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Can a Caregiver Change a Loved One’s Power of Attorney?

While it may seem like an unusual scenario, there are a few legitimate reasons why family members may want to change an aging loved one’s power of attorney designation. Of course, changes are easy to make if the principal is still mentally competent and wishes to name someone else (known as the agent) to act on their behalf. However, things can get complicated when a loved one is incapacitated and family members believe that a change is in order.

There are a couple of different ways to go about this, but it depends on how a person’s POA document is written and what the desired outcome is. Two of the most common scenarios are when a caregiver no longer wishes to serve as POA for a loved one and when a family member wants to challenge the legality of the current POA’s actions.

 What to Do if You Want to Resign as Power of Attorney

Any caregiver will tell you that this responsibility is not for the faint of heart. There are many reasons why an agent may need or want to step down as POA. Perhaps they have moved out of state and are too far away to effectively manage a loved one’s medical and financial affairs. In some cases, the principal may be abusive and the agent must resign in order to safeguard their own physical and mental health. Acting as a person’s agent is a serious legal responsibility and, regardless of the reason, it is important for an agent to resign if they feel they cannot carry out their duties.

To resign, an agent must compose a formal letter notifying the principal, any co-agents and all parties with which the original POA has been filed, such as banks, elder care providers, etc. While each state has different rules for relinquishing POA, taking formal steps to notify all involved parties offers the most protection from any legal issues. It’s best to sign the resignation letter before a notary and then send copies of it via certified mail with return receipt requested. In this letter, you’ll want to include your full name, the principal’s full name, the date that the original POA document was signed and the date you will terminate your position as an agent. An attorney can help you draft this document easily and at minimal expense if you need help.

Can an Agent Give POA to Someone Else?

The process of resigning as an agent is not particularly difficult, but it can have serious implications for the principal. Who will assume the agent’s responsibilities? If a successor is listed on the original power of attorney document, then he or she will become the new acting agent. It would be wise to cancel the original POA and have a new document drawn up, directly naming the successor as the new agent. However, this is only possible in cases where the principal is still of sound mind. POA can be difficult to “prove” and have accepted by certain entities like banks, so a simple and straightforward document is ideal.

Naming a successor agent (or two) is recommended. It gives the principal a legal back-up plan in case the original agent resigns, becomes incompetent themselves or passes away. If no successor is listed on the original POA document and the principal is already incapacitated, then there are few options left. Unless the document grants the original agent the specific ability to delegate powers to another individual, the general rule is that he/she may not do so. Guardianship is the only other option for passing on this responsibility.

How Guardianship Factors Into Resigning POA

Continuing with the scenario above, an interested family member or friend would have to petition the court for guardianship of the incompetent principal to ensure that their medical and financial affairs continue to be managed responsibly after the original agent resigns. This is a lengthy and expensive process that should only be considered as a last resort, but sometimes there is no other choice.

If no other individuals are interested in or capable of serving in this role, then the principal may wind up as a ward of the state and under public guardianship. A concerned party, such as a physician or Adult Protection Services (APS), may file a referral to a local public guardianship service provider indicating that the indigent and/or incompetent adult requires assistance making medical, financial, and/or daily living decisions. Information is collected about the incapacitated individual and a hearing is conducted to determine if they meet the legal guidelines for public guardianship and rule out the possibility of another suitable person serving as their private guardian. Guardianship in any case is not ideal. It is costly and time consuming and it strips wards of their independence and many personal rights. However, it is sometimes necessary to protect vulnerable adults from neglect and abuse.

Contesting a Power of Attorney

Guardianship can also play a significant role when a person wishes to challenge a current POA. This may be appropriate if you know or suspect that an agent has abused their authority and you wish to take over their duties. Again, going to court to prove that a POA document is invalid or that an agent has mismanaged a principal’s funds or neglected their needs can be a long, expensive and emotional process. These suspicions must be proven in court and, if the agent is removed and the principal is deemed incompetent, then a petition for guardianship will also have to be filed.

It is crucial to understand how power of attorney documents work and carefully consider who to appoint as an agent. Guardianship is an important method of protecting vulnerable seniors, but it should only be used as a last resort. Ultimately, every caregiver’s focus should be on meeting their loved one’s needs and safeguarding their wellbeing. It is imperative to take action if any agent, whether it is yourself or someone else, is unable to handle this responsibility.

Source: AgingCare.com

How to Minimize Wandering In a Senior With Dementia

I have spent my career as a nurse practitioner working with people with Alzheimer’s disease and other forms of dementia. My interest began when my grandmother developed dementia and I was dissatisfied with the care and level of understanding she received from medical professionals.

Families often consult with me about one worrisome symptom of dementia: wandering. For dementia patients, this behavior is very different from the aimless wandering of hikers exploring the woods or tourists moseying around a new city. Most often, there is nothing purposeless about the wandering behaviors I observe.

Take my grandmother, for example. While she was in the middle stages of the disease, she became adamant about “going home across the river.” She must have been thinking of a childhood home in Europe, because she never lived near a river in the United States. My grandmother would escape from the house, walk straight across a nearby golf course and interrupt people’s games. Later, she would say that the people outside were very nice because they waved at her. In reality, the golfers were mad and trying to shoo her off the course!

Despite locks on the doors, my grandmother was an escape artist. Everybody in the neighborhood knew her, and when we were out searching for her, the mail man, neighbors or delivery truck drivers would help point out which way she went. My grandmother was also well known at the local police department because officers had to bring her home in a police car on two separate occasions.

