Create Your All-Star Care Team in 5 Steps

In this country, there is a growing problem regarding a lack of supportive resources for family caregivers. There are government programs, charities and nonprofits that might be able to help intermittently, but what caregivers often need most is sound advice, regular respite and an extra set of hands.

Friends may scatter when one begins caring for a spouse or parent, and not everyone has siblings or other family members they can depend on to share the load. It is crucial for each caregiver to take inventory of their personal supports in order to utilize their help as efficiently as possible. A carefully selected care team is a necessary complement to a loved one’s plan of care. Use these five steps to build your team.

Step 1: Draft a List of Prospective Team Members

Write down the name of each family member, friend or neighbor that you interact with on a regular basis. Forego any initial judgements or doubts about their usefulness in your care plan. You want to avoid limiting any potential sources of assistance from the very beginning, so just let the ideas flow.

Step 2: Assess Each Individual’s Strengths

Now is the time to assess the strong suit of each person on your list. Is your best friend financially savvy? Can your cousin listen to you vent without interrupting or casting judgement? Does your neighbor offer to keep an eye on Mom when she’s tinkering outside in the garden? Each of these people has specific talents or capabilities that can help you execute your care plan, and most have something to contribute, whether big or small. However, be sure to factor in each person’s attitude before asking them to join your team. Your sister may have plenty of free time to drive Dad to and from doctor’s appointments, but if she brings negativity or criticism to your regular routine, then the drawbacks may outweigh the benefits of her involvement.

Step 3: Create Your All-Star Care Team

Revise your remaining list to create a foolproof roster of people who will assist you with hands-on care and day-to-day tasks. Do not include anyone who may make your duties more difficult. This is your go-to tool for getting outside help, whether it is planned well in advance or needed at the last minute. Include each person’s contact information and, if possible, an outline of their weekly schedule. This will help you quickly reference when a team member is available to pitch in.

Step 4: Assign Roles for Each Member

Once you have narrowed down your list to reliable, positive individuals, identify specific tasks in your care plan that would be a good fit for each one. Friends and family often wish they could help, but they are usually unsure of what would be useful to contribute. Individuals who have never walked in a caregiver’s shoes tend to have a difficult time understanding all of the responsibilities that are involved.

It is best for caregivers to be very specific about the kinds of assistance they would appreciate. For example, if your son lives nearby, ask if he can tend to yardwork or any home maintenance projects once or twice a month. If you struggle to prepare dinner on Wednesdays (your busiest day of the week), see if Mom’s friend from church can pick her up for a weekly dinner date. The goal of creating this team is to be able to meet your loved one’s needs (as well as your own) without every single responsibility falling solely on your shoulders. A care plan that lacks meaningful support and respite time is not viable over the long term.

Step 5: Add Some Pros to Your Team

Relatives and friends aren’t the only ones to recruit for your care team. You may feel most comfortable with these people helping out because you know them personally, but remember that not everyone has the personality, time or resources to be even a part-time caregiver. Fortunately, there are a number of professionals who can facilitate the technical aspects of providing care. A financial planner can assist with complicated fiscal decisions, an elder law attorney can ensure that you and your loved one are legally prepared for the future, and a geriatric care manager can coordinate the care your loved one deserves. A social worker or advisor at your local Area Agency on Aging (AAA) can help you find and apply for federal, state and local resources that can assist you in your caregiving duties.

Any remaining gaps in your care plan can be filled by paid caregivers and other services. For example, in-home care and adult day care services can provide supervision and stimulation for your loved one when you need to run errands, attend your own doctor’s appointments, enjoy some respite time or go to work. If housekeeping rarely fits into your daily or weekly routine, then hire a cleaning service or arrange to have these tasks added to your home care professional’s responsibilities. Healthy meal delivery, pre-sorted prescription medications, and transportation services are some other options that can simplify your schedule and reduce your workload.

A comprehensive team assists with daily duties and can provide valuable back-up care in instances when the primary caregiver cannot see to their responsibilities. The more support a caregiver has, the less likely they are to experience burnout and the more sustainable the care plan will be.

Who Should Join Your Care Team?

  • Family and Friends
    • Siblings
    • Significant Other
    • Adult Children
    • Close Friends
    • Neighbors
    • Members of Local Community or Religious Groups
    • Grandchildren
  • Professionals
    • Physicians (Primary Care and Specialists)
    • Elder Law Attorneys
    • Geriatric Care Managers
    • Social Workers
    • Financial Advisors
    • Pharmacists
    • Home Care Agencies and Professional Caregivers
    • Adult Day Care Centers
    • Charities, Organizations and Support Programs
    • VA, Medicare and/or Medicaid Advisor(s)

See also: Care Plan 101: Set Yourself Up for Success As a Caregiver

Source: AgingCare by Ashley Huntsberry-Lett

Forming Your “Circle of Help”

Forming Your “Circle of Help”

Never go it alone. The best way to stand up to Alzheimer’s is to gang up on it.

The best way to defeat Alzheimer’s is to come together and gang up on the disease. If you or your spouse have been diagnosed with Alzheimer’s, please know that you are not alone. Right now, thousands of Alzheimer’s researchers, doctors, nurses, caregivers, support groups, and long-term care facilities are fighting for you on many fronts.

One of the most important fronts, of course, is the home front. My new book, Mike & Me, is one of several new books to chronicle the changing face of home care among Alzheimer’s couples and caregivers. Together, we are learning how the astonishing power of love, patience, compassion, and stay-at-home care can be mobilized by virtually every couple to help Alzheimer’s patients defy the old statistics and live a longer, fuller life.

My Husband and I Made A Deal

Early in my husband Mike’s 10-year journey with Alzheimer’s, we made a mutual commitment: As long as it was safe for him and me, Mike and I would live together in our home and make the Alzheimer’s journey together. Our goal was to keep Mike’s life as normal as possible for as long as possible, and that would entail staying in our home and community. It turned out that keeping that commitment to Mike was only possible because of a circle of friends and family who gradually formed around us and helped us every step of the way.

Looking back, I now realize that one of the most important things Alzheimer’s couples must learn in the early going is to simply reach out for help from friends and family. That probably sounds too obvious to mention, but you would be surprised to learn how many Alzheimer’s couples try, initially, to go it alone in their care. My husband Mike and I were one of those couples in the beginning. You see, we weren’t accustomed to asking people for help or bothering others with our difficulties. In the past, whenever a problem arose, Mike and I had always turned to each other for help, and, at first, that’s how we tried to deal with Alzheimer’s too.

Forming Your Circle of Help 

So why do I tell you these things? I tell you because I want you to believe that your “circle of help” – your friends, family, neighbors, and community – is waiting for you, too, if you will only let yourself reach out.

Perhaps like you, my challenge in the beginning was to simply open up to the idea of accepting help from others. But once I opened up, I quickly learned two things.

First, I was surprised at how many people were more than willing to help Mike and me. And second, I didn’t have to accept everyone’s help; I could still be selective about who I would let into our circle.

As time went on, I eventually built a small team of people – kindred spirits – who were helping me care for Mike. I like to think of them not just as a team, but as a “circle” of thoughtful people who surrounded us and helped care for our physical, emotional, and spiritual needs. It felt like such a natural process. One by one, along came certain friends and neighbors who thoughtfully recognized that we had a need of one kind or another and offered to help, each in his or her own way.

You may not know it yet, but you, too, have a circle of support quietly waiting for you. Watch for it, welcome it, be thankful for it. Yes, it’s a little scary at first to allow people in when you feel most vulnerable. But if you do plan to stay in your home together, rather than go to a care facility, then you too will have to turn to a circle of caring people who can help you.

Source: UsAgainstAlzheimer’s by Rosalys Peel

7 Common Flu Myths Debunked

Myths about the flu are everywhere. Is what you hear true, or is there too much misinformation floating around? Debunk the seven most common myths about influenza.7 Common Flu Myths Debunked

Myth #1: Getting Vaccinated Can Give You the Flu

According to the National Foundation for Infectious Disease, there is no way that the vaccine can make you sick. Vaccines only contain a weakened or inactivated form of the virus, which cannot infect you. The truth is that people often mistake the side effects of the vaccine for the illness itself. Side effects of inoculation may feel like mild symptoms of the flu, but soreness around the injection site is typically the only symptom people experience. Keep in mind that flu season (which generally lasts from October to March) coincides with a time of year when bugs causing colds and other respiratory illnesses are in the air. It is possible to get the vaccine and then get sick with a completely unrelated cold virus within a few days.

Myth #2: There Is No Treatment for the Flu

There are three FDA-approved antiviral drugs that are highly effective against the flu. Tamiflu (oseltamivir) is available in pill and liquid form, Relenza (zanamivir) comes in powder form, which is inhaled, and Rapivab (peramivir) is administered intravenously. While these antiviral medications do not cure the viral infection, they can minimize symptoms, reduce the amount of time you are sick by one or two days and make you less contagious to others. Furthermore, treatment can prevent complications of the flu, like pneumonia, which can be especially dangerous for older individuals. It’s best to take these drugs within 48 hours of getting sick, so do not hesitate to make a doctor’s appointment if you or a loved one have symptoms of the flu.

Myth #3: Antibiotics Can Fight the Flu

Antibiotics only fight bacterial infections. Since influenza is a virus, antibiotics have no effect. Furthermore, overuse and misuse of antibiotics can result in reduced effectiveness against the bacteria they are actually intended to kill and even “superbugs” that are entirely resistant to these treatments.

Myth #4: You Can’t Get the Flu More Than Once During Flu Season

You can certainly contract the flu more than once a year, because there are many different strains of the influenza virus. There are two main types of flu, Type A and Type B, and there are also different subtypes of each. It is possible that you could get infected with one strain and then another during a given season, especially if you have a compromised immune system.

Myth #5: If You’re Young and Healthy, You Don’t Need to Get the Vaccine

The Centers for Disease Control (CDC) recommends that everyone over 6 months of age get vaccinated each season. Healthy adults are just as susceptible to the virus as other demographics. If you are caring for an aging loved one, simply getting them vaccinated only provides some protection. You and other family members should also get the vaccine to avoid endangering their health.

Myth #6: Cold Weather Causes the Flu

The influenza virus is spread year-round. Contrary to popular belief, going outside during winter without a hat on does not directly increase your risk of getting sick. Influenza peaks in fall and winter for a few different reasons. Scientists speculate that the flu virus thrives in cooler, low-humidity environments. Of course, during the colder months, people tend to spend more time cooped up indoors, making it easier for the virus to spread from person to person. Furthermore, less time spent outside means that most people experience drops in vitamin D during winter that can weaken the immune system. All of these factors contribute to the timing of flu season, which is the same throughout the whole country, even in warmer states like Florida.

Myth #7: If You Haven’t Gotten a Flu Shot by November, It’s Too Late

Flu season often peaks between December and February, but the timing can vary. Some years heightened flu activity has lasted until May. No matter how late it is, if you have not been vaccinated yet, go get it done. You could spare yourself and your family a great deal of misery.

The Facts: How to Avoid Spreading the Flu

Influenza spreads from person to person, often through the air, and you can pass on the infection even before you begin feeling symptoms. An infected individual is also contagious for several days after the onset of symptoms. Infection can stem from a contagious person near you coughing, sneezing or talking, or even from touching a surface that the virus is on, like a telephone or doorknob.

To avoid contracting and spreading the virus, use the following tips:

  • Clean your hands regularly with soap and water or an alcohol-based hand sanitizer. This is especially important after you touch a sick person, common surfaces, used tissues or laundry.
  • Individuals with the flu should cover their mouth and nose with a tissue when coughing and sneezing to avoid spreading the virus to others.
  • Immediately throw away tissues and other disposable items used by an infected person.
  • Once diagnosed, talk to a healthcare provider about taking antiviral medication to prevent the virus from spreading to other family members, coworkers or friends.
  • Keep surfaces like bedside tables, bathroom surfaces, doorknobs and children’s toys clean by regularly wiping them down with a household disinfectant.
  • Do not share eating utensils, dishes or cups with a sick person. These items do not need to be cleaned separately, but they should not be shared without washing thoroughly first.
  • Wash linens (such as bed sheets and towels) by using household laundry soap and tumble dry on a hot setting. Use a basket to transport laundry prior to washing to prevent contaminating yourself.
  • Avoid touching your eyes, nose and mouth to minimize the likelihood of contracting the flu and other viral infections.

Source AgingCare  Marlo Sollitto

FEED YOUR BRAIN: TIPS FOR BETTER BRAIN HEALTH

FEED YOUR BRAIN: TIPS FOR BETTER BRAIN HEALTH

Spend some time with the 50-plus age group and it becomes clear that memory and brain function are hot topics.

With many baby boomers encountering changes in their brain function—causing concern, and, let’s face it, amusement, at times— it is not surprising that boomers are looking for ways to hold on to their memory and increase cognitive ability.

Being vital until the end of life is something that everyone wishes for but not all of us are lucky enough to experience. According to the Alzheimer’s Association (alz.org), 44 percent of Americans between the ages of 75 and 84 have dementia or Alzheimer’s disease, and by age 85 that number goes up to 50 percent. Those numbers are driving a whole new market of brain-enhancing health products, from supplements to video games, all aiming to increase cognitive ability. But will this do us any good? Are there proactive steps we can take to stop the deterioration of the brain as we age?

According to mounting evidence in the field of neuroscience, the answer appears to be yes. Research is revealing that the aging brain actually has more capacity to change and adapt than was previously thought. According to Sandra Bond Chapman, PhD, founder and chief director at the Center for Brain Health in Dallas, Texas, it appears that the brain continues to develop neural pathways to adapt to new experiences, learn new information, and create new memories.(1) In fact, studies show that the brain can actually get smarter as we age: the more new learning experiences we have, the more neural pathways we create, which means we can actually stockpile a larger network of neurons that can markedly slow down the process of cognitive decline. The more we develop in the brain now, the fewer years of decline we experience down the road.

Research conducted by the Center for Brain Health shows that older brains can be more receptive to pattern recognition, judgment, and accumulation of knowledge and experience, giving those over 50 an advantage over younger brains if—and that is a big if—the physical structure of the brain is not in decline.(2) Physical decline of the brain, meaning the actual shrinkage and deterioration that begins in our forties, corresponds with cognitive decline. All of this is to say that brain health needs to be a priority for those heading into their forties and fifties to reap the most significant rewards.

The goal is to decrease stress on the brain, which breaks down brain function, and to build new neural pathways through mental stimulation. The good news is that building better brain health in your everyday life is easier than you might think.

  • Reduce multitasking to help preserve brain function. Practice focusing on the most important thing at the moment instead of trying to cover everything all at once. This higher level of thinking actually means less dementia as we age.
  • The brain does not like routine so avoid robotic, automated behavior and take initiative to learn new behaviors. Simple things like changing your morning routine or learning to eat with your left hand will stimulate the brain.
  • Repetitive mental stimulation such as learning a new language or a new word every day, can improve performance of other tasks. Just think: improving your bridge game may actually improve your ability to drive a car.
  • While “brain games,” video games, and subscription websites are flooding the market, there is no evidence that these things are more effective than learning new skills on your own. The key concept is new: branch out into new languages, sports, and other novel skills to stimulate to the brain.

All the information we are learning about how significant a role basic life functions—the way you eat, sleep, and move—play in maintaining brain health and preventing chronic health conditions like diabetes and heart disease emphasizes the value of living a healthy lifestyle.

6 Tips for Brain Health
Here are six lifestyle factors that can have an impact on brain health.

  1. Diet. Many foods have been linked to brain health, and new information about the role of diet continues to emerge. Some of what research is revealing includes the benefit of the anti-inflammatory properties of a plant-based Mediterranean diet, which includes healthy fats such as olive oil and high-fiber grains, in preventing cognitive decline;(3) the impact of vitamin E, found in nuts and seeds, on the development of dementia; and the importance of decreasing the consumption of refined sugar and eating a limited amount of high fiber carbohydrates because research shows that dementia and Alzheimer’s may be due to “diabetes of the brain,” meaning insulin resistance in the brain that may cause loss of brain cells.(4,5,6)
  2. Weight control. An increasing body of evidence shows that being overweight in midlife increases risk factors for lower and faster decline in cognitive ability.(7) Weight control aids in blood pressure control, which affects brain function. Slow, steady weight loss that is sustainable has great benefit to brain health.
  3. Sleep. The brain actually does a lot of smart things while you sleep, so getting adequate sleep (seven to nine hours for the majority of us) can boost learning, attention, and memory. While sleeping, your brain practices new skills, sorts out memories for the future, and problem-solves, which is one of the reasons why “sleeping on it” often brings answers to problems.
  4. Exercise. Cardiovascular exercise is vital to brain health; it increases blood flow, delivering more nutrients to the brain. Most important, it increases brain derived neurotropic factor (BDNF), a protein that aids in the survival of brain cells. Any exercise helps, but the real benefit shows up when one is active at least three hours per week.
  5. Stress management. Stress and anxiety are associated with memory disorders. Stress can interfere with the function of neurotransmitters in the brain and create toxins that cause cell damage and shrinkage of the brain. Meditation, prayer, and other relaxation techniques along with more-intense therapies may be necessary to control stress. Downtime and relaxation improve higher level thinking and brain health.
  6. Supplements. Dietary supplements that have flooded the market have not been proven effective in slowing cognitive decline. It is not about one nutrient but the diet as a whole. An aspirin per day and however, has been shown to be effective due to its anti-inflammatory properties. Statin medication that is prescribed to prevent heart disease has been shown to provide the same benefit, and there is increasing evidence that a multivitamin a day keeps the brain in tip-top shape.(8,9,10)

That’s right—supplementing with a daily multivitamin can improve cognitive function, according to a series of studies published by researchers from the United Kingdom.

Several teams of British neuroscientists studied the effects of multivitamin supplementation on mood and cognitive functioning among adults and children. In each study, healthy men, women, and children took the daily supplements for four to twelve weeks and then were tested for attention span, memory, accuracy, multi-tasking and other cognitive functions. The researchers also assessed participants’ mood and stress levels.

The results of the studies indicated that multivitamins improved cognitive function—even after only a few weeks of supplementation. In fact, men who took high doses of vitamin B-complex supplements showed improvements of cognitive function and also reported less mental fatigue and higher energy levels. Women also benefited from the daily supplements, as evidenced by an improvement in the ability to multi-task. Children between the ages of 8 and 14 performed well on attention-based tasks.

A multivitamin isn’t a magic bullet and certainly cannot serve as a substitute for a healthy diet—but it can be one component of a healthy lifestyle. It’s one of those things that falls into the category of “can’t hurt, might help.” So, if you needed another reason to add a multivitamin to your daily health regimen, add cognitive function to the list. If you want to give your brain a boost, start by swallowing your vitamins.

Source: Age Gracefully America  Charles H. Weaver, MD

What a doctor wishes patients knew about the end

As a hospice and palliative medicine physician, my job is to help reduce suffering. At the end of life, that job becomes especially intense when time is short, when machines and data seem to be taking over, and so many intense emotions surround a body that is trying to die.

BJ Miller

BJ Miller

But here in that narrow trench, both providers and patients do have power to shape their experience together, especially if they take the time to have a few crucial conversations. In the spirit of palliation, here are a few things, as a physician, I wish I could share more often with patients and their caregivers.

You don’t need to be dying to receive palliative care

In hospitals, it is still common for palliative care clinicians to be pulled aside by a well-meaning though misinformed nurse or doctor who says, “This poor family is miserable, but they’re not ready for palliative care yet.” They imply that either the patient is not dying, or the patient does not realize that he or she is dying. But what this statement does is to conflate hospice or end-of-life care with palliative care. Palliative care is an approach, framed within the context of serious illness, where easing suffering is the goal. So, you just need to be sick and suffering to qualify for palliative care, not necessarily dying any time soon. Don’t be afraid to say you want it.

Don’t wait for your doctor to bring up hospice

What a doctor wishes patients knew about the end

Doctors tend to wait too long to acknowledge when death is close. And as research has made clear, the closer we feel to the patient, the more wildly we overestimate their prognosis.
The median length of stay in hospice care in the United States is 24 days.
As a rule, this is too short. So here’s an inside tip for patients and loved ones starting to wonder about hospice. In an effort to get primary physicians to think sooner about recommending hospice, researchers came up with the “surprise question.” As in: “Doctor, would you be surprised if your patient died within a year?” If the answer is no, then that doctor should start considering a referral to hospice. But there is nothing stopping you from asking the surprise question yourself. If you live with advancing chronic illness and are thinking about how you want your life to go, you might turn the table and ask: “Hey doc, would you be surprised if I died in the next year?” This is a good and bold way to open an honest dialogue with your doctor and get the sort of support you need.
The healthcare system is wired to extend physical life, without much regard to the psychological, spiritual, or financial costs. With advances in technology, we are able to prop up a body practically indefinitely. And it’s well known that doctors tend to presume you want aggressive care, even when care geared toward your comfort may be more in line with your wishes. Unless you say otherwise, the doctor’s presumption rules the day. This means that at some point you may need to say “no” to that next treatment. So be sure to look up now and again and check that the care you’re getting is the care that suits you.

It’s OK to laugh

Deaths from dementia have more than doubled in US, report says
In my book, “A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death,” someone tells of their stepfather wearing a shirt that read, “I’m so old I can’t find my own nuts,” with a doodle of a squirrel on it. His dying wish was to make his daughter laugh, and it helped both of them immensely. To honor him, she buried him in that shirt, sealing his personality in death as it had been in life. Illness isolates people, not just physically. When we get sick, people around us start censoring themselves. The solemnity is supposed to be a form of kindness, perhaps, but it can feel more like yet another loss, almost a premature death. As patients and caregivers know, illness and its indignities offer plenty of rich material for humor. The joke is only on us if we don’t find some way to laugh back.

Those guardrails on the hospital bed go down

Dr. Marianne Matzo is a PhD nurse who researches sexuality at the end of life. She told me a story about a patient who died in his hospital bed while he and his wife were in the middle of oral sex. Dr. Matzo tells this story as a triumph rather than a tragedy: The couple had found a way to maintain intimacy until his last breath. We are still living when we are dying. When those guardrails go down, it is possible to cuddle or caress one another. Those moments are about feeling connected, sexually or otherwise, and finding ways to be in that body while you have it. They are about reminding yourself and each other that you are still here, both of you, able to love and be loved. This is how healing works, and it is very much possible to be healed — to be whole — even as your body falls apart.

To the caregivers: Don’t be afraid to leave the room

In their final days and hours, dying people are usually in and out of consciousness; even when awake, they are often delirious. That means your loved one might say or do things that are completely out of character. Behavior ranges from sweet to insufferable. I met an elderly woman at a conference once who nervously relayed the story of her husband hurling strange and vulgar accusations before losing consciousness for good. Now there was trauma on top of sorrow. I wish someone had told her earlier about the very normal condition of deathbed delirium.
I also wish that caregivers knew it was OK to leave their loved one’s bedside. How many times will they have spent hours gathered in the room, not eating or sleeping for days, barely blinking, not wanting to miss that last breath, only to have the person die just when they nod off or use the bathroom?
As any hospice worker can tell you, this is also a well-known phenomenon. It’s almost as if the presence of others — especially deeply loved ones — gets in the way of the dying person’s final step. That big moment may need to happen alone. What dying people seem to need at the very end is to know that the people they love are going to be OK; that life will go on and that you — the person they care for — will be able to take care of yourself. So, the kindest thing you can do is to demonstrate that care by leaving the room when you need to. Just be sure to give a kiss and know that it may have to be the last.
Source: CNN BJ Miller, M.D.
BJ Miller, M.D. is a hospice & palliative medicine physician who sees patients and families at the UCSF Helen Diller Family Comprehensive Cancer Center. Miller’s career has been dedicated to moving healthcare towards a human centered approach and he advocates for this on a policy as well as personal level. He is the co- author of “A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death.”
The opinions expressed in this commentary are his own.

Bidet Attachments: The Toilet Tweak That Can Keep an Older Adult Clean

Bidets are commonplace in bathrooms across Europe, Asia, Latin America and the Middle East, but this plumbing fixture has never really caught on in the United States. For some reason, Americans prefer to use toilet paper and wet wipes to cleanse themselves instead of water.

However, more and more people—myself included—are beginning to embrace the bidet. In fact, many seniors are finding that bidets offer a safer and more efficient method of freshening up after toileting.

Bidet Attachments: The Toilet Tweak That Can Keep an Older Adult Clean

Bidet Attachments vs. Freestanding Bidets

To clarify, I’m not talking about traditional freestanding bidets. They take up lots of bathroom space, and older users would likely have a great deal of trouble transferring from the toilet to straddling the bidet.

What I’ve found very helpful are toilet bidets. These devices simply attach to the existing toilet in your home and require no remodeling, plumbing work or additional floor space. Essentially, the attachment is a small wand underneath the toilet seat that moves into position and sprays water over the perineal area.

I don’t remember how I first learned about toilet bidets, but when I found a cheap one that could be easily installed on my toilet without major plumbing expense, I decided to try it. The Blue Bidet—now a feature on every toilet in my house—retails for just $37. There are countless models, each with different features on the market. Simpler electric models allow for adjustable water temperature and pressure, while so-called “intelligent” cleansing seats offer features like a nightlight function, a heated air dryer and remote-control access (at a hefty price).

When I installed my cheaper toilet bidet several years ago, I became an instant fan. As I age (and as my symptoms of Parkinson’s disease worsen), I am more and more disgruntled when I have to use a standard toilet and toilet tissue. After returning from a recent short trip, I told my housemates I had missed them almost as much as I had missed my bidet!

Bidets Help with Better Hygiene, Safer Toileting

“As people get older and frailer, it’s harder for them to do good personal hygiene, particularly if they have arthritis,” Dr. Mary Tinetti, Chief of Geriatrics at Yale School of Medicine, explained to New York Times blogger Paula Span via email. Maneuvering around to wipe and wash becomes surprisingly difficult for people as they age. In fact, attempting to do so can even lead to a dangerous fall from the toilet.

For many older adults, a bidet toilet could mean the difference between independence and needing assistance with toileting. Many seniors refuse help with personal care because it comes with a loss of privacy and often dignity. However, this can jeopardize their safety, and poor personal hygiene can lead to an increased risk of urinary tract infections (UTIs), skin breakdown and general irritation. Prompt and thorough cleansing of the genitals, perineum and anal areas after toileting is crucial for maintaining skin integrity, especially for elders living with incontinence. Bidets can provide a higher level of cleanliness, safety and modesty while toileting.

For caregivers who must assist with toileting and personal hygiene, bidets can help immensely with this delicate task. It may take some practice to get the hang of using a bidet seat or attachment, but it can be easier, cheaper, more hygienic and less awkward than assisting with toilet paper or wet wipes. Better yet, adequate cleansing after toileting can help maximize cleanliness between the shower or bath days that caregivers and seniors alike typically dread.

Explore toilet bidets and other senior assistive devices in AgingCare’s Senior Product Guide.

Source: AgingCare by Joh Schappi

Emergency Planning: Is Your Loved One’s Long-Term Care Facility Prepared?

Each year, nature pummels the United States with various natural disasters. Americans find themselves contending with tornadoes, hurricanes, earthquakes, blizzards, wildfires, floods and heat waves that only seem to be increasing in frequency and intensity.

Individuals who are elderly, disabled or have special needs are particularly at risk during and after these events. Preparedness is crucial for those who are still living in the community and for those who reside in residential care communities like assisted living facilities, memory care units and nursing homes. When disaster strikes, long-term care facilities are responsible for ensuring the safety of all their residents and staff on site. In some cases, evacuation and transportation to another care facility out of harm’s way may be necessary.

Securing the safety of frail elders is a huge undertaking. Many long-term care residents are unable to walk on their own, connected to life-sustaining medical equipment or have severe cognitive impairments due to Alzheimer’s disease and other types of dementia. Every senior living facility should have a comprehensive disaster preparedness plan in place that establishes protocols for both evacuating and sheltering in place.

It’s beneficial for family members who have relatives in senior living to learn about how these communities handle potential emergencies. This will help families understand exactly what the plan of action is for their loved ones and how it may or may not mesh with their own emergency preparations and plans.

Questions to Ask a Long-Term Care Facility About Disaster Preparedness

The following list highlights crucial information on emergency planning and evacuation procedures provided by The National Consumer Voice for Quality Long-Term Care. You can print these questions out and use them to help guide your discussion about emergency procedures with the administrator at your loved one’s long-term care facility.

General Emergency Planning

  • What is the facility’s emergency plan for evacuation and for sheltering in place? (Plans will be different for hurricanes, tornadoes, etc.)
  • How are these plans coordinated with community resources, the city, county and state emergency management?

Emergency Training for Staff Members

  • What staff training procedures are in place for emergency evacuations?
  • Are evacuation drills practiced with both staff and residents?
  • Are there enough staff available to execute emergency plans during all shifts? For example, if a fire breaks out in the middle of the night, will the skeleton crew be able to handle the emergency?

Family Communication

  • How does the facility discuss emergency planning with their residents?
  • How and when will families be notified about a loved one’s status and whereabouts?
  • Is there a phone number for out-of-town family members to call for information before, during and after an emergency event?

On-site Emergency Resources

  • Does the facility have an emergency backup power system or generators? If so, how long can this back-up system provide power? What parts of the facility will have electricity?
  • Are extra medical supplies, equipment and medications (at least a 7-day supply for each resident) stored on-site?
  • How much emergency oxygen is available in portable cylinders?
  • Is the facility prepared with enough potable water and nonperishable food for residents and staff?
  • If the facility is multi-level and the elevators cannot be used, what is the procedure for evacuating physically impaired residents quickly and safely down the stairs?
  • Do residents have emergency supplies and first aid kits in their rooms? (Kits should contain clothing, toiletries, a flashlight, ID and other critical items.)

Evacuation Procedures

  • How will residents be evacuated? Are there contracts in place with transportation providers to relocate residents?
  • Where will residents be evacuated to? Are there contracts in place with other facilities to provide temporary housing for displaced residents?
  • Do family members have the right to evacuate their loved ones on their own if they choose? How would this decision affect a senior’s residency in the facility and associated costs?
  • How are elders who are on life-support or receiving hospice care transported?
  • If the building must be evacuated quickly, what procedures are in place to ensure that no residents are misplaced or left behind?
  • How will residents be identified during and after an evacuation?
  • If the facility is evacuated, how are residents’ charts, medical information, medications and other supplies transported and when?
  • Can family members meet residents at a designated location? Can they assist loved ones at the facility to prepare for evacuation?
  • Will a trained employee ride with residents on each vehicle to oversee their care as needed?

Source: AgingCare by Marlo Solitto

8 Odd Assisted Living Rules to Be Aware Of

The world of elder care is fraught with countless rules, regulations and guidelines. It’s enough to make even an experienced caregiver’s head spin. The myriad of complex laws that apply to the different levels of senior housing often makes an already difficult decision even more challenging.

There are federal guidelines in place for long-term care facilities that are certified by Medicare, licensing standards and Medicaid regulations enacted on the state level, and unique in-house rules that individual communities elect to follow (these are usually detailed in a facility’s contract or admission agreement). These policies and procedures are used to calculate costs for services, set staffing ratios, determine when care plans must be updated, define the level of care a facility can provide and much more.

Because assisted living is an intermediate level of long-term care that varies widely by state, gaining even a cursory understanding of some of the unique rules these providers must follow will be invaluable when making care decisions for an aging loved one.

  1. The Band-Aid application ban: Most assisted living facilities (ALFs) are only able to provide “limited health care services,” which are carefully regulated. For example, ALFs in the state of Rhode Island are not allowed to provide even basic wound care, such as the application of a Band-Aid, unless it has been ordered by a physician and it must be applied by a qualified, licensed staff member. While this regulation may seem frivolous, it helps control what level of care an assisted living community can legally provide. Compared to a skilled nursing facility, which offers around-the-clock medical care, ALFs follow less strict staffing, licensing and training requirements. It’s important to educate yourself on what medical care services a particular community can provide, especially when accounting for future changes in your loved one’s condition, before making the decision to move them there.
  2. The care plan command: Many states require assisted living staff to conduct a comprehensive needs assessment of each resident upon admission to develop a personalized care plan. In Georgia, this must be done within 14 days of an elder’s admission, and the plan must be reevaluated at least once a year (or every three months for those residing in memory care units) and whenever an elder’s care needs change.
    In California, an aging adult’s care plan must also include an assessment of their likes and dislikes, as well as suggestions for appropriate community-run social activities for them to engage in.
    It’s important to inquire about prospective facilities’ care plan policies. You should be able to receive a written copy of the current plan at any time and request care team meetings to discuss any issues and potential changes.
  3. The medication adherence mandate: Residents have the right to control their receipt of medical services based on informed decision making, including the refusal of medications. However, ALF residents in Idaho must take their medications as prescribed by their doctor or risk being discharged. A reputable facility will document the refusal and contact the resident’s physician and authorized family members to work on a solution, but these facilities are not obligated to retain residents who endanger their own health.
    Rules regarding who can dispense and administer medications in assisted living communities can be especially tricky. The key is to determine which staff members are allowed to help a resident with their medications, how much assistance they can legally provide and how related issues are handled. This will enable you to determine whether a prospective facility can provide adequate assistance to ensure your loved one’s regimen is followed.
  4. The continuous medical care cut-off: In most states, the cut-off point for an individual to be able to reside in an assisted living community is whether they need around-the-clock skilled nursing care. Assisted living communities may be able to offer residents increased help with certain medical tasks, such as medication management, insulin administration and blood glucose testing, at an increased cost. However, even those facilities that employ certified nursing personnel are not allowed to admit residents who require full-time medical care. If your loved one needs 24/7 care, you may want to consider hiring home health care or placement in a skilled nursing facility.
  5. The leisure activities requirement: Assisted living communities in Georgia require their residents to be capable of participating in the social and leisure activities they provide. Obviously, staff members cannot demand that your loved one actually engage in these events, but it’s often advisable to encourage an elder to pursue an active social life when moving to senior living.
  6. The toe nail care condition: In Idaho, there are restrictions on which staff members can clip a diabetic resident’s nails. Only licensed medical professionals may assist with this personal care task because individuals with diabetes tend to heal slowly and experience limited sensation in their extremities. Even a minor cut or abrasion can become dangerously infected. This is one example of how a loved one’s unique needs directly influence your search for a long-term care provider.
  7. The dementia training directive: States typically require anyone working in an assisted living community to undergo formal training in how to interact with residents who have dementia. In some cases, this mandate may extend beyond the obvious medical staff and personal care aides to encompass all employees who have regular contact with residents, including kitchen, housekeeping and maintenance staff. If you’re caring for a loved one who has Alzheimer’s disease or another form of dementia, be sure to ask all prospective communities what type of initial and ongoing dementia training is mandated for their employees. This can have a big impact on a resident’s safety and the overall quality of care they receive.
  8. The ineffective CPR exemption: In the event that an ALF resident in Georgia becomes unresponsive and it is apparent that any effort to revive them would be futile (i.e. their body is stiff, their skin is blue/grey and cool to the touch, etc.), staff members do not have to perform cardiopulmonary resuscitation (CPR). There is a great deal of controversy surrounding the effectiveness and advisability of CPR on seniors. For example, an independent living facility in California came under intense scrutiny when a nurse refused to give a dying woman CPR.
    When it comes to emergency resuscitation efforts, the best way to avoid confusion is to encourage your loved one to fill out an advance care directive. Also, be sure that you fully understand the policies and procedures a particular community has regarding CPR and do-not-resuscitate (DNR) orders.

Of course, only a few of these sample regulations may apply to an aging loved one who is looking to move into an assisted living community. However, being aware of the varied and complex policies that govern this type of residential care will assist you in your research and help you determine which questions to ask when evaluating potential providers.

Source: AgingCare Anne-Marie Botek

Caregiving is the Greatest Teacher for Future Planning

Our Guest Author this month will help many who are facing aging alone once their family caregiving role comes to an end. Carol Marak is the founder of CarolMarak.com, the Elder Orphan Facebook group, and @Carebuzz Facebook Live events. She is an expert about everything aging. Herself a former family caregiver, Carol is personally equipped with aging alone expertise.

No matter what stage of caregiving you’re in, if you’re past it, in the middle of it, or it’s a paying job, the lessons learned will equip you for your own older life.

That’s what happened to me.  After caring for both parents, I realized, “There’s no one here for me to do all that I’ve done for them.”  A thought like this will quickly jolt anyone into scrambling for a plan. I’ve always been the independent sort, and now I face growing older without a spouse, partner, or adult children.

Like me, there are many women, and men, who find themselves in the similar circumstances. Growing older alone. And most of you, I bet, are caring or have cared for a relative as well.


          Carol Marak,
      Aging Alone Expert

The lessons learned give insights into what’s ahead.  At first it’s scary, but soon you’re grateful because you know so much and feel prepared, sort of. You know how to respond in an emergency, what’s needed when making serious medical decisions and legal matters, how to prepare for a medical treatment, the out-of-pocket costs of medical and other necessities, what to expect when you ring a doctor at 2:00 AM, and how to arrange for extra help.

Above all, you know that one day you will need help!  That’s wisdom you cannot buy.

But what people like me, aging alone, don’t learn from helping parents is, who do we count on for assistance, to help us respond to an emergency, make medical decisions, bring us a cup of soup, take us to the doctor, run errands, and more.

We learn what’s to come. But we don’t know where to start when planning for it or even thinking about it.

Growing older for my parents was totally different than what it is for me. They didn’t feel the need or urgency to prepare.  Growing older was part of life and they had no doubts about knowing who would step up for them.

Caring for an older person is hard. Period. No ifs buts or maybes. And making a plan for that is even more difficult. Period.  It’s takes time, effort, and patience. But making a plan when aging alone, well, that’s titanic. We question:

  • Will my money outlast me?
  • Who do I call in case of an emergency?
  • Who will be my health care proxy?
  • What if I’m all alone and lonely, who will come over?
  • What if I’m sick, who will look in on me?

That’s the short list.

Future Planning

These are the tough questions and they’re the reason I started working on my future plan soon after my dad passed away.  I’ve created a FREE starter kit for people who have the urgency to prepare. It’s yours for free to download here.

The thing about planning, it’s not meant to be a once and done deal. Instead, it expands our understanding of the kind of world we want and shows us a path we’d need to take to get to a better place–or, at minimum, the paths we need to avoid.

I believe we all need to have a sense of what’s next, and a vision of the kind of world we want. Planning for the future should deal with tomorrow’s problems–which if not addressed will inevitably leave us weakened, vulnerable, and blind to challenges to come.

Source: Senior Care Corner

Taking Risks Can Be Empowering

We want autonomy for ourselves and safety for those we love. That remains the main problem and paradox for the frail. Many of the things that we want for those we care about are things that we would adamantly oppose for ourselves because they would infringe upon our sense of self.” ~ Atul Gawande

While keeping people—especially those who are living with chronic conditions and physical challenges—safety is important, there can be benefits to risk also.

One expert cautions that there is such a thing as being too safe and that occasionally a little risk is a good thing. Dr. G. Allen Power, author of Dementia Beyond Drugs and Dementia Beyond Disease, recently hosted a webinar, “Negotiating Autonomy and Risk: A Relational Approach,” in which he explained the benefits of risk.

Three Pillars of Dementia Care

Dr. Power’s approach to dementia care rests on three “pillars” which he describes:

“The first pillar is redefining dementia, not simply as brain disease but in a more holistic sense. I define dementia as a shift in the way a person experiences the world around her or him.”

“The second pillar is to stop this trying to mitigate disease and instead work on a more proactive strength-based approach which is to try to enhance a person’s well-being regardless of their diagnosis or how much disability they may have. There’s always a way that we can improve people’s well-being to some extent.”

“The third part is the so-called culture change part…we have to transform the systems of care. The systems of care could be a nursing home, but they could also be how care is provided through home/community-based care.”

The Importance of Autonomy

“We don’t repress people because we’re mean, but because we are caring people. And sometimes in our caring we can be a little bit over-caring and we can actually oppress people without realizing that we are doing so.”

“If you have a failed sense of identity and connectedness, then your autonomy is going to be less. If there’s a good sense of security, it can help with autonomy but an over-reliance on safety can actually decrease autonomy; there’s a very fragile dynamic between these two. Autonomy is directly supporting meaning and growth. In order to do things that are truly meaningful, you have to continue to grow as a person. We need to have a sense of autonomy.”

According to Dr. Power, the ways that well-meaning people (both family members and professionals) can erode autonomy in those for whom they care include exclusion from discussions, exclusions from decisions, segregated living environments, maintaining low expectations, inconsistent staffing patterns, segregated living environments and more.

How Autonomy is Imperiled

Two common practices that erode autonomy: all-or-none thinking and surplus safety.

“All-or-none thinking is basically black-and-white; you can do this or you can’t do this; you can decide this or you can’t do that; you are capable or you’re not capable. We don’t have any in between, we just say you can or you can’t. And there’s a lot of that thinking that goes on with dementia care both with families and professionals in all care environments,” Dr. Power explains. “It comes from many things—those stigmas, those deficit-based views of dementia, our need for black-and-white solutions so that we don’t have the ability to get the grey areas to say, maybe you can do some of this, maybe there’s a way we can have some nuances in what you’re able to decide.”

This all-or-none approach can come from a misunderstanding of the role of a caregiver—either family or professional.

“We think our job is to take over,” he says. “We think our job is absolutely to keep the person 100% safe and not take on any risk and that’s a misunderstanding.”

No Such Thing as Zero Risk

“Surplus safety is too much concern with upside risk as opposed to downside risk,” Dr. Power explains. “There is never just an upside or a downside. Every decision we make, whether it’s you, me, or a person we care for with dementia, every decision has an upside and a downside.”

And when it comes to dementia, “nearly all of the focus is on downside risk.”

Rather than aim for no risk or take an all-or-none approach, Dr. Power recommends practice with different scenarios:

  • You can say a person with dementia absolutely can drive or can’t drive and you can just leave it at that.
  • Or you can say, there’s a lot of things in between, depending on the individual.
  • You can say, you can drive but only in your neighborhood, maybe only to the local store or a place of worship, maybe only during the daytime or only when the weather’s nice or only when there’s somebody with you.

“So, there’s many different parameters you can put on the choice to make it safer than just all or nothing,” he says.

Next, “you’d like to make a decision in as collaborative a way with the person with dementia as possible trying to maximize both autonomy and minimize risk knowing that risk will never be zero.”

Further, you want to document and follow your results.

“Document because if things don’t go well you want to show that there was a thought process behind it, that you can back and examine,” he says. “And you want to monitor because if things don’t go perfectly, you may need to go back to the drawing board and say okay that didn’t go so well, what if we add this additional guideline, this additional aspect, maybe we can make it safer. And the other reason you monitor results is because people’s abilities change over time so the plan that works today may not work six months from now.”

When caring for another, consider their autonomy as well as their safety, and be prepared to make changes as their needs and abilities change over time.

“The truth is that failure-free activities are meaningless,” Dr. Power states. “None of us has ever had an experience of meaning or growth because we accomplished something that didn’t have a chance to fail. So we can’t have a zero risk environment.”

Source: Homewatch Care Givers