Keep the Memories Alive

As we wind down from the hubbub of the holidays, we can look back on memories of holidays just passed and from long ago. We will have hopefully been spending time with family and friends catching up and reminiscing about the good old days. Now would be a good time to check with our aging family members to record memories from long ago.
Talking with aging relatives gives them the opportunity to relate cherished times in their lives and will give you a chance to understand events that made them the people they are today. Recording the conversations as audio or audio/video files will allow you to pass the family stories down to future generations. Remember to mark the records with the date, time and name of the persons involved in the discussion. It will also be necessary to move the records to newer technology as it becomes available, before there is no way to play back the recording due to changes.
Questions you might think about asking to start the conversation include (but are not limited to): Tell me about your favorite holiday memory from before you married Mother/Father. Tell me about your first holiday together. What do you remember about how holidays were celebrated when you were a child? Are there memories you are willing to share now that you kept from us as we were growing up?
Don't restrict your memories to pleasant memories if your family member wants to talk about something sad or disturbing. Let them direct the conversation after you get it started. You may find that your aging relatives have had a much more interesting life than you expect.

Back Again Finally

It has been too long since I have published anything on this blog. It it very hard to keep up with posts without any feedback. I will be posting again starting with the New Year, hoping to post at least twice a week. Please make comments on what you have read. What lead you to this blog? Did you find the information helpful? Is there a topic you would like to learn more about?

MERRY CHRISTMAS to all and a HAPPY NEW YEAR!!

Diet and Better Health

There has been some recent hoopla about the effectiveness of multivitamins taken over time. Some of us take multi-vitamins to treat a deficiency in our diet (low calcium or iron) or just because it seems the prudent thing to do. Unfortunately, for some vitamins more is apparently not better. If we are getting enough of the proper nutrients in our diet, vitamin and mineral supplements may not be needed. We just need to eat our vegetables and drink our milk the way our mothers taught us.
Older persons may have an additional barrier to good nutrition. The inability to drive makes it very hard to do the marketing. Stocking up on canned or frozen goods may reduce the need for weekly trips to the market but when we are looking at nutritional content, fresher is usually better. Make it a point to assist your aging relative to get to the market at least weekly. If this is a problem, consider making use of the delivery programs more and more food markets are making available. Your loved one can place an order one time a week and have there groceries delivered directly to the house. There is usually a small fee but this will be off set by a decrease in the need for medical care.

Safety on Your Feet

As we get older, our sense of balance can diminish. Our ability to catch ourselves if we start to fall also declines. In order to prevent a fall, we need to be sure that we are wearing the proper footwear. I am seeing some really attractive and cute slippers being offered in the catalogs we get this time of the year. If you intend to order these, take the time to check the soles. If they do not indicate that they are slip resistant, don't buy them. If you have them in hand, return them.

Flexibility: the Key to Mobility

Thanks to the Americans with Disabilities Act (ADA) it has become easier for mobility challenged folks to get around but it is not yet perfect. There are some public spaces that have been grandfathered into the act that have not been adapted for wheelchair accessibility. As facilities are remodeled, more and more are making the adaptation for access. Unfortunately, non-challenged people may not be able to spot subtle barriers. A 2" step may be too much for a small powered wheelchair or the rest rooms may be on another level without an elevator. Some places are just too narrow or otherwise cramped for someone to get through using a wheelchair or a walker.

Being adaptable and thinking creatively will go a long way to overcoming these challenges. Restaurants need to get supplies in somehow, you may find yourself coming in through the kitchen. If you can transfer or stand briefly, you maybe able to shift to a chair at the slightly higher level while someone lifts the wheelchair up one set of wheels at a time.

This is also the "teachable moment" for the manager or owner of a facility. Point out the barriers as pleasantly as  possible and if you can, suggest a solution for future reference. It has been our experience that most facilities are more than eager to help and happy to have the feedback.

Medication Safety: Keep it Bright

As we age, our eyes change. We may need glasses to read, cataracts may form or other issues arise. We are also more likely to be taking medication for a long term health issue. It is not uncommon for someone to be taking several medications several times a day. In order to be sure that we are taking the correct medication at the correct time we need to be able to identify the bottles when we go to take our medications. One of the best things to be done is to be sure that the area is well lit. If the medications are moved from the bottles from the pharmacy to a pill case, be sure to fill the pill case in a well lit location.

Trust But Verify

Everyone who is old enough to vote is old enough to have a will. Power of Attorney documents should also be set up at the same time as well as Advance Directives. These should all be reviewed every 5 years or so or when there is a significant change in circumstances.
What sometimes happens is that sometimes there is family strife and seniors may be told that Person A is now in charge of the money and medical decisions. Don't take this at face value. Insist on seeing the documents in question and verify the signatures. Bear in mind that a document is not enforceable if the person signing away rights is not competent to do so. If your estranged relative has signed over control of finances to someone after they have been diagnosed with dementia or Alzheimer's challenge the documents through your attorney. This is especially important if you feel that this person does not have your best interests in mind.

Gift or Not to Gift

Keep in mind that when we are retired, there is no easy way to replenish the money in our accounts. We are not working or any work we do perform is often poorly paid. It is therefore a bad idea to gift our children or grandchildren with large sums of money. Even making a loan is chancy.
One thing that may not come to mind is that if you were to need to apply to Medicaid for assistance there may be consequences to giving money to family members. Many states will look at your monthly income, your resources and how you have spent your money for the last number of years. In New Jersey, the look back at spending patterns is five years. If you have given money away, it will delay your ability to receive assistance.
This will also apply to your house. You may sell it to a child or family member but do not just sign it over in an attempt to continue to live there.