Although these episodes were rather embarrassing, we were fortunate to live in a safe neighborhood full of caring individuals. Sadly, this isn’t the case for every family looking after a person with dementia. That is why it is crucial to try to understand the driving forces behind a loved one’s wandering and take the necessary measures to prevent them from getting lost and injured.

 How to Manage Dementia-Related Wandering

To prevent a loved one from wandering and promote safe walking, you first need to define what they are trying to achieve or where they want to go. Don’t assume a “wanderer” is literally just wandering. This behavior is very individualized and a full description of their actions is essential. Of course, that’s easier said than done. I know family caregivers and nursing staff are very busy, but it is important to take the time to observe the nuances of their behavior. Sometimes, it is as simple as asking your loved one what they are doing, but often you will need to step back and closely watch what is happening to discover the purpose behind their behavior. This may take time and require multiple observations. Just remember that, if you cannot define and measure the wandering behavior, how can you or dementia care experts develop interventions?

Wandering is complex, and there is no one-size-fits-all intervention for this symptom of dementia. In my line of work, I use the following three-step approach when troubleshooting these behaviors.

Step 1: Describe What You Are Seeing

The term wandering is vague and misleading. We often fall into the trap of slapping labels on things or lumping a group of unrelated behaviors together, but dementia and its symptoms are unique to each person. To find a workable solution, you must try to understand your loved one’s feelings and motivations during these episodes. Below is a list of questions about common wandering behaviors that can help you begin analyzing their actions.

Are they:

  • Trying to escape and leave the building?
  • Frequently or continuously moving from place to place with no perceived direction or destination?
  • Walking in a goal-oriented manner? (e.g. in search of “missing” or unattainable people or places)
  • Waking up in the middle of the night and acting disoriented?
  • Getting lost or unintentionally leaving the premises?
  • Anxiously pacing or fretfully walking?
  • Having trouble locating/recognizing significant landmarks/belongings in a familiar setting?
  • Following behind or “shadowing” another person’s movements?
  • Feeling paranoid or in danger?

For example, these questions may be able to help you differentiate between whether your loved one’s nighttime wandering is due to disruptions in their sleep/wake cycle, scary visual hallucinations before falling asleep or disorientation after getting up to go to the bathroom. Remember, though, a person with dementia may exhibit multiple types of wandering behavior that can fluctuate in frequency and severity.

Step 2: Consider the Time of Day and Frequency

Think about how often these unusual behaviors occur, the time of day they occur, and what the consequences of them are. These patterns can help caregivers prepare for episodes before they begin and prevent negative effects. Examples could be:

  • Behavior occurs daily at 3:00 p.m. for two hours and results in the person attempting to escape the premises.
  • Behavior occurs once a month in the middle of the night and results in the person turning on all the lights in the house and waking up family members.
  • Behavior starts daily at 8:00 a.m. and lasts for 10 hours, non-stop. The result is the person fell three times this week and lost 10 pounds over the last month.
  • Behavior occurred once while on vacation at 10:00 a.m. and resulted in the person being lost outside for two hours.
  • Behavior occurs about twice a week at 7:00 p.m. and results in the person pacing around the home.

Step 3: Contemplate the Underlying Causes

Think about your loved one and ask yourself what could be causing them to wander. A person’s lifelong routines, the onset of new symptoms and even basic personal needs could be triggering their behaviors. The following questions might help:

  • Was your loved one always very active?
  • Is there a specific activity that they used to do during the day that coincides with the timing or actions of your loved one’s wandering? (e.g. going to pick the kids up from school, taking a morning walk, preparing breakfast)
  • Is your loved one at the stage of dementia where they are confusing the past and present?
  • Do they recognize familiar surroundings?
  • Does your loved one have any unmet needs, such as needing to use the bathroom, wanting food or water, or desiring comfort?
  • Does your loved one seem worried, anxious or bored?
  • Have any new medications been added to your loved one’s regimen? What about dosage changes?
  • Has their environment changed at all recently?

Only after you have defined the problem by completing these three steps can you start thinking about whether an intervention is needed and what that might entail.

Ways to Prevent Wandering Behaviors and Promote Safety

You may come to find out that your loved one’s wandering behaviors are merely annoying and do not pose any harm. This is a good thing, because it does not require an intervention. Walking provides many health benefits and can be a good activity. However, if a person with dementia is walking to the point of exhaustion, losing weight, falling, getting lost or escaping into unsafe areas, then interventions are necessary.

I have often found that family, paid caregivers and health care providers tend to want to control or stop behaviors through medications or physical restraints first. That is the worst thing you can do. There are no FDA-approved medications for wandering behaviors, and the medications many doctors recommend can cause sedation and contribute to falls. The use of physical restraints can lead to poor circulation, weakness, incontinence and impede quality of life.

Individuals who wander should have choices and be allowed to be as independent as possible. There are instances where a wanderer may benefit from medications to regulate their sleep/wake cycle or alleviate pain. But, it is still very important to go through a rigorous assessment process first to analyze their behavior. This will allow for the development of interventions that will work for the specific individual who is wandering.

With my grandmother, we understood that her wandering stemmed from a desire to go home and take care of her family. This escape behavior typically occurred at 3:00 or 4:00 in the afternoon, when the house was quiet and not much was going on. Therefore, in the late afternoons, we made a point of keeping my grandmother engaged in activities so she was not worrying that she needed to be somewhere or do something. We encouraged her to participate in her normal household routines such as setting the table for dinner, peeling potatoes, looking at magazines or going out for car rides.

