able to tell you.

In many assisted living communities nationwide, the memory care area is in the same building.  Often residents begin in the regular assisted living section, and then move to memory care if and when the need arises.

Another option for elders with moderate to severe memory issues is adult family homes.  These may or may not be available in your parent's state.  But if they are, they're a good alternative for many with dementia.  There's a high staffing ratio, often one staff member for three residents, and the small setting allows caregivers to keep a watchful eye over residents who are at risk for falls. 

If  your parent will need Medicaid funding, care options will likely be limited.  Often adult family homes and nursing homes are the only Medicaid-funded choices for those with moderate to advanced dementia.

King County, WA: Free Program Aims to Reduce Recurring Falls

Does your parent live in King County in Washington State?
Has he or she called 9-1-1 for a fall, or has someone else called on his or her behalf? 
Or has a health care professional assessed him or her as at high risk for falling?
Does your parent live independently--not in assisted living, nursing or senior public housing?

If your parent meets these criteria, he or she could be eligible to participate in a free program aimed to reduce the risk for reoccurring falls.  Sponsored by King County Emergency Medical Services, the program helps elders be safe and independent in their own homes.

The program includes:

• A free in-home safety walk through of their home by a physical therapist
• Home environment assessment which may provide the following items free of charge:  tub grab bars, night lights, rug slips, shower chair, toilet safety frame, raised toilet seat, bed assist handle, hand held showerhead, shower transfer bench, bath mat, wall bar, smoke alarms

How it works:

Each client will be visited by a physical therapist who will administer the following:

• Demographic and health characteristics questionnaire and "Up and Go" test or "Sit to Stand Test."
• Clients sign a medical release so their doctor can be contacted.

The program has been running since 2003.  In that time, 82.6% of those who completed the evaluation did not have a fall after  the intervention.

For more information, contact "One Step Ahead," 206-296-4866.

Caregiving at a distance: Questions to Ask Yourself

You're juggling family, friends and a job.  Plus an aging parent who lives far away.  How do you manage his or her care from a distance?  And when should you visit?
.
Here are some questions to ask yourself from time to time.  Dr. Jim McCabe, President of
Eldercare Resources, shared these at a presentation for the Certified Senior Advisors.

1.  What do the local helpers (church people, neighbors, friends) say about Mom or Dad?  Often their input is more objective than your parent's.  He or she may minimize any problems, not wanting to worry you.

2.  What is your parent's style:  half full or half empty?  This will color his or her perception of what is going on.

3.  Can you afford a trip now?

4.  Can you make arrangements for your family and work right now?

5.  What if you delayed your visit and did not go?


McCabe advises that long distance caregivers work with a Geriatric Care Manager in the area where their parents live,  and also connect with local resources such as senior centers, and the US Network on Aging.

For a Senior Care Professional You Can Trust, Look for the CSA

"Vulnerable adults."  That's what the law in the State of Washington calls people who need help to navigate life.  Your aging parent may be among that group, due to physical, cognitive or emotional frailty.  Or maybe all three.

You, too, may FEEL like a vulnerable adult at times, simply because of the complexity of eldercare issues that you must wade through.  Although age is on your side (you're not pushing 80), you can still be confused by the financial, legal, and social ramifications of decisions you make on behalf of your parent.

Not long ago I spoke with a business owner.  He and his wife own a clothing store in the heart of our city.  He is respected by leaders in the business and professional fields.  Yet when it came to finding housing and care for his dad and mother, he felt like he was in kindergarten.

Fortunately he got some help through a professional with three letters behind her name:  CSA.  Those letters stand for SocietyCertified Senior Advisors, a national society of professionals who work with seniors.  Realtors, Home Care Providers, Senior Care Advisors and Financial Planners are just a few of the types of professionals holding this designation. 

What makes the CSA special?  Those seeking the CSA attend classes which provide a strong foundation on the many issues facing seniors:  psychological, medical, financial, legal, religious and more.  They pass an exam, which also includes an ethics section.  And afterwards, they commit to doing continuing education which usually includes learning about issues outside their field of speciality. 

The Certificated Senior Advisor program produces accountability.  If members violate ethics standards, they can be sidelined or ejected from the group.

Trust is huge in working with adult children and their parents.  When I refer families to a home care agency, a professional organizer, a moving company or other professional, I look for the CSA.  When I refer to other CSA's (yes, I'm one of them), I can be pretty sure those folks will meet the needs of the families I work with l as their "vulnerable adults."  Trust builds trust.