Medications and the Granny effect

There has been a recent rise in the number of children being seen the Emergency Room for accidental poisoning. Children have been known to take prescription pills, thinking that they are candy. They come in such an array of pretty colors after all. One of the reasons that children find medications and take them inappropriately is the "Granny effect."
When grandparents come to visit they will naturally bring their medications. Often there will not be a particular place to store the medications out of the reach of children and the medications may be in a pill dispenser case and not in a child proof container. Older adults often receive their medications in non-child proof containers because child proof can also mean senior proof as well.
Remember to find a place for visiting grandparents to store their medications safely out of the reach of little hands.

Dating and the Aging Mother

There is a commercial being aired in some markets in which a mature gentleman calls for his date. The woman's son answers the door and is very concerned as his mother and her date "lay rubber" as they leave the house. This is of course a dramatization but it makes an excellent point. Single Seniors are perfectly capable of enjoying the dating scene just as they were when they were younger. Be prepared to see this happen and do what you can to support them in establishing these relationships.
Another point to keep in mind, if you are introducing your relative to someone new, keep in mind their respective mental/emotional ages. I have a friend who has been introduced to several very nice women who are 10 to 15 years older than him, in their outlook on life. He has had the good fortune to meet a lady who is his age as it refers to his outlook on life. He met this lady incidentally through a friend and as a part of his usual social activity.

Taking Care of Yourself While Helping Your Aging Relatives

It is not uncommon to find people caring for aging relatives while they are trying to prepare for their own retirement or even when they are retired themselves. It takes thought, planning and ingenuity to manage to continue to accumulate money for your own retirement while you are in the position of helping your relatives. It is not news that the longer someone is retired, the greater the influence of inflation. We sometimes find that we need to provide financial support and this needs to be approached carefully.
Whenever possible, look for a low cost or free means of providing support. Check with insurance carriers to be sure which goods or services are covered under the policy. Also verify what pre-certification is needed and what documentation  is required. (receipts, doctor's order, etc)  If there is a need for home modification and money is tight, try the local carpenter's union. There may be an apprentice who can do the work for a smaller fee as a part of what needs to be learned to become a journeyman. Also, check with trade schools for students who need a project.
Remember that there is always more than one way to accomplish a task.

Keeping up with medication changes

You will often hear healthcare providers and folks in the media reminding people that they need to take medications as they are prescribed. It is important to take medications as frequently as they are ordered, at the right time and in the right amount. One thing they don't mention very often is when to stop taking a medication.
When you or your loved one are talking with the doctor at a routine visit or as you are being discharged from the hospital or ER be sure that you listen very carefully to the instructions. It is a good idea to repeat what the doctor has told you to be sure you have understood accurately. Also, verify if you are to stop taking any of the medications you are already using. Also, if you are to stop taking a particular medication, when should you start taking that medication again if at all.

Scam Alert for the Aging

There is an article in the newest AARP magazine regarding changes in scams and who is doing the scamming. Historically, the aging population has been a prime target for scam artists. We have resources and we want to be helpful. Also, there are some physical changes that alter our ability to process and evaluate situations. Now there is a trend to aging persons being the scam artists. We all need to be aware and wary of unscrupulous people.
Two important things to keep in mind: no one can guarantee a return on investment greater than the market average and all investment goes hand in hand with risk. If the sales person is making these kinds of claims, head for the door.
It is also good to keep in mind that you should never put all of your money in one fund in the market. Only risk what you are able to afford to lose. If you are already retired, move investments to low risk areas.

Family dynamics in crisis

As we are growing up we have the role that we play in the family and these will not change just because we are all grown up. In fact, the roles even become more rigid over time if nothing is done to change the dynamics. We also need to be aware that if one person changes everything else becomes unstable. When a family finds itself in a crisis situation, each person will usually act and react in a well established pattern.
There is the person who is "in charge" who takes care of everyone else and makes sure that what needs to get done gets done. The flaw here is that there is no one to step up if the person needing help is the one who has always been the organizer. This also interferes with other family members learning how to cope for themselves. This person is also less likely to ask for help or to accept help when it it offered.
The person who always finds humor in things can relieve pressure but can also keep folks from taking things as seriously as they should be. This person distracts everyone from the problem because they do not want to face the issue. This family member will find it hard to accept that Mother or Father needs help and may sabotage the efforts of the organizer.
There is also a behavior pattern that distracts from a problem by being a more "urgent" problem. This pattern will pull energy and resources from an aging relative who needs help. If this person has managed to grow out of this pattern it is hard for the family to trust that help offered will be there if it is accepted. Take the time to ask for help from this family member based on recent behavior rather than historic behavior.

