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.

Plan for Eldercare Now Before the Choice is No Longer Yours

We spend our lives making plans and preparing for future events. From the beginning we plan and work towards education, a career, marriage and a family. We work hard and save, invest and build our assets. We insure to protect our home, automobiles, health and medical needs.

Retirement age comes and our plan is finally in place. Finances and time have come together to allow us to enjoy the elder years of life. This is where the planning ends. But life does not end at retirement. There is a portion of life that the majority of us will live through after the retirement years called "eldercare."

Very few of us plan for this part of our life, but yet it is as important if not more important to plan for it. If we don't, we are leaving our last years in someone else's hands. As much as children love us and mean to do right by us, they cannot possibly know what we want if they are not told.

Ruby, age 80, lost her husband. She had cared for him at home after his stroke. Understandably, she felt lost and depressed after his death. An inner ear infection caused Ruby to lose her balance and fall, breaking her hip. While she was in the hospital recuperating from surgery, Ruby's children were deciding her future.

Concerned for her health and safety they moved some of her belongings to an assisted care facility. Upon Ruby's release from the hospital she was taken to her new home at the facility. Between pain medication and the unfamiliar surroundings, Ruby never was herself again. She spent her last days asking what had happened to her home and belongings. Though her children had her best interest at heart, they did not know how Ruby wanted to spend her elder days.

An article on the AARP website titled, "Talking about Independent Living" states, "Research has shown that, as people age, they prefer to continue living independently, preferably in their own homes. While adult children often worry about their parent's situation, it can be difficult to know if parents really need, or want, help from their children."

Children and parents should talk about all these things.

What do you want your children, or friends to do on your behalf? When it comes time for them to help, you may not be physically or mentally able to execute your wishes. This is where your long term care plan comes into effect. You need to be the responsible person for your own personal care in the future.

The time to start planning is now.  Don’t wait until the choice is no longer yours!

Managing Medications

A major problem with medical treatment for the elderly is the large number of prescription medications the average older person is taking. On average, a person over age 75 has five prescription drug medications and is using at least two over-the-counter medications as well as taking herbal supplements.

Many older patients continue prescriptions with a number of doctors and specialists and no one doctor, not even the primary care physician, often knows the number or extent of medications being taken. It is not surprising to see the large number of adverse drug reactions and hospitalizations and deaths due to drug reactions among the elderly.

In order to control the problem with an older person taking multiple prescriptions from many doctors, the older person or a responsible family member should bring all medications being taken by the patient to a doctor's appointment. This definitely includes all herbal supplements and over-the-counter medications as well.

It is useful to go over with the doctor what each medication is for. If there is no reason to take that medication or if it may be causing interaction the doctor should indicate that and should withdraw the prescription. As a general rule, the more the medications, the more the potential for problems. A concerted effort should be made by the physician to prescribe the fewest medications possible to control a medical problem.

One way to combat the problem with an older person who is not complying with taking pills at the proper time or not taking enough or taking too many is to use the popular "pill calendar box."  Many people have already adopted this idea but for those who haven't this is an extremely effective way to administer medications.

Many people order their medications through the mail and some may even obtain prescriptions on the Internet. Internet prescriptions might be a common practice for very popular medications such as Phetermine or Viagra. For the elderly this may not be a good practice.

It is recommended that all medications be ordered through one pharmacist, particularly a pharmacist that has a certification in geriatric pharmacy. By controlling all medications through one database, the pharmacist can alert the older person or his or her family about a possible drug interaction or adverse drug reaction.

This central database approach should become much easier for those older people who enroll under the Medicare Part D drug program. Presumably the company offering the drug benefit will have a database for its insured

Depression in the Elderly

The holiday season is quickly coming upon us. If you are a caregiver for an elderly loved one, you may notice a change in your loved one's mood as the holidays approach. Perhaps you are one of many, who visit elderly parents and family during the holidays who live a distance away. When you visit you may notice that loved ones are not as physically active, or they show symptoms of fatigue or sadness and have no interest in the holiday or in their surroundings.

According to the National Institutes of Health; of the 35 million Americans age 65 or older, about 2 million suffer from full-blown depression. Another 5 million suffer from less severe forms of the illness. This represents about 20% of the senior population -- a significant proportion.

Depression in the elderly is difficult to diagnose and is frequently untreated. The symptoms may be confused with a medical illness, dementia, or malnutrition due to a poor diet. Many older people will not accept the idea that they have depression and refuse to seek treatment.

What causes depression in the elderly? It is not the actual holiday that causes depression, but the fact that holidays tend to bring memories of earlier, perhaps happier times. Additional contributing factors that bring on depression may be the loss of a spouse or close friend, or a move from a home to assisted living, or a change with an older person's routine.

Depression may also be a sign of a medical problem. Chronic pain or complications of an illness or memory loss can also cause depression. In addition, diet can also be a factor when proper nutrition and vitamins are lacking.

As an example, Selma’s husband passed away, a few months before Christmas. Her family lived close by and would call or drop in often to check on her. Selma seemed a little preoccupied and tired, but this was to be expected as she had been the caregiver for her husband for many years. It wasn’t until the family noticed that her holiday decorations were not out and her yearly routine of Christmas card writing was not happening that they began questioning her mental and physical well being.

A trip to her physician confirmed depression, caused by not only the loss of her spouse, but a vitamin B12 deficiency. There were both mental and physical reasons for her depression.

Symptoms to look for in depression might include:

• Depressed or irritable mood
• Feelings of worthlessness or sadness
• Expressions of helplessness
• Anxiety
• Loss of interest in daily activities
• Loss of appetite
• Weight loss
• Lack of attending to personal care and hygiene
• Fatigue
• Difficulty concentrating
• Irresponsible behavior
• Obsessive thoughts about death
• Talk about suicide

How do you know if it is depression or dementia? Depression and dementia share similar symptoms. A recent article on Helpguide.org gives some specific differences:

In depression there is a rapid mental decline, but memory of time, date and awareness of the environment remains. Motor skills are slow, but normal in depression. Concern with concentrating and worry about impaired memory may occur.

On the other hand, dementia symptoms reveal a slow mental decline with confusion and loss of recognizing familiar locations. Writing, speaking and motor skills are impaired and memory loss is not acknowledged as a being problem by the person suffering dementia.

Whether it is depression or dementia, prompt treatment is recommended. A physical exam will help determine if there is a medical cause for depression. A geriatric medical practitioner is skilled in diagnosing depression and illnesses in the elderly. If you are a care taker of an elderly person it may be beneficial for you to seek out a geriatric health care specialist. For more information on senior health services go to http://www.longtermcarelink.net/about_senior_health_services.htm

Treating depression in older people. Once the cause of depression is identified, a treatment program can be implemented. Treatment may be as simple as relieving loneliness through visitations, outings and involvement in family activities. In more severe cases antidepressant drugs have been known to improve the quality of life in depressed elderly people. Cognitive therapy sessions with a counselor may also be effective.

As a care giver or family member of a depressed older person, make it your responsibility to get involved. The elder person generally denies any problems or may fear being mentally ill. You can make the difference in and remove the Holiday Blues from seniors suffering from depression.

Helpful Tips to Avoid Falls

• Paint the edges of outdoor steps a light color.
• Mark steps that are especially narrow or are higher or lower than the rest. 
• Paint outside stairs with a mixture of sand and paint for traction.
• Keep outdoor walkways clear and well-lit. 
• Inside your home, remove clutter. 
• Keep telephone and electrical cords out of pathways.
• Tack rugs and glue vinyl flooring so they lie flat.
• Remove or replace rugs or runners that tend to slip or attach nonslip backing. 
• Do not stand on a chair to reach things. 
• Store frequently used objects where you can reach them easily. 
• Have a lamp or light switch that can easily be reached without getting out of bed. 
• Use night lights in the bedroom, bathroom and hallways. 
• Keep a flashlight handy. 
• Have light switches at both ends of stairs and halls.
• Install handrails on both sides of stairs. 
• Add grab bars in shower, tub and toilet area. 
• Use nonslip adhesive in shower or tub. 
• Consider sitting on a bench or stool in the shower. 
• Consider using an elevated toilet seat. 
• Use canes & walkers as directed by your health care provider. 
• Wear nonslip, low heeled shoes or slippers that fit snugly.
• Avoid walking around in stocking feet. 
• Review medications with your doctor or pharmacist. Some drugs, including over the counter drugs, can make you drowsy, dizzy or unsteady. 
• Have your hearing and eyesight tested. Inner ear problems can affect your balance. Vision problems can make it difficult to see potential hazards. 
• Exercise regularly to improve muscle flexibility, strength and balance. Talk to your healthcare professional about an exercise program that is right for you. 
• If you feel dizzy or light-headed, sit down or stay seated until your head clears. Stand up slowly to avoid unsteadiness. 
• Consider using an emergency call pendant like Guardian Alert or Freedom Alert

Helping Your Older Parents Stay Healthy and Happy

If you're fortunate enough to have one or both parents still living, you may have noticed a role reversal taking place in your relationship. Remember the days when Mom shuttled you to the doctor whenever you were sick? Now, it may be you who's driving her to her medical appointments. Perhaps you've become even more involved in managing her healthcare needs – serving as her healthcare proxy, moving her into your home to care for her, or even having to select a nursing home for her to live in.   Whatever the case, it's natural to feel challenged – and, yes, intimidated – in the role you've undertaken. But if you stay positive and proactive, you'll be in a great position to advocate for your parents' optimal care. And, really, what better way is there to say "Thank You" for all they've done for you over the years?

The following six recommendations will help you understand what may be happening to your parents as they age – and what you can do to help.

1. Stay vigilant to sudden changes. Typically, sudden changes arise from sudden problems. Your elderly father who becomes confused one week but was alert and oriented the week before, or becomes unsteady walking and starts falling, is likely experiencing an acute problem – an infection, medication side effect, or
perhaps, a heart attack or stroke. If you pay attention to your parent's baseline health and behavior, you'll be alert to sudden, and subtle, fluctuations. Being attuned to what's “normal” for your parent is critical in advocating for his care. By informing his physician of these changes, you help ensure that he receives a proper diagnosis and timely treatment – especially important in acute conditions.

2. Investigate the source of gradual decline. Several years ago, I met an elderly woman living in a nursing home. Her family, assuming she had dementia, had moved her there after she had gradually stopped speaking. After performing a brief procedure on her, I asked how she was doing. “I'm OK,” she replied. A miracle? Not exactly. I'd removed bullet-sized pieces of wax from her ears. She'd stopped speaking because her ears were too plugged to hear. A host of conditions can cause gradual decline. Before jumping to the conclusion – as many people do – that Alzheimer's disease is the culprit, recognize that your parent may be experiencing an altogether different problem: a vitamin B12 deficiency, an underactive thyroid, Parkinson's disease or depression, to name a few. When discussing your parent's decline with her physician, make
sure the two of you consider all the possibilities. To prepare for the appointment, make notes detailing how her decline has manifested itself – loss of appetite, a failing short-term memory and so forth – and how long you've noticed these changes. That way, you won't leave anything out. To help you, I've created a free checklist that either you or your parent can complete at seniorselfassessment.com – make sure you print or email the “Test Result Details” at the bottom of the page to analyze your responses and give you advice based on your answers.

3. Know thy parent's medicine cabinet. Familiarize yourself with the medications your parent takes: what each one is for and how often he takes them. Make sure you notify each doctor your parent visits of all the medicine he takes, including over-the-counter products. Ask what side effects you might observe from each medication and whether it's potentially dangerous if your parent takes them together. You also want to tell the doctor whether your parent drinks alcohol or caffeinated drinks and whether he smokes, as these substances can affect some medications' efficacy and safety. To recognize which medications might cause the symptoms your parent experiences, check out drugscanmakeyousick.com .

 4. Discourage ageist attitudes. Simply put, ageism is prejudice against the elderly. It exists in many forms but can be particularly damaging to an older person's self-esteem when it assumes that all of her woes are age-related. Here are a couple of ways of expressing ageism to an elderly parent: “What do you expect at your age?” “You're not getting any younger.” If you're ever tempted to utter something similar, remind yourself that by chalking up everything that ails her to her age, you sell your parent short. If she's depressed, it may have nothing to do with the fact that she's 80 and everything to do with a biological predisposition to depression. And remember that right-knee pain in a 90 year-old can't be just from age if there's no problem with her left knee. (More about Dr. Stall and a more in-depth article on the attitude of society towards medical care for the elderly can be found at http://www.longtermcarelink. net/eldercare/medical_care_is sues.htm )

5. Address not just symptoms—but emotions, too. There is disease and then there is “dis-ease” – that is, a lack of ease, security or well-being. “Dis-ease” can manifest itself as myriad emotions in an elderly person: fear, grief, boredom, embarrassment and sadness among them. The fact is, these emotions can be every bit as debilitating as disease.   Take the case of a parent who's incontinent. Too embarrassed to socialize, she cuts herself off from friends. Without companionship, she becomes lonely. Instead of allowing her to become a hermit, discuss with her doctor how to address the incontinence. Together, you can consider different solutions that will ease her embarrassment and reinvigorate her social life.

6. Strive to maximize your parent's quality of life. No matter our age, we all want to enjoy life to the fullest and have the capability to do the things we want to. Improving the enjoyment of life and a patient's functional ability are the cardinal goals of geriatric care. But you don't need a medical diploma on your wall to help your parent achieve either of those goals.   Being there to solve a problem or provide company are tremendously worthwhile services you can provide – no expertise required. Remember, as your parent gets older, his quality of life becomes more
important to him than how much longer he lives. And he doesn't necessarily need medications or surgery to ensure that he's living the latter part of his life to the fullest.   If he enjoys books but has difficulty reading regular-sized type, check out sight-saving titles at the library. If he's grieving the loss of his best buddy, introduce him to new acquaintances at the senior center. If he's living in a nursing home, bring your kids there to share a meal with him. Sometimes, it's the small gestures that have the most profound impact. As the child of an elderly parent, you are uniquely positioned to deliver these life-changing gifts.

 Dr. Robert Stall is a geriatrician practicing in Tonawanda, New York and a clinical associate professor at the University of Buffalo's School of Medicine and Biomedical Sciences. He serves as medical director and attending physician at Beechwood Homes in Getzville and Blocher Homes in Williamsville. To learn more about senior care issues, visit his website at stallgeriatrics.com or call 716213-4345. For information on a new program offering balance assessment and fall prevention tips, call 716-213-0772.
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Comparison between In-Home, Home Health, and Hospice Care

In-Home Care:

Private duty in-home care offers home care aides or Certified Nursing Assistants (CNAs) in a clients home or living facility. The services include: companionship, light housekeeping, meal planning and preparation, help with personal hygiene, medication reminders,  and escorted transportation for errands, shopping and doctor appointments.  The goal of in-home care is to allow an individual to remain living in their preferred location as long as possible. In-home care can be anywhere from a few visits up to 24 hours a day, 7 days a week, 365 days of the year.  Payment options vary based on the individual situation from Long-term Care Insurance, Community Long Term Care, Grants, Veteran's benefits and private pay. In-home care does not require a doctor’s order.

Home Health Care:

Home Health care offers skilled nursing services.  It is intermittent or short-term care provided by registered nurses (RNs), physical therapists (PTs), occupational therapist (OTs), speech language pathologists (SLPs), home health aides (HHAs) and medical social workers (MSWs) as a limited number of up to one hour visits, primarily through medical insurance as this is a medical service. A Home Health care agency coordinates skilled care services once they have been ordered by a physician.

Hospice:

Hospice programs are available to help those at the end stages of life live their remaining days with dignity.  Hospice normally involves a team of nurses, physicians, home health aides, clergy or other spiritual counselors, social workers and volunteers who provide comprehensive support for families dealing with end of life decisions. Hospice is primarily a concept of care, not a specific place of care. Hospice care usually is provided in the patient's home and requires a doctor’s order. Hospice may be covered by Medicare, private health insurance,  veterans' benefits and Medicaid (confirm your coverage with your insurance provider