Archive for category: Senior LIving

Getting Compensated for Caregiving Can Change Family Dynamics

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Getting Compensated for Caregiving Can Change Family DynamicsYou can be paid for your work and treated fairly

Does money change everything, as the old saying goes? If Alicia had won the lottery, then she might understand why her siblings were now treating her a little differently. But all she’d done was become certified as a home health aide so she could receive a modest hourly wage from her county for dressing, grooming and feeding her Parkinson’s disease-stricken mom. Nowadays, however, her sisters seemed less interested in pitching in with caregiving tasks since family caregiving had officially become her “job.” Even her mother seemed to be asking more of her, as if she were now the hired help and not her youngest daughter.

More states are allowing care recipients to hire and pay family members as their home health aides under what is sometimes called consumer-directed care. These are popular programs for obvious reasons: Family members — some of whom had to quit or cut back on work to take care of a loved one — are now being paid at least a little money for all the care they provide. No one is getting rich, but at least they are better able to cover some bills. More importantly, receiving an hourly wage gives them a feeling of being publicly acknowledged and valued rather than (as is too often the case) feeling invisible and underappreciated.

In my clinical practice, I’ve also worked with many families in which a parent’s decision to leave a house or the bulk of an inheritance to the primary caregiver roils family dynamics like nothing else. The caregiver who will receive money becomes immediately suspected by others of playing the Altruistic Child to cash in. Anger and conflict frequently result.

How can family caregivers earn some compensation for their devoted efforts but not be regarded as mercenaries by other family members? Here are some ideas:

Demonstrate transparency: Many of us are inclined to keep our financial affairs private, even when among family members. But because caregiving is inherently a family enterprise, it is vital that we are aboveboard about monetary transactions, especially if we are profiting in some way from a parent’s need for assistance. Let other family members know about the opportunity to earn an hourly wage for providing hands-on care. Tell them exactly what you’ll make. Communicate plainly that this money is going to offset costs incurred by caregiving activities — e.g., expenses for medication copays, lost salary, the price of fuel for driving to the doctor.

Keep in mind what others think is fair: It may seem fair to you to receive money for the many sacrifices you are making on behalf of someone you love. (I agree with you.) But there are other family members who may believe they are also making sacrifices — though, admittedly, not as many as you are — and deserve to be compensated to some degree as well. For them, it may seem patently unfair that you get glory and money and they get neither. Don’t begrudge or disagree with their feelings. Empathize with them instead and tell them that you greatly value their participation in caregiving. You don’t have to fork over some of your newly earned cash to prove that. Just express your appreciation that the two of you are part of a cohesive caregiving team whose sole mission is to help Mom.

Preserve your parent-child relationship: Care recipients can become increasingly demanding over time even when money is not involved. But when a family member has been hired for a caregiving job, there is a greater tendency for the care recipient to treat even close relatives with impatience and barked orders. Even when you’re on duty, though, you’re not just an employee. Complete the necessary tasks but let your parent know that you’re there for love, not money, and that you expect that your personal rapport with one another is not going to be suddenly altered by changed economics.

Weigh the money’s worth: For some families, receiving a caregiving salary will be an unmitigated boon about which everyone is thrilled. For others, there will be no end to the resentment, jealousy and sniping. Judge for yourself whether working as a loved one’s home health aide is worth it. If it isn’t, then don’t be resentful in kind. Instead, be consoled that peace in the family may ultimately be of greater value than any amount of money in the pocket.

by Barry J. Jacobs

Source: AARP

6 Ways to Get Vision Coverage When You Retire

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6 Ways to Get Vision Coverage When You RetireAbout 1.3 billion people in the world live with some form of vision impairment. The reasons vary but the fact is, your risk of developing vision problems drastically increases as you age. Over 91% of people age 55+ use some form of vision correction, so having access to quality vision care is critical as you get older. Issues with vision can increase the risk of falls, driving incidents, and impacting quality of life.

Medicare plans cover a wide variety of services including doctor visits, home health care, and a range of preventive screenings and treatments, but when it comes to vision coverage, beneficiaries’ options are extremely limited. So, what are the available options when you retire?

Original Medicare (Part A and Part B)

Vision coverage through Original Medicare is limited to mostly preventive and emergency services. Original Medicare generally doesn’t cover routine eye exams for eyeglasses or contact lenses. Medicare Part A covers medical emergency related to your vision if you are admitted to the hospital and Medicare Part B covers preventive treatments and screening related to diseases affecting your vision.

Medicare Part B covers annual glaucoma test for at-risk individuals which includes those with diabetes, African-Americans aged 50+, Hispanics aged 65+, and/or those with a family history of glaucoma. Annual exams to test for diabetic retinopathy among diabetics, diagnostic tests and screenings for macular degeneration, cataract surgery and one pair of post-surgery eyeglasses or contact lenses are also covered. Medicare will only pay for contact lenses or eyeglasses from a supplier enrolled in Medicare. For each of these services, the out-of-pocket costs is the 20% Medicare-approved amount, and Part B deductible.

Medicare Advantage (Part C)

One of the easiest options for vision coverage when you retire is Medicare Part C. Part C includes the same emergency and preventive benefits included with Original Medicare, but some Part C plans may also offer additional benefits that include a yearly eye exam, eyeglass frames and lenses, or contact lenses. The cost and coverage for these services vary from plan to plan. The best way to find a Medicare Advantage plan that covers all the services you need is to compare plans online or speak with a licensed benefits advisor.

Vision Programs

Enrolling in a Medicare Advantage plan to receive vision coverage is not necessarily the best option for everyone, but that doesn’t mean you should not be able to get adequate vision coverage. There are national and local programs available that can provide vision care for little to no cost, but there may be additional requirements to participate and resources may be limited.

  • EyeCare America®, a service from the Foundation of the American Academy of Ophthalmology, provides free eye exams and up to one year of care for low-income individuals who qualify.
  • Local Lions’ Club chapters often have programs to assist those with severe vision impairment. Local chapters will be able to provide more information on how to get assistance.
  • Vision USA, a program of the American Optometric Association and Mission Cataract USA both offer vision services for those without insurance including Medicare or Medicaid. Vision USA provides free eye exams for low-income Americans and Mission Cataract USA offers free cataract surgery to those who qualify.

As you begin to research your Medicare options keep in mind the enhanced services you may need to maintain, or maybe even improve your quality of life. Having yearly eye exams and updated prescriptions or dental cleanings and fillings may not be the things you consider when choosing a Medicare plan, but they should be.

To get help discovering a plan that covers your needs try taking our Medicare Questionnaire, which allows you to compare plans online or connects you to free professional advice from licensed benefits advisors. You can also contact your local State Health Assistance Insurance Program (SHIP) for access to federally-funded Medicare counseling from trained staff members.

By: The My Medicare Matters Team

Source: My Medicare Matters

New Study Shows Benefits of Person-Directed Care in the Home

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New Study Shows Benefits of Person-Directed Care in the HomeA new study shows the positive impact of person-directed care on people who need assistance with activities of daily living.

A randomized clinical trial published in JAMA Internal Medicine recently found that, “The findings suggest that disability may be modifiable through addressing both the person and the environment.”

Let Me Explain

A person-directed approach to care is one in which the decisions belong in the hands of the person receiving the care. The focus is on an individual’s abilities—rather than on their disabilities or what they can no longer do for themselves—and their unique preferences. When using this approach, an individual is encouraged to participate in activities that support their well-being. For example, instead of doing the grocery shopping, cooking the meal, serving it, and cleaning up, a caregiver would find out if the person in need of care and assistance would like to write up the shopping list or be a taste tester in the kitchen during the cooking or other activities in the meal preparation—especially if this is someone who finds joy in this.

Statistics show that 1 in 3 older adults in the United States need help with at least one daily activity. The Family Caregiver Alliance addresses who needs long-term care on their website, citing data from AARP that, “The lifetime probability of becoming disabled in at least two activities of daily living or of being cognitively impaired is 68% for people age 65 and older.”

Details, Details

The study looked at 300 low-income “community-dwelling” adults who are living with a disability, age 65 or older, “cognitively intact,” and who self-reported difficulty with one or more Activities of Daily Living (ADLs) or two or more Instrumental Activities of Daily Living (IADLs) over a four-year period. The majority of study participants were women who have multiple chronic conditions such as heart disease, arthritis, and COPD (chronic obstructive pulmonary disease).

The study applied a program called CAPABLE (Community Aging in Place—Advancing Better Living for Elders) for one group or a choice of sedentary activities for the other group. Those in the CAPABLE group had visits, as needed, from a nurse, a handyman and an occupational therapist depending on the goals of the participant.

Over the course of five months, participants in this part of the study experienced 30% fewer difficulties with ADLs such as showering or bathing, getting dressed, transferring in or out of bed and moving easily around their home.

The reason for this study was, “Disability among older adults is a strong predictor of health outcomes, health service use, and health care costs,” the study author explained in the abstract. “Few interventions have reduced disability among older adults.”

Yet they saw with a person-directed care approach that there was a “substantial decrease in disability” for these people.

The conclusion was, “Disability may be modifiable through addressing both the person and the environment.”

Click here to see our infographic about quality care with tips on “This, Not That” when it comes to person-directed care.

Source: Homewatch Care Givers

WHEN IT’S TIME TO SEE A GERIATRICIAN

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If you’re in your 60s or 70s, you may have wondered if you should start seeing a geriatrician instead of, or in addition to, your primary care provider. These are family doctors or internists with special training in the health needs of older adults. About 30 percent of people over age 65 need one, according to the American Geriatrics Society.

But you might not need to book an appointment at the same time you sign up for Medicare. “Geriatricians specialize in the care of people with multiple chronic medical conditions that cause challenges with their day-to-day physical and mental functioning,” explains Michael Steinman, a geriatrician at the University of California San Francisco. And so the reason for using this specialist is not determined by just age. “A 65-year-old with high blood pressure, high cholesterol and type 2 diabetes may benefit, but an 80-year-old who walks five miles a day and is only on one or two medications doesn’t need one.”

Usually, you see a geriatrician  for an initial consult, with follow-up as needed, says Mary Tinetti, M.D., chief of geriatrics at the Yale University School of Medicine. Most geriatricians work in centers and have a team-based approach; for example, besides meeting with the doctor, you’ll see a social worker, hearing specialist, nutritionist, and even physical or occupational therapists in the same visit. You’ll still see your primary care physician for day-to-day matters, like blood pressure checks or visits when you’re sick. If there isn’t a geriatrician near you and it’s hard for you to travel, Tinetti suggests seeing if a geriatric center will do a telemedicine consult. (You can check the American Geriatrics Society’s online locator serviceto find out if any of the nation’s 7,000 certified geriatricians practice near you.)

Reearch shows that it’s best to make an appointment sooner rather than later. Adults who see a geriatrician are less likely to end up in the hospital, possibly because these physicians are more likely to be on the lookout for warning signs such as frailty and appetite loss, and also are more likely to avoid prescribing potentially risky medications.

Here are four signs that you may need a geriatrician.

  • You’re on multiple medications. More than a third of adults over age 62 are taking at least five prescription drugs. Over 60 percent use some type of herbal or dietary supplement. But the more meds you’re on, the more likely you are to experience side effects, have cognitive problems or even end up in the hospital. “The older you get, the harder it is to metabolize and clear medicines from your body,” says Steinman. “And the more drugs you’re on, the more likely you are to experience drug-drug interaction.” A geriatrician can review all your meds and determine which ones you really need and which you can shelve.
  • You’re having trouble with your memory. Almost 60 percent of people over age 65 with probable dementia are undiagnosed or unaware that they have it, according to a Johns Hopkins University School of Medicine study published last year in the Journal of General Internal Medicine. A geriatrician can screen you for mild cognitive impairment (MCI), which is a precursor to dementia, as well as for depression, which can be more subtle in older adults, says Veronica Rivera, a geriatrician at the Icahn School of Medicine at Mount Sinai in New York City.
  • You’re less mobile. If you don’t feel as steady on your feet as you used to or are having trouble getting around, it’s a good idea to see a geriatrician who can assess your balance and gait, says Tinetti. (Falls are the leading cause of injuries and death from injuries among adults over age 65, according to the Centers for Disease Control and Prevention). A geriatrician can also give you balance-strengthening exercises to do at home and/or prescribe a course of physical therapy, as well as send a physical therapist or occupational therapist to your home to do a fall-risk assessment. All these steps can help keep you independent — and in your home — longer.
  • You’re hospitalized. Research shows that older adults who get care from a geriatrician in the hospital do better once they’re discharged. People over age 65 who got a geriatric consult while hospitalized for a traumatic injury such as a broken rib, head injury or fracture were able to resume about two-thirds more of their daily activities (like shopping, walking across a room, managing finances and self-care) than those who didn’t, according to a University of Michigan study published in JAMA Surgery. 

Written by: Hallie Levine, AARP

Source: agegracefullyamerica.com

Why Does My Elderly Loved One Sleep All Day?

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As people age, they tend to sleep more lightly than when they were younger and often wake up during the night from achy joints or the need to use the restroom. Many seniors compensate for this lost sleep by catching a restorative nap during the day. That’s normal.

Daytime sleeping only becomes a problem when an elder spends most of their time dozing in bed or their favorite chair instead of engaging in life. If you want your elder to stay awake more during the day and sleep better at night, you will need to discover the underlying reason(s) why they are napping excessively. In some cases, you may need a doctor’s help to narrow down the cause and recommend treatments. Knowing what to look for can give you a jumpstart on improving a loved one’s sleep schedule.

Common Reasons Why Seniors Sleep So Much

Boredom in the Elderly

As people age, they may suffer from chronic health conditions and age-related changes that affect their ability to do the things they enjoy. When options for outings, activities and entertainment are limited, it can deal a serious blow to an elder’s quality of life. They aren’t working anymore, they may struggle with reading or puzzles because of poor eyesight, and eventually they get tired of watching TV. In these cases, elders may not be clinically depressed or even all that tired. Instead, their fatigue stems from the fact that they are incredibly bored. With no schedule to keep and not much going on in their lives, they slide into the habit of napping throughout most of the day.

Medication Side Effects and Interactions

The average senior in the U.S. takes several different medications each day. All medications have side effects, so it should come as no surprise that taking multiple drugs can produce interactions that magnify these effects. In addition, older individuals metabolize medications differently than their younger counterparts, meaning that they are even more susceptible to adverse effects like drowsiness and dizziness.

Over-the-counter and prescription medications for conditions like anxiety, depression, high blood pressure, insomnia, chronic pain, Parkinson’s disease, nausea and allergies can all cause excessive sleepiness. Atypical (second generation) antipsychotics are notoriously hard on most elderly patients as well. If your loved one is on one of these medications, discuss the side effects and alternative medication options with their physician. You may even find that there are some medications in their regimen that could be reduced to smaller dosages or discontinued completely. Sometimes simply altering the timing of a senior’s medications can improve their alertness during the day.

Depression and Sleep

Many elders become sad and lose interest in life, but depression is in no way a normal part of aging. Most people are familiar with the basic signs of depression, but for older individuals, the red flags can be a little different. Sleep issues and fatigue can often indicate that a loved one is suffering from a mental health disorder. If you notice these symptoms in a loved one, do your best to talk with them about how they are feeling and make an appointment with their physician.

If a loved one is already on antidepressant medication or begins antidepressant therapy, keep in mind that finding the correct medication usually takes some trial and error. Again, sleepiness is a common side effect of these prescription drugs, so be sure to communicate with the doctor about any adverse effects to ensure your loved one finds the right medication.

Dementia and Difficulty Sleeping

Many seniors with dementia experience a wide array of sleep problems, especially in the later stages of the disease. As the brain deteriorates, issues arise with circadian rhythms and temporal awareness, making it difficult for dementia patients to sleep through the night and keep a normal schedule. In some cases, sleeping during the day is the only way that patients can make up for the shuteye they lose at night.

The resulting odd schedules can be frustrating for caregivers, but sleep deprivation can also exacerbate the symptoms of dementia, like sundowning. While there aren’t many foolproof methods for helping a loved one sleep through the night and stay awake during the day, sleeping pills typically aren’t advisable. The best methods for encouraging good sleep habits include using engaging activities during the daytime, scheduling brief naps as needed during the day, and sticking to a set sleep schedule as best as you can. A solid routine can be very helpful for helping a loved one stay oriented and managing behaviors and symptoms of dementia.

Excessive Sleep in the Elderly

In some instances, excessive sleeping in individuals with one or more serious medical conditions can indicate that their health has taken a downturn. This may not necessarily mean that death is near, but it certainly is cause for contacting the doctor to see if a specific treatment should be altered, added or removed. If a loved one is spending a great deal of time asleep, it is important to devise ways to ensure they still get the nutrition, personal care and medications they need. Otherwise, complications like dehydration, malnutrition and pressure ulcers can arise. In the most severe cases, the doctor may recommend an assessment for a different level of care, such as skilled nursing or hospice.

The Importance of Staying Active

In addition to being vigilant about an aging loved one’s medications and health, it is also important to encourage them to participate in life as fully as they can. Providing plenty of opportunities for social interaction, mental stimulation and physical activity is key to a high quality of life. But, for many family caregivers, seeing to all these needs in addition to their hands-on responsibilities and personal schedules is nearly impossible. Seeking out respite care that doubles as a source of stimulation for a loved one is a common solution for many families.

In-home care and adult day care are two such options. Both professional in-home caregivers and adult day care staff can help set and maintain daily routines, provide engaging activities and outings, and broaden a senior’s social circle. Assisted living and nursing home care can also offer these benefits in a residential setting. When elders spend more time engaged in life during the day, it reduces boredom, minimizes depressive symptoms and typically leads to better quality sleep at night.

Your goal is to determine why your loved one is so fatigued and how you can boost their spirits and energy level. The problems and solutions above may not apply to every senior, so don’t try to solve the problem alone. Communicate with your loved one as best you can and ask for help from physicians, friends and other caregivers. By doing so, you’ll get the support and reassurance you need, and you may find a workable solution.

Source: AgingCare by Carol Bradley Bursack

Robotic Assistants for Dementia Family Caregivers — Here Now!

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Robotic Assistants for Dementia Family Caregivers — Here Now!There have been many technological innovations that help family caregivers as they care for older adults.

Do we always love — or even use — them when we get them? Nope!

When it comes to older adults, the population is quickly becoming larger than the number of those available to care for them. Many family caregivers can’t stop working, for financial reasons, to become full-time caregivers, have other immediate family needs raising their children, or live at a great distance away all, any of which may prevent them from being full-time caregivers.

What about the number of seniors who have no family members, never had children, or have outlived their family members? What can they do to get their aging needs met?

This is a prime reason that technology to fill the gaps of caregiving is here to stay and will only continue to increase in breath and scope of devices and innovations.

Non-traditional solutions need to be embraced by caregivers and older adults, as well as made useable and practical by tech companies.

Many seniors have been slow to adopt new technology and many caregivers have stalled getting technology in place because they feel overwhelmed and undereducated about what is best for their senior loved one. Both of those must be overcome for caregivers and seniors to get the benefits of technology.

Smart home technology, voice activated assistants, and remote medical monitoring are all at the forefront in technology becoming part of daily life for our seniors.

Are we giving due consideration to robotics and the promise of great things to help manage chronic disease, reduce loneliness and improve the well-being of people living with dementia?

Dementia Decline Impacted by Robot Interaction

A new project has been focused on the effects that robots can have on the decline associated with dementia’s progress.

Advanced Brain Monitoring Inc (ABM) has introduced a robot companion that will interact with a person with dementia to determine if it can mitigate cognitive decline. ABM has received a grant from the National Institute on Aging at the NIH to carry out this study using socially assistive robot interventions. You can read more about it in this article.

Caregivers have been searching for strategies to meet the needs of their older loved ones and keep them mentally stimulated and engaged.

ABM used a socially assistive robot named Mabu from Catalia Health to interact with people with dementia in their own homes. The ABM team states, “We foresee the potential for the robot intervention to be used alone or in combination with other treatments for dementia.”

Mabu will ask questions, get answers, and give reminders as desired. It can be voice activated or directed using a touchscreen tablet. Daily conversations of only a few minutes at a time are individualized to the person and their needs. Although not mobile, the head and eyes move to interact with the person and follows their face to engage.

Change in Chronic Disease Needs Technology Solutions

Seniors today typically suffer from chronic diseases instead of an acute medical diagnosis that ends in their quick demise, as it did in the last century. The struggle then becomes managing chronic disease (and often more than one at a time) for optimal aging and independence that will allow aging in place.

Unfortunately, with the growth in the older population combined with the decline in number of people who can be caregivers to this population of elders, family caregivers will need to depend more on innovative technology to face health and aging challenges.

Success of technology to improve the life of our older adults will require engagement with this technology. That will mean, in a sense, having a relationship with our tech devices and staying engaged over time without abandoning it.

Clearly, if our seniors stop using a device, there is no benefit.

What if there was a technology that was engaging, effective, and acted as a companion that would become meaningful enough to achieve results of engagement that leads to true disease management and medication administration?

Technology such as this could keep a senior connected over a long period of time instead of being discarded. One that becomes almost a buddy.

Cost Versus Benefit of Technology Interventions

Many seniors who have begun needing additional care, but want to remain at home, need a helping hand.

Particularly for those older adults who live alone, a companion robot that interacts on a daily (even more than once a day) basis and is there to confirm they are following their treatment plan is very important to not only their medical status and quality of life, but also for the senior’s mental health to reduce loneliness.

Loneliness, which affects as many as one third of our seniors, has been shown to be a predictor of poor health.

The cost of most of this new technology rivals that of once a week in-home care. While the cost of care will likely rise over time due to supply and demand impacts, the cost of technology typically declines.

UBTECH Lynx (at Amazon)

Cost reductions in avoiding a medical crisis or hospitalization, home safety interventions, proper medication management, reduction in depression and loneliness, and the time given back to family caregivers far outweigh over the long-term other costs of facility or even routine home care.

Digital companions who interact with seniors and the healthcare team can help avoid health crises that lead to hospitalizations. It can also reduce the number of in-home visits needed when chronic diseases are monitored more closely and routinely using digital companions. Non-adherence to the treatment plan is a real barrier to health for many seniors.

Robots on the market and coming to market soon are not intended to take the place of in-home caregivers but to supplement the care they provide based on each senior’s situation.

It is important to note that many of these social robotic companions do not store health data. Any information relayed to a healthcare provider is encrypted, HIPPA compliant and secure.

Technology to Defeat Dementia

Robotics are being used with people with dementia in order to get their attention, engage them with companionship and stimulate them.

There are several of these robots either on the market in specific sectors or available to the consumer including MABU, ElliQ, CareCoach GeriJoy, Buddy, Paro the seal, and Hasbro’s Joy for All pets.

Robotic pets cost in the $100 range and are easily accessible. One of these would be a great gift for many seniors!

The sad truth is the level of frustration and anger family caregivers have when caring for elders in the advanced stages of dementia who ask repetitive questions and need constant redirection at tasks. It is human nature to react when someone asks 15 times in a row what time it is.

Robot companions, however, don’t react with judgment or frustration and are able to maintain a constant tone of voice. This interaction may help avoid conflict which could escalate behaviors in the person with dementia. A robotic companion can relieve a daily caregiver when seniors need constant conversation.

Robotics Doesn’t Replace but Enhance Caregiving

Many caregivers will balk at the thought of machines taking over the caregiving role and replacing the human touch.

This has never been the intention.

Everyone we have seen and heard in the field of robotic research and those implementing digital companions with seniors agree that a human caregiver is essential. Robots are to be used to enhance the experience of aging and augment the capabilities of busy caregivers not replace it.

You are the most important caregiver for your senior loved one, but you need help.

Socially assistive companion robots could help you improve the quality of life for your senior while helping you be able to continue to be a strong caregiver!

Source: Senior Care Corner by Kathy Birkett

How to Convince a Resistant Elder to Attend Adult Day Care

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While caring for my elderly parents, I was often advised to enroll them in a local adult day care program. Well-meaning people explained that going to the adult day center would give my mom and dad a life outside of lying in bed and watching TV all day. They also emphasized that I would get a much-needed break while they were out of the house. As nice as that sounded, I must admit I quietly scoffed at these suggestions for months. I couldn’t even get my father to take a shower on a regular basis, so how was I supposed to get him to attend a senior center?

A year later (and at my wits’ end), I decided adult day care was worth a try after I toured the beautiful facility nearby. I pleaded with my father for weeks before he begrudgingly agreed to go. Mom, on the other hand, was open to the idea right away. At the end of their first day at the center, she giggled, “Oh, honey, guess what? I won some lovely new earrings at bingo!”

Unfortunately, my father had quite a different experience because he was determined to sabotage the idea from the start. I was so embarrassed when the staff told me they had spent that whole first day trying to manage him. He wouldn’t leave my mother alone, holding onto her too tight and touching her inappropriately (which he had never done before). Apparently, he threw his lunch on the floor during a temper tantrum and even tried to escape out a bathroom window. By the time I arrived to pick up my parents, the staff members were completely exhausted and sincerely doubted he would ever be a good fit there.

Although I did my best when initially pitching the idea of adult day care, it didn’t exactly go over well. Like most caregivers, I’ve spent ample time reflecting on mishaps like this one and thinking over all the other ways I could’ve handled things better. I’ve brainstormed a few different ideas that I think would’ve helped convince my father to attend the adult day center without causing a scene. Hopefully, these tips can help fellow caregivers who are interested in adult day care avoid the mistakes I made!

Introducing the Idea of Adult Day Care

The very first change I would make is to avoid referring to adult day care as such. For most people, the term “day care” evokes images of young children who can’t take care of themselves and require total supervision. Understandably, many seniors find this term condescending and infantilizing. Alternative names include day center, senior center and even “the club.” You know your loved one best, so try to find a term that would appeal to them.

I would’ve also tried to introduce the social worker from the adult day center to Dad on a social basis first. A few phone calls or even a home visit will allow a staff member to develop a commitment-free relationship with a senior in a safe space. If this goes well, then your care recipient will recognize at least one familiar face at the day center, which can help them feel more comfortable.

When it comes to actually getting a senior to go to the center, I think that framing it as an opportunity rather than an obligation can help immensely. For my dad, an invitation from one of the staff to assist with an activity or event would’ve made a huge difference in his willingness to attend. By giving my father a “job” to do or a volunteer opportunity and telling him he was needed there, he would have felt honored to go help out.

This approach can also work if you plan to drop by the local center for a low-key tour and introduction under the guise of saying hello to your “friend,” the social worker or an administrator. Again, communicating with a staff member beforehand about your loved one’s apprehension and personality traits can help them navigate the situation better. They can ask your loved one to pitch in with preparing and/or serving lunch if they enjoy cooking or request assistance with folding laundry—an activity my mother always enjoyed.

Helping a senior strike up a friendship with someone at the center and presenting them with an opportunity for an increased sense of purpose can be very valuable steps in convincing them to give adult day services a try.

Helping Seniors Adjust to Adult Day Care

One thing I especially regret is sending my parents to adult day care by themselves on the first day. I now understand how scary any kind of change can be for an elder, particularly for someone who is in the beginning or middle stages of dementia. My father was used to always being in control of his environment. So, when I dropped him and Mom off at the center, it completely overwhelmed him and he acted out.

If you anticipate any issues like the ones my dad caused, then it’s best to opt for a gradual introduction and transition to minimize stress and aggravation for everyone involved. In a redo, I’d be sure to go with my parents to the center as many times as needed until I was sure my father felt comfortable and safe enough for me to leave.

I know that one of the points of adult day care is to provide you, the caregiver, with a break, but easing into things will ensure this is a lasting option for respite care. My father almost wasn’t welcomed back after his chaotic first day at the center. To me, a little bit of hand-holding is well worth keeping all your options open.

The Benefits of Adult Day Care

Even though I went about introducing adult day care all wrong, eventually I succeeded in getting my father to accept the routine of going to “the center.” My parents finally had someplace to go during the day, friends to socialize with and numerous activities to look forward to. Best of all, the activities tired them both out so much that they finally slept through the night. This meant I got some sleep, too! The burden of caring for and entertaining them both during the day was dramatically reduced, along with my blood pressure.

It wasn’t long before my parents became shining success stories. They progressed so dramatically in their behavior and strength that even their doctors were impressed. I was delighted that they were emotionally and physically healthier than they’d been in years, thanks to the increased activity and socialization at the center.

Now, as I lecture all over the country about caregiving issues, I always emphasize the tremendous value of adult day care, what I consider the best kept secret in elder care. I smile each time I hear fellow caregivers express the same reluctance I once had: “Oh, Jacqueline, my loved one would never agree to such a thing!” But then I explain that, with a little extra creativity, effort and patience, adult day care can make a significant difference in the lives of even the most challenging seniors and the lives of their overwhelmed caregivers.

Source: AgingCare by Jacqueline Marcell

Caregiving Language – Use It to Uplift and Embrace

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Caregiving Language - Use It to Uplift and EmbraceIf you are caring for someone who is living with Alzheimer’s disease, maybe you can relate to this experience:

“Are you with me or not?” my father asked sternly.

“Yes, I’m with you!” I replied without hesitation.

Alzheimer’s disease had progressed between the mid- to late-stage of the disease for my father.

I scanned his face and the area for clues. None. I had no idea what he was talking about.

He looked annoyed at me – at my inaction. “We have to get going, now!”

“How about you take the lead? I’ll be right beside you.”

He walked to the front door. We stood there and waited.

It turned out, we were waiting for the train from California to England to fight with our “fellow countrymen.” My father’s never been to England. His fellow countrymen are Armenian, not English. And, of course, no train travels from California across the ocean, but none of that was important.

Even when someone is making so little sense, how you respond as a caregiver matters to your relationship with them. Even when a person with dementia can express himself, we might still be left asking ourselves, “What is he talking about?” You can’t be a mind reader, and you don’t have to be. Choose your words carefully with kindness to help this person feel secure and safe in your company.

The Negative Nature of Our Language

The words we choose impact how secure we help our care recipients feel. Oftentimes, we don’t realize how our language affects others.

After initial mishaps, I learned to align with my father’s requests.

When he says he wants to drive somewhere, I hand him the keys. Like the improvisational artist, I try keep the scene moving, having no idea what to expect. The fact is, he cannot legally drive anymore.

After he moved to California from his Wisconsin home of 45 years, I knew the new setting would be disorienting and he no longer had a car to drive. With some confidence I’d reply, “You had the car last. I don’t know where you parked it.” My strategy was to go along with him, not argue or correct.

He’d take the car keys and walk rapidly, pause, look at the car keys – two postal box keys, two house keys and a car key fob. Confusing to a man who was used to plain similarly sized keys. Distracted by something else, he set the keys down. Each time, I thought, Phew, that was a close call!

Ask yourself, “Do my words push people away or do they bring them closer?”

Our goal is to give verbal hugs with language that embraces. I aligned with my father’s request to drive and even handed him a set of keys. We want to uplift those we care for with our remarks.

It’s quite a challenge, because the English language limits our choices.

We speak mainly in either-or, black or white and yes or no. There are few words to describe the greys, the in-betweens and the maybes. Furthermore, our use of language tends to skew negative.

For example, consider one deflating yet all-too-frequent response to a compliment. A server, receptionist or a customer-care employee, may reply, “No problem.” After I uplift a person with words of praise, hearing “no problem” is deflating. I wonder, when did this become a “problem?”

It might feel more uplifting to reply with, “You’re welcome” or “My pleasure.” These words can feel more like an embrace.

Consider practicing these three tips to embrace and uplift with your words.

Language-Use Tips

Say what is.

Instead of saying what we don’t want or what isn’t –

“What did you think of that?”

“Not bad!”

“What would you like to eat?”

“Not ham!”

Practice using words to express what we want.

“I’m really in the mood for a small piece of roast beef. That would really hit the spot, right now.”

We spend so much time on the exception or what we don’t want, we can lose sight of the plentiful buffet of options before us.

Keep things positive with encouragement such as, “I’m in the mood for…” and keep a conversation going rather than shutting it down with a negative. Reread the italicized replies, above and take note of how you feel.

In general, this negative slant in our language-use, may be one reason our goals are elusive. When we focus on excluding or what we don’t want, that’s what we often get. When our attention and efforts are aimed toward what we want in life, we’ll have a better chance of achieving it.

Habits are hard to change. When we muster the courage each day and commit to apply these skills, we’ll have a better chance of success in day-to-day care of our loved one. Adding an improvisational tool will help, too.

Improv
The goal with improvisation is to keep the scene moving. The primary way to accomplish this is to respond affirmatively. Improvisational artists will say, “Yes.” They’ll also add “and” followed by a new piece of information.

While presenting a keynote recently, I briefed a volunteer and then asked her, “May I have $5.00?” She replied, “Yes.” As she reached into her pocket, she asked, “And may I have a $20?”

The audience laughed. She kept the scene moving, instead of refusing with “No” or “I don’t have a “five.”

Practice responding in such a way that you align yourself with your care recipient’s interests. Instead of shutting down communications and creating feelings of insecurity, you’ll strengthen your relationship and find space to add a touch of humor.

Add Humor
When the conversation is flowing, it frees-up creative energy. In the example above, the attendee’s response was a win-win. I got what I wanted and her clever response got her even more. Plus, we entertained the audience.

Interactions that include laughter (even smiles) bring people closer and strengthen feelings of security.

Are You with Me?

As my father and I stood at the door waiting for a train that would never come in our lifetimes, I remained clueless. I had no idea what he had in mind. Without challenging his resolve, I asked tangential questions.

“Do you think the train will take us from California to England?”

He looked at me quizzically.

“I mean, will we need to board another train?”

Trying to assess my sincerity, he replied, “We’ll be traveling through the night, making many stops to pick up others.”

Oh my! This is going to be a challenge. What the heck is he talking about? I tried another approach.

“Since we’ll need our strength, shall we eat, first? I’ll check the schedule to make sure we don’t miss the train.”

“Sure, let’s eat. Let’s make sure we don’t miss the train.”

After all that, I learned we were in the midst of WWII. He had been paging through an issue of LIFE magazine.

In my personal experience as a caregiver, I have found that using these strategies results in uplifting and embracing communications and improving our relationships.

Source: Homewatch Care Givers – By Brenda, Avadian, MA, The Caregiver’s Voice

8 Facts to Know About Lewy Body Dementia

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Most people mistakenly believe that all types of dementia share similar symptoms, like the hallmark signs of forgetfulness and confusion that are associated with Alzheimer’s disease (AD). However, Lewy body dementia (LBD), the second most common type after AD, is characterized by unique symptoms that make it difficult to diagnose and treat.

It’s important for family caregivers who are looking after aging loved ones to familiarize themselves with some of the basic signs of various age-related diseases like LBD. Noticing strange new behaviors or quirks early on can help ensure a senior gets the medical attention they need in a timely manner.

Facts About Lewy Body Dementia

  1. It affects millions of seniors. 
    According to the Lewy Body Dementia Association, LBD affects approximately 1.4 million individuals and their families. Although it is widely unknown, it is the second most common form of dementia after Alzheimer’s disease.
  2. LBD is not Alzheimer’s disease.
    Many people use the terms “dementia” and “Alzheimer’s disease” interchangeably, but dementia is an umbrella term used to describe a progressive neurological disorder that affects cognitive function, of which there are many different kinds. Alzheimer’s is one form of dementia that is characterized by impaired memory, issues with decision making, trouble with problem solving and difficulty learning new skills.
    There are crucial differences between AD and LBD. For one thing, people with LBD experience unpredictable changes in cognition, regardless of the time of day, whereas people with Alzheimer’s tend to have more trouble in the late afternoon and evening—a symptom known as “sundowning.” Those with LBD also tend to have more visual hallucinations and movement issues, while the hallmarks of AD include memory loss and trouble performing familiar tasks. Furthermore, abnormal alpha-synuclein protein deposits in the brain called Lewy bodies are the hallmark biological marker of LBD, unlike Alzheimer’s, which is caused by the accumulation of beta-amyloid plaques and tau tangles in brain tissue.
  3. LBD is difficult to diagnose.
    As with Alzheimer’s, LBD can only be conclusively diagnosed through an examination of brain tissue after a person has died. However, medical advancements have significantly improved the certainty with which doctors can diagnose living patients.
    Doctors consider the person’s symptoms, interview their family members, perform physical and mental evaluations, obtain a family and personal medical history, and conduct blood tests and brain imaging tests like MRI, PET and CT scans. Symptoms of LBD include problems with depth perception, hallucinations (often visual), delusions, paranoia, Parkinsonism (body stiffness, tremors, trouble walking), and physical issues like heart rate and blood pressure fluctuations, constipation, and fainting spells. To be diagnosed with LBD, an individual must have dementia as well as several of these symptoms.
  4. Medications and LBD can have adverse interactions.
    An accurate, timely diagnosis of LBD is essential to avoiding dangerous medication reactions. Many drugs prescribed to people with Alzheimer’s disease and Parkinson’s disease—especially antipsychotic drugs used to control hallucinations—can have a dangerous effect on people with LBD. Neuroleptic malignant syndrome (NMS) is a neurological disorder brought on by a negative reaction to antipsychotic medications that often occurs in people with LBD. Individuals who develop NMS can experience muscular rigidity, high fever, variable blood pressure and severe sweating. Anticholinergic medications, benzodiazepines and over-the-counter sleeping pills can also have negative effects on seniors with Lewy body dementia.
  5. Parkinson’s disease and LBD are very similar.
    People with LBD often exhibit the same symptoms as those with Parkinson’s disease dementia (PDD). While the two conditions start off differently, their biological underpinnings are closely related, and people with Parkinson’s disease can be diagnosed with either PDD or LBD. The factor that physicians use to distinguish between these two conditions is the timing of the onset of cognitive symptoms. People who develop dementia within a year of their Parkinson’s diagnosis are thought to have LBD, while those whose dementia symptoms start beyond the one-year mark are thought to have PDD.
  6. LBD affects sleep quality.
    Sleep issues and dementia often go hand in hand, but there’s a specific sleep condition that appears to disproportionately affect people with LBD. Studies indicate that as many as two-thirds of LBD patients struggle with REM sleep behavior disorder (RBD). RBD is an ailment that causes movement, speaking and gesturing during the REM (rapid eye movement) stage of sleep, which is usually characterized by paralysis in healthy individuals.
  7. Like most dementias, LBD is unpredictable.
    One of the biggest challenges facing seniors with LBD and their families is the fact that symptoms of the disease tend to worsen and improve erratically. Periods of mental fog, aggressive behavior, movement issues and vivid hallucinations can last seconds, minutes, hours or days. Fluctuations in symptoms can be caused by underlying infections, medications or general progression of the disease. Because of this, it can be nearly impossible to determine how far LBD has progressed in a given individual. However, if the exacerbating factor is capable of being fixed (like a urinary tract infection), then the person with LBD can often return to their prior level of functioning after receiving treatment for the secondary issue.
  8. LBD has no cure.
    There is currently no way to cure or halt the progression of LBD. Instead, treatments are aimed at controlling the cognitive, psychiatric and motor symptoms of the disorder. Those who have been diagnosed with the condition may benefit from palliative care, which focuses on using drugs and nonpharmaceutical treatments to manage symptoms and improve a patient’s comfort and quality of life. For instance, cognitive issues may be addressed with cholinesterase inhibitors, a type of medication that promotes brain cell function by regulating the neurotransmitter acetylcholine. To improve sleep quality and minimize the effects of RBD, careful treatment with clonazepam (Klonopin) or melatonin might be prescribed. Levodopa may be used to mitigate the motor effects of severe Parkinsonism. Occupational, speech and physical therapies are the most common nonpharmaceutical approaches to helping people with LBD manage their condition and maintain day-to-day functionality. Average life expectancy after diagnosis is about 8 years, with progressively increasing cognitive and functional disability.

Source: AginCare by Anne-Marie Botek

When to See a Doctor for Sleep Problems

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When to See a Doctor for Sleep ProblemsIf you consistently have trouble sleeping at night, you may be one of millions of Americans who suffers from a sleep disorder. Almost everyone has had trouble sleeping at one point or another, but a sleep disorder occurs on an ongoing basis. Because there are more than 100 types of sleep disorders, it can be difficult to figure out what is causing your sleepless nights.

Here are the most common sleep disorders:

  • Insomnia is the inability to fall asleep or stay asleep through the night. It is the most common sleep disorder in the United States. About 15% of U.S. adults report having chronic insomnia.
  • Narcolepsy is excessive daytime sleepiness with sudden muscle weakness. Sleep attacks is another name for this condition.
  • Parasomnias are emotions, behaviors and activities that take place while a person is sleeping. Sleepwalking, sleep talking, sleep aggression, sleep eating, teeth grinding, and nightmares are parasomnias.
  • Restless legs syndrome (RLS) is the overwhelming urge to move your legs at night. This is usually in response to unpleasant sensations, such as creeping, crawling, tingling, burning, achy or itchy feelings. Moving the legs often relieves these sensations.
  • Sleep apnea is breathing pauses during sleep that last at least 10 seconds. Loud snoring, gasping, and choking noises are also typical symptoms. The most common form is obstructive sleep apnea.

Common Causes of Sleep Disorders

For most people, sleep debt is due to busy lives, shift work or “night owl” syndrome—staying up too late. Poor sleep may also stem from napping too much, depression, anxiety, caffeine or other stimulants, or simply getting older. However, sleep disorders can occur on their own. This is true for narcolepsy, RLS, sleep apnea, and even insomnia in some cases. Sleep scientists know that sleep is controlled by our genes, and many sleep disorders run in families.

Sleep Disorder Treatment at Home

Treatment and prevention strategies depend on the exact sleep disorder, but in general, making a sleep a priority and good sleep habits are essential. This includes having routine sleep times, keeping your room cool and dark, and limiting caffeine, nicotine and alcohol. Doctors also recommend limiting daytime naps, getting regular exercise, and not eating close to bedtime. Your doctor may have more suggestions based on your specific habits.

When to See a Doctor for Sleep Disorders

Talk with your primary care doctor or provider if any of these situations applies:

  • You have trouble sleeping at night for 30 days or more.
  • You find yourself drowsy or dozing off during the day, with impaired memory, alertness or concentration.
  • You have tried good sleep habits (good sleep hygiene) and sleep problems persist.

Who to See for Sleep Disorders

It is important to explore the possible causes of your sleeplessness and try to find a solution. Your primary care doctor will be able to talk about solutions, but may also recommend seeing a sleep medicine specialist for a full evaluation and diagnosis. A sleep specialist is also the best choice for advanced care and treatment if you have a clinical sleep disorder.

Source: Healthgrades. by Kate Kling