Pets and the Aging - Part II

Having a pet is often a very good thing for us as we age. This is especially true for those of us who live alone. The companionship is comforting and being responsible for an animal is a reason to get up in the morning. Unfortunately, there can be too much of a good thing. In the last two weeks there have been at least three separate hoarding events in the news that involved animals.
The most common types of animals involved in these cases are cats or dogs. They are easy to collect and if they are not spayed or neutered they will produce new litters regularly. Many towns and cities have ordinances that limit the number of pets someone can own. There is a very good reason for this. Both the animals and the people will soon find themselves in an unsanitary and unhealthy situation if there are more than the home and grounds can reasonably handle. Cats and dogs need room to move around, a suitable place for them to "do their business" and a clean place for food and water. Cramming large numbers of animals in a small space is not fair to the animals or the people involved.
If your family member is hoarding animals, give them the opportunity to find homes for the excess animals. If this is not going to happen without intervention, call the animal control office. They will come and remove the animals and provide you with information regarding the next steps to take.d

Pets and the Aging

Pets are an important part of the lives of many people. I grew up with a dog in the house. (Yes, a dog. He was 18 when he died) and most of my friends had dogs or cats as well. Animals are a part of the family and a source of comfort to most of us as we begin to find our friends and families becoming more distant for a wide variety of reasons. Our pets love us back without reservations and they keep us active as we care for them. This is especially true with dogs as they need to be taken for walks which benefit us as much as it does them.
As our loved ones age, they may find that it is more difficult to care for their beloved pets. It is in the best interest of everyone to do what can be done to help them to continue to provide for pets that are like additional children. If your parents need to move into a facility to obtain regular care but cannot take the dog or the cat, it is only right that you do what you can to see that their beloved companion has a good home. That may be with you or may be with a good home elsewhere if you cannot take them in.

Listening to Our Aging Relatives

Listening is something we all think we are doing all the time. Multitasking by texting while we are also in a conversation or playing a game on the computer while we are on the phone may lead to incomplete understanding of what was said. This can be especially a problem if we are having a conversation with our aging relatives.
We need to be present in mind as well as in body when we are talking with our relatives, friends and acquaintances. Listening is an active process. Paying attention to what is being said, noting non-verbal clues and knowing what has already been said in the conversation are all ways to listen actively. Do not think of your reply before the other person stops speaking. Ask for clarification of a statement that was made. Restate something or paraphrase it to be sure that you understood. All of these practices will improved communication.
Another thing we need to keep in mind while we are talking with our aging relatives is that they do usually have something to say. They have many years of experience and may provide a new point of view to enliven the discussion. They may also be giving you an opening to discuss uncomfortable issues such as money concerns, safety concerns or end of life issues. How they feel about the last days of a friend or relative can give you a hint about how they want to be treated.
We also need to allow them to be happy, sad, fearful, angry or any other emotion that presents itself. Nodding and making "listening noises" (I see, and then what happened, really!?) will encourage them to share what is really going on. You need to acknowledge how your relative is feeling about an issue, do not assume that they want you to fix whatever is wrong and do not try to minimize what they are feeling.

Supporting New Hobbies and Pursuits

As we age many of us find that old hobbies and activities are not so pleasurable as we once thought. Our abilities change, the activity becomes associated with a negative memory or we simply lose interest. Those of us who are intellectually lively will usually seek out a new interest. Meeting a new friend or beginning to date someone may also stimulate the desire to learn new things. The same situation holds true for our aging relatives.
Just because someone decides to become involved with new pursuits does not mean that they have taken leave of their senses. Learning about new things or starting a new career are clear indications of being an active participant in life. Your loved ones deserve your support in the new activity.
One thing you need to do when this new activity breaks out is to be sure that your loved one has the physical capability of participating safely. Be sure that they have checked with the doctor and are taking appropriate safety precautions.

Information: More is Better

As we age and find that our bodies are trying to betray us, we will need the assistance of others for day to day activities and decisions will need to be made regarding health care. When we find ourselves helping with these decisions for our loved ones the steps we need to take are much the same. Ask questions until you and your family are satisfied that you have enough information to make a good choice.
What constitutes a good choice is unique to every person and family. Some folks may want only enough care to be comfortable and others may want everything that the medical community can provide. Most of us will fall somewhere in between. We also need to remember that choices may shift over time and our health care proxy needs to know if we have had a change of heart concerning what level of care we want so that our desires may be respected.
It is also important to be sure that our health care proxy is able to follow through with our wishes. If we want to be made comfortable and decline the use of machines or feeding tubes to keep us alive and our health care proxy is insistent that all medical science be attempted to keep us alive there will probably be a moral dilemma to be resolved if and when these choices need to be made. 

Power Of Attorney for Health Care

I have recently been asked about assisting with getting a man transferred from one treatment facility to another. The problem is that the lady asking for help is not the person named in the POA (power of attorney) that this gentleman executed several years ago. Another issue is that the person named as POA does not have a copy of the document and was unaware that he had been named. Additionally, he lives on the Pacific coast while the person needing assistance is on the Atlantic coast. Thankfully, the gentleman needing help is able to give consent to the move.
There are several problems in this scenario that could have been avoided. Always notify the person you name as your healthcare proxy and provide them with the original of the document. You should keep a copy for your own records. It is also advisable to name someone who is geographically close so that they can get to you quickly in the event you need to activate the healthcare proxy. The need to have someone make healthcare decisions on your behalf may occur suddenly (accident, stroke, loss of consciousness) or over a longer period of time. The person will not know if you need help if they only see you a couple of times a year and talk on the phone once or twice a month. If you have a sudden change in your condition, decisions will need to be made quickly.

Fall Risks for the Aging

Just this past weekend we had two risky events. I stumbled in the parking lot of the local big box store and my husband slipped in the bathroom. Of the two, the bathroom slip was the more dangerous. The stumble was only potentially embarrassing.
As we age the risk of serious injury from falls increases. Bones become more brittle and the risk of a break secondary to a fall increases. Our loss of muscle mass leads to greater challenges as we try to catch ourselves to stop a fall or weakness that may lead to a fall. We are also more likely to have challenges to our sense of balance.
These are only the reasons that we may fall, where we fall also effects the outcome. In the parking lot I had visions of scrapes on hands and knees from the blacktop while I moved forward to regain my balance. The risk of a break is there as it is with any fall but scrapes and bruises are more likely.
The concerns in the bathroom were greater for a couple of reasons, the first being the hard surfaces in most bathrooms and the fact that my husband uses a blood thinner per his doctor's orders. We have grab bars well placed around the toilet and the shower which came in handy to help my husband to guide himself to a sitting position and a softer landing. We have added slip resistant tape to the bottom of the shower rug (it slipped to cause the incident) and will be adding another grab bar in the shower to accommodate his increasing difficulties with balance.
When there are changes in status, always move to change the responses as quickly as possible. The changes we have made and will make in the bathroom will allow us to continue in our home with safety.