In addition, we placed latch locks high up on exterior doors and always kept the garage door shut. There were bells on all these doors as well, which functioned as a back-up alert system in case a door was accidentally left unlocked. Wearable medical alert devices can be a godsend for wanderers, but my grandmother refused to wear one. Instead, we sewed her name and phone number into her coat and placed pieces of paper with this information in her purse and pockets. Lastly, we handed out pictures of my grandmother with contact information to the local police department, our mail man and our neighbors so they would know what to do if they saw her alone outside.

Dementia-Related Wandering May Evolve and End

Remember that dementia-related behaviors change over time. My grandmother’s escape behavior lasted about a year and then went away. She died over 20 years ago, before information on wandering was readily available, but my family was proactive and improvised ways to keep her as safe as possible while living with us. We were fortunate that our multi-faceted approach was successful.

The experience of having dementia is different for everyone. It is up to us to adjust our attitudes and the environment to address our loved one’s reasons for wandering. If we focus on their emotional, cognitive and physical needs, we may be able to prevent the behavior altogether or at least make it safe. For some individuals, this is impossible. If both a caregiver and a dementia patient’s health and safety are at risk, then placement in a secure memory care facility may be the only solution.

Source: AginCare.com

Skin Care Tips for Seniors

Skin Care Tips for Seniors

Our skin is often the first place we notice signs of aging. Beyond just wrinkles and age spots, our skin is a reflector of our overall health, and yet it is often overlooked.  

Did you know… 

The skin is the largest organ in the body. It has a very important job — protecting our internal organs and systems from bacteria and other foreign matter that can make us sick or otherwise damage us. 

As we age, however, our skin also begins to change. It loses elasticity, becomes thinner and drier, begins to sag, and takes longer to heal. Damage to the skin that occurred in our youth can also start to appear in the form of age spots and dry patches. Medications, diet and exercise can also impact your skin, which is why it is important to check it regularly for changes. 

Among the changes that require attention is the appearance of moles and skin tags, as they can indicate more serious conditions, including diabetes, kidney disease, and several forms of cancer. (link to: https://www.cancer.gov/types/skin) 

 Good Skin Care Is a Must 

  • Drink plenty of water! The human body is 70 percent water. Staying hydrated is essential to overall health as well as keeping your skin soft and supple. Dry skin can create itchy patches, redness and, if you scratch them, sores that can take time to heal and allow bacteria to enter the body. 
  • Eat your veggies! A well-rounded diet that includes lots of vegetables is a must. Beyond our overall health, vegetables contain the ingredients essential for healthy skin. 
  • Moisturize! Use a good body lotion daily in order toto keep skin supple and smooth. Moisturizing also helps with itching and reduces self-imposed scratch marks. Other ways to keep your skin moist is to take fewer baths. Use warm, not hot, water. And, if dry air in your room is a problem, try a humidifier to add a little moisture. 
  • Use Sunscreen! Everyone today knows the dangers of too much sun. While we need sunlight to provide the vitamin D that we absorb through our skin, too much sun is responsible for age spots and several types of cancers. 

Be Vigilant 

Skin checks are not often standard in wellness checks at the family doctor. In addition to annual visits to the dermatologist, With months in between visits, however, it is good practice to do a skin check every month or two.  

Even if your loved ones are in an assisted living or other facility, it is a good practice check their skin periodically. The aides that dress or bathe them may not notice or be as adequately trained to spot changes in skin health other than skin breakdown that may indicate a serious health issue.  

Catching problems early is the best prevention.  

The National Institutes of Health has provided  this handy guide for what to look for. 

Check Moles, Birthmarks, or Other Parts of the Skin for the “ABCDE’s” 

A = Asymmetry (one half of the growth looks different from the other half) 

B = Borders that are irregular 

C = Color changes or more than one color 

D = Diameter greater than the size of a pencil eraser 

E = Evolving; this means the growth changes in size, shape, symptoms (itching, tenderness), surface (especially bleeding), or shades of color 

See your doctor right away if you have any of these signs to make sure it is not skin cancer. 

7 Common Flu Myths Debunked

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

Myth #1: Getting Vaccinated Can Give You the Flu

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

Myth #2: There Is No Treatment for the Flu

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

Myth #3: Antibiotics Can Fight the Flu

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

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

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

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

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

Myth #6: Cold Weather Causes the Flu

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

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

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

The Facts: How to Avoid Spreading the Flu

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

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

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

Source: AgingCare.com

I Have Alzheimer’s Disease – Changes in Relationships

Alzheimer’s may affect your relationships. While your abilities may change over time, your ability to live well with Alzheimer’s depends on how you choose to continue to be a partner in your relationships.

How Alzheimer’s affects relationships

It is crucial to remember that you are still the same person you were before the diagnosis. However, after sharing your diagnosis, you may find that others are uncertain about how to respond. Some individuals may shy away, while others may be eager to stand by you and provide support. You may find that people with whom you once had a close relationship are now uncomfortable talking to you or asking you about how you are coping.

Establishing and maintaining meaningful relationships throughout your experience with Alzheimer’s can enhance your ability to stay both physically and emotionally healthy.

It can hurt to realize that certain family and friends you thought would be there for you can’t meet your expectations now. They may have discomfort about your diagnosis, as it stirs up fears about their own futures. People who can’t be a part of your support circle now may join later once they have had time to adjust to your diagnosis.

You may find it difficult to participate in social activities or interactions that were once enjoyable for you. Anxiety, frustration or loss are common emotions that you may experience about changes in your ability to follow a conversation, stay focused with competing background noise, or have enough energy to participate in social activities. For many, these changes in relationships can lead to isolation, withdrawal and depression, which can have a negative impact on your physical and emotional well-being. Learn how others are coping with Alzheimer’s and changing relationships by joining ourALZConnected message boards and seeing Tips for Daily Life.

Role changes

As your abilities change, there will be changes in your roles and responsibilities with family and friends. As a result, you may feel:

  • Excluded from conversations about long-term planning and other important decisions.
    1. – Family members may have conversations or make plans for the future without
      your presence or feedback.
  • Loss of independence or specific functions that were your primary responsibility.
    1. – Those close to you may feel the need to make the decision for you about when to
      stop driving.
    2. – You may experience a loss of employment or a loss of your role as a bread-winner.
    3. – Others may feel that you should no longer make financial decisions.
  • Fear of burdening others with a caregiving role or other responsibilities that you once managed.
  • Becoming more dependent on spouse, family or friends.

All of these issues and feelings can affect your relationships. You may find that those closest to you have good intentions, but may provide help that feels invasive or unnecessary at times.

It can be difficult to do, but adapting to changes and accepting help from others can be a way to acknowledge the value their assistance brings to your life. The more you can be involved, the fewer negative feelings you may have.

How to keep your relationships positive and productive

  • Be open about your feelings.
    Share your experience living with the disease.
  • Be specific about how you would like to continue relationships and how you would like to be treated.
    Let others know what social activities you feel most comfortable doing and the best ways to share time together.
  • Learn how to ask for help.
    Tell others how they can help and your expectations for support.
  • Strengthen trusting relationships.
    Focus on those relationships which are supportive, and show your gratitude for the people you love and appreciate.
  • Reevaluate relationships.
    Don’t dwell on people unable to support you at this time or are unable to have a positive presence in your life. Give them the time to adjust to your diagnosis. Try not to take their pulling away personally.
  • See yourself as unique and human.
    You have much left to experience.

Intimacy and sexuality

Throughout your life, your need for physical and emotional closeness and your sexuality and how you experience it, undergo changes. Some of these changes come with maturation, while others reflect changes in life circumstances, such as a diagnosis of Alzheimer’s. The disease may affect sexual feelings and behavior. Take your needs and expectations for intimacy into consideration as the disease progresses.

dementia changes

If you have a sexual partner, openness about sexual changes is a key part of maintaining closeness. The more open and honest you can be with each other, the more you can avoid assigning blame, feeling guilty or lowering the self-esteem of either partner. It is important to educate yourself and your partner about the changes that occur and how to respond appropriately.

Your interest and expression of intimacy and sexuality may be affected by Alzheimer’s in the following ways:

Changes in roles and responsibilities: You may experience uncertainty, frustration or reduced confidence because you need help with things you once managed on your own. These emotions may lead to stress and changes in feelings toward your partner. Your partner may experience some of these same feelings and may need to make adjustments if there is uncertainty about your comfort level with sexual contact or activities that were once pleasurable for you.

Medical issues: Depression can lead to a loss of interest in sex. Speak to your doctor if you or others have expressed concern about your emotional health. Some medications may have side effects that alter your sexual desire. As the disease progresses, you may experience significant increases or decreases in your sexual behavior. Speak with your doctor if these changes are problematic for you or a partner.

Tips for coping with changes in intimacy and sexuality:

  • Accept that changes in your intimate and sexual relationships will occur over time.
  • You may want to explore new ways to express sexuality and obtain satisfaction. This may include non-sexual touching or sharing memories about intimate moments.
  • Communicate with your partner. Discuss new ways to connect and express closeness in ways that are mutually enjoyable.

Download Sexual Relationship Changes and Alzheimer’s

Source: Alzheimer’s Association

I Have Alzheimer’s Disease – Sharing Your Diagnosis

Sharing ySharing Your Diagnosisour diagnosis with others is an important step toward integrating Alzheimer’s disease into your life. You may be hesitant to share your diagnosis with some people, given the impact such a disclosure may have for you. Keep this mantra in mind: Alzheimer’s disease is not your fault.

Why tell others about your diagnosis

As the disease progresses, you will need the support of those who know and understand you. Concealing or denying your diagnosis will limit your ability to cope with the challenges ahead. While some relationships may be tested by what you are revealing, other relationships may be strengthened.

It is normal to experience fear or discomfort about sharing your diagnosis. However, talking openly with those you trust is a powerful way to educate those around you about the disease and to engage their support.

Deciding who to tell

Some individuals choose to share their diagnosis with just their closest family and friends, while others may be comfortable sharing their diagnosis with a broader group of people. Assess your personal comfort level before making this decision. You may feel more supported sharing your diagnosis with close friends and family first before telling others.

Consider the relationships in your life and determine who should be included in your disclosure:

  • Who are the people I feel closest to?
  • Who will continue to support me with this diagnosis?
  • Who I am responsible for telling (spouse, partner, friends)?

How to share your diagnosis

After deciding to share your diagnosis, consider when to tell your news. You may want to tell others about the diagnosis as soon as you get it. Or you may want to wait until you have had time to come to terms with your diagnosis.

o increase the likelihood of a comforting reaction when you tell your friends or family about the diagnosis, find a time when you can be alone and relaxed together. Give some thought to the conversation — what do you want to say? Consider writing your thoughts on paper and bringing that with you.

When you share your diagnosis, you may want to talk about planning for the future or about how family and friends can help; you also may wish to explain more about Alzheimer’s.

Help those closest to you come to terms with your new situation by considering these questions:

  • How do I think this person will react? If the reaction is something unexpected, how might I feel? What can I do in response?
  • How do I want this person to treat me? The diagnosis represents a big change, but it’s only gradually that my needs will change. What do I want from this person right now?
  • What does the person need from me now? What can I provide that will help?

Tips from individuals in the early stage

  • Go slowly.
    You don’t need to talk about everything in one sitting if the person is having a reaction that is difficult for you.
  • Let the person know that both of you will be having different reactions about this over time.
    You both can continue to talk about your thoughts and feelings throughout your relationship.
  • Provide educational brochures about the disease.
    You can also direct him or her to alz.org for additional information.
  • Let the person know that you are still you.
    Even though you are now living with this diagnosis, who you are and what has made you close to each other continues unchanged. Continuing your commitment to the relationship you have can be comforting to both of you.
  • Let people provide assistance when it makes your life easier.
    Just like it helps you to feel useful and needed, helping may make them feel better, too. Accepting help is not an all-or-nothing proposition, and letting others help is not the same as being helpless. They are trying to make life easier for you, and it may help you to let them do that when it feels appropriate.

Responses to diagnosisEarly stage dementia

Consider how you felt after hearing your diagnosis for the first time. Just like you, the people with whom you share your diagnosis will likely experience similar reactions including fear, anger or relief that there is an explanation for symptoms. You may encounter unexpected or negative reactions. Family and friends may react with denial, or with comments or behavior that reflect their misconceptions abo

 

ut Alzheimer’s disease. Responses may include, “But you seem to be fine” or “You’re too young to have dementia.”

Denial is a common response to the disclosure of a serious illness; it provides distance from overwhelming feelings. Stigma or misconceptions about Alzheimer’s may exist due to a lack of information. These reactions reflect the person’s need for more time and/or education before they can respond to you in helpful ways. Allow your family or friends time to digest your news so everyone can move forward together in a positive way.

Your first conversation about your diagnosis may grow into an ongoing dialogue about your experience living with Alzheimer’s. Honest communication about your experience and your expectations of each other can help strengthen your connection. Learn ways you can help your family and friends adjust to your diagnosis.

Source: Alzheimer’s Association

I Have Alzheimer’s Disease – Just Diagnosed

Just DiagnosedReceiving a diagnosis of Alzheimer’s is never easy — it’s life changing. It is normal to experience a range of emotions. Acknowledging your feelings can be an empowering first step in coping with the challenges ahead.

Emotions you may have

You noticed symptoms. You made a doctor’s appointment. You took tests. And you felt a roller coaster of emotions — fear, hope, despair, denial. Then you received a diagnosis. You may have felt numb, unsure of how to respond or where to turn.

You also may be grieving over the present losses you are experiencing, or the expectation of future changes as the disease progresses. It can be helpful to identify and understand some of the emotions you may experience after receiving your diagnosis.

These emotions may include:

  • Anger. Your life is taking a different course than the one you and your family had planned. You cannot control the course of the disease.
  • Relief. The changes you were experiencing were cause for concern. A diagnosis validated these concerns by assigning a name to your symptoms.
  • Denial. The diagnosis seems impossible to believe. You may feel overwhelmed by how your life will change as a result of Alzheimer’s.
  • Depression. You may feel sad or hopeless about the way your life is changing.
  • Resentment. You may be asking yourself what you did to deserve your diagnosis or why this is happening to you and not someone else.
  • Fear. You may be fearful of the future and how your family will be affected.
  • Isolation. You may feel as if no one understands what you’re going through or lose interest in maintaining relationships with others.
  • Sense of loss. It may be difficult to accept changes in your abilities.

If these feelings linger week after week, you may be dealing with depression or anxiety. Feeling depressed or anxious about your diagnosis is common, but both can be successfully treated.

Taking care of your emotional needs

Coming to terms with your diagnosis and the emotions you are feeling will help you accept your diagnosis, move forward, and discover new ways to live a positive and fulfilling life.

You are the only person who can change how you feel about your diagnosis. So it’s important to find healthy ways to deal with your emotions. This can be difficult at the beginning. But once you make the commitment to take care of your emotional needs, you may find that you can rise to the challenge and face your diagnosis. This is a new phase of your life, and you can choose to experience it with sense of connection to your emotional health.

When working through your feelings, try a combination of approaches. The following tips may be helpful:

  • Write down your thoughts and feelings about your diagnosis in a journal.
  • You may find your friends and family struggling with your diagnosis and their feelings. Learn more about how you can help family and friends.
  • Share your feelings with close family and friends. Speak open and honestly about your feelings.
  • Surround yourself with a good support system that includes individuals who are also living in the early stage of the disease and understand what you’re going through. Join our ALZConnected message boards or learn more about support programs.
  • Join an early-stage support group. It can provide you with a safe and supportive environment of peers. To find a support group in your area, check with your local Alzheimer’s Association chapter.
  • Talk to your doctor if you or others are concerned about your emotional well-being. Your doctor can determine the most appropriate treatment plan to address your concerns.
  • Seek help from a counselor or clergy member. He or she can help you to see things in a new way and help you understand more fully what you are feeling.
  • If you are feeling misunderstood or stereotyped because of your diagnosis, learn what you can do to overcome stigma.
  • Stay engaged. Continue to do the activities you enjoy for as long as you are able.
  • Take the time you need to feel sad, mourn and grieve.
  • No two people deal with their diagnosis in exactly the same way. There is no right approach. Some days may be more difficult than others, but don’t be discouraged. Learn coping tips to help you manage challenges.

You are not alone

A diagnosis of Alzheimer’s disease can leave you feeling disconnected, isolated or abandoned from others. You may feel unsure of where to turn and that no one can possibly understand what you’re going through. People living with early-stage Alzheimer’s have stated that one of the most important lessons they learned early on in their diagnosis is this: they could not just wait for others to help them – they had to go out and help themselves to the best of their ability.

Whenever facing difficult times, having a good support network you can turn to for advice and encouragement may help you feel socially connected and give you a sense of belonging and purpose. Make sure your network includes other people who are living in the early stage of the disease. Connecting with others like you may help put your own experiences living with the disease in perspective, and provide you with the support and encouragement necessary to move beyond your diagnosis.

Questions for your doctor

After receiving your diagnosis, it’s normal to leave your doctor’s office unsure of what questions to ask. You just received life-changing news, and you need time to absorb this information and understand what it means for you and your family.

Your doctor is an important member of your care team. Use the opportunity to ask your doctor questions about your diagnosis, all the available options, and the benefits and risks of each choice you make.

You may be asking: “How do I know what to ask my doctor?”

Members of our Alzheimer’s Association National Early-Stage Advisory Group have shared their own experiences and questions they wish they had asked their doctors. You may find this information helpful as you develop your own list of questions.

Download these questions and others as a PDF

Example questions:

The diagnosis of Alzheimer’s disease

  1. What test(s) or tools did you use to determine my diagnosis?
  2. What are you measuring with the tests you performed?

Alzheimer’s disease

  1. How will the disease progress?
  2. What can I expect in the future?

Treatments

  1. What treatment options are available?
  2. Which symptoms are being targeting by each medication?

Clinical trials

  1. What clinical trials are available?
  2. Where can I find published information about clinical treatment studies?

Care team

  1. How familiar are you with Alzheimer’s disease? Will you be managing my care going forward?
  2. If I need to be hospitalized, will you be able to provide care in this setting?

Care and support

  1. What resources are available to help me learn more about my diagnosis? My family?
  2. What support services are available to help me live well with the disease, for as long as possible?

Source: Alzheimer’s Association

Carefully Consider the Implications of Moving an Elderly Loved One Closer to You

Carefully Consider the Implications of Moving an Elderly Loved One Closer to YouThese days, family members are often scattered in various cities and states throughout the country. This poses a serious challenge when a loved one requires increased care or assistance. There almost always comes a point in time when long-distance caregivers give serious consideration to moving their loved ones closer to them. This can occur when aging family members are still healthy and able to live independently, following a sudden change in health status, or even once they are already living in an assisted living or skilled nursing facility.

There are obviously logistical and psychological challenges in such a decision. This can include deciding which family member the senior should move to be close to and whether or not this family member is willing and able to meet their loved one’s care needs. However, there are even more significant factors to take into account. Sometimes families do not think through the financial, legal and medical implications of such a move. It is important to consider whether it will cost more for a loved one to live and receive quality care in a different city or state, and these expenses are not always obvious.

Let’s look at some possible scenarios to see what factors might influence such a decision. Keep in mind that these situations can change rapidly, so it is important to give all of the following questions and factors proper consideration, even if they do not apply yet.

Scenario One: The Preemptive Move

At some point in time, multiple generations within a family may sit down together and look at the possibility of everyone living in the same time zone or zip code. This discussion may arise when your elders are still healthy, because visits are few and far between. There are certainly benefits to such an arrangement, but what about the drawbacks and contingencies of moving your elders closer to you?

Considerations

  • What is the availability of primary care physicians (PCPs) in your area?
  • Do available PCPs routinely accept new Medicare patients? Check with your own physicians to see if your family member might have preference in being admitted to their practice.
  • Are there particular specialists that your family member must have access to? Even if your loved one is still living independently, they may have a chronic disease or two that needs more specialized monitoring or attention.
  • Does your family member’s current PCP or specialist have any recommendations for colleagues near you?
  • Does your loved one still drive? If not, or if they lose this ability, how will they access transportation? What are the costs for the bus system, subway, cabs, etc.?
  • What are their expectations in terms of your involvement in their health care and medical issues? Do they want you to accompany them to physician visits, or are they used to doing these things themselves? They may appreciate the opportunity to have you more involved. However, you may see this move as a way to limit the time you need to devote to long-distance travel, not an opportunity to set up a whole list of new responsibilities and obligations!
  • On the other hand, are you assuming they will help you with child care, babysitting or similar tasks?
  • Be clear about boundaries before entering this new situation. Will you be having family meals or gatherings on a regular basis, or will you be taking a “live and let live” approach?
  • If they are going to live with you, will they share expenses?
  • Do they have a houseful of furniture and personal belongings that they will have to move? Are they open to downsizing? How do they plan on moving their things? How much will this cost?

Scenario Two: The Reality Check

After a loved one experiences a significant change in their health status, family members tend to think more seriously about moving them closer to provide support and assistance more regularly and be available on shorter notice. This arrangement also allows for easier monitoring of a loved one’s health and overall situation. Depending on a senior’s current status and prognosis, there are a number of factors to take into account before making a decision.

Considerations

  • If your loved one has been living independently, can they continue to do so safely? Has the family considered assisted living? Are there facilities in your area to choose from? Do they meet your standards? What are the costs?
  • Does your loved one have a long-term care insurance policy or veterans benefits that can help cover the costs of housing and/or care?
  • If they have a limited income, does your community have subsidized or senior housing for which they might be eligible? What is the waiting time? Should you be filling out applications now, even if the move is more than a year away?
  • What is the availability of home care services in your area? Keep in mind that rates and sliding scale fees for personal services can vary greatly from one state or area to another. A person who was eligible for Medicaid in one state will need to reapply in their new state, and they may not qualify. Ask questions! Do not assume that what is available for them now “at home” will be transferable once they change residences.
  • What kind of health insurance do they have now? Areas with large concentrations of seniors often have reasonably priced Managed Care/Medicare Advantage/Medicare Part C plans. If you move your loved one to a rural area or a place with limited choices, you may find that their health insurance expenses will rise because they need to have original Medicare (Parts A and B) and a supplement (sometimes referred to as Medigap). (Please note: Moving from a Medicare Advantage plan to original Medicare is not always easy or possible. Leaving a service area begins a special enrollment period, but the options and pricing for supplemental coverage could be much different than expected. For more information, see the article “Time to Re-Evaluate and Change Medicare Plans.”
  • Following a new diagnosis or illness, a loved one’s health status may require a different type of coverage. If they are seeing lots of specialists, a Medicare Advantage plan that was useful “back home” may not be cost effective at this point. Speaking to a SHIP (State Health Insurance Program) counselor at your local Area Agency on Aging or senior center may be a good place to start. The counselor can give good basic information about plans that are available and projected costs.

Scenario Three: The Facility Move

Many families find themselves balancing life at home and caring for a loved one in an assisted living facility or a nursing home. Unfortunately, distance often complicates this situation even further. If you are thinking about moving your loved one to a facility nearby where you can be regularly involved in their care without extensive travel or disruption to your work or daily life, be sure to consider the following factors.

Considerations

  • If your loved one is already in a senior living facility and they are accessing Medicaid, you need to check with the Medicaid office in your state about whether they can transfer to a new facility and automatically and retain this coverage. Your family member will have to qualify for Medicaid all over again in their new state of residence, and this may involve paying out of pocket for some time before they are approved. You may be reimbursed retroactively, but it might not amount to much. Medicaid regulations vary from state to state, so be sure you understand any differences between programs. It may be wise to contact an elder law attorney just for an informational session.
  • If they must reapply in their new state of residence, are there different asset and income limits for Medicaid eligibility? What are the differences in coverage and benefits between the state programs?
  • If you are taking someone out of an assisted living or continuing care community, are there deposits that were paid that are nonrefundable? Furthermore, are there any contracts that might interfere with a move?
  • Are there similar facilities in your area that only charge monthly fees and do not require another buy-in or down payment? (These monthly fees may be higher than what the individual was paying before.) Can your loved one afford such fees?
  • If your loved one has Alzheimer’s, dementia or another serious condition, will they be able to mentally, physically and emotionally handle a move? Will they require specialized transportation? How much will it cost?
  • Thinking more long term, what are the estate tax and inheritance laws in your state compared to where your family member lives now? If they are considerably different, will your loved one need to reevaluate and update their estate plan and other legal documents? Are there any reputable elder law attorneys in your area to assist with this? What do they typically charge?

There can be many advantages to having a care recipient live closer to family, but it is important to research some of the financial, medical and legal implications before making a commitment. This will ensure that the transition goes as smoothly as possible and minimize the likelihood of surprises. If there are significant concerns, you may want to reconsider such a decision or proceed very carefully.

Source: AgingCare.comhttps://www.agingcare.com

Saying “No” to Family Drama while Caregiving

Over the years, there have been many posts in the Caregiver Forum about the questionable things family members do and how deeply these actions affect elders and their caregivers.

It seems that every family has a “difficult” member: the one who is never around but somehow knows everything; the one you can never please, no matter how hard you try; or the one who makes every conversation and situation about themselves. These people would never consider helping you in any tangible way with caregiving. Yet, like I said, they consider themselves to be experts. They know it all and have done it all.

My wife, Phyllis June, and I have a few of these people in our family. The strange thing is, it has always been these few who seem to stick together through thick and thin. One could lie, and the others will swear to it. Everything is always about them, and they do nothing to help anyone else. When something happens to them, they always add their own flare to the story so it’s much more dramatic than it would be if they told the truth.

How are caregivers supposed to handle family and friends like this? Back in the day, before I was diagnosed with early-onset Alzheimer’s, I just let their nonsense roll off my back. I didn’t give them a second thought until my health and my outlook changed.

When I was diagnosed, one of the things everyone told my wife and me repeatedly was that I had to stay away from stress of any kind. We immediately made some adjustments, including retiring from my career in law enforcement and EMS. Some modifications were easier than others, but the hardest part was making changes based on another person’s behavior—especially when it’s someone you are related to. Most people can and do put up with a lot, especially from their family, but our new circumstances meant that had to stop.

Ignoring our family members and their antics only worked for a couple of years. Then they did something that neither my wife nor I could put up with. I won’t go into details, but it was a deal breaker for us. We have washed our hands of these people, and we are better off for it. It is a sad thing to do, but we have accepted that they are never going to change. Now, when we see them, they look the other way, which is fine with me. I suppose they know they should leave well enough alone after the events that have transpired.

What I am trying to get at is, when you have dementia or another serious medical condition, you simply cannot put up with any nonsense. The stress that some family members bring to the table is entirely unnecessary and unacceptable. Furthermore, it is harmful.

The same applies for caregivers. You and your loved one are under an enormous amount of pressure just dealing with the emotional toll of dementia, daily hands-on care and any other serious health issues. Additional drama has no place in the caregiving equation.

I simply do not have the time or the inclination to deal with insensitive people. I would never go out of my way to be mean or hateful to anyone, but there comes a time when boundaries need to be set and respected.

The bottom line is you cannot change people. Balancing your own sanity, your loved one’s wellbeing and the duty you feel to relatives is an immense challenge. However, your number one concern is your loved one’s welfare. Because they depend on you, that means your mental and physical health is also a high priority.

You can try to sit these people down and be rational about your feelings and their treatment of you, but most will never see the light. I want to be clear: I am not promoting family break-ups or estrangement. Everyone faces familial challenges and handles them in their own way. However, since I was diagnosed, my outlook and approach have changed.

Two simple questions helped me reflect on my troubled relationships. If you are experiencing difficulties with a family member, sit back and ask yourself, “What does this person bring to my life and my loved one’s life? What have they done to make this journey easier on us?” If you are honest with yourself, the answers will speak volumes about your relationship.

If you can come to an understanding where they realize you will not tolerate such behavior, then that is a wonderful thing. Open communication and appreciation of other points of view are vital to healthy relationships. However, your family member may not entertain either of these notions. They may not even be capable of doing so. If they were, they probably would have examined their behavior and made efforts to change already.

Instead, it is up to you to make the adjustment. Change your situation for the better. If that means altering who is involved in your life and the extent of their involvement, so be it. You will be surprised how much better off you will be by eliminating unnecessary negativity.

Stress is an inevitable part of life, but stress that is brought on for no reason is unacceptable. Sometimes we just need the courage to say, “What you are doing to me is not right, and I am not taking it anymore.”

Source: AgingCare.com

3 Simple Happiness Hacks for Caregivers

3 Simple Happiness Hacks for CaregiversHave you ever met someone who seems happy all the time? Maybe it’s that person who always has a cheery, upbeat greeting for everyone, or someone who inexplicably manages to remain positive amidst challenging circumstances. But it might make you wonder, “Why am I not one of those people?”

A recent Harris poll revealed that just one-third of Americans describe themselves as “generally happy.” Canadians fare a bit better: two-thirds said they feel “pretty happy” in a recent poll.

Why is happiness so elusive? For many caregivers, the answer seems obvious. Physical fatigue, emotional exhaustion, lost sleep and the general stress of juggling caregiving responsibilities with your children’s needs and a career all can make it difficult to find happiness in life.

Then again, if you think of happiness as an object to “find,” you may be looking at the situation the wrong way. According to science, happiness isn’t something you find–it’s something you make.

Philosophers have discussed the nature of happiness for more than 2,500 years, and modern psychologists began more recently to study happiness from a scientific perspective. Contemporary researchers have crafted studies to examine what constitutes happiness and whether or not people can create happiness for themselves. The answer? Yes, they can.

Best of all, creating more happiness in your hectic caregiving life need not be labor-intensive or time-consuming. Try these three tactics to help start increasing your happiness right now.

1. Stop looking at your cell phone so much

Technology can be a boon for family caregivers. You can carry a loved one’s medication inventory with you on your phone, and you have all emergency numbers literally at your fingertips.

Yet a study by Kent State University of 500 students in the United States showed that frequent cell phone use made students feel anxious and less happy. Perhaps this is because many people use their cell phones as a distraction—checking social status updates, flipping through news headlines—and researchers have linked distraction  with feelings of unhappiness.

The antidote to distraction as a happiness-killer? Focus. As a caregiver, you may be able to increase your feelings of happiness by setting down the phone and interacting with the person sitting across from you at the table, preparing a complex recipe or reading a book. These activities all require your brain to focus for an extended period of time, and happiness usually follows when the brain feels engaged.

2. Hug a few trees

The Japanese call it forest bathing,” and we North Americans could learn something from this practice. Since 1982, people in Japan have been encouraged to spend more time in nature because science supports a direct link between nature appreciation and increased wellbeing.

Caring for a spouse, older adult relative or friend over a long period of time can lead the care partner to feel housebound. After all, most caregiving activities take place indoors. But this lack of exposure to the outdoor environment can cause a distinct decrease in general happiness levels.

And if the idea of hiking or cycling outdoors turns you off, you’re in luck. True forest bathing does not involve any sort of arduous effort. Indeed, the point is to relax and commune with nature, not to turn the activity into an exercise session. So take time to regularly sit on a park bench or enjoy a picnic beneath a mighty oak. You may find your happiness levels increase tree-mendously.

3. Keep a gratitude journal

Some caregiving days go smoothly, while others can be filled with challenges. And while you may feel a tendency to focus on all the things that went wrong on a particular day, you may be better off focusing on all the things that went right.

One 2003 study found a correlation between happiness and focusing on gratitude. Fortunately, recording the blessings in your life is an easy exercise that takes little time. Simply purchase a small notebook and jot down each evening all the things you were grateful for during the previous 24 hours.

Beyond making you feel better at the end of each day, consistently focusing on the positive aspects of your life can actually reinforce the neural pathways of your brain, leading you to naturally develop an optimistic outlook that increases your feelings of overall happiness.

The life of a care partner can be hectic and stressful. But these three simple techniques can help you increase your happiness no matter your life circumstances.

Source: CaregiverStress.com