19 Free and Discounted Services for Seniors and Their Caregivers

Most seniors these days are living on limited incomes from sources that may include Social Security, a small pension or maybe some other form of government assistance. With few resources at their disposal, finding affordable products and services is crucial. While numerous resources exist, most of them are either difficult to find or largely unheard of.

Your local Area Agency on Aging (the names of these offices may be different in your area) is the best place to begin when looking for assistance. Local charities and nonprofit organizations, such as the Lions Club and Meals on Wheels, can also be great sources of help.

In my opinion, the most valuable items for seniors and their caregivers—things like free hearing aids and free dentures—are also the most difficult to come by. From my experiences as a caregiver, I have compiled a list of useful and affordable services and a roadmap for finding them.

Free and Discounted Services for Seniors and Their Caregivers

  1. Benefits Counseling
    How many times have you, either as a senior or as a caregiver, wrestled with trying to figure out what type of help was available to you? Free counseling is available through your local Area Agency on Aging (AAA) that can point you in the right direction. You can get answers regarding health insurance coverage, food stamps, income assistance and other benefits through these counselors.
  2. Adult Day Care
    Adult day care centers may be run by government entities, local charities, or even religious groups. The purpose of these centers is to provide seniors with a safe place to socialize, engage in activities and eat a hot meal in a supervised setting. Adult day care is ideal for seniors who cannot remain alone but do not need the intensive care that a nursing home provides.
    Your local AAA will probably be able to direct you to a local provider, or you can conduct a quick search in AgingCare’s Adult Day Care Directory for a facility in your area.
    When it comes to paying for adult day services, most facilities charge nominal fees merely to cover their operating costs. Many offer services on a sliding scale, depending on a senior’s income and ability to pay.
    Eligibility requirements are different for each facility. For example, some centers will only accept seniors who are continent because they do not offer supplies or trained staff to change adult briefs. Other facilities may require a certain amount of mobility for those attending (i.e. they are able to get out of a wheelchair on their own or with minor assistance). More intensive care and supervision are available at specialized adult day health centers. These facilities have a registered nurse on staff and can help seniors take their medications, monitor their health, and provide certain types of therapy to promote healthy aging.
    When initially contacting your AAA or a day center directly, give them as much information up front regarding ability to pay and the physical condition of the applicant so they can give you accurate enrollment information.
  3. Medicaid-Covered Dental Care
    Due to complicated billing processes and slow government reimbursement, there aren’t many dentists that accept Medicaid. To find a dentist in your state that accepts Medicaid, contact your State Department of Health.
    Keep in mind that because there are a limited number of dental practices that accept Medicaid, seniors might have to travel to receive these services. For example, in my home state of New York, the Department of Health website only lists about 40 dentists that accept Medicaid. That’s not a great number for a state with a population of nearly 20 million people.
  4. Free Dentures
    As incredible as it may seem, it is possible for low-income seniors to receive a free set of dentures. In addition to calling your AAA to see if they can refer you to any resources, try contacting your state dental association and any nearby dental colleges. These organizations will be able to direct you to free or low-cost dental programs.
  5. State Pharmaceutical Assistance Programs (SPAPs)
    Select states offer drug assistance programs to seniors and individuals with chronic illnesses like end-stage renal disease. If you live in Colorado, Connecticut, Delaware, Idaho, Indiana, Massachusetts, Maryland, Maine, Missouri, Montana, North Carolina, New Jersey, Nevada, New York, Pennsylvania, Rhode Island, Texas, Virginia, Vermont, Washington State or Wisconsin, you may have access to an SPAP that can help you afford your prescription medications.
    Income and residency requirements, coverage details, and copay amounts vary from state to state, so be sure to contact your state’s department of health and/or human services for details.
  6. Low-Cost Prescription Drugs
    Despite the advent of Medicare Part D and state-run assistance programs (outlined above), many seniors still cannot afford their medications. Fortunately, there are other sources of help. Many pharmaceutical companies provide assistance for those who cannot afford their medications. You can find a comprehensive list of these programs on the Partnership for Prescription Assistance website as well as the instructions to apply for assistance.
    Another cost-saving strategy is to make the switch to generic drugs. According to the Food and Drug Administration (FDA), “Generic drugs are important options that allow greater access to health care for all Americans. They are copies of brand-name drugs and are the same as those brand-name drugs in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use.” Generic drugs cost about 80 to 85 percent less than their brand-name equivalents, so it makes all the sense in the world to speak with your doctor about making the switch.
  7. National Family Caregiver Support Program (NFCSP)
    The NFCSP provides funding to states for the support of informal caregivers. AAAs often administer these programs in conjunction with other community-based organizations and providers. NFCSP services are designed to supplement, not replace, the efforts of family caregivers. They include counseling, training, support groups, and respite care.
  8. Discounted Phone or Internet Services
    LifeLine is a federal government program for qualifying low-income consumers that provides discounted phone (either landline or wireless cell phone) or internet services. To qualify, seniors must have an income at or below 135% of the federal poverty guidelines or currently participate in some form of government assistance, such as Medicaid, the Supplemental Nutrition Assistance Program (SNAP) or Supplemental Security Income (SSI). Visit to see if you qualify and to find participating companies in your state.
  9. Free Phone for Hearing Impaired Individuals
    CaptionCall is a service funded by the Federal Communications Commission (FCC) that provides free captioned telephones to those with medically recognized hearing loss. To be eligible, a senior must obtain a signed certification of hearing loss from a medical professional. CaptionCall also offers a free mobile application through the Apple App Store that allows users to receive captioned phone calls on an iPad.
  10. Supplemental Nutritional Assistance Program (SNAP)
    This program used to be called “Food Stamps” and provides monetary assistance to low-income families so that they can afford nutritious food. You can apply through your AAA or local SNAP office. Each state has slightly different requirements based upon income, household size and countable resources. I have found that most states offer a website where you can learn more about the program and apply online. Visit the USDA SNAP website for a list of nationwide office locations and states that offer online applications.
  11. Other Free Food Services
    In addition to programs such as SNAP, local charities and governments offer programs that provide seniors with a nutritious meal (typically lunch) and the opportunity to socialize. Transportation may be provided as well. Check with your local AAA to see what programs are available in your area. Local food banks are another source of assistance for low-income seniors. Locate soup kitchens, food pantries and other resources at
  12. Free Hearing Aids
    Buying a new hearing aid can run into the thousands of dollars, so it’s no wonder that seniors are hard pressed to pay for these devices. Fortunately, I have found that there are a few ways to obtain free and discounted hearing aids. Some programs offer new devices and others provide used ones.
    First, try your local Lions Club. Most chapters either operate or know of a hearing aid bank that can match needy seniors with recycled hearing aids. Another approach is to seek out clinical trials of new hearing aids. Contact manufacturers to see if you can volunteer for a trial. When the trial is over, you typically get to keep the product. You will have to meet medical qualifications for the trial, and you may have to contact several manufacturers until you find one that works for you. Sometimes there are waiting lists for trials, but this can be a great way for seniors to receive free hearing equipment.
  13. Free Legal Help
    Many seniors and their caregivers are in need of legal guidance. Whether you need assistance with small estate planning issues, power of attorney documents, drafting letters to creditors, or help with Medicaid applications, free and discounted legal help is available.
    Check with your AAA, local law schools, and state and local bar associations to see if they directly offer reduced fees or pro bono services or know of other programs and attorneys who do. The VA also provides some services for veterans, and the Legal Services Corporation specifically assists low-income individuals with legal matters.
  14. Medical Alert Systems
    Medical alert devices can be invaluable to seniors who wish to maintain their independence and caregivers who need some added peace of mind. A person only needs to push a button on their device to summon help in the event of an emergency, such as a heart attack or a fall. The devices come in wearable wristband and pendant forms, or as base stations that can be placed strategically throughout the home for easy access.
    There are a number of different systems to choose from, but their differing features, costs and contract terms can make it hard to compare them. To minimize costs and maximize benefits, look for a system that only involves a monthly fee (about $35 on average), does not charge a device fee, and features an in-house response service rather than an outsourced one.
    This last point is particularly important. When your loved one hits that button, you want a response from a trained, competent professional who can calmly contact emergency services and stay on the line until help arrives. LifeStation and Rescue Alert are two companies who offer this simple fee structure and reliable service.
  15. Free Walkers or Rollators
    A walker will typically cost at least $40, and rollators are even more expensive. That can be a lot of money for a senior. If you are looking for a discounted or free mobility aid, try thrift stores and local non-profit organizations. Hospitals and nursing homes may also periodically dispose of reliable, used equipment at a lower price point.
  16. Low Income Home Energy Assistance Program (LIHEAP)
    Through your local AAA, you can apply for assistance to efficiently heat and cool your home. Help is provided either in the form of weather upgrades to your residence or as direct cash assistance for energy costs based upon your income level. Weather upgrades make homes more energy efficient and are provided through the Low Income Weatherization Assistance Program (LIWAP). LIWAP can help families install insulation, repair or replace HVAC systems, and seal doors and windows. One little-known fact about HEAP is that it is available to both homeowners and renters, making it more widely accessible for low-income seniors.
  17. Long-Term Care Ombudsman Services
    Each state has an ombudsman program whose sole purpose is to “address complaints and advocate for improvements in the long-term care system.” Ombudsmen are somewhat similar to union representatives. They are trained to investigate complaints and ensure that residents of nursing homes, assisted living facilities and board and care homes are being treated fairly.
    If you feel a resident is being neglected, exploited or abused in a long-term care facility, getting the ombudsman’s contact information is easy. It must be prominently displayed in all nursing home lobbies. You can also find this information on the National Consumer Voice for Quality Long-Term Care website.
  18. Residential Repair Services
    Need some minor work done around the house, but can’t afford the labor? Many AAAs run a residential repair service that offers minor upgrades and adaptations to homes or rentals to make them safer and more conducive to aging in place. You may have to pay for supplies, but the labor is typically provided for free by volunteers.
  19. Wandering Programs
    Individuals who care for seniors with dementia are often concerned about wandering. Getting lost on foot is worrisome enough, but if a senior is driving with dementia, the consequences can be very serious. There are many ways to combat this. One way is through a Silver Alert program, which is a public notification system that broadcasts information about missing persons with Alzheimer’s disease, dementia, and other mental disabilities in order to expedite their location and return. These programs vary by state. Some require preemptive registration of vulnerable seniors, while others simply require a person to contact their local law enforcement agency in the event a cognitively impaired driver goes missing.
    Another wandering program is Project Lifesaver. This nationwide program requires advance registration and is offered by many public safety agencies, such as police departments, fire departments and search and rescue organizations. These agencies provide a small transmitter for wanderers to wear. The watch-like device transmits a unique signal that can assist trained law enforcement officials and emergency responders in locating a missing person. Costs vary for enrollment in this program, so locate a participating agency in your area and contact them for additional details.