KS - More progress, good results

KS has moved into the assisted living facility she chose about 2 weeks ago. With her challenges this is moving at light speed. New clothing was purchased during a whirlwind shopping trip in one evening. More will need to be purchased but we can now take our time and only purchase small quantities as needed. She left all of her clothing at the old house and will need new clothing for each season as we move through the year.
New furniture was purchased with her room in mind and it fits wonderfully. The way her husband's will is set leaves all of the furniture in the house to her stepsons. That combined with the level of contamination in the house makes the furniture unusable without decontamination. The new furniture has been a wonderful option for her and she is having fun deciding how it will be arranged.
The new computer is set up and we need only buy a USB cable to connect the printer. This is the last we need to do in the facility and we hope to make today the last walk through of the house before KS leaves for good.

Hot, hot, hot

Even if you think that global climate change is not real, you cannot ignore the heat that is baking the US at present. There is also a drought in Africa that is resulting in famine. The rains and run off from snow melt combined to create flooding in the Midwest this past spring and the evaporating waters drive the humidity to raise the heat index to record levels.
Throughout all of this we need to keep in touch with our aging relatives and neighbors. The power grid is being stressed and we are beginning to hear about brown outs and other power interruptions. This raises the risk of heat related injury and death, especially for the very young and the very old.
One of the problems for the aging population is that they do not notice that they are becoming dehydrated. By the time they are thirsty they are already at risk. Be sure that they stay out of the heat in an air conditioned area and that they drink at least a quart of water or non-alcoholic beverage an hour if they are not in air conditioning. Preventing heat stress is easier than treating it.
If your family member or friend is in distress, call 911. They will send help and will provide guidance for what you can do while waiting for the Emergency Services to get to you.s

More regarding KS and her saga

KS has made the decision to move to an Assisted Living facility. Now the real fun begins. Because of the unsanitary situation in her home, she will not be bringing any clothing from home to the facility. We will be taking her to purchase all new clothing as well as the furniture pieces she will be using in the facility. All of us helping her have other work obligations and she has been taking up huge amounts of time. With any luck KS will be in the facility by the end of the week and we can scale back how much time we spend. There will be more to be done but the urgency will recede.
This is the kind of situation you may find facing you as someone suddenly needs much more time and attention. Personal relationships may be stressed while you deal with the crisis and you need to keep an eye on maintaining these as well as they need to give you the flexibility to deal with a short term situation.
An additional side to this whole situation is that KS has the resources to "go first class" and working out how to pay for things is not a pressing issue. We will be looking for sale items and ways to conserve money but she will be able to buy with an eye to value for price more so than price alone.

Making the Move, more in the saga of KS

KS has made the choice to move to an Assisted Living facility. This was not easy for her because she has trouble making decisions, hates/fears change and worries about the cost. In many cases cost will be a significant issue but in the case of KS, she has sufficient funds to make the move.
Now we begin the process of down sizing her belongings. The house she is moving from is a 4 bedroom home with a living room, dining room, family room and kitchen with 2 1/2 baths. The house is also a hoarder's nightmare. KS will be going through the things in the home to choose what she is taking. Because of cleanliness issues, she will only be taking her books and a few other personal objects. This will work for her, if your family is in a similar situation it may not be an easy sell.
Working with someone to move into a small space will require thought and tact. If you have helped them to make the decision to move, try to choose the space first. This will give you the opportunity to measure space available and present concrete limits to what can be moved into the apartment or room. You may even suggest new furniture to fit the new space if there are sufficient resources to accomplish that. Remember that second hand furniture can be a choice if you are careful about checking its condition.

Further facts on the Tale of KS

KS is rapidly closing on the day that she will make a decision regarding where she will live. The three significant choices are remaining in her current home with a significant clean-up, assisted living #1 or assisted living #2. We are now dealing with an issue that rises often enough to be almost usual, opinions offered by well meaning but incompletely informed family members.
If you remember, those of us assisting KS are not relatives, we are friends. KS has trouble making decisions and will agree with the last person to talk with her. Two relatives who are unable to understand the degree of the challenges she faces in getting from today to tomorrow are trying to get her to choose a living arrangement that would be suitable for them. Unfortunately this is without understanding her need for supervision, interpersonal interactions, and a need to limit further changes.
There need to be several conversations with these family members to help them to understand that KS is not well served by the conflicting advice and by advice based on incomplete information.

Coping With the First Crisis

There will come a time when it is impossible to ignore that someone is no longer able to continue to be the independent person they have been in the past. The call comes in that Mother or Daddy has fallen, had a stroke or some other crisis has occurred. Rest assured that you and your other family members will cope with the decisions that need to be made. The conversation will be underway whether or not you or your loved ones are prepared.  If you are lucky the crisis will be a small pothole, not a washed out bridge. If you have had the conversations before the crisis, you will be making decisions with more information and some things will have been decided ahead of time.

Age: Is it no more than a number?

