Wednesday, March 29, 2017

Healthy Living and Successful Aging

The United States is experiencing a remarkable increase in the number of people who live to an old age. Our older population (people 65 years or older) numbered nearly 40 million in 2009 (latest year of available data). These folks represent one in every eight Americans, or 13% of the population. By 2030, it is projected that the U.S will be home to more than 72 million people age 65 and older.

This astonishing increase is largely a result of medical and health care advancements that simply allow people to live longer. Currently, the average life expectancy of an American is about 80 years old (nearly double that of our ancestors).

Health is Wealth

Living a long life is a goal most of us have in common. Ensuring that we spend the latter years of our life feeling healthy and happy should be an important part of that goal.

Health is indeed wealth, especially as we age. Embracing a healthy lifestyle and making health our number one priority will bring invaluable wealth to us as we age.

Although growing older is inevitable, there are many things we can do to avoid feeling older. Medical breakthroughs have and will extend our longevity, but how we decide to live our senior years will be crucial. Managing our physical health, maintaining relationships, following safety tips, and making adequate preparations to fund our retirement and long term care can help us make the most of our so-called 'golden years.'

Below are suggestions for healthy living that will help each of us age successfully.

Stay Connected and Productive

One of the most important things you can do to stay healthy and happy as you age is to maintain your sense of purpose by staying productive and connected to people and things that are important to you. Spend quality time with at least one person (a family member, friend or neighbor) every day. Seek out those who uplift and challenge you. Avoid secluding yourself.

You can also fill your days rendering service to others who are not as fortunate as you. Giving time for a cause beyond yourself brings with it a sense of purpose you can’t achieve anywhere else. Your wealth of wisdom and experience will continue to grow as you reach out to others.

Activities that can help you remain connected and productive include: gardening, cooking, knitting, volunteering at a library or hospital, helping neighbors, visiting museums, traveling, playing cards or games, joining a senior center, starting a book club, taking a class, attending church, or learning and using a social media like Facebook.

Finally, challenge yourself mentally. Reading books or newspapers, doing crossword puzzles, drawing or painting, writing, studying, or learning to play a musical instrument are effective and fun ways to keep your mind sharp.

Collect and Write Family Histories

Those who pursue the gathering and writing of personal and family histories are always rewarded. As one of the older people in your extended family, you likely hold memories of people, places, and events that might be lost forever upon your passing. In this case, you are the family history. Don’t let it be lost to future generations. Take the time to preserve your heritage by writing these memories down.

Exercise Regularly

Exercise is a significant part of good health at every age. Unfortunately, many older adults do not get enough physical activity and exercise. Staying active can improve vitality, help maintain strength and flexibility, expand mental function, decrease risk for health problems, and may even help relieve chronic pain.

Find an activity you enjoy then ease into it at a pace and consistency your body can handle. Try to include a variety of endurance, strength, stretching, and balance exercises in your routine. Exercise choices may include yoga, walking, swimming, biking, gardening, and exercises classes designed for seniors. The key to successful exercising is variety.

Be sure to talk to your health care provider before beginning an exercise program.

Prepare Financially

For some, successful aging equates to financial responsibility, making sure that they have the right Medicare health plan, long term care insurance coverage and enough money to cover the costs of health care in retirement.

As soon as you have a job and a steady income, begin to plan frugally for retirement and the decades which follow. Planning early will help you to avoid unnecessary debt and live more comfortably during your final years. Use caution in cosigning financial notes (even with family members) when retirement income might be jeopardized. As you near retirement, be even more cautious about “get-rich” schemes, mortgaging homes, or investing in uncertain ventures. In all financial aspects, proceed cautiously so that the planning of a lifetime is not disrupted by one or more poor financial decisions.

The National Care Planning Council provides lists of eldercare planning services to help the public prepare for the years following retirement. The list includes care management services, financial advisers, elder attorneys, reverse mortgage specialists, advocates for veterans, home care services, and other types of eldercare providers.

Have a Healthy Diet and Lifestyle

Don't smoke, eat right, and practice good hygiene. We’ve all heard these tips before, but we repeat them so often because they are crucial to maintaining a healthy lifestyle.

Eating right should include consuming nutrition-packed meals every day. Extra weight from poor diet choices increases your risk for heart disease, diabetes and high blood pressure.

Staying healthy also has the very practical impact of reducing out-of-pocket health care costs. A healthy person spends far less time at the pharmacy, the doctor’s office, and even the hospital.

Prevent Injuries from Falling

Falling is one of the most common causes of injury among seniors. Simple home modifications, the use of assistive devices, wearing sensible footwear, and removing hazards can reduce the risk of falling and the injuries that come with it.

Visit Your Doctor Regularly

About 80 percent of seniors are living with a chronic condition. Many chronic conditions, like diabetes and heart disease, can often be prevented.

Visit your health care provider regularly and follow their recommendations for screening and preventative measures. Screenings are particularly helpful as they serve as an early warning system. Much of the illness and disability associated with aging can be prevented (or slowed down) when you have the benefit of early detection. Regular dental, vision and hearing checkups should also be taken into consideration.

One of the most common conditions affecting older men is enlargement of the prostate gland, or benign prostatic hyperplasia (BPH). Among aging women, a loss of bone density (osteoporosis) is a particular concern.

Many people age 70 and older seek the care of a geriatric physician, also called a geriatrician. Geriatric physicians are medical doctors who specialize in the diagnosis, treatment and prevention of disease and disability in older adults.

Summary


Growing older is inevitable, but there are many things we can do to avoid feeling older. Medical breakthroughs have and will extend our longevity, but how we decide to live as we age is crucial. Managing our physical health, maintaining relationships, being productive, taking safety precautions, visiting our health care providers often, and making adequate preparations to fund our retirement and long term care can help us make the most of our senior years.

Getting Your Affairs in Order

If we had a crystal ball and could see into the future, we would not need to prepare ahead for end of life decisions. James was 62 years old when a stroke made it impossible for him to communicate with his family. Neither his wife nor children knew anything about his financial or medical information. James had always taken care of things himself and left no written directives in his behalf. Besides having to locate important documents, the family was left to make their own decisions about James long term care.

The National Institute on Aging gives three simple, but important steps to putting your affairs in order:
  • “Put your important papers and copies of legal documents in one place. You could set up a file, put everything in a desk or dresser drawer, or just list the information and location of papers in a notebook. If your papers are in a bank safe deposit box, keep copies in a file at home. Check each year to see if there's anything new to add.
  • Tell a trusted family member or friend where you put all your important papers. You don't need to tell this friend or family member about your personal affairs, but someone should know where you keep your papers in case of emergency. If you don't have a relative or friend you trust, ask a lawyer to help.
  • Give consent in advance for your doctor or lawyer to talk with your caregiver as needed. There may be questions about your care, a bill, or a health insurance claim. Without your consent, your caregiver may not be able to get needed information. You can give your okay in advance to Medicare, a credit card company, your bank, or your doctor. You may need to sign and return a form.” National Institute on Aging http://www.nia.nih.gov
Preparing Advance Directives or Living Will
Advance directives are legal documents that state the kind of medical care or end of life decisions you want made in your behalf. It is a way for you to communicate your wishes to family or health care professionals. Emergency response medical personnel cannot honor Advance directives or living wills. They are required to save and stabilize a person for transfer to a hospital or emergency facility. Once at the facility a physician will honor the directives.

The Living Will as part of your directives gives your consent or refusal for sustained medical treatment when you are not able to give it yourself. If this document is not in place then a family member or physician will decide such things as:
  • Resuscitation if breathing or heartbeat stops
  • Use of breathing machines
  • Use of feeding tubes
  • Medications or medical procedures
Advance Directives and Living Wills are legal throughout the United States; however, some states may not honor other states' directive documents. Be sure to check with the state you live in for their requirements.

Review your directives periodically. They do not expire, but your wishes may change.

A new or revised Advanced Directive invalidates the old one. Be sure your family member or healthcare proxy has a current copy.

Choosing a Power of Attorney
General Power of Attorney - authorizes someone to handle your financial, banking and possibly real estate and government affairs as long as you remain competent.

Special Power of Attorney - authorizes someone you designate to handle certain things you cannot do yourself for a period of time.

Durable" Power of Attorney -The general, special and health care powers of attorney can all be made "durable" by adding certain text to the document. This means that the document will remain in effect or take effect if you become mentally incompetent.

Many people do not know the difference between a general and a durable power of attorney. A general power of attorney is a document by which you appoint a person to act as your agent.

Agents are authorized to make decisions for you, sign legal documents, etc. Many people are unaware that a General Power of Attorney is revoked when the person granting that power becomes incompetent or incapacitated.

It is the "Durable" Power of Attorney that allows for an agent to continue making decisions on your behalf no matter what happens to you. A responsible adult child of an aging parent would be given a "durable power of attorney" to act on behalf of the parent. This provides broader authority than just adding the child's name to bank accounts and documents.


You may choose to produce notarized power of attorney documents on your own. If your estate is large and real estate or business is included it is advised to secure a reliable attorney.   National Care Planning Council http://www.longtermcarelink.net/a2cfindattorney.htm

Family Reunion -- a Good Time for Family Planning

Summertime brings a lot of family time. With family reunions, picnics, weddings and other events, long distant family members travel to gather together. It is also the perfect time to do some planning for the future. With parents aging and their health and lifestyles changing, children need to discuss some changes and decisions that will be needed in the near future. Parents should take the time to tell their children where important documents are kept and what their wishes are in the event of needing health care directives or experiencing long term care needs.

For those children who live away, the change they see in their parent's health and mental capacity may be alarming -- whereas siblings that have daily contact are working with these issues constantly. Here is the chance to compare notes and work together as a complete family in the long term care planning process. For you parents who are well and active, this is a good time to hold a family meeting and share with your children your plan for long term care. Tell them where financial and legal documents are located. Review health care directives, living wills and long term care alternatives.

Experience has shown that even families that are close can quickly grow angry, jealous and hostile towards each other when an aging parent begins to need long term care. If a
sibling moves into the parent's home, others can easily be suspicious of ulterior motives and fear losing their inheritance. On the other hand, the child providing the elder care becomes bitter and feels there is no support or help from siblings. Pre-need meetings for the purpose of making a plan, before eldercare becomes imminent, avoids these types of conflicts.

In its book, “The 4 Steps of Long Term Care Planning,” the National Care Planning Council provides guidelines and checklists for family planning meetings. Here's an excerpt from the book:
“The first step to holding a meeting, and perhaps the most difficult one, is to get all interested persons together in one place at one time. If it's a family gathering, perhaps a birthday, an anniversary or another special event could be used as a way to get all to meet. Or maybe even a special dinner might be an incentive.
 The person conducting the meeting can be a parent or one person of a couple who are doing their planning, years before the need for care arises. A meeting on behalf of someone already receiving care or needing care in the immediate future could be conducted by that person or by a member of the family, by an adviser or a friend.
 The agenda could be formal or informal. If you want a formal agenda, we suggest using our care planning checklist as the agenda. Copies of the care plan should be prepared prior to the meeting and presented to those attending. Discussion is encouraged and we recommend that the person in charge not dictate but encourage input from everyone.  
After a thorough discussion of the issues and the presentation of the solutions to the problems that will be encountered, there should be a consensus of all attending to support the plan. If the plan needs to be altered to meet everyone's expectations then by all means do so if that can be done. But it is not always possible to please everyone so there must sometimes be compromise.  
The end of the meeting should consist of asking everyone present to make his or her commitment to support the plan.
GET IT IN WRITING! All good intentions seem to be forgotten with time. It may be years after this meeting before the long term care plan begins. If there are vocal commitments to help with transportation to doctors, give respite to the caregiver or other commitments, write them down on the care agreement. You can even have each person put a signature to his or her commitment if you think that is important.”
 
The U.S Department of Health and Human Services states:
“No one wants to think about a time when they might need long-term care. So planning ahead for this possibility often gets put off. Most people first learn about long-term care when they or a loved one need care. Then their options are often limited by lack of information, the immediate need for services, and insufficient resources to pay for preferred services. Planning ahead allows you to have more control over your future”.
 
"Whether you plan a formal meeting with an agenda or informally gather for a discussion, when the family is together make it a point to start the long term care planning process.
There is a lot to learn and many decisions to make concerning finances, health issues and legal work. It may take research and a lot of time to put a plan together, but if everyone is involved it will work, and be worth it." National Care Planning Council, www.longtermcarelink.net 

The 4 Steps of Long Term Care Planning

This article is a synopsis of the National Care Planning Council's new book "The 4 steps of Long Term Care Planning." To learn more about this book and to obtain a copy, please go to the following link: www.4stepsbook.com

The Importance of Planning for Eldercare
According to some sources, 60% of us will need long term care sometime during our lives. It is important for all of us to prepare for that day when we will need to help loved ones with care or we will need long term care for ourselves.
We may prepare financially for unexpected disasters by covering our homes, automobiles and health with insurance policies. But no other life event can be as devastating to an elderly person’s lifestyle, finances and security as needing long term care. It drastically alters or completely eliminates the three principal retirement dreams of elderly Americans:
1. Remaining independent in the home without intervention from others
2. Maintaining good health and receiving adequate health care
3. Having enough money for everyday needs and not outliving assets and income
Yet, it is our experience that the majority of the American public does not plan for the devastating crisis of needing eldercare. This lack of planning also has an adverse effect on the older person's family, with sacrifices made in time, money, family lifestyles and even affecting the family’s or caregiver’s medical and emotional health.
Because of changing demographics and potential changes in government funding, the current generation -- more-than-ever -- needs to plan for long term care before the elder years are upon them.

What Is Long Term Care?
The need for long term care arises when an individual requires, from someone else, assistance with medical care, daily living activities, comfort, supervision or advice. This need for care may be caused by an accident, disease process, or frailty. Such conditions may require help with the ability to move about, dress, bathe, eat, use a toilet, medicate, and avoid incontinence.
Also care may be needed to help the disabled person with household cleaning, preparing meals, transportation, shopping, paying bills, visiting the doctor and answering the phone. Oftentimes, long term care in the form of supervision or confinement is needed due to cognitive impairment from stroke, mental retardation, depression, dementia, Alzheimer's, Parkinson's Disease and so on. Most long term care is provided at home by family members.

What Is Long Term Care or Eldercare Planning?
For seniors, the terms "long term care" and "eldercare" are synonymous. For younger people, "long term care" is the more appropriate phrase.
For the uninformed family member, eldercare or long term care might appear to be a very straightforward and easy-to-understand process. Unfortunately, the reality is that long term care is very complicated and finding care systems and providers is a frustrating and time-consuming process. There is no one single source to help caregivers find services or solve problems with a simple phone call or a single community contact. For this reason, planning for care requires a great deal of prior knowledge in order to avoid operating in a crisis mode trying to find help when the need for care suddenly arises.
However, knowledge of long term care systems is not enough. Because it can happen suddenly, at any time, you must take action now to prepare for the day when you will need to deal with eldercare for your loved ones or for yourself. This action involves
  • Determining the care settings and services you or a loved one most likely would want.
  • Providing funding for paying the cost of care, especially when government support programs are lacking or require sacrifice of assets.
  • Completing a survey to determine necessary financial and legal arrangements to be made.
  • Completing a written long term care planning document to provide instructions to caregivers and to your care coordinator in advance of needing eldercare.
  • Assigning a care coordinator and determining the role of other family members, friends or advisers involved in caregiving.
  • Holding a planning meeting and drawing up a written agreement for involvement between all those who are willing to participate in future caregiving for you or a loved one.
We have defined four crucial steps necessary in this process for long term care planning. These four steps will be described below. The four steps are based on the following four concepts:
1. Knowledge and preparation are the keys to success.
2. Having funds to pay for care greatly expands the choices for care settings and providers.
3. Using professional help relieves stress, reduces conflict, and saves time and money.
4. Success is assured through a written plan accepted by all parties involved.

STEP 1-Understanding the Nature of Care, Care Settings, and Government Programs (Knowledge and preparation are the keys to success.)
This step requires an understanding of 12 different living arrangements and four different settings under which care is provided. In addition, understanding the provisions and limitations of government programs is essential because the public generally has a misconception that the government will step in and provide care when the time is needed.
Government programs are limited and according research by the National Care Planning Council (www.longtermcarelink.net), only 16% of all long term care services are provided by government programs. The other 84% is provided free of charge by family members, friends, charity, church groups or volunteers or paid for by private funds.
Our new book goes into great detail on step 1 and provides a comprehensive single-source reference for understanding the issues above and how long term care systems fit in with your personal long term care plan.

STEP 2-Funding the Cost of Long Term Care
(Having funds to pay for care greatly expands the choices for care settings and providers.)
Much emphasis is being placed on purchasing long term care insurance or arranging for reverse mortgages in order to fund the cost of care. These are two excellent tools for providing funding but in reality, this approach for planning is not working that well.
After 30 years of being touted as the ultimate solution, less than 2% of the American public and only 9% of seniors own long-term care insurance policies and using reverse mortgages may be a good strategy but in practice, few seniors are using them to pay for care. Our new book definitely covers these two funding options but also addresses at least 30 other strategies that can be used when trying to provide funds to pay the cost of long term care.

STEP 3-Using Long Term Care Professionals
(Using professional help relieves stress, reduces conflict, and saves time and money.)
Long term care services are complicated and provider contacts are fragmented throughout the community. For the majority of Americans, eldercare becomes a frustrating do-it-yourself process. This approach is unnecessary. Using care professionals is the most cost effective and efficient way to provide help for a loved one.
Those people who need help with long term care and use the services of professionals often find they save money over doing it themselves. They also reduce their stress and they free up a considerable amount of their personal time. Another benefit with using professional help, such as a care manager, elder law attorney or mediator, is to help you alleviate or avoid family conflicts that often arise as a result of caregiving.
Hiring professional advisers or providers to help with long term care is no different than using professionals to help with other complex issues such as car repairs, dealing with taxes or dealing with legal problems With their education and training, long term care professionals also bring experience that only comes from dealing with countless hands-on, caregiving challenges.
In much the same way that a three legged stool needs all three legs to be useful, the care planning approach needs at least three key entities in order to be successful. It needs YOU, LONG TERM CARE PROFESSIONALS, and GOVERNMENT LONG TERM CARE PROGRAMS. Our new book describes this team planning approach in more detail and outlines 13 vital professional services necessary for a successful long term care plan.

STEP 4-Creating a Personal Care Plan and Choosing a Care Coordinator
(Success is assured through a written plan; accepted by all parties involved.)
The first three steps in the planning process are designed to give you a wealth of information about long term care. It is important for you to have an understanding of care systems and the resources you can turn to when the need arises. However, knowledge of long term care systems is not enough. You must take some tangible action now to prepare for the day when you will need to deal with eldercare for your loved ones or for yourself.
The final fourth step in the planning process will help you make a care plan. If you follow our instructions and prepare a written plan for you or a loved one, the challenge of dealing with long term care will unfold for you in a more manageable manner. You will experience less stress, have fewer costs, require less time committed and have fewer family conflicts.

Our book is designed as a self-contained reference for long term care services and advisers. The book also becomes your written care plan since it contains your personal document locator, your personal survey, your written care plan with instructions and a written care planning agreement between all parties involved. By including all of the necessary information, documentation and instructions under one cover, the book becomes a single-source, valuable resource used by family members, caregivers and the care coordinator for carrying out the plan. The book also introduces the unique concepts of assigning someone as a care coordinator, who is not a caregiver, and organizing a meeting and completing a written agreement between family members or others who are involved in the care.

The Accidental Caregiver

You've heard people say it and maybe you have even said it yourself.  "Don’t worry Mom or Dad, I’ll take care of you in your old age."

This always seems to be a simple loving gesture on your part as you see them beginning to age and settle into retirement.  The thought of their actually failing in health or mental capabilities seems absurd or at most, years down the road. Thus it catches most children and spouses unprepared and sometimes surprised when their loved one needs care and help with daily living activities.
  
 A stroke, injury or sudden illness may result in the immediate need for a significant caregiving commitment.  On the other hand a slowly progressing infirmity of old age or the slow onset of dementia may require intermittent caregiving.  Either way, if you have not made provisions for this, you will accidentally become a "caregiver."

Former first lady Rosalynn Carter made this statement,

"There are only four kinds of people in this world: those who have been caregivers, those who currently are caregivers, those who will be caregivers, those who will need caregivers."

Statistics show that the possibility of becoming a family caregiver grows yearly.

"43.5 million of adult family caregivers care for someone 50+ years of age and 14.9 million care for someone who has Alzheimer's disease or other dementia."
Alzheimer's Association, 2011 Alzheimer's Disease Facts and Figures, Alzheimer's and Dementia , Vol.7, Issue 2.

"The value of unpaid family caregivers will likely continue to be the largest source of long-term care services in the U.S., and the aging population 65 and over will more than double between the years 2000 and 2030, increasing to 71.5 million from 35.1 million in 2000." Coughlin, J., (2010). Estimating the Impact of Caregiving and Employment on Well-Being: Outcomes & Insights in Health Management, Vol. 2; Issue 1

There are two types of caregiving scenarios, Formal and Informal.

Formal Caregivers

Formal caregivers are care providers associated with a service system.  Service systems might include for-profit or nonprofit nursing homes, intermediate care facilities, assisted living, home care agencies, community services, hospice, church or charity service groups, adult day care, senior centers, association services and state aging services. Professional care managers and legal and financial professionals can also be of help.  Some these formal caregiver services are covered by Health Insurance, Long Term Care Insurance, Medicare and VA Benefits.  Otherwise for formal care where there is a charge, payment is out-of-pocket by the individual or family members.  Private pay, out-of-pocket for long term care services can be costly and advance financial planning is advised when possible.

Informal Caregivers

Informal caregivers are family, friends, neighbors, or church members who provide unpaid care out of love, respect, obligation, or friendship to a disabled person. 
 The number of informal caregivers range from 20 million to 50 million people.  This could represent about 20% of the total population providing part-time or full-time care for loved ones. 

About two-thirds of those caregivers for people over age 50 are employed full-time or part-time and two-thirds of those–about 45% of all working caregivers–report having to rearrange their work schedule decrease their hours or take an unpaid leave in order to meet their caregiving responsibilities. 

The average amount of time informal caregivers provide assistance is 4.5 years, but 20% will provide care for 5 years or longer (National long term care survey 1999).

Below are some of the activities provided by or supervised by informal caregivers. The Accidental Caregivers, involved in this type of care, will find themselves picking up a few things that need to be done or supervised in the beginning and adding more as the need increases.

Managing money and paying bills
Writing letters or notes
Making repairs to the home, maintaining a yard, and removing snow
Providing comfort and assurance or arranging for professional counseling
Answering the phone
Making arrangements for meeting medical needs and doctors' appointments
Shopping and running errands
Providing transportation
Maintaining the household
Attending to personal hygiene and personal grooming
Administering medications
Help with walking, lifting, and bathing
Help with using the bathroom and with incontinence
Providing pain management
Preventing unsafe behavior and preventing wandering
Feeding
Providing meals
Doing the laundry
24 hour care and monitoring
Nutrition management
Financial planning
Legal directives
Medical directives
End of life planning


Understanding the Progression of Care Commitment
As care needs increase, both in the number of hours required and in the number or intensity of activities requiring help, there is a greater need for the services of formal caregivers.

"Unfortunately, many informal caregivers become so focused on their task, they don't realize they are getting in over their heads and that they have reached the point where partial or total formal caregiving is necessary.  Managing their own needs and daily schedule along with those of the person they are caring for can become so consuming and energy depleting that the caregiver themselves are in need of care.  It becomes time to bring in other family members, professional services and medical advisors to create a plan of care that is best for all involved." - National Care Planning Council


Caregiver stress and caregiver burnout are serious issues that face caregivers providing both formal and informal care. Make certain you take care of yourself as well as take care of your loved one. The work of caregiver is difficult, but as caregiver Marlo Solitto said "Caregiving can be one of the most rewarding experiences of your life.

Who was Suppose to be Watching Grandma?

There is a popular tune played this time of year called “Grandma Got Run Over by A Reindeer” which relates that Grandma -- after drinking too much eggnog -- went out into the winter cold to get her medication and was run over by a reindeer. The question is, “Who was supposed to be watching Grandma?”

Though this little tune is just for fun, it may very well raise alarms to many caregivers of the elderly. Caregivers know that even at a holiday party they cannot let down their diligent watch over their elderly loved one. As far-fetched as it may sound, with all the people and noise, an elderly family member with dementia or Alzheimer’s may be enjoying the family gathering and then suddenly become confused and walk to the door and leave.

For family caregivers the added stress of the holidays with decorating, shopping, parties and keeping up with all the family traditions is an overwhelming quest. Feelings of isolation, depression and sadness come with this added stress. There are millions of Americans who are caring for elderly frail loved ones and most of these caregivers will go through some of these emotions, especially this time of year.

There are some things you can do as a caregiver to help you and those you care for enjoy the holiday season.

First take care of yourself. Try to eat right, get plenty of sleep and exercise. This will help reduce stress and strengthen your ability to cope with caregiving responsibilities.

Prioritize your holiday traditions. Perhaps instead of cooking a large family dinner, have everyone bring his or her favorite dish. Use paper plates. Forfeit the traditional outside light decorating for a lighted wreath on the front door. Choose one or two parties or concerts to attend instead of trying to do it all.

Arrange for help. Call on other family members to help with the caregiving while you do your shopping or go out for the evening. If family is not available, ask your church group or a neighbor if they would donate a few hours.

Use community services. Many senior centers provide meals for the elderly and supervised activities, onsite, at no charge or a minimal charge. For locating senior services in your state, call your state Area Agency on Aging or check the national locator website.

Use adult day care services. Some assisted living facilities provide day activities and meals for seniors on a day by day basis. Other organizations called "adult day service providers" specialize exclusively in this sort of care support at a reasonable cost. These support services provide respite for caregivers from their caregiving responsibilities as well as social interaction for their elderly family members. There is a cost for adult day services, but the benefit for all is worth it.

For example:
Jean had brought her mother into her home to care for her when mom's Alzheimer’s made it impossible for her to be alone. When the Christmas season approached, Jean realized she had to make some choices. She did not want to give up the traditions she had set with her daughters in shopping and lunches, but it wouldn’t be possible with her caregiving responsibilities. In searching for a solution, Jean visited an adult day services facility near her home. She found she could schedule the days she needed off for her mother to come in. The adult day services company also provided transportation and would pick up mom and bring her home in the evening.

Although Jean's mother was not sure she would like to go at first, she found she enjoyed the programs, meals and conversation with new friends and the activities provided.
The time it gave Jean to have for herself was worth the extra cost for the day care.

Technology to the rescue. Here is a solution that would have kept “Grandma” from going out in the winter cold and getting run over by a reindeer. Companies that have created monitoring systems, security alarms and other safety equipment are “tweaking” them to adapt to the needs of seniors and their care givers.
Here are a few examples:
  • Ankle or wrist bands that monitor location and alert the provider when a person has gone beyond the designated perimeter, such as out the front door of the house.
  • Motion detectors. Set throughout the home, motion detectors allow someone outside the home to follow a senior as he or she moves through the house.
  • Smart medication dispensers. Live monitoring and dispensing of pills.
  • Emergency response alert. At a touch of a button on a desktop monitor, bracelet or necklace, emergency help is summoned.
Whether providing care in your home or helping senior family members in their own homes, your use of monitoring and “tech” help aids can provide extra safety for your loved ones, and peace of mind for you.

You are not alone. Join a caregiving help group. Your local senior center may have one or go on the internet to find one. Hearing about other caregivers' problems and solutions and being able to share your own and ask questions is a great way to relieve stress and gain a new perspective. Check out websites like the National Family Caregivers Association at http://www.nfcacares.org/

Work with a Senior Care Professional. Recognize that you are doing the very best you know how. You are not a geriatric health care practitioner, geriatric care manager, home care nurse or aide, hospice provider or family mediation counselor, nor do you have the years of training and experience these professionals have, but you can definitely use their experience. In fact, using a senior care specialist will make caregiving easier for you and more beneficial for your elderly family member.

As an example:
Mark stopped by his father Dan’s home every night after work to help with any errands or things he needed around the house. He began to notice that Dan was not showering, dressing or even fixing meals some days. Another concern was his father's growing confusion and disorientation. A trip to the family doctor only brought more concern to Mark, since the doctor claimed it was just the aging process that caused the confusion.

Wanting a second professional opinion on what was best for his father, Mark hired Shelly -- a Professional Geriatric Care Manger -- to do an assessment. Shelly arranged for Mark and Dan to see a geriatrician, who advised that proper meals and an increase in some vitamins, would help clear up the confusion and disorientation. Shelly arranged for a home care company to come in daily to help with personal needs and prepare meals.

Soon Dan was back to his old self and able to function on his own.

You can find a wide variety of care professionals in your area on the National Care Planning Council website at www.longtermcarelink.net.


One more thing to remember. As a family caregiver, the greatest gift you are giving this holiday season is “Love.”

Your Home - Typically the Desired Setting for Eldercare

Most of those receiving long-term care and most caregivers prefer a home environment. Out of an estimated 8 million older Americans receiving care, about 5.4 million or 67% are in their own home or the home of a family member or friend.

Most older people prefer their home over the unfamiliar proposition of living in a care facility. Family or friends attempt to accommodate the wishes of loved ones even though caregiving demands might warrant a different environment. Those needing care feel comfortable and secure in familiar surroundings and a home is usually the best setting for that support.

Often the decision to stay in the home is dictated by funds available. It is much cheaper for a wife to care for her husband at home than to pay out $2,000 to $4,000 a month for care in a facility. Likewise, it's much less costly and more loving for a daughter to have her widowed mother move into the daughter's home than to liquidate mom's assets and put her in a nursing home. Besides, personally taking care of our parents or spouses is an obligation most of us feel very strongly about.

For many long term care recipients the home is an ideal environment. These people may be confined to the home but continue to lead active lives engaging in church service, entertaining grandchildren, writing histories, corresponding, pursuing hobbies or doing handwork activities. Their care needs might not be that demanding and might include occasional help with house cleaning and shopping as well as help with getting out of bed, dressing and bathing.

Most of the time these people don't need the supervision of a 24/7 caregiver. There are, however, some care situations that make it difficult to provide long term care in the home.

It is precisely the ongoing and escalating need for help with activities of daily living or the need for extended supervision that often makes it impossible for a caregiver to provide help in the home. Either the physical demands for help with activities of daily living or the time demand for supervision can overwhelm an informal caregiver. This untenable situation usually leads to finding another care setting for the loved one.

On the other hand if there are funds to hire paid providers to come into the home, there would be no need for finding another care setting. By planning for eldercare in advance and providing the funding necessary to remain in the home, no one need go to a facility to receive long term care.  With enough money, anyone who desires, can remain at home to receive the necessary care.

Recognizing the Need for Outside Help

Caregivers often don’t recognize when they are in over their heads, and often get to a breaking point. After a prolonged period of time, caregiving can become too difficult to endure any longer. Short-term the caregiver can handle it. Long-term, help is needed.  Outside help at this point is needed.

A typical pattern with an overloaded caregiver may unfold as follows:

• 1 to 18 months--the caregiver is confident, has everything under control and is coping well. Other friends and family are lending support.
• 20 to 36 months--the caregiver is taking medication to sleep and control mood swings. Outside help dwindles away and except for trips to the store or doctor, the caregiver has severed most social contacts. The caregiver feels alone and helpless.
• 38 to 50 months--Besides needing tranquilizers or antidepressants, the caregiver's physical health is beginning to deteriorate. Lack of focus and sheer fatigue cloud judgment and the caregiver is often unable to make rational decisions or ask for help.

It is often at this stage that family or friends intercede and find other solutions for care. This may include respite care, hiring home health aides or putting the disabled in a facility. Without intervention, the caregiver may become a candidate for long term care as well.

It is also important to use outside professional help in a caregiver setting. A financial planner, care funding specialist or a reverse mortgage specialist may find the funds to pay for professional help to keep a loved one at home. A care manager can guide the family and the caregiver through the maze of long-term care issues. The care manager has been there many times the family is experiencing it for the first time.

An elder law attorney can help iron out legal problems. And an elder mediator can help solve disputes between family members. Having competent advice can often make the difference between allowing a loved one to remain in the home or being forced to seek out government welfare assistance.

Due to pride or sheer determination some caregivers allow the situation to go beyond their control. They have gotten to a point where depression and fatigue have clouded their judgment. At some point the caregiver will have to admit that he or she can't handle it alone and a better solution must be found.

Recognizing the Symptoms of Dementia

The Brown family reunion has always been an event everyone looks forward to. Family visits, games, stories and everyone’s favorite foods are always on the agenda. On the top of the menu is Grandmas Lemon Coconut Cake. Grandma always makes the traditional cake from her old family recipe. This year, however, the cake tasted a little on the salty side, perhaps a half cup full of salty.

Though the family was disappointed over the cake, of more concern was Grandma’s confusion with the recipe and her similar confusion about the loved ones around her. Could something be wrong with grandma's mental state?

One might say that for an elder person a little forgetfulness or confusion is normal, but when do you know if there is a serious problem, such as dementia?

An online article from FamilyDoctor.org outlines some common symptoms in recognizing dementia. "Dementia causes many problems for the person who has it and for the person's family. Many of the problems are caused by memory loss. Some common symptoms of dementia are listed below. (Not everyone who has dementia will experience all of these symptoms.)

* Recent memory loss. All of us forget things for a while and then remember them later. People who have dementia often forget things, but they never remember them. They might ask you the same question over and over, each time forgetting that you've already given them the answer. They won't even remember that they already asked the question.
* Difficulty performing familiar tasks. People who have dementia might cook a meal but forget to serve it. They might even forget that they cooked it.
* Problems with language. People who have dementia may forget simple words or use the wrong words. This makes it hard to understand what they want.
* Time and place disorientation. People who have dementia may get lost on their own street. They may forget how they got to a certain place and how to get back home.
* Poor judgment. Even a person who doesn't have dementia might get distracted. But people who have dementia can forget simple things, like forgetting to put on a coat before going out in cold weather.
* Problems with abstract thinking. Anybody might have trouble balancing a checkbook, but people who have dementia may forget what the numbers are and what has to be done with them.
* Misplacing things. People who have dementia may put things in the wrong places. They might put an iron in the freezer or a wristwatch in the sugar bowl. Then they can't find these things later.  
* Changes in mood. Everyone is moody at times, but people who have dementia may have fast mood swings, going from calm to tears to anger in a few minutes.
* Personality changes. People who have dementia may have drastic changes in personality. They might become irritable, suspicious or fearful.
* Loss of initiative. People who have dementia may become passive. They might not want to go places or see other people."

Dementia is caused by change or destruction of brain cells. Often this change is a result of small strokes or blockage of blood cells, severe hypothyroidism or Alzheimer’s disease. There is a continuous decline in ability to perform normal daily activities. Personal care including dressing, bathing, preparing meals and even eating a meal eventually becomes impossible.

What can family members do if they suspect dementia? An appointment with the doctor or geriatric clinic is the first step to take. Depending on the cause and severity of the problem there are some medications that may help slow the process. Your doctor may recommend a care facility that specializes in dementia and Alzheimer’s. These facilities offer a variety of care options from day care with stimulating activities to part or full-time live-in options. Sometimes if patients tend to wander off, a locked facility is needed.

In the beginning family members find part time caregivers for their loved one. At first, loved ones need only a little help with remembering to do daily activities or prepare meals. As dementia progresses, caregiving demands often progress to 24 hour care. Night and day become confused and normal routines of sleeping, eating and functioning become more difficult for the patient. The demented person feels frustrated and may lash out in anger or fear. It is not uncommon for a child or spouse giving the care to quickly become overwhelmed and discouraged.

Family gatherings provide an excellent opportunity to discuss caregiving plans and whole family support. It is most helpful if everyone in the family is united in supporting a family caregiver in some meaningful way. "The first step to holding a family meeting, and perhaps the most difficult one, is to get all interested persons together in one place at one time. If it's a family gathering, perhaps a birthday, an anniversary or another special event could be used as a way to get all to meet. Or maybe even a special dinner might be an incentive. The end of the meeting should consist of asking everyone present to make his or her commitment to support the plan. This might just simply be moral support and agreement to abide by the provisions or it is hoped that those attending will volunteer to do something constructive. This might mean commitments to providing care, transportation, financial support, making legal arrangements or some other tangible support." The Four Steps of Long Term Care Planning Professional home care services are an option to help families in the home. These providers are trained and skilled to help with dementia patients. Don’t forget care facilities as well. It may be the best loving care a family member can give is to place their loved one in a facility where that person is safely monitored and cared for.

The National Care Planning Council supports caregiving services throughout the country. www.longtermcarelink.net

Possible Situations for Family Caregivers

Some caregivers, willingly or unwillingly, fail to provide the level of care necessary to nurture loved ones at home.

Here are some of the problems that derive from unprepared or overloaded caregivers:

Caregiver Neglect
If the caregiver can spend only minimal time in the morning and evening and will be absent the rest of the day, those receiving care quite often become imprisoned by their environment. They receive little or no social stimulus and may spend day after day just sleeping or watching television. They typically get no exercise other than moving to or from the bathroom and often they suffer from poor nutrition and dehydration due to lack of adequate food and fluid intake. Drinking and eating are deliberately avoided to lessen trips to the bathroom or to avoid soiling a diaper. Malnutrition and dehydration often result in poor mental reasoning or stupor, thus contributing to the daily routine of only sitting, sleeping and enduring the TV.
This is not a noble way to finish one's life.  Harried caregivers are doing these people an injustice by keeping them imprisoned in this manner at home.  Care recipients should either be in a good adult day services center or in a stimulating environment of an assisted living facility or the family should sacrifice, spend money and bring in full-time aides to provide more adequate care.

Self-Neglect
Self-neglect is where the care recipient is not interested enough or is incapable of taking care of his or her own needs. This may mean not eating or drinking enough or not attending to personal hygiene. It may mean allowing garbage to accumulate in the home or having pets that are unattended leaving feces and urine in living spaces.
There may be a caregiver involved but for whatever reason the caregiver is not stimulating that
person receiving care to take care of him or herself or the home environment. And for whatever reason the caregiver is not providing needed help. Self-neglect with or without a caregiver is actually a form of elder abuse and in some states it is required by law that its existence be reported. A caregiver allowing this to happen could be criminally charged.

Failure to Bring in Help
This is probably the biggest mistake caregivers make. Perhaps, in order to save money to use when the loved one is gone or because they think they are "tough" many caregivers will not ask for help. Or it is common for caregivers to become so involved with their loved one that they isolate themselves from others. This isolation makes them reluctant to contact those who can help. Or a child may try to provide care from a long distance away and find it difficult or impossible to do. Regardless of the cause, failure to ask for help or to hire help can have dire consequences on the welfare of the care recipient and the caregiver.

If you are a caregiver please do not allow yourself to fall into the situations described above.  Seek help or training or involve other members of the family if you are overburdened.