I have used many of these services to assist me in my role as a caregiver and hope that this list is useful to you and your family as well.


What to Look for (and Avoid) in an Emergency Alert System

What to Look for (and Avoid) in an Emergency Alert SystemCaregivers’ worries never end, especially when their loved ones are living alone in their own homes. Falls, stroke, heart attack and other medical emergencies are the biggest concerns for seniors’ safety. According to the National Council on Aging, one in four Americans age 65 and over fall each year. Research from the National Institute on Aging shows that 60 percent of these falls occur in their homes, where most seniors wish to remain as they age.

Seniors want to maintain their independence, but family members often worry since they cannot be present around the clock to ensure their loved ones’ safety. This dilemma prompted the creation of medical alert systems that are capable of instantly summoning help in the event of an emergency.

There are many types of these devices on the market, and they go by a few different names, such as personal emergency response systems, medical alert devices or medical emergency response systems. They all typically work in a similar way, and all function to help ensure a senior’s safety and provide peace of mind for their family members.

How Medical Alert Systems Work

Most systems have three basic components: a small radio transmitter (a help button carried or worn by the user); a console or base station connected to the user’s telephone line; and an emergency response center that monitors calls.

When the help button is pressed, the console automatically dials the central monitoring center and connects the user with an operator. Most consoles feature a two-way speaker, so the operator and the senior can hear one another. Some systems can dial out even if the phone is in use or off the hook. This is called “seizing the line.” In addition to dialing the monitoring center, once notified, the operator may also contact family, friends or neighbors that the senior has listed as emergency contacts.

“A medical alert system provides peace of mind for both the caregiver and the senior,” says Ken Gross, President of Medical Alert, by Connect America, a leader in the medical alarm industry since 1977. “The senior simply presses a button and help is on the way.”

These systems can vary widely, though, so it is important to carefully compare different companies, products and service packages.

What to Look for in an Emergency Response System

To help you shop for an emergency response system, Gross suggests considering the following factors.

  • Pricing and Contract Terms: Medical alert companies assess fees differently. Some offer monthly, semiannual or annual payment plans for monitoring services, and some also charge for necessary equipment like the base unit and the wearable transmitters.
    Ask about minimum obligations for the service. Some require a 30-day, 90-day or even 36-month minimum contract in order to provide services. In the same vein, inquire about activation fees, cancellation fees if you need to end the contract early, and whether monitoring costs are locked in or will increase. Keep an eye out for additional fees, and be sure to obtain an itemized written quote when inquiring about prices.
  • Features: Along with pricing, it is crucial to ensure that an emergency alert system is a good fit for a senior’s unique medical conditions. What is the main objective for the system? For example, if a loved one has Alzheimer’s disease, they may wander and get lost. A system that provides GPS monitoring services would be especially beneficial in case they go missing. For a senior who is prone to falls, a system that offers automatic fall detection technology in its wearable transmitters would be ideal. These special call buttons have motion-sensing capabilities to determine if the wearer has fallen and contact help automatically even if the wearer cannot.
    A number of additional features have been added to these systems over the years, including fitness trackers, medication reminders, daily check-in calls, home security features and more. Additional “bells and whistles” typically mean higher costs, so steering clear of unnecessary features is equally as important as ensuring you get the ones you want.
  • Experience and Reputation: How long has the company been in business? Do they have a good reputation? Search online for customer reviews of systems you are considering, and try to find feedback from real users with similar medical conditions and concerns. If consumers report the same complaint again and again, it is likely an issue that should factor into your decision.
  • Range and Portability: What is the range of the system? Does the senior need more than one base unit for adequate coverage of their home, and will that increase the cost? Can the system be used when the elder is working in their yard or away from home? These are important considerations for seniors who lead active lifestyles and those who live in more than one place during the year.
    Some companies offer plans with nationwide cellular coverage or base units that can be moved from home to home. “These setups allow seniors to take the system with them when they travel, and it will work in all 50 states. It’s great for snowbirds,” Gross says. Just remember to update your current home location with the response center, otherwise they may send help to the wrong home address.
  • Ease of Use: Be sure to research the actual equipment included in the system. Look at the dimensions of the base unit and wearable transmitters and the different buttons on each. Is the emergency button large and easy for the senior to see and press? Are there any complicated instructions, buttons on the console or other features that might be troublesome for the elder to operate? Are the wearable devices comfortable? Do they need to be charged?
    Ask if the company you are considering offers a trial period for their system so that you can ensure it is the right fit. You want a product that the senior is willing to wear every day and able to use with ease. This is especially important for users who have poor eyesight, limited dexterity or other impairments that may complicate using these devices properly. A system that is uncomfortable or difficult to use is not going to be effective.
  • Waterproofing: “Most accidents happen in the bathroom,” Gross points out. Make sure the wearable button is waterproof and can be worn in the bath or shower. This will ensure that a senior can summon help if they slip and fall while bathing.
  • Trained Operators: Determining the quality of the monitoring service is also very important. Ask about the training that monitoring center staff members receive and look for a company that has its own in-house center located in the United States to handle incoming calls. When that button is pressed, every second counts. You want a qualified response team to assist the user and contact the proper emergency personnel.
  • Hours of Operation: Make sure the monitoring center is available 24 hours a day, 7 days a week, for both emergency monitoring and customer service. What happens if there are problems using the system or questions arise about the service?
  • Contact Options: Some systems have options for connecting users with various contacts depending on the nature of their call. In emergencies, of course the operator will summon the proper authorities, but some systems allow users to program family members and friends as contacts for nonurgent situations. This keeps seniors connected with a comprehensive support system, regardless of what kind of help they may need.
  • Testing: The company you choose should test the system on a regular basis to ensure it is functioning properly. Ask what procedures the center uses and how frequently these tests are conducted. “Medical Alert systems receive a silent signal from the home on a weekly basis to ensure that the customer’s system is connected and functioning,” Gross explains. Make sure the system includes repair and replacement services as well.

The tips above will help you compare providers and products before making a purchase. Obtaining the right medical alert system is crucial for your loved one’s security and knowing that help is only a push of a button away can give the entire family invaluable peace of mind.


Winter Top Tips: How to Keep Seniors Happy, Healthy and Warm

Winter Top Tips: How to Keep Seniors Happy, Healthy and WarmThe forum is filled with people coming together to share valuable information. We’ve compiled experienced caregivers’ suggestions for keeping a loved one cozy, content and clean in spite of cold winter weather.

 Winter Skincare Tips

“Although many people use baby oil, it contains mineral oil and artificial fragrances. If your loved one has any chemical sensitivities (and a lot of older people do), it is best to stay away from any artificial fragrances, artificial ingredients and mineral oil. Try organic coconut oil for soothing and moisturizing dry skin. It is simple and very effective. I also recommend visiting a good health food store and asking about lotions that are all natural.” –oceansong

“My primary care physician (whom I hold in very high regard) recommends Eucerin lotion products. They are a little pricey, but they last forever. I think they also make a lotion specifically for diabetics.” –Miasmom1

“Many of us love the bath or shower to be very hot, especially when it is cold outside. However, high temperatures can be very drying for the skin. I know my hands also become super dry in colder weather. I tried just about everything, but my hands felt like I had a dozen paper cuts and I looked like I was attacked by my cats! Then I found O’Keefe’s Working Hands Hand Cream. It’s mainly advertised to men, but I tried it and so far, so good! It can be found in grocery stores and hardware stores.” –freqflyer

“My mom developed dry, irritated skin last winter, and I thought she was having an allergic reaction. When we went to the doctor, he called it ‘winter itch’ (a seasonal type of eczema). It was all over her body and, of course, she has opened some areas on her skin. We are using antibiotic ointment and heavy cream specially forumlated for eczema. This has helped a great deal in just a couple of days!” –Seastar

Staying Warm While Bathing in Winter

“Temperature! Turn up the central heat to keep the bathroom warm during bath time. Seniors are often cold, even when we are wearing short sleeves. If there is cold tile in the bathroom, cover it with a plush bath rug and make sure they don’t fall. If you have an overhead heater, turn that on, too. Wear light clothing so you do not get totally overheated while helping them!” –homeandhearth

“A radiant heater panel can be especially useful for bathrooms. During fall and winter, mine is plugged into a motion sensor timer that you set for automatic shut off. We have it set to go on when motion starts, and it goes off when no motion is detected for five minutes. It makes the bathroom warm (I go and trigger it before Mom goes into the bathroom for a shower), and there’s no risk of it tipping over because it’s anchored to the wall.” –glasshalffull

“I purchased a small fan heater for our bathroom. My loved one gets cold easily, especially since the water is not running on her constantly because she uses a shower seat while bathing.” –Anonymous6636

Ending the Thermostat Wars

“As people age, typically the circulation in their extremities (arms and legs) diminishes, causing them to feel cold. Any time you go to a senior living center, you’ll see older people dressed far more warmly than younger people because the seniors are chilly. They’ll even wear sweaters when it’s hot and humid outside. Low thyroid can be another cause of being cold, so be sure to get that checked. My mom’s thyroid quit working about two years ago. Once we got her on thyroid medications and got the dose regulated, she felt warmer and had more energy.” –blannie

“Last winter (out of desperation), my husband and I installed a programmable thermostat and we put it high enough that Mom can’t reach it to crank the heat up. It has worked so well without having to leave notes or try to remind her not to touch it.” –chrisblair63

“I use a Sunbeam heating pad on the back of my dad’s chair. I just saw that Sunbeam and Sure Fit offer heated slip covers, too. As for me, I have been spared by a tall Dyson fan. It makes very little noise and feels like the air it puts out is cooled even though it isn’t. I set it up pointed directly at my chair. It can also oscillate, but the stationary position is perfect since my dad does not feel it and I do. This setup has kept him warm and me cool—something that many caregivers struggle with.” –pipruby

“If you get an electric blanket, make sure it has a cutoff temperature. My mom hates my electric heating pad for her back because it will only keep a high temperature for so long and then it turns off as a safety feature. I told her it’s better than falling asleep on it and getting burned.” –timbuktu

“Beanbag/microwavable heat packs can be heated and strategically placed at the hip, stomach, back and feet. They also make a slipper version that has helped my mom with the Raynaud’s syndrome in her feet.” –glasshalffull

Indoor and Outdoor Safety Tips

“My dad has two walkers. There is one that he leaves in the garage after going all over the yard and through the snow/dirt. Mom won’t let him in the house with it unless he cleans it off, so Dad just bought another walker for indoor use only.” –freqflyer

“Your loved one’s favorite holiday decoration may be a fifty-year-old menorah or Nativity scene with incandescent bulbs. On all décor, check thoroughly for dried and cracking wires and loose connections on the plug. It may have been perfectly safe for many years, but old wiring causes many fires this time of year.” –pamstegma

“A word of caution: canes are terrible on ice. If your loved one needs someone or something to help them walk, it is better that they stay indoors until the weather improves. If they need to get out and about, have someone meet them at home to help them on snowy, icy walkways.” –freqflyer

“I worry when my mother-in-law runs the temperature up higher in her home due to her tendency to get dehydrated. Each and every time she has been hospitalized, it has been because of dehydration. It is common knowledge that it is easier for seniors to get dehydrated when it is hot outside, but it is also a serious issue during winter, especially for those who have trouble getting enough liquids. Help them hydrate any way you can!” –oldcodger2


Holiday Depression: Strategies for Overcoming Seasonal Stress

Holiday Depression: Strategies for Overcoming Seasonal StressSometimes as we age, the holidays no longer seem very jolly, and we don’t feel like celebrating much anymore. What used to be a joyous occasion can change and take on new meanings as life throws us curve balls.

We think we’re supposed to be exceptionally happy this time of year, but that expectation alone can cause people of all ages to become sad or depressed. Caregivers and older adults are especially susceptible to the holiday blues. “As a caregiver, you can be prone to adopting your loved one’s melancholy feelings or anxiety and vice versa,” says Leslie Dunham, LCSW, a social worker at Levindale Hebrew Geriatric Center and Hospital in Baltimore, Maryland.

While the holidays may not be the same as they were in the past, there can still be plenty of reasons to celebrate. One of the most important things to remember is that it’s okay to enjoy the holidays as they are now. Old memories hold a special place in your heart, but there is always enough room to add new ones.

Knowing what exactly is triggering these gloomy feelings during the winter season can help you find ways to cope and feel better.

Dealing With Death During Holidays

Dunham reveals that one of the biggest challenges for families is losing a loved one. Whether the loss is recent or it occurred a decade ago, this time of year often highlights absences and brings intense feelings of grief, loneliness and emptiness. You may even feel guilty if you find yourself having a good time.

Innocent gestures may also spur feelings of sorrow. For instance, receiving a holiday card addressed to your late loved one from a well-meaning friend who doesn’t know the circumstances may cause your grief to resurface. On the other hand, it can also be stressful when family and friends purposely don’t mention your loved one’s name to avoid upsetting you.

These feelings are all normal, but to help you get through these tough times, talk about how you would like to handle the situation with someone you trust. That person can then communicate your wishes to others. If you want to do something to honor your loved one, there are different ways you can pay tribute. Choose whatever feels right. Consider the following ideas:

  • Place the person’s picture in a place of prominence at home.
  • Light a memorial candle.
  • Make a photo album of previous holidays together to focus on positive memories.
  • Set aside a time so that everyone who wants to can share a memory or a funny story about the deceased.
  • Toast to your loved one.
  • Go to church or synagogue.
  • Volunteer to help those in need.

Remember that not everyone grieves in the same way. There is no accepted norm. You may cry at the drop of a hat, while someone else is more stoic. Some people may grieve for weeks, and others mourn for years. Understand that the holidays won’t be the same as they used to be, but recognize that the “new normal” can be fulfilling in other ways.

Stress Over Too Much to Do

Another thing that can cause stress is pressure from family and friends to continue holiday celebrations the same way they have been done in the past.

Nothing can ruin a holiday faster than having too much on your plate. By default, caregivers are already busier than the average person, and adding decorations, holiday meals, and shopping to the mix is enough to undermine anyone’s holiday spirit.

To keep from feeling overwhelmed and out of control, Dunham offers the following suggestions:

  • Focus on what you and your loved one need instead of what others expect of you.
  • Be realistic.
  • Accept help when others offer it and ask for help when you need it. It makes other people feel good to help those they care about.
  • Prioritize and downsize holiday tasks. Decide which decorations are most important to you and compromise. For example, put up the tree lights and the mantle decorations, but skip the outdoor lights this year. The same idea applies to dinner, gifts, etc. Don’t make a ham, a turkey, macaroni and cheese, sweet potatoes and mashed potatoes. Stick to two or three favorite dishes instead of six or seven. You could also start a new tradition of a potluck meal. If everyone brings a dish to share, it significantly lightens your load.
  • Make lists. It often helps to see what exactly needs to be done, and it gives you a sense of accomplishment when you cross off completed tasks.

Financial Pressure During Holidays

Finances are another notorious source of stress during the holidays. Money is often already tight for seniors and caregivers alike. Spending also tends to increase this time of year on things like gifts, holiday meals and heating. Dunham offers these suggestion for coping with financial worries:

  • Set a budget. This is important for managing your finances year-round, but it can be very helpful to take a closer look at your income and expenses before planning celebrations and purchasing gifts. Making a budget may seem like a bummer, but it’s far better than realizing after the holidays that you spent far more than you could afford.
  • Remind your loved ones that less expensive gifts can be just as thoughtful and useful as more expensive ones.
  • Make baked goods or create handcrafted gifts for family and friends.
  • Have your family members draw one or two names for gifts, instead of having everyone buy presents for each person. This may help other family members save money as well.
  • Don’t wait until the last minute to mail cards or buy presents. Take care of a few items each day to complete tasks with minimal stress and expense.

Avoiding Holiday Depression

There is no reason to wait until depression happens to act on it, because there are approaches that can help prevent and minimize the symptoms. Generally, what can help is not being too hard on yourself for the difficulty you may be experiencing. Try to:

  • Keep a regular schedule and build in breaks. Adequate rest is crucial, especially during the hectic holiday season.
  • Avoid feeling guilty for picking and choosing which holiday gatherings you and your loved one can attend.
  • Make sure you and your loved one get regular exercise. Unfortunately, it’s typical for people to stop doing the healthy things they usually do because of holiday activities and the inclement weather. Make exercise a top priority, even it’s only twenty minutes each day.
  • Avoid overeating at every meal. Save indulging for special meals, like the big family dinner or the pot luck at work. Balancing indulgence with light, healthy meals will help you feel less lethargic and improve digestion.
  • Be careful about the amount of alcohol you drink.

Remember that the real meaning of the holidays is to be thankful for what you had, what you have now and what the future will bring. Be honest and recognize that the holidays may not be the same as they once were. Talk with people you trust about how you are feeling. You can also find a support group, where you can discuss your thoughts with those who are facing similar difficulties. It may be wise to make an appointment with your doctor as well. He or she can suggest medications and nonpharmaceutical options to help you feel better.


Taking AIM at Elder Mistreatment

Taking AIM at Elder MistreatmentMr. P is a 78-year-old man with early-stage Alzheimer’s disease. His son was observed in the pharmacy yelling at him as his Dad kept repeating the same question. The pharmacist called Adult Protective Services (APS), and they discovered that Mr. P lives with his son, daughter-in-law and two small grand-children in a two-bedroom apartment. During the interview, it became clear that the family needed the combined incomes to stay in the apartment. The son and daughter-in-law explained that they are overwhelmed with caregiving needs and admitted that sometimes they yell or “get a little physical” with him.

“It’s So Complicated!”

Though elder abuse (mistreatment) can take many forms, it is defined by the Centers for Disease Control and Prevention as “an intentional act or failure to act by a caregiver or another person in a relationship involving an expectation of trust that causes or creates a risk of harm to an older adult.”

Mistreatment can play out as physical, sexual, emotional or psychological abuse, as well as financial abuse and neglect. Often, older adults are the victims of more than one form of mistreatment, and many cases are not clear-cut, either in determining whether abuse has occurred or in deciding what steps to take once possible abuse is discovered. Many cases involve complicated medical, social, emotional and financial issues that intersect and interact, making it difficult to shape an appropriate response.

The Abuse Intervention Model (AIM)

The AIM model, which can help in situations like Mr. P’s, is a useful tool for identifying multidimensional, modifiable risk factors for elder mistreatment. AIM is a practical framework that allows for targeted and practical individualized intervention to successfully prevent, stop and mitigate elder mistreatment. Mistreatment is multidimensional, made up of complex relationships between risk factors in three broad domains (see Figure 1, above). These domains include the older adult (potential or known victim of mistreatment), the “trusted other” (potential or known perpetrator of mistreatment) and the context in which the mistreatment occurs. One goal of the AIM model is to identify modifiable risk and protective factors in individual cases, thus enabling a practical plan to be developed and implemented.

How Older Adults Are at Risk for Abuse

Many physical or emotional conditions or financial circumstances older adults face increase their susceptibility to mistreatment. Dependence upon another for care or being perceived as difficult to care for are examples of personal characteristics associated with mistreatment.

Functional issues like impaired physical abilities or diminished cognitive abilities can make activities of daily living more difficult for older adults. Physical and-or cognitive limitations can also lead to dependency upon a trusted other for management of finances, transportation, meal preparation, shopping and medication management.

Illnesses such as Alzheimer’s disease may cause impairment in executive function, which makes a person an easier tar-get for exploitation. A diminishing ability for self-control can contribute to challenging behaviors, making caregiving more difficult. An elder’s emotional distress and mental illness can lead to emotional dependence—a situation that caregivers and others may resent or exploit.

Caregiving and the “Trusted Other”

Trusted others include family members, neighbors, friends and paid caregivers. Dependence upon the older adult, especially financial dependence, may compel the trusted other to remain in an unwanted relationship. Emotional dependence can lead to conflicted relationships and foster resentment in a caregiver. Mood, substance or personality disorders can compromise caregiver reliability. If a caregiver feels overwhelmed, he or she may be hostile or abusive. Physical impairment and limited mobility also can reduce the caregiver’s ability to provide appropriate care.

The context in which the older adult and trusted other interact can moderate or intensify the risk for elder mistreatment. Social isolation that separates either the older adult or caregiver from supports and resources can exacerbate the risk. Often, the relationship of the vulnerable older adult and the trusted other predates the caregiving phase. The quality of the relationship prior to the caregiving relation-ship can alter the risk for mistreatment. A good relationship can be a protective factor, while a poor quality relationship can increase the risk for mistreatment.

Culture also can influence the perception of elder mistreatment. In some cultures, illnesses, such as Alzheimer’s disease, are considered shameful or embarrassing and may lead to an older adult’s isolation.

Managing Mistreatment Risk

Some risk factors for elder mistreatment are modifiable and some are not. The AIM model can give professionals like medical providers, social workers, APS and law enforcement a framework to assess and identify risk factors for elder mistreatment from the perspectives of the vulnerable adult, the trusted other and the context in which they interact. Once the model is applied to an in- case (such as Mr. P’s), professionals can identify risk factors that can be mitigated and protective factors that can be bolstered.

It seems that Mr. P has experienced emotional mistreatment, and possibly physical mistreatment. His risk factors include cognitive impairment, accompanied by behavior change, dependence on his son for housing and dependence on the family for assistance with daily living activities. Knowing the course of the disease, we can predict that Mr. P’s cognition will become further diminished with time, which correspondingly increases his dependence and elevates his risk for mistreatment.

The trusted others (Mr. P’s son and daughter-in-law) are financially dependent on Mr. P’s income and admit to feeling overwhelmed and stressed by care-giving. The family lives in a cramped apartment with two very young children whose needs are many and may compete with Mr. P’s caregiving needs. Though we don’t know the relationship history of Mr. P and his son, we do know their relationship is currently strained. Additionally, there is evidence that Mr. P’s son has the propensity to be verbally and physically aggressive with his father.

AIM in Action

Though Mr. P’s cognition cannot be substantially improved or reversed over the course of his disease, the AIM model could be used to analyze and improve the situation, as follows:

•  Mr. P’s son and daughter-in-law attended their local no-cost Alzheimer’s Association Savvy Caregiver course. This helped them to understand that Mr. P’s repetitive and bothersome be-haviors were not purposeful, but rather a part of his illness. The family learned strategies to lessen frustration and reduce conflict.

•  A social work referral was made through their area agency on aging. The social worker helped the family receive In-Home Supportive Services (a government-subsidized benefit) several days a week to help with some of the caregiving responsibilities.

•  The family doctor referred the son and daughter-in-law to several sessions of low-cost counseling in which they learned stress-reduction techniques to use when feeling particularly upset.

•  Mr. P’s geriatrician discovered that Mr. P was feeling nauseated and light-headed much of the time, which was exacerbating his agitated behavior. By dis-continuing one medication and reducing another medication’s dosage, he became calmer and more content.

This combination of interventions had a significant impact on decreasing the stress of the family’s situation, and the abusive behavior was drastically reduced.

Source: ASA – American Society on Aging

VA Benefits for Veterans and Their Caregivers

VA Benefits for Veterans and Their CaregiversWhat is the VA?

The U.S. Department of Veterans Affairs (VA) is an agency that provides benefits for military veterans and their families. The VA is composed of three main divisions that administer different programs and services:

  • The Veterans Benefits Administration
  • The Veterans Health Administration
  • The National Cemetery Administration

Who Is Eligible for Benefits?

Eligibility requirements vary depending on the specific benefit or service. In general, the following groups may receive benefits through the VA:

  • Uniformed servicemembers
  • Veterans
  • Veterans’ dependents
  • Surviving spouses, children and parents of deceased veterans

A baseline eligibility requirement for veterans is a discharge other than dishonorable. Additional criteria, such as wartime service, disability status, income and net worth limitations, and minimum duty requirements, may also apply. Eligibility for dependents and family members is based on the related veteran’s eligibility.

VA Monetary Benefits

Basic Pension

Wartime vets with limited income can receive a tax-free monthly pension if they are permanently and totally disabled or at least 65 years old.

Improved Pensions

There are increased pension benefits for seriously disabled and housebound veterans with limited income. The Aid and Attendance (A&A) improved pension is a tax-free monetary benefit for veterans and surviving spouses who need another person to assist them with activities of daily living (ADLs), such as eating, bathing, dressing, and toileting. The A&A pension includes vets who are cared for at home, in nursing homes and in assisted living facilities.

The housebound allowance is another increased monthly pension specifically for veterans and surviving spouses who are confined to their own homes due to a permanent disability.

Disability Compensation

Veterans who incurred or exacerbated a disease or disability during their service or have a disability that is presumed to be related to their service may be entitled to a monthly tax-free monetary benefit.

Survivors Pension

Also known as a death pension, this monetary benefit is payable to some unremarried surviving spouses and children of deceased wartime veterans. The benefit amount is based on recipients’ financial need.

Home Loans Services

The VA offers a few different housing benefits and grants to veterans, servicemembers, spouses and other beneficiaries.

  • Guaranteed Loans: The VA guarantees a portion of a loan made by a private lender to help eligible individuals purchase homes, condominium units, manufactured homes or plots for manufactured homes. These loans can also be used for building, repairing and improving homes.
  • Refinancing Loans: The VA can help vets refinance VA and non-VA loans at a lower interest rates.
  • Special Grants: Veterans and military personnel with severe disabilities can receive grants to adapt or acquire housing that is suitable for their needs.

VA Health Care Services

The Veterans Health Administration provides a wide range of services at more than 1,700 sites of care across the United States and in U.S. territories.

Services provided to veterans include:

  • Hospital, outpatient medical, dental, pharmacy and prosthetic services
  • Domiciliary, nursing home, and community-based residential care
  • Specialized health care for female veterans
  • Alcohol abuse and drug dependency treatment
  • Homeless veteran programs

Civilian Health and Medical Program of the Department of Veteran Affairs (CHAMPVA)

CHAMPVA is a comprehensive health care program that shares the cost of medical services and supplies with eligible dependents and survivors of certain veterans. CHAMPVA is not to be confused with the Department of Defense TRICARE program, which provides health care for active duty and retired members of the uniformed services, their families and their survivors.

VA Burial Benefits

The VA offers a number of different benefits and services to honor deceased veterans.

  • Veterans may be able to receive an inscribed headstone or marker at any cemetery, or a medallion for affixing to a privately purchased headstone.
  • Burial allowances may be available to surviving family members to partially reimburse them for a veteran’s burial and funeral costs.
  • An American flag may be supplied upon request to drape a veteran’s casket.
  • Surviving family members may request Presidential Memorial Certificates to honor a veteran and their service.
  • Eligible veterans and their dependents can be buried in a VA national cemetery.

For more information on these and other VA benefits and services, contact the Department of Veteran Affairs at 1-800-827-1000 or visit

To find your VA regional office and its contact information, visit


The Greatest Gift: Make Yourself a Priority This Holiday Season

The Greatest Gift: Make Yourself a Priority This Holiday SeasonWhen I counsel my caregiver clients to take care of themselves, they usually respond with something like, “Yes, I know I should, but…” This indicates to me that it’s not the first time they’ve heard this advice, and it’s not the first time they’re going to ignore it.

I’m really not trying to be a nag. I’m simply trying to help them avoid the inevitable train wreck that caregiver burnout causes. It can truly turn a family upside-down. All caregivers think that their situation is unique, and it absolutely is. However, there are common threads that appear in many, many situations. As someone who has observed countless people who are trying to cope while providing care for a loved one, I’ve noticed that there is a specific time when they need to concentrate on self-care the most.

Around October and November, I am adamant about caregivers putting themselves first before they take on the remainder of the year. Medicare’s Annual Election Period (also known as “Open Enrollment”) begins October 15, and this often signifies the arrival of the busy holiday season. Once that train leaves the station, it can be difficult to pause, plan, prioritize and persevere. The situation can quickly turn to panic, so let’s try to avoid that, shall we?

Your Health and Insurance

Keeping up with a loved one’s medical issues and insurance coverage is pretty much a full-time job for some, but you MUST take some time to think about your own health care needs. Consider the following:

  • Have you had your annual physical yet this year?
  • Have you been keeping up with recommendations to get more exercise or change your diet? (Trust me, I know that this can be incredibly difficult in the midst of all your responsibilities.)
  • If you are a Medicare beneficiary, have you taken advantage of preventive screenings (which are often free) to at least keep an eye on your blood pressure, cholesterol and blood sugar levels?
  • Have you handled any changes that must be made to your health insurance coverage for the coming year?
  • Have you scheduled that day off or weekend away that you’ve been promising yourself all year? (Whether friends and family have been offering to help or not, there are resources out there that can help you accomplish this!)

If you don’t see to these tasks now, they’re even less likely to get crossed off your to-do list as the winter season ramps up.

Preparing for the Holiday Season

The holidays will be here before you know it. There are a lot of things, big and little, that you either need to plan ahead for or at least confirm are not your responsibility. For example, have you made absolutely sure that you are NOT the person who will be hosting everyone for Thanksgiving dinner? What about chauffeur duty when relatives have to be transported to and from the airport? Cross your t’s and dot your i’s now, or they may come back to bite you.

If you will be entertaining this year, the second part of being prepared is sharing the load. Even if you are a consummate professional who is able to organize national conferences with one hand tied behind your back, it doesn’t mean that you have to keep all the plates spinning in the air for everyone else to watch. If you are hosting or helping plan some get-togethers this season, use your organizational skills to send out a group email asking everyone what part of the celebration(s) they will be responsible for. Setting up a simple spreadsheet or collaborative Google Doc can help everyone stay organized and communicate easily. It’ll also prevent tasks from falling through the cracks.

Lastly, be realistic and scale back. Your loved one will appreciate get-togethers that are full of reminiscing, personal time, family songs and jokes and free of drama, complexity, and stress. When you’re tense, your loved one and other guests are sure to pick up on it. If friends and family aren’t able to contribute dishes to Christmas dinner for whatever reason, don’t take on making a gourmet spread by yourself. Instead, opt for simpler recipes, make some dishes ahead to spread out the work or buy a few store-made sides so that you can enjoy more time with family and friends.

If you MUST cook your heart out because it is an outlet for stress or it gives you a bit of solitary time in the kitchen while the house is full, just make sure you have a substitute caregiver lined up. This will allow you to spend the day cooking without worrying about your loved one. Your back-up can be a trusted family member, a half-day at an adult day care center or a professional in-home caregiver.

If your loved one has Alzheimer’s or another form of dementia, scaling back takes on a much greater meaning, since this time of year can be especially overwhelming for dementia patients. The decorations, hubbub and crowds can cause anxiety, agitation and confusion for some. Keep this in mind when decorating and planning get-togethers. Sometimes small gatherings or one-on-one visits are best for loved ones in the later stages of the disease.

Family Gatherings Provide Valuable Opportunities

For most families, the holiday season provides a rare occasion for relatives to gather. Start taking advantage of this in every way you can!

As a family caregiver, you face many challenges and concerns that most people have never truly considered before. For example, have you discussed important medical and legal issueswith your close family members? Are there things that you’ve learned in your role as a caregiver that you don’t want to happen if you ever need care? Does your family know about respite and long-term care options, such as home care, adult day care, assisted living and skilled nursing? Have you talked about these choices (for your care recipient AND yourself) openly with others? Do they know your wishes or those of your care recipient? It is crucial to voice these concerns and share this information early on.

Give your family members an update on your current situation. How are you doing physically and emotionally? Have you been putting on a brave face or unsuccessfully asking other family members to pitch in? This is the time to fully explain the extent of your duties as a caregiver, articulate how they may be affecting you, and provide ideas for contributions that could truly improve your situation and your loved one’s care. If something were to happen to you, does your family know who would take over your role? What if you fell, needed surgery or injured your back? Having an “emergency plan” that everyone is aware of is essential.

Although it can be difficult for many to imagine, your caregiving journey will come to an end at some point. Does your family know how you’ll spend your time then? Will it surprise or shock them? Are you expecting that someday your own family will give you the same kind of tender, loving care that you’ve been providing? If the answer is yes, expectations need to be shared and discussed. It’s much easier to have “what-if” conversations about long-term care and the end of life when there is no immediate crisis looming.

Make Yourself a Priority

Achieving balance in life is never easy; it is something that everyone has to work towards. The holiday season can be physically, emotionally and financially demanding, but only if you let it get the best of you. Even if you have not taken the time for self-care throughout the first part of the year, at the very least make some strides before your responsibilities increase. Planning ahead and self-care are gifts to yourself, your care recipient and the rest of your immediate and extended family. Take a deep breath and use the coming weeks to “set the table” so that your holiday preparations and celebrations can be heartfelt, productive and enjoyable.


Capgras Syndrome: How to Cope with a Loved One’s Delusions

Capgras Syndrome: How to Cope with a Loved One’s Delusions

Capgras is a type of delusional misidentification syndrome (DMS) that may present due to any number of neurological diseases or psychiatric disorders. Although the exact prevalence of this disorder is unknown, a 1999 study estimates that it is present in between two and 30 percent of individuals with Alzheimer’s disease. This disorder can seriously complicate a dementia patient’s quality of life and their caregivers’ efforts, so it is crucial to spread awareness of this little-known condition.

What is Capgras Syndrome?

“Capgras is a misidentification syn­drome characterized by the transient, recurrent, or permanent belief that someone known to a patient has been replaced by an impostor with a strong physical resemblance,” explains Erin Shvetzoff Hennessey, MA, NHA, CPG, and Vice President of Health Dimensions Group. “These delusions are suggested to stem from impairment of the brain’s facial recognition system and are also associated with brain lesions.” There is limited research available on this condition, but it affects those with a variety of neurological and psychological diagnoses, including schizophrenia, Alzheimer’s and other forms of dementia.

Capgras can be extremely stressful for the person with the syndrome, but it is also very disturbing for those around them. “While dementia caregivers usually anticipate a loved one’s forgetfulness and inability to remember close family members and friends, it can be very painful and confusing when this syndrome causes a different kind of loss of recognition,” laments Shvetzoff Hennessey. A loved one may remember their caregiver, spouse, or other relative—and may even ask for them by name—but they believe that this person is an impostor. Such delusions can make caregiving, family time, and other social experiences extremely painful and confusing.

Reality Orientation Techniques

When interacting with a person who is experiencing Capgras, it is common for caregivers and family members to attempt to correct or explain their delusions. A research article in the Frontiers in Human Neuroscience journal states that, “A defining characteristic of delusions also present in Capgras syndrome is that patients will firmly hold on to their delusional beliefs [even] in the presence of mounting contradictory evidence.”

While some caregivers may continue to correct sufferers and try to convince them that they are merely experiencing delusions, the use of reality orientation techniques for sufferers of memory loss has declined in recent years. “This strategy includes frequent reminders of present time, location and facts based in reality, including deaths, moves or other major life events,” Shvetzoff Hennessey explains. Reality orientation may be logical and appealing for those without Capgras but is often frustrating and upsetting for individuals who are experiencing delusions.

Validation Therapy

Shvetzoff Hennessey says that reality orientation has largely been replaced by validation therapy, which supports the patient’s delusions rather than correcting or contradicting these very real ideas, thoughts and feelings. Validation techniques have been found to reduce stress and anxiety in both dementia patients and their loved ones.

For some sufferers, neither reality orientation nor validation techniques are successful, leaving both the patient and their loved ones frustrated, lonely and anxious. For these situations, a mixture of several techniques may be needed in order for both parties to enjoy spending time together. “By working with the patient’s care team, including direct care providers, physicians, social work professionals, pharmacists and therapists, techniques and strategies can be developed to relieve the symptoms in the patient, as well as reduce the stress and frustration of loved ones,” advises Shvetzoff Hennessey. “This can include communication techniques, medications, and creative problem-solving methods.”

Interactions and Caregiving

Research shows that time and interactions with loved ones who have Alzheimer’s or other types of dementia is valuable for both the patients and their caregivers. However, this delusional condition can make it difficult, if not impossible, for the patient and the believed impostor to interact. Some patients may blatantly refuse to speak or cooperate with the “impostor.” Changing the format, timing and length of visits may help in some cases.

“If the patient does not live with those they do not recognize, these loved ones may have to visit during certain times of the day when the patient is more relaxed,” Shvetzoff Hennessey recommends. “Impostors” may need to visit along with other people that the patient recognizes, or even visit as a stranger, but these options may still allow for interaction.

Shvetzoff Hennessy emphasizes that safety and wellbeing are paramount. “If the patient’s delusions make caregiving, living together and safety challenging, housing changes may be needed to ensure the emotional and physical health of everyone involved.” In such cases, placement in a specialized memory care unit might be the best option.

Care for Yourself, Too

Alzheimer’s and dementia caregivers already experience serious emotional and physical strain, and this is only compounded by the development of Capgras syndrome. “It is important for family members and caregivers of sufferers to care for themselves in order to better care for their loved ones,” Shvetzoff Hennessey urges. This self-care can include increased time away from the patient, self-acceptance of limitations and reliance on other support systems including friends, family, and community and healthcare resources.

Interacting with Someone Who Is Suffering from Delusions

Shvetzoff Hennessey offers family caregivers the following tips for interacting with a person who is experiencing Capgras syndrome.

  • Validate their feelings and concerns. Rather than challenging their perspective, make it clear that you understand how they are feeling and that it is perfectly acceptable for them to feel this way. Try to identify with their reality rather than correct it.
  • Make a safe, emotional connection. Dementia alone can be extremely confusing and disorienting for a patient. Adding delusions that someone they trust has been replaced with an identical fraud can be very frightening for them. Remind the patient of how much you love them and how much the “impostor” loves them. If the patient has additional misconceptions that this fake is trying to harm them or steal from them, gently reassure them that they are safe and you will not allow anything of the sort to happen.
  • Rely on auditory interactions. Since this disorder makes it difficult or impossible for sufferers to visually connect with loved ones, sound is the next best way to communicate. Rather than visiting face-to-face, try conversing over the telephone or just outside of their line of sight. If a patient has difficulty interacting in person, it can help for the impostor to announce themselves while still out of sight. This helps to establish an emotional connection and begin a conversation that continues while they come into sight. This may assist the patient in positively identifying their loved one.