Is a person's age more than just an number? Yes and no. Today the news made note that Nancy Reagan is celebrating her 90th birthday. Last week, at the conference we attended, a friend was serenaded in the hospitality suite to mark her 90th birthday. Betty White is spry and active at 89 and Ernest Borgnine is past 90 and still working. There are people well into their 8th and 9th decades celebrated for their level of activity on a regular basis. The thing to keep in mind is that they are celebrated because they are outside of the norm. Most of us are not physically active and in good health past 75 or 80. It is advantageous of us to begin to help gradually as our loved ones age.
We need to acknowledge that our loved ones are probably slowing down as they age. Bone strength can be promoted by weight bearing exercise but bone loss will eventually catch up with all of us as we age. Women represent a greater percent of those who experience osteoporosis because of two factors. Women have less bone mass at the peak of skeletal strength and we live longer into the ages that result in bone loss. Men will also experience bone loss as they age but they start with more. Other effects of increasing age include a loss of muscle mass and strength, diminished collagen under the skin which results in wrinkles, and diminished sensory sensitivity.
A diminished sense of taste and smell makes food less appealing and appetites often decrease. This will result in weight loss and poor nutrition if we don't find ways to help our aging relatives find ways to enjoy food with more intense flavors as well as good nutritional content.
Keeping active physically will improve bone mass and muscle strength. It will be helpful to promote exercise if we attend classes or the gym at the same time. If you ask them to come to support you in your efforts to be more fit they may see it as a means to help you even if it is really the other way round. Of course, it never hurts to be more active ourselves.

Day to Day needs to keep up with cleanliness

As we age we will all gradually lose our ability to perform simple daily tasks or at least to find them more of a challenge. As our muscles lose mass and strength, lifting a gallon of milk or other beverage becomes more difficult. Changes in vision will require brighter lights to allow us to read labels, magazines and books. We are more prone to broken bones as our skeletons become more fragile over time.
We need to be aware that these things are also happening to our aging relatives and friends. There will be opportunities to provide assistance in subtle ways such as asking if a family member will come along on a shopping trip that you are already making. When you stop by for a quick visit, take a moment to pitch in with fixing the food or cleaning up after. If your family member is finding housework to be too much you may give them a maid service as a gift for a special occasion. Approach the maid service carefully, they may not take easily to the suggestion that they are not able to do the house work independently.

Finding the most suitable living arrangement - Part 3

More about the ongoing saga of KS. We went to a continuous care facility on Friday and got a good look at the Assisted Living part of the campus. There are apartments for independent living and a nursing home area for those who need more intense care. It is a lovely facility but not really for KS.
Even though KS has the resources to enter this facility there are issues. The way I found out about this issues was by taking the time to listen to her. Listening to our aging relatives is the best way to understand what they want, what they fear and what they find uncomfortable. In the case of the LG continuous care facility, KS felt that they were too far from the geographic area with which she is familiar (10 miles is too much for her) and the facility has a religious basis that is more rigid than KS would find comfortable.
KS told me all of these things indirectly at first and then more directly when I asked for her opinion directly. If we take the time to ask questions and then listen attentively to the reply we will be able to be supportive of our loved ones need for independence as well as our need for them to be safe. They must be as actively involved in the decision process as they are able.

Living Arrangements for the Aging -What's out there

I have recently been posting about my friend's search for a new and more suitable living arrangement. We have been looking at Assisted Living facilities and tomorrow we will tour a Continuous Care facility. Many of the services that each of these offer are similar but there are specific differences between them.
Assisted Living facilities will usually charge a one time community fee and a monthly rental on the space to be occupied. This will be a room and bath at the least but will often also include a kitchenette with a space for a microwave and a small refrigerator. Some larger units will also have a small second room as well. Meals are supplied in a communal dining room and there will be support services to keep things clean, get the laundry done and support your loved one with taking medications. Depending on the facility, these services will be included in the rent or may be additional cost as needed. Nursing care will be available 24 hours a day when needed.
Continuous Care facilities have more options and a resident can move through the facility depending on the amount of care they need at any time. It is possible to move from independent living with meals and access to medical support all the way to a nursing home placement if it were to become necessary. There is generally a larger buy in fee than for Assisted Living along with the monthly rental fee but this will allow you to be sure that your loved one will be well cared for with a minimum of disruption as they age. There will also be an age restriction for the youngest age at entry to the facility.
Either option is worth considering if you can take your time and work through the process before there is an urgent need for a new place to live.

Finding an Appropriate Living Arrangement - Part 2

Last time I alluded to the challenges presented by KS's supposedly adult stepchildren. She has a life estate for the house. This means that she may stay in the house until she chooses to leave but the house will become the property of her stepsons if she moves to another home. Unfortunately, her stepsons and their wives are pushing her attorney to push her to leave the home as soon as possible. They are being everything but helpful.
These young men are prime examples of how to NOT handle your parent's second spouse. While there are those who prey on vulnerable seniors this is still the exception rather than the rule. You need to step back and put your first response in neutral to review the reality with a minimum of emotion in the mix.
Questions to ask yourself include: Is this person good to my parent? Does my parent appear to genuinely care for this person? If this is a union based on financial benefits, do they both benefit? Are they better together than separately?
It is also best to set greed aside in these situations. If there is a particular object you want to have from the house and it was left to the surviving spouse, ask nicely. If they do not want to give it up right away, maybe they will leave it to you in their will. If they feel that they need to sell items to provide for living expenses, ask to be offered the items before anyone else. Of course, if your step parent is reduced to sell items to make ends meet, you may consider how much more help you should try to offer.
All in all, talk to each other, open the lines of communication and try to see in this person what your parent did.

