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Validation Therapy for Dementia: Calming or Condescending?

People with Alzheimer’s disease and other types of dementia often come to live in an altered reality that doesn’t mesh with ours. Their hallucinations and delusions may not make any sense to us, but their perceptions are as real to them as ours are. Dealing with this stark contrast can be difficult, but validation is often the kindest, most respectful way to handle the beliefs and perceptions that a loved one’s brain creates.

Sadly, this is a tough concept for many adult children and spouses of people with dementia to absorb. Most people’s initial reactions to an off-the-wall remark are to refute or correct it. Years ago, this kind of “reorientation” was widely accepted, but the downfall is that it only works on individuals who are capable of rational thinking. Dementia patients lose this ability as the disease progresses and can become agitated or upset when their concept of reality is challenged. Thanks to the work of one woman, jarring reality orientation techniques gave way to the gentler practice of validation in dementia care.

A Dementia Care Pioneer

Naomi Feil MSW, ACSW, was born in Munich in 1932. She grew up in the Montefiore Home for the Aged in Cleveland, Ohