What Happens When a Senior Can No Longer Care for Their Pet?

Howard Cutler knows the joy animals can bring to people. His childhood memories are filled with stories of his family’s two beloved dogs and cats. After moving into a senior housing complex in Atlanta, Georgia, Cutler acted on his love of animals and adopted a Shih Tzu named Ollie from a fellow resident who could no longer care for the animal. For seven years, the pair was inseparable until Cutler’s Parkinson’s disease forced him to move to a different assisted care facility that didn’t allow pets.

“He was my friend and my companion, and giving him up was very difficult for me,” Cutler explains. As much as he wanted to keep little Ollie, Cutler knew he needed to rehome his beloved pet. He began looking among his neighbors in the senior complex to find a new owner. “Ollie was loved by everyone there, but I was worried that I wouldn’t find the right person.”

Cutler was fortunate to find the perfect fit in his friend and neighbor Nancy Markovich. “Howard was heartsick that he had to give up Ollie,” Markovich recalls. “So, I offered to adopt the dog and promised to take good care of him.”

Ollie’s veterinarian, Dr. Duffy Jones, says pets provide much-needed comfort and companionship to people of all ages, especially seniors. “The value that animals bring to people is amazing,” he says. “I’ve seen older pet owners who are struggling financially choose not feed themselves so they can feed their animals. Their pet is the reason they get up in the morning.”

But when aging pet owners find themselves unable to care for their animals, surrendering the pet is often the best course of action. “Most owners understand they’re sick and their pet needs more care than they’re able to provide,” Dr. Jones says. “They want to make a plan for their pets; It’s a real source of comfort.”

Senior Pet Owners Must Plan for the Unexpected

Dr. Jones encourages all pet owners to devise a succession plan for their animals as early as possible. Having a “plan b” in place before the pet owner becomes too ill, needs to move to a care facility or passes away will offer invaluable peace of mind for the owner and added security for their pet. He offers the following tips for creating a contingency plan for a loving animal:

  • Consider adoption. Ask friends and family who are familiar with the pet if they are willing and able to offer the animal a new home. Those who interact with the pet regularly will be better equipped to determine if the animal’s size, personality, routine, etc. would fit well with their schedule and lifestyle.
  • Talk to a vet. Veterinarians have many resources at their disposal and can often help rehome a pet. No-kill shelters can also be a useful option, and there are many non-profit rescue organizations around the U.S. that will also assist older adults in finding new homes for their animals.
  • Get the owner’s input. Be sure to let the pet owner have a say in the decision. Ask them who they would like to look after their pet. “In some cases, older people don’t have a lot of family around and their friends are going through similar transitions, so they worry what will happen to their pets,” explains Dr. Jones. “Animal owners are visibly relieved when we tell them we’ve found their pets a new home. It’s not uncommon for them to cry.”
  • Allow for a smooth transition. Ideally, the current owner will be able to help the pet transition to its new home. The goal is to help the animal and new owner build trust and become familiar with one another incrementally. Try having the new owner come for extended visits with the pet, take the animal for walks and care for it in the new home for short periods before full-time ownership begins. Small steps are easier on everyone involved compared to an abrupt change.
  • Rehomed pets aren’t gone forever. While evaluating prospective adopters, discuss the possibility of allowing the original owner to continue visiting with the animal. Even a monthly visit with a cherished furry friend can brighten up a senior’s day.

Dr. Jones says euthanizing a pet should be the last resort. “Some older people think that putting a pet down is best because the animal is so bonded to their owner,” he says. “We usually try to talk them out of it, explain that there are so many other options and then we work with the owner to rehome their pet(s).”

When Is It Time to Rehome a Senior’s Pet?

With so much research touting the physical and mental benefits that animals provide to humans, Dr. Jones advises that older people keep their pets for as long as possible. Unfortunately, though, circumstances do change. If either the pet or their elderly owner is living in a neglectful situation or experiencing a reduced quality of life, then it is time to explore alternative options. It can be difficult to balance the health, safety and happiness of both the senior and their pet, but it must be done.

Dr. Jones sympathizes with family members who don’t know what to do about their aging loved ones and their furry friends. “For caregivers, the thought of taking care of a person and their pet can be overwhelming,” he notes. “Sometimes older people haven’t trained their pets well, which can amount to behavioral problems and unsanitary conditions. But what people don’t see is that these animals mean so much to their owners. Separation often causes physical and emotional decline in both parties.”

Balance What Is Best for the Senior and Their Pet

Markovich has no regrets about adopting Ollie. She tried to make the transition as smooth as possible for both pet and owner. Cutler now receives the care and assistance he requires while Ollie gets the love and stimulation that dogs thrive on. Markovich inherited Ollie’s food and water dishes from Cutler and even places them in the same spot in her apartment at the senior housing community. The twosome goes for daily walks and Markovich hopes that she’s kept Ollie trained to Cutler’s standards.

Every month, Cutler gets to see his favorite companion when Markovich brings Ollie for a pet therapy visit at the assisted living community. “When he comes to see me, he’s overjoyed,” says Cutler. “When Nancy is ready to leave, he goes to her side to let me know he was happy to see me, but he is leaving with Nancy. I feel sad about that, but also happy that I was able to find a good home for him.”

Markovich is equally grateful for the opportunity to help a friend in need and to find the loving companionship that a pet brings. “Ollie sits by me on the sofa, sleeps on my bed and we are thick as thieves. He is a true blessing for me,” she remarks.

Source: AgingCare  by Candace Rotolo

Should You Quit Your Job to Care for Your Elderly Parent?

As parents age and need more assistance, most adult children do what they can to help. For many, the first step is a weekly stop by Mom and Dad’s home to assess the situation and perhaps help with some chores and errands. Often, these check-ins increase in frequency until it becomes a routine part of each day.

Family caregivers typically look into community services and in-home care for assistance. They research adult day care centers and assisted living communities. However, most seniors are adamant about wanting to remain in their own homes and receive assistance from their own children. They don’t want “strangers” in their house or driving them to engagements.

Sick days and paid time off begin to dwindle. Performance suffers and unpaid leave becomes the only option for taking time away from work to handle emergencies and doctor’s appointments. Eventually, like so many other family caregivers, you consider quitting your job, putting your career on hold. While it won’t be easy, it’ll just be a temporary solution, ideally with minimal impact. Right?

The Benefits of Leaving Work to Care for a Family Member

You already know what may be gained by giving up your job and becoming the primary full-time caregiver for your parents. You would benefit from knowing firsthand how they are faring day and night. You could save them from paying for in-home care or adult day care. You wouldn’t have to worry about the quality of care they are receiving from outside sources. You could likely delay, if not eliminate, their need for nursing home care. You may be able to deepen your relationship with your parents and grow closer to them.

Keep in mind that every family is unique. For some, these benefits are realistic yet short-lived. For others, these benefits are simply unattainable ideals. Caregiver burnout, financial strain and changes in health and relationships can severely undermine even the best laid care plans.

The Costs of Quitting a Job for Caregiving

While the benefits seem straightforward enough, the true costs of deciding to quit your job to care for Mom or Dad are much more complex.

A deficit in or loss of monthly income is likely the biggest factor in this decision, and that change can usually be tolerated on a temporary basis. However, caregiving can drag on for months and even years. Many caregivers do not think about the long-term effects of this choice, but it’s crucial not to forget about or ignore your own financial future.

Yes, stepping in to help your aging parents may feel good and help them save money. If they have significant assets and don’t outlive their savings, you may even recoup some of the financial resources you gave up by inheriting part of their estate when they die. But, my best advice to family caregivers is never to rely on that outcome.

It is highly likely that your parents will still need care in a senior living facility at some point, regardless of whether you embrace unemployment to personally spearhead their care. When the time comes for placement in long-term care, their financial resources will dwindle quickly unless they are fortunate to have a very good long-term care insurance policy or abundant savings. Therefore, assuming that you will financially recover after “it’s all over” is very risky. Even if a personal care agreement is put in place very early on to compensate you for your services, there is still no guarantee that your parents’ funds will see them through.

Obviously, this decision involves giving up a paycheck for a certain amount of time, but that’s not the only thing that’s on the line. Consider the following implications that may not initially occur to family caregivers who are contemplating quitting their jobs.

  1. Social Security Benefits: Even though family caregivers work very long, hard hours, these work hours do not show up on one’s Social Security record. Depending on the number of years you spend officially unemployed, you not only lose your take-home wages, but you also lose the opportunity to work toward earning hundreds of dollars a month in Social Security retirement benefits.
  2. Retirement Savings Plans: Without a job, you’ll miss out on the ability to participate in an employer’s retirement plan or 401(k) match. Unless you had a healthy retirement plan before you quit your job, your financial future is likely to be bleak. In fact, most family caregivers who give up their jobs end up withdrawing funds from their savings and retirement accounts prematurely to offset their lost income and cover monthly expenses.
  3. Job skills: As other colleagues in your field move up and gain experience, your skills are likely to wane during your unemployment. Countless people have left the workforce and been unpleasantly surprised to find that new educational requirements, technological expertise and training are now required for jobs similar to the ones they held before.
  4. Re-entering the Workforce: It’s easier to get a new job when you already have one, compared to job hunting while unemployed. In today’s tight job market, re-entering the workforce may not be easy, especially with a significant gap in employment on your resume.
  5. Ageism: As your parents age and you care for them, you, too, are growing older. Age discrimination is illegal, but when you’re finally able to work again, potential employers can find other ostensible reasons for not hiring you, such as out-of-date skills.
  6. Caregiver Isolation: Not everyone is cut out to be a full-time caregiver. You may find that, while you are glad not to be juggling a job and caregiving responsibilities, you miss the work atmosphere, your paycheck and the social interaction you had as an employed person. Caregiving can be a profoundly lonely job.

As with all issues in caregiving, there is no black and white answer. For some, leaving work for caregiving is the only right thing to do. For others, it can lead to financial ruin and a lost sense of purpose and identity outside of providing care. As a nation, we need more affordable elder care resources and better support from employers so that gainful employment, financial security and dedication to family are attainable goals that can coexist. Until more options are made available to Americans, adult children who wish to care for their aging parents will continue facing heartbreakingly difficult decisions like this one.

Source: AgingCare Carol Bradley Bursack

5 Ways to Be a Healthy Alzheimer’s Caregiver

Caregiving is a labor of love, and love is about selflessness and sacrifice. Spouses give up so much for each other, parents constantly put their children’s needs before their own, and when those 5 Ways to Be a Healthy Alzheimer’s Caregiverchildren become grown adults with aging parents, they want to return the love and care they received.

If you find yourself consistently making sacrifices to care for your loved one with Alzheimer’s disease, your heart is certainly in the right place. But such devotion can also take its toll on your health and well-being.

According to the Family Caregiver Alliance, caregivers of individuals with Alzheimer’s disease are more likely to report higher levels of burden and stress than other caregivers due to the cognitive and physical limitations experienced by the care recipients. And, a word of caution: a study from the National Alliance for Caregiving (PDF 2.6 MB) found that as care recipients’ dementias get worse, the health of their caregivers tended to diminish significantly as well.

Consciously taking steps to care for yourself is important both for your sake and your loved one’s. Feeling physically, emotionally and mentally refreshed will help you be the best caregiver you can be.

    1. Say Yes to Help
      It might require swallowing some guilt or pride, but if you feel overwhelmed, stressed to the max and exhausted, it’s time to ask for help. Talk to your other family members and come up with a solution together. Maybe the others can pitch in more regularly to give you a respite. Or maybe you’ll decide to hire outside help. Non-medical in-home senior care agencies like Home Instead Senior Care specialize in finding just the right caregiver to match your loved one’s needs, interests and personality. They can provide care for just a few hours per week or as much as 24/7 care. You’ll find peace of mind when you can take a break from caregiving and attend to your own needs knowing your loved one is with a well-trained, trusted caregiver.
    2. Stay Informed
      Knowledge is power when it comes to caring for a loved one with Alzheimer’s. Arming yourself with information will reduce worry and stress while boosting your confidence and ability to take control of your situation.

    3. Find Support
      This could mean joining a caregiver support group in your community, taking part in an online community for Alzheimer’s caregivers, or just finding a good friend willing to listen and lend a shoulder to cry on. You need a safe space to vent your frustrations (without taking it out on your family) and a source of encouragement. Caregiving for a loved one with Alzheimer’s disease or other dementias is one of the hardest jobs out there, so it may help to hear other caregivers’ stories and take the journey together.
    4. Take Care of YourselfMuch easier said than done, of course, but taking time to take care of your own needs is absolutely essential.
      • Avoid skipping or putting off your own doctor appointments
      • Take time to yourself everyday to do something you want to do
      • Listen to your body and give it what it needs—rest, exercise, a chance to cry, a nice massage, healthier food, a doctor’s check-up, etc.

While you will inevitably still make some personal sacrifices, limit them to the ones you feel are most important. Keep your stress levels in check by taking the Caregiver StressMeter assessment and learn what you need to do to maintain your own health and spirits.

  1. Focus On the Positive
    Make a point each day to note the things that went well, focus on what your loved one can do rather than dwelling on the difficulties, and don’t hesitate to break out your sense of humor! Never underestimate the power of a good, hearty laugh to ease tension and melt away stress. Negativity, on the other hand, will just drag you down, so strive to maintain good moods and attitudes to remain at the top of your game.

Even if it seems like caring for a loved one with Alzheimer’s demands all your time and energy, know that you’re entitled to take personal time for yourself. It’s not only allowed, it’s necessary. Start right now—choose one thing you can do to feel better today and you’ll be on your way toward a more rewarding caregiving experience.

Source CaregiverStress.com

Scams to Watch Out for in 2019

Scams to Watch Out for in 2019It is estimated that older adults lose billions of dollars to scammers each year. But there is good news—last year the Federal Trade Commission noted that older consumers are more likely to report they’ve been victimized by financial exploitation than their younger counterparts.

Here are three scams that are notably making the rounds.

1. Beware of Social Security spoofing calls

There’s been a significant uptick in fraudulent telephone calls from people claiming to represent the Social Security Administration (SSA). In them, unknown callers threaten victims that they face arrest or other legal action if they fail to call a provided phone number or press the number indicated in the message to address the issue. Sometimes the scammers switch tactics and say that they want to help an individual activate a suspended Social Security number. They may even “spoof” the actual Social Security hotline number to appear on the recipient’s phone: 1-800-772-1213.

If you receive one of these calls, hang up. Know that Social Security rarely contacts persons by phone unless you have ongoing business with them and they never make threats about arrest or legal action.

Report suspicious calls to the SSA Office of the Inspector General by calling 1-800-269-0271 or submitting a report on the OIG website.

2. Watch for a new twist on the old grandparent scam

The grandparent scam has been around for several years. In this approach, a person calls an older adult pretending to be a grandchild who’s been involved in an accident or legal trouble and needs money immediately.

Recently, the Federal Trade Commission (FTC) found that instead of using wire transfer or gift cards, an increasing number of older adults are mailing cash to these fraudsters, with a median individual loss of $9,000. According to reports, the scammers often ask seniors to divide the bills into envelopes and place them between the pages of a magazine, then send them using various carriers, including UPS, FedEx, and the U.S. Postal Service.

The FTC warns that if you or a loved one receives one of these calls, don’t act right away. Call that grandchild back on a correct phone number and verify their whereabouts. If you’ve mailed cash, report it right away to the Postal Service or shipping company you used. Some people have been able to stop delivery by acting quickly and giving a tracking number. Be sure to also file a complaint to the FTC at FTC.gov/complaint.

3. Only work with reputable agencies after a natural disaster

Wildfires, earthquakes, tornadoes, hurricanes—these unpredictable forces of nature can be devastating to those living in affected areas. Even those not directly affected may want to lend support in whatever way they can.

Unfortunately, natural disasters are a golden opportunity for scammers, who target both those who’ve been directly affected and those who want to offer their support. Natural disaster scams typically start with unsolicited contact by telephone, social media, e-mail, or in person. Scammers may:

  • Impersonate charities to get money or private information from well-meaning consumers.
  • Set up fake websites with names that mimic legitimate charities to trick people into sending money.
  • Pretend to be from the IRS and collect personal information under the guise of helping victims file loss claims and get tax refunds.

To find reputable charities to support victims of natural disasters, use the IRS’s tax exempt organization search or look for an organization’s charity rating on places such as Guidestar and Charity Navigator.

If you’re a disaster victim, use NCOA’s BenefitsCheckUp® disaster assistance tool to find legitimate help with relief and financial assistance.

Pass it on!

One of the most important ways to avoid becoming a victim of a scam is to pass along information about scams that are making the rounds. Through the Pass It On campaign, the FTC offers free materials you can download or order and share in your community to protect older adults from scams.

Source: NCOA – Nationa Council on Aging

How to Motivate Without ‘Bullying’ During Caregiving

How to Motivate Without ‘Bullying’ During CaregivingDuring my caregiving years, my mother and I had many tense moments about rousing her from bed to get ready for medical appointments. I’d pop into her bedroom and wake her, then remind her a few minutes later that she really needed to get up, then cajole her, plead with her, and ultimately use my sternest, I-mean-business tone. I thought I was helping motivate her in those instances. She’d say she felt like I was bullying her.

I never liked being called a bully and denied it was so. After all, we were always in a rush. If I pressured her, I reasoned, then it was for her own good. But in retrospect now, 20 months after her death, I wonder if I was in the right. What really mattered to her during those times? Was she clinging to the comfort of her pillow because she was still tired or even depressed? Was it more important for her to have control over her own life and sleep in than submit to another routine exam with a doctor who couldn’t help her much anyway? Instead, I overruled her and expected her to “obey” me.

I don’t think I’m the only family caregiver to transgress the blurry line between supportive guidance and arm-twisting. Sometimes when tired or frustrated or impatient — or when there really is a situation of dire urgency — many caregivers are prone to pressure care receivers too hard to conform to schedules and regimens. We rationalize the approach we’ve taken on the basis of practicality and expedience. But many of us second-guess ourselves later about whether it was necessary.

Certain things do have to get done. Otherwise, family caregivers might feel that they are guilty of irresponsibility and neglect. But how can we manage to be coaches, not bosses, and effective motivators, not feared bullies? Here are some ideas.

Rarely put tasks over the relationship: There are few caregiving tasks so crucial that they warrant trampling a care receiver’s feelings in the process of accomplishing them. Rather, there are what I think of as front- and back-burner issues. On the front burner are mostly issues having to do with safety, such as taking medications appropriately or driving capably, for which the caregiver should be firm and persuasive. However, most other issues are on the back burner of importance and need for action. For these items, caregivers should allow care receivers to exercise as much choice as possible and shift plans accordingly. That means being more flexible and accommodating, as well as respectful. In retrospect I could have scheduled my mother’s doctor’s appointments later in the day, even if it was less convenient for me, or canceled them altogether.

Develop a range of approaches and strategies: Great coaches are attuned to the moods of their players and apply the right touches at the right time to encourage maximum effort and performance. Great caregivers, too, can sense what care receivers are feeling at a given moment and tailor their requests — for instance, appealing to reason, resorting to silly humor or changing the subject entirely — to the approach that will motivate.  In general, I found that a gentler style was more apt to work with my mother, but there were also times that she wouldn’t agree with me at all. That’s when I would turn to my wife, who, with a smile and an even softer tone, could somehow win my mother’s cooperation making the same request she’d already rejected from me.

Solicit and heed feedback: We can sometimes get so wrapped up in the hectic pace of caregiving life that we lose a sense of how we are coming across to others. But we can listen to feedback from family members about how we are conducting ourselves. Take a moment to say to the care receiver, “We are having to work together more closely nowadays than we ever have before. Am I treating you the way you want to be treated?” Regard the answer seriously.

Beware of creeping bullying: No caregiver sets out to be the sort who pushes others around. But if he finds that applying pressure to the care receiver is the most efficient way of completing his many tasks, then he may slowly tend toward using sheer force. Caregiving isn’t about efficiency, however; it’s about caring. And nothing could be less caring than bending people to one’s will. We need to be aware of the excesses of our own styles and never convince ourselves that the ends justify the means.

by Barry J. Jacobs

Source: AARP

The 4 Most Surprising Bathroom Hazards for the Elderly

The 4 Most Surprising Bathroom Hazards for the ElderlyBathrooms can be a perilous place in the house, especially for people who are older or living with a chronic condition that can make falls more likely. Much like the kitchen, this is a risky space in the home with slippery surfaces and sharp objects.

One study found that the most common location for fall injuries in the home was the bathroom, including when people are hurrying to the bathroom. A National Institute on Aging statistic states that 80% of falls in the home happen in the bathroom.

Yet these injuries are not just the result of missing grab bars in the shower, and not all of the risk involves a fall. Consider these other risk factors that could lead to a fall in the bathroom:

  1. A bath mat in the tub or shower. In theory, these mats are there to prevent a fall on the slick surface. In reality, they can become a tripping hazard as they bunch up or simply move when stepped on. The solution is to put on non-slip decals to the surface of the tub or shower.
  2. Lack of adequate lighting. It’s not uncommon for people age 65 or older, or those living with certain conditions or taking specific medications, to need to use the restroom in the middle of the night. Unfortunately, being half awake is only going to increase the chances of tripping or slipping and possibly falling in the bathroom. The solution is to install a simple night light that can at the very least make it clear where the light switch is in the dark.
  3. No handheld showerhead. When someone needs to use a chair in the shower or tub, they will also need an easy-to-reach shower head that they can move around without too much twisting and turning. The solution is to add an adjustable shower head that allows the individual to clean themselves while remaining safely seated.
  4. Hot water. As we age, our skin becomes thinner and more sensitive to exposure to high water temperatures. At the same time, there is a decreased ability to sense when water is so hot it can scald or burn the skin. The solution is to have an expert set the water heater thermostat between 110 to 120 degrees, which is considered safe by experts.

Source: HomeWatch Caregivers


LOOK FOR THE GOOD AND YOU’LL FIND ITThe dishwasher overflowed last night, you woke up to a kitchen floor full of suds and were late to work.

You found out two days ago that the mole on your Dad’s ear was malignant.

A monster typhoon slammed into the Philippines and left 10,000 dead.

It seems that everywhere you turn these days there’s more than enough stress, chaos, and bad news. It’s easy to feel overwhelmed, anxious, and just flat-out disgusted with it all.

How in the heck do you find the good, happiness, and joy in the midst of so much bad?

You have look for it, notice it, and take it in.  That’s how.

Noticing the Good
In his book, Hardwiring Happiness: The New Brain Science of Contentment, Calm, and Confidence, Rick Hanson explains that our brains don’t automatically recognize the good for two reasons.  First, there isn’t a stimulus to catch your attention usually in something good.  There’s no threat, no fear, nothing to make your brain take notice.  Your brain doesn’t automatically note all the bad things that didn’t happen.

Second, through a process called habituation, your brain filters out the run-of-the-mill happenings that don’t change every day whether it’s the refrigerator’s constant hum or, thankfully, the routine absence of major disasters in our daily lives.

While habituation is an efficient use of your brain’s neural resources, it causes a lot of the good that’s around us all the time to simply go unnoticed. According to Hanson, to counteract the brains’ natural tendency, we have to look for, put emphasis on, and create good experiences.  To do this, you have to become aware of what good is present in your life and make the thought an embodied experience accompanied by good feelings, sensations, desires, and actions.

Hanson’s not talking about making anything up here.  He only asks that we see what’s true and already right there in front of our eyes. It’s a shift in perspective.  Noticing the good doesn’t mean denying the bad realities.  It means choosing to focus your attention on anything that could yield a positive experience.

Hanson writes:
Often we see a good fact but don’t have any feelings about it.  This seemingly small step – from idea to embodied experience – is critically important, for without it, there’s not much to install in your brain.  In terms of building neural structure, what matters is not the event or circumstance or condition itself but your experience of it.  

How to Take in the Good
So how, exactly, do you do this?

You take in the good by noticing a positive that’s already present in your life or creating one.  He suggests finding good facts in your current setting, recent events, ongoing conditions, personal qualities, the past, and the lives of others.

  • You’re alive.
  • You ate today.
  • The sun is out.
  •  That trip to the beach last summer was awesome.
  • You exercised yesterday.
  • You have always been a hard worker.
  • You’re smart.
  • You earned a college degree and nabbed that award at work last year.
  • Your cousin just had a healthy baby boy.

These seemingly small, but good things can be turned into embodied experiences by tuning into your body and allowing yourself to really feel the positive emotions and sensations accompanying the thoughts.  It’s important to follow through on any positive actions that might occur to you, like writing a note or making a phone call.

Good facts are all around you every moment of every day.   Even “bad” facts often contain seeds for good experiences.  You have to intentionally look for the good in the bad.

  • What lessons did you learn?
  • Are you stronger for having had the experience?
  • What did you gain?

Sometimes, it’s impossible to find good or create a good experience. You might be in terrible pain, have suffered a tremendous loss, be buried in depression or in a panic. That’s OK.  That’s being human.  With compassion for yourself, accept where you are, ride out the storm, and look for the good when you can come up for air.

Finding the Good in My Life
After a suicide attempt years ago, I was left seriously brain injured and lost custody of my two sons who moved to a different state with their father.  As part of my emotional recovery in the years that followed, I had to consciously look for the good around me because there wasn’t much readily apparent anymore.

At times, I had to get out the magnifying glass, but good was always still there.  I just had to notice it.  The sun warming my cheeks as I walked the dog on a chilly morning; the silkiness of the cat’s fur as I scratched her rumbling chin with her curled up on my lap; a really good tune playing on my iPod were the smallest of joys, but joys nonetheless.

Noticing the good has become an invaluable staple in my mental health toolbox. It’s a choice, costs nothing, and anyone can do it anywhere at any time. With practice, making a conscious effort to notice the good and internalizing it becomes a habit making it easier to activate and maintain a positive state of mind even in the midst of chaos or upsetting events.  Over time and through neuroplasticity, the practice actually changes the neuronal structure of your brain hardwiring it for happiness.

Look for the good, and you’ll find it. Promise.

Written by: Debbie Hampton

Source: Age Gracefully America

Getting Compensated for Caregiving Can Change Family Dynamics

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

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 CPart 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

The End-of-Life Doula Movement

The End-of-Life Doula MovementA doula shares her role in bringing comfort and empowerment to dying patients.

In ancient Greece, doulas were servants who supported women through childbirth. The reemergence of doula work began in earnest during the 1960s, this time featuring trained professionals providing emotional, informational, and physical support. The essence of being “of service” remains.

Doulas establish relationships with clients, gaining trust and developing rapport, clarifying the goals, fears, and wishes of each expectant family. Then, during labor, a birthing doula provides continuous support—wiping a brow, holding a hand, fetching ice water, rubbing an achy back, suggesting positions and breathing techniques, whispering encouragements, and ensuring all invited are operating within their preferred roles. As a laboring woman weathers the ups and downs, the doula remains steady and calm, believing in the woman and in the process.

More recently, doulas have begun offering support to people at the end of life as well. Dying and death offer many striking similarities to birthing. There’s unpredictability. There’s a unique unfolding of events. Time fades away, as do the usual distractions of daily life. As doulas, we tune in. We listen more deeply. We feel compelled to take each moment as it comes, knowing we cannot make assumptions. Clients face intensity, doubt, and suffering, which takes many forms, including spiritual, emotional, physical, intellectual, and psychological. There’s difficulty. There are heightened feelings and reactions. Dynamics shift and sway, threatening our sense of foundation—the anchor to our past, present, and future.

Both birthing and dying become a sort of liminal space, thresholds to mystery. Doulas honor them as such. They are rites of passage that have three distinct features. As people enter into the rite, the initial experience is one of severance. We exit the usual pace of our schedules. We separate from our responsibilities. We put life on hold.

In early labor, women generally return to or remain at home (in their comfort zone), giving full attention to the beckoning task at hand. They shift between working through intermittent contractions and preparing for their journeys into motherhood (gathering supports, nourishing themselves, arranging and organizing).

In early dying, we often notice changes in a person’s breathing, communication, and physical activity. People spend more time sleeping, less time socializing, and occasionally appear to be in a separate realm. In the case of both birthing and dying, consciousness and presence seem to waver between complete embodiment of awareness and what seems to be a level of dissociation with the reality those surrounding the person are experiencing.

Gradually, people enter the transition period of the rite. For birthing women, this could be considered the time between laboring and delivering the baby, ie, pushing. Contractions now bring different sensations and the body propels the process onward. Hormones shift and surge. The end goal is within sight. Women may experience exhaustion, exhilaration, fear, and excitement.

In the case of death, a person enters into active dying, the time of deep rest. Sometimes this is a quiet, peaceful phase. Sometimes there’s persistent pain and relentless agitation. Loved ones and care teams attempt to meet the needs of the dying person and lessen suffering as much as possible. It can be a time of great worry. Support people ask: How long will this go on? Am I ready for it to end?

Birth and death end relatively abruptly due to the incomparably momentous nature of both. For birth, it is the emergence of new life. For death, it is the end of a life. Reintegration is the final act of the rites of passage. A woman is reincorporated as “mother” into her community. Anything beyond death remains best understood by belief systems and mortal imaginings. We are without certainty. Survivors of the deceased reemerge as mourners, however.

How Might Doulas Serve? 
The main task of a doula is to offer emotional support. In every word, touch, approach, and method used, we bring careful attention to the inner well-being of our clients. We believe in people. We honor life and the mysterious enigma of death. Our aim is to listen deeply and provide personalized, nonjudgmental care to promote our clients’ growth and sense of agency.

Doulas have a number of compassionate offerings available to clients, although personalization is always key. We align with the goals, wishes, and needs of our clients and we respect their choices. Throughout the University of Vermont Larner College of Medicine’s End-of-Life (EOL) Doula Professional Certificate Program, we illuminate ways of being a doula (the heart of the work) and ways of doing doula work (techniques and approaches), including the following:

• discovering a client’s wishes;
• working through a client’s anxieties;
• honoring and holding sacred space;
• leading guided imagery, visualizations, and breathing exercises;
• promoting informed consent;
• assisting with legacy and completion work, as well as advance directives;
• conducting life review sessions;
• providing resource referrals;
• coordinating care; and
• vigil planning and sitting.

Doulas support both the dying person and their natural network, knowing that by attending to the needs of loved ones or incomplete life tasks, we enable our clients with more opportunities to consider deeper meaning and connection. We expect that different personalities will present at varying points along the spectrum of disbelief, anger, sadness, and acceptance. The components of grief are not good or bad, right or wrong—they just are. And doulas meet people where they are as they vacillate, remaining neutral and caring.

Like a birth doula, an EOL doula can help prepare clients and their loved ones for what is to come. In the case of pregnancy and a terminal diagnosis, there’s time to plan. EOL doulas can help families develop wishes for this often overwhelming period. Just as a birth doula inquires about a client’s postpartum plans, an EOL doula can ask about a postpassage plan: What expectations do you have? What might help you feel most supported? What do you have in place and what can we consider arranging?

These conversations require grace. Doulas need to recognize the appropriate moments to broach these topics—or, if clients and their loved ones are not ready, to plant seeds for future talks. Minimizing surprises helps enhance people’s sense of confidence as they enter into the unknown. We can alert people to what commonly occurs, nurturing foresight and readiness.

This focus on planning and plan implementation is integral in doula work. It’s how we ensure support is unique to each client. It’s how we respect each client’s dignity. We assist families with preparing for loss. Additionally, doulas help arrange clients’ calendars to honor their priorities for time spent while weighing energy levels. We ask questions such as the following:

• Which appointments and visits are most important?

• Can we create a meal train so that friends, neighbors, and family members can deliver food and necessities?

• Are there any additional services available that we might consider suggesting?

• Would our clients like to finalize expressed wishes for care (before, during, and after dying)?

• Can we work through some options for visualizations, keeping clients’ “special places” in mind, as we develop a personalized script to read?

• Would our clients like to complete a life review?

• Can we work on legacy gifts together?

• Can we plan for the vigil time (ie, how the clients would like their spaces to look, smell, and sound as well as who they would like to have present)?

• Are there readings or rituals we can explore and include?

Doulas carefully consider how we fit into the care team. Is a social worker already drafting funeral plans with the family? Is the hospice chaplain or priest from the client’s church meeting regularly to discuss existential questions? Would an aunt love to organize the creation of a giant photo collage? Is there a brother who feels compelled to manage the appointment and visitor schedule?

Doulas don’t duplicate. We provide complementary care, honoring the roles of all involved. No two clients will require the same level and type of doula support.

Why Does Doula Support Work?
Studies repeatedly demonstrate positive outcomes associated with birth doula care. According to researchers, “The presence of a trained doula providing continuous support to laboring women and their partners appears to have a significant effect on rates of instrumental vaginal deliveries and cesarean sections,”1

Furthermore, say the authors of a study comparing doula care with standard care, “Continuous support during labor may improve outcomes for women and infants, including increased spontaneous vaginal birth, shorter duration of labor, and decreased caesarean birth, instrumental vaginal birth, use of any analgesia, use of regional analgesia, low five-minute Apgar score, and negative feelings about childbirth experiences. We found no evidence of harms of continuous labor support.”

They add that “Continuous support from a person who is present solely to provide support, is not a member of the woman’s own network, is experienced in providing labor support, and has at least a modest amount of training (such as a doula), appears beneficial.”2

Why might continuous support from a doula be advantageous? When reviewing similar benefits of birth support in their research, Gruber and colleagues speculate: “Communication with and encouragement from a doula throughout the pregnancy may have increased the mother’s self-efficacy regarding her ability to impact her own pregnancy outcomes.3

We imbue our commitment to positive regard into our approach to care—every touch, gesture, and conversation. We do not dip into internal reserves to replenish a client’s sense of emptiness. Instead, a doula believes in the inherent wisdom and strength of each human being and their limitless potential to evolve. We recognize the tendency toward self-doubt during times of intensity and firmly believe in people’s capacity to find their footing and next steps, even—especially—when they feel lost or overwhelmed.

In the throes of liminal space, doulas remain the calm in the chaos. We encourage a thoughtful slowing down when many feel rushed to get past a hurdle. We nurture contemplation as clients consider tumultuous periods, questions, and crossroads. We turn toward and lean into suffering with our abiding faith in people and know we are not meant to “save” or “rescue” people from their journeys.

Might there be comparable opportunities and equally beneficial reasons to include doula support at end-of-life in addition to birth? In a study investigating the effectiveness of lay health workers, researchers from Stanford University Medical Center found that “Patients with advanced cancer who spoke with a trained nonclinical worker about personal goals for care were more likely to talk with doctors about their preferences, report higher satisfaction with their care, and incur lower health costs in their final month of life.”4

In these cases of research on birth and death, a nonmedical emotional support person provided the listening ear required to forge connection, cultivate honesty, and improve outcomes. Satisfaction went up; costs went down.

Barriers to Providing Doula Care
There are a few marked obstacles EOL doulas face as they enter the field, the most pressing being role recognition and financial structures. Currently, there’s no credentialing body overseeing doula work. Doulas are not licensed professionals. This remains true of birth doulas, who have been completing training protocols since the early 1990s with the inception of DONA International, the oldest and largest doula training organization.

There are myriad options for becoming a doula (birth and EOL). Most programs are rigorous and comprehensive although they range in terms of the breadth of topics covered, length of studies, and required assignments.

In recognition of this burgeoning field, the National Hospice and Palliative Care Organization (NHPCO) has established an End-of-Life Doula Advisory Council that “provides information and resources to NHPCO, its members, affiliated organizations, and the general public to promote awareness and understanding of the end-of-life doula role. It also informs those constituents of the benefits of doulas for dying people and their families, and guides them on incorporating doulas into existing services and how to access outside doula providers.”5

Doulas and medical teams need to work collaboratively, respecting our common goal of providing superb, holistic care. Increasingly, hospice and palliative care programs are including doulas on their teams, although mainly in a volunteer capacity thus far.

How do doulas establish this new role? Doulas often balance this effort in the workspace and in the public sphere. When serving clients, we are introducing our scope of offerings. We are indirectly educating as we allay the fears of care providers who wonder about our place in the realm: Will doulas invade? Will we push people to the side? Will we take over? Will we make/question medical decisions? What do we do? What is our agenda?

Doulas have numerous jobs, activities, exercises, and techniques to administer, but we are also there as a companion, witness, and listener. This requires graceful flexibility. Meeting people where they are means not always adhering to a premeditated itinerary. We need to be versatile and adaptable while remaining within our scope.

As team members witness doula work, they begin to value our contributions and realize what we offer is augmenting what’s already available. We add harmony. We complement care. We acknowledge the varied personalities and gifts of those present and involved.

Doulas do not offend. We are anodyne in our neutrality. Our presence is innocuous and does not arouse anxiety. We offer support without drawing attention to ourselves. This is not ego work; this is heart work. While supporting clients, we become caregiving chameleons. There’s shape-shifting involved. We read the room. In accordance with the needs of the moment, we step forward or back.

Financial structures also present issues for doulas. Charging fees for this type of work has been and will remain a challenge. Doula work primarily has been a private pay transaction or volunteer work. Insurance programs offer very little in the way of coverage. In a few states, birth doulas have worked to pass legislation to require Medicaid coverage, but the low reimbursement rate has prevented most practicing doulas from completing and filing the necessary paperwork.

There is some potential for more inclusionary coverage as hospitals shift away from fee-for-service models to value-based reimbursement.6 Also, choices for care and long term care programs offer options for fund allocations, which could perhaps include doula support.

Core Care Components
What remains at the core of doula efforts, and enhancing the experience of death at large, is our fellow humans. How do we want to be treated? How do we want to be honored? What would we want for ourselves? What can we make available and possible?

Options are empowering. There is work to be done. There is a place for doulas by the bedside. As I explained in my book, Cultivating the Doula Heart, “We are sensitive and affirming, soothing in our care. We are not dismissive. We do not minimize a person’s interpretation of what they are undergoing. Through all the ways we doula, we promote empowerment and healing born of processing and bravely facing that which threatens one’s sense of intactness. This healing—not in the sense of a cure, but in the sense of an unbroken soul—generates peace in the face of chaos.”7

— Francesca Arnoldy is the author of Cultivating the Doula Heart: Essentials of Compassionate Care.

Source: Todays’ Geriatric Medicine