Finding an Appropriate Living Arrangement - Part 1

Wow, what a week! Well actually, two weeks. A friend has recently been widowed and since she has no family living close enough to be of help, a couple of us have stepped up to help her deal with the issues resulting from her husband's death.
Her attorney friend is dealing with issues around the estate, her chronologically adult stepchildren and the utter chaos in the house. RS, her husband had a progressive dementia and began to hoard cats several years ago. Unfortunately, most of the 20 plus cats were feral even though they were in the house. Their waste (and the resulting smell) will need to be removed from the home to restore it to sanitary conditions.
An additional challenge to cleaning up the house is that both of them were hoarders. The house is littered with papers, furniture (she had a home before the marriage) and items that were in the collections that RS had amassed over the years. Add this to the general accumulation of stuff from his being in the house for more than 55 years.
In the midst of this, we have managed to get KS to consider moving to an assisted living facility. She will be living in more sanitary conditions, her meals will be provided and being around people will keep her from becoming socially isolated. We have been to two facilities so far and will look at at least one more before she makes a decision. The problem for KS is that she has mental health issues that make it very hard for her to make choices without second guessing herself. She also has trouble remembering what questions have been answered and what the answers were if she doesn't write it all down.
I will keep you posted as the saga unfolds.

Death and the Aging

It has been quite awhile since I posted a blog entry. Life has gotten ahead of me in the form of a crashed hard drive and in the middle of all that, death has also paid a visit.
As anyone can tell you, death comes to all things that live at one time or another. In this case, my 84 year old cousin passed away. Her funeral was a celebration of her life and we all had the chance to formally say good-bye. This formal leave taking is the true purpose of funerals.

Of course, as we age there are increasing numbers of funerals to attend as our elders begin to die and then as we get even older, our contemporaries will die as well. It is important to help our aging parents to participate in this solemn ritual that is a part of all life. If they have any difficulties in getting to the place of the services, take the time to provide transportation. Most places are accessible and will find ways to get people in no matter what the challenges may be.

These occasions will offer the opportunity to learn what your aging relatives may want if you don't yet know. I am not advocating that you ask directly but if you listen you may pick up a clue or two. My first thought at my cousin's funeral was that she had been cremated because there was no casket and a recent photo was displayed at the altar. As it turns out, she had made arrangements ahead of time to contribute further to society by donating her body to science. Her choice stimulated plenty of conversation at the "victory feast" luncheon that was held after the services. Plenty of people were very open about what they had in mind.

Protecting the Aging from Excessive Heat

Here we go again! We just posted several days of 90 + degrees and summer is still three weeks away. Now is the time to pay close attention to our aging friends and relatives. They are more prone to become dehydrated and will often forget to drink enough to prevent problems. Of course, it is not uncommon for them to restrict water because they don't want to need the bathroom all that frequently. They are also at risk to not notice the signs of dehydration until they are really in trouble.
My best trick for getting them to drink enough liquid is to find a particular glass and give them specific instructions to drink 3 or 4 glasses full from that glass. The number of times that they should fill the glass each day is calculated to give them at least 32 ounces of water each day. This water in addition to the liquid in their food and taken with meals will help them to stay hydrated.
Notice that you need to keep hydrated yourself. Drink water, juice, milk or soda to keep up your hydration. Avoid caffeine because it pushes your kidneys to put out more liquid and you will be defeating your purpose. Alcoholic beverages should also be avoided because they will also interfere with staying hydrated.

Wild Weather and our Aging Family and Friends

Every time we turn on the news lately, it seems that there is a new story, complete with distressing pictures, regarding damage to lives and homes by the forces of nature. The flooding in the Midwest has been horrendous but there was plenty of warning, particularly for towns downstream. There is some warning regarding tornadoes but not nearly as much as we would all like. This year the storms seem to be more violent than usual as well.
Every area has its own dangers from nature. Humans find themselves in the path of everything the planet can throw at us but we can also be prepared for what can be expected.
Take the time to sit down with your aging loved ones, maybe even all of your family and make a plan to meet the challenges you can reasonably expect where you live. Set up an emergency pack with items you can expect to need that can be grabbed in a hurry if you need to evacuate. Include a list of medications and contact information in a water proof bag in the back pack or other bag along with a couple of days worth of clean clothing and a small quantity of high energy food (energy bars, trail mix, etc) When the time comes to leave the home it will be easy enough to toss all your medication into a large storage bag and add it to the larger emergency bag.
Take the time to store irreplaceable items in a manner that will reduce the likelihood that they will be destroyed by a flood, fire or storm. It may even be worthwhile to store them in a safety deposit box at the bank.

What Makes an Accurate List of Medications?

If you listen to the ads on TV or read them in magazines, they will remind you to tell your doctor about all the medications you are taking. This is important because you need to be sure that your doctor has all the information needed to make good decisions regarding changing your medications. The medications you need to list for your doctor include all the medications that have been prescribed by this doctor and other specialists you may see as well as over the counter medications such as vitamins, stool softeners and non-prescription pain relievers. Also, include any folk remedies or supplements. Any or all of these have the potential to interact and cause problems such as making a medication work less well than expected or more intensely than expected.

Never take it for granted that you doctor knows everything that you are taking. In order to get the most from your health care you need to be an active participant or partner with your health care provider.

Medication Safety for the Aging

The older we get the more likely we are to need some sort of medication on a regular basis. I have talked about storing medications safely but there is so much more to keep in mind. You may have heard it before but it bears repeating; store medications in the containers in which they come. These containers will be labeled with the name of the medication, the strength of the pills (milligrams) and how often it is to be taken. There may also be additional important information. It is perfectly fine to set out a week’s worth of pills in a pill case that is labeled for the day of the week and possibly the time of day that the medications are to be taken. If you are traveling, be sure that you have a list of the medications you are taking and if any of them are narcotics, keep them in the original prescription bottle.

Be sure that you understand why your physician wants you to take each medication, how you are to take the medication and what side effects can be expected. You may need to take a medication with or without food, avoid certain foods while taking the medication or you may need a certain amount of fluid with each pill. You may also need to sit upright for at least an hour after taking the medication. Side effects may need to be reported right away or only when you next see the doctor. You should also know any symptoms that would require a trip to the Emergency Room due to an allergic reaction. Never hesitate to ask for clear instructions and plenty of time to ask questions.

Driving, withdrawing gradually

Beyond a doubt, when to hang up the car keys is arguably one of the most stressful decisions a family needs to make. Sometimes we are lucky enough to have our aging loved ones voluntarily stop driving, more often there is stiff resistance to the idea. Driving represents independence as no other issue except maybe control of money. Recognizing the need is hard enough for the family, the aging driver is unlikely to acknowledge the increased challenges unless there is a significant or dramatic incident that is unmistakable.

It is possible to start the conversation related to events in the news. The current high gasoline prices represent a wonderful opportunity to talk about decreasing time behind the wheel. Offer to take your aging loved one to the market when you go as a cost saving measure. Suggest that you will drive them to religious services, to the doctor or wherever else they need to go and you can complete an errand of your own at the same time. Any news item regarding an aging individual who got into trouble driving will also present an opportunity to open the topic for discussion. It also is possible to start the discussion if there is a change in a person’s medical condition that will make it less safe for them to drive.

If you can get the conversation started, consider suggesting a gradual decrease in driving. Limiting driving to daylight hours, close to home and/or familiar destinations is a way to ease into the change.

Health Literacy

As we all age, we will find that we need to spend a greater portion of our time with MD’s and other health care providers. In order for us to make the best use of this time it is important to be as informed as possible. We can do that by asking questions that lead us to the best and most complete information. We need to use our best critical thinking to separate the good info from the garbage.

Remember that you need to be aware of the source of any health information that comes your way. The web is a wonderful source of information but anyone can post anything that takes their fancy. Reliable info will come from government websites, the Centers for Disease Control (CDC) or from sites that post research papers. The trick is to be suspicious of the hype and to look for well conducted research that uses control groups and can be repeated. Testimonials of how wonderful some new treatment seems to be are the beginning of the research not the end.

Storing Medications Safely

As we and our loved ones age, it becomes increasingly likely that we will need to take medications for chronic conditions. We also usually keep over the counter medications in our homes for pain management, symptoms of the common cold or other simple occasional problems. The most common places to store medications are the bathroom and the kitchen. There are issues with both places.

The bathroom may be a convenient place to store medication but there is a great deal of humidity due to bathing activities we complete in the bathroom. The medicine chest is often placed over the sink which increases the rate at which medication is affected by moisture. Medications will often lose potency from the exposure.

The kitchen is the other place that people store medications. This keeps them convenient to remind us to take them as we should but will often put them in easy reach of children. We should always take care to teach children to leave medicines alone but the teaching isn’t always effective. There is less chance of humidity becoming a problem in the kitchen.

The safest place to store medications is in a sealed container (Rubbermaid, Tupperware or such) in an upper level cabinet.

Keeping Connected through Faith

Today is Easter Sunday for many of us here in America and over the rest of the world. Passover began at sundown last Monday evening. There are Islamic observances during this time as well. As we age, it becomes more difficult to attend services at our local place of worship while it often becomes more important to our sense of well being to participate in religious practice. It is important for those of us who are still able to move about without problems to make the effort to support the desire to attend services for our aging relatives and friends.

There are also ways for mobility challenged persons to participate in religion via technology. More churches are broadcasting over the web as well as those that have broadcast on television or radio for many years. As it relates to smart phones…there’s an app for that. You can now download a copy of your holy book or stream video from your chosen place of worship. It would be a very good thing to help our aging relatives to be able to worship electronically.

Allergies change over time

The news broadcasts are heralding the pollen counts for tomorrow and the rest of the week, apparently they are going to be exceptionally high for certain tree pollens. Most of us know if we are allergic to pollens and know what medication or other treatment works well for us. What we often forget or may not be aware of, allergies can change over time. As we age, we may suddenly find that spring or fall allergy season is suddenly a problem.  If you are experiencing itchy, reddened eyes, stuffiness or sneezing you may be allergic to something in your environment, if it is new, see your Primary Care Physician who may refer you to an Allergist.

Eating well for improved health

There is a renewed interest in improving our lives by improving how we eat. The obesity epidemic is discussed on TV and radio and in print media every day. One circumstance that is not part of the conversation is how to encourage our aging population to take in enough calories and the proper nutrients in order to keep them healthy. As we age, our ability to taste diminishes and eating becomes less enjoyable. Also, eating alone is more often the reality for aging people and it is less fun that food taken in company. Unfortunately, we find that many people grab a quick meal that is high in processed foods which do not deliver complete nutrition.

To combat these circumstances, take the time to cook with your loved ones and encourage them to experiment with more strongly flavored foods. Spices and other seasonings may need to be added in greater quantities and trying to balance the amount of fat in the diet with the need to reduce the effects of fat on the heart. Remember that fat adds flavor to food. Limiting processed foods and cooking more “from scratch” will improve the nutritional quality of the foods they have to eat. Cooking with them, preparing meals that can be frozen and reheated later and helping them to shop for healthy foods will go a long way to improve their quality of life.

Writing your Medical and Financial Power of Attorney

It is advisable to write a will with the help of an attorney and to write a medical power of attorney and a financial power of attorney. These legal documents will help you and your family handle issues when they crop up with a minimum of confusion.

An attorney friend of mine recently told me that she often needs to convince people that they need to not worry about offending someone. You need to make a choice regarding who you trust to make medical or financial decisions on your behalf if you are not able. If you talk it over with the person accepting the responsibility before the documents are signed you will be sure to have some one who is willing to help.

After the documents are signed, take the time to sit down with other interested parties to let them know what decisions have been made and to help them to understand that you still love them but you have asked X to take the responsibility for your own reasons. You will probably find that everyone is relieved that choices have been made and a plan is in place.

Gun safety in the home

You only need to open the newspaper or turn on the television to see that there is a great deal of gun violence. The response to this violence is to either get rid of any firearms or to get and keep a gun in the house. Whichever choice you make, you have every right to decide for yourself. One thing you need to be sure of if you choose to own a gun you must take gun safety into consideration. There is nothing more unsafe than having a gun in the house that you do not know how to handle.

If your aging relative has a weapon in the house, take the time to be sure that they can still use it properly. Take them to the firing range to have them checked by an expert. It is a good idea to verify with them that they know how to load, unload, clean and where the safety is and when it is on or off. Be sure that they have the gun and the ammunition stored safely.

If your relative has changes in their mental status or physical condition that result in them being no longer able to use a gun safely, ask them to give up the weapon. If they wish to keep the gun, do what you can to remove all of the ammunition from the house.

Changes in Mental Status

Change in Mental status is a general description for any alteration in a person’s ability to think clearly. This may be a decrease in alertness, an increase in confusion or other change such as increased suspicion of people around the person with the change. This should usually be evaluated in the ER so that the cause can be identified and treated as quickly as possible in order for the person to have the best outcome possible.

There are many reasons for a change in mental status for our aging family members and friends. The most concerning would be stroke and the easiest to treat would be a urinary tract infection (UTI). Any infection could be a cause of confusion in an elderly person but for some reason UTI’s do get missed for several days if the proper tests are not completed quickly. This will happen in the ER because the lab is in the same building while results may take a couple of days in the doctor’s office.

Choosing the best doctors for yourself and your aging relatives

As we age, we are more likely to need the services of health care professionals. These will probably be recommended by your Primary Care Physician (PCP) in response to a change in your medical condition. If you are not getting the recommendation from your PCP there are couple of things you need to consider when choosing a specialist.

The first and foremost issue to settle is whether or not the MD is Board Certified in their specialty. Any licensed physician is able to treat any person for any disease but most will focus in a particular area of medicine. They will also participate in additional education regarding the most current treatment of this area of focus. The very best will become Board Certified. This will include additional testing and continuing education to keep up with the latest standards of practice.

The other issue to resolve is how well do you interact with the MD? If you do not feel comfortable working with the doctor or cannot communicate well your care will not be the best. Always take the time to find the doctor who makes you feel that you are important enough to listen to.

ER visits and the Aging

It is very likely that each of us will need to be seen in the ER at some time or another. It can be an overwhelming experience but if you and your aging relative have taken the time to be prepared things can go as smoothly as possible.  Some things you may set up for emergencies include beyond your identification and personal information include the following:

·         A complete list of all medications you (and your loved one) take. This needs to include medications prescribed by the doctor, over the counter medications and any herbal remedies. This needs to include the amount of each medication and how often each medication is taken. Include a list of allergies with your medications.

·         A list of your doctors that includes first and last names, telephone numbers and specialties.

·         A list of chronic health conditions and at least a brief medical and surgical history.

·         The name and contact information of your Medical Power of Attorney

·         Your health care insurance name and identification numbers. This will be on your insurance card and contact information will be on the card as well.

·         The name and contact information of your religious or spiritual leader if that is important to you.

The reason to keep this information together is to allow you to focus on the emergency that caused you to come to the ER and not need to remember details that are important but hard to recall. This information can be written on a paper and kept in your wallet (and the wallet of your Medical Power of Attorney) or stored on line by a Medic Alert company and made available by information on a Medic Alert bracelet or necklace.

Caring for Relatives with Special Challenges

I have just become aware of the death of the husband of a friend. While this is very sad, he was 85 and had been ill for sometime. He died at home and no extraordinary measures were taken. The problem left behind is that his wife, my friend, has challenges that make it very hard for her to handle the day to day responsibilities to keep the bills paid and the house maintained. She is 60 and is a person with Asberger’s syndrome which is often described as a high function type of autism.

Fortunately, there is a will and she has two step-sons who will be able to assist her and possibly become conservators for her and the estate.  I am aware of another situation where this was not the case and the lack of a will complicated matters so that nothing was settled for nearly a year. This wait occurred while the intellectually challenged son of the deceased struggled regarding his own care and living arrangements. In that case, the nephew of the challenged person was able to step in to help.

If you are aware of a person with intellectual challenges, the challenges presented by autism spectrum disorder or physical challenges due to mobility issues and are close enough to pose the questions, be nosy. Ask if arrangements have been made. Offer to help find the proper attorney. If this person is in your family, take the time to be part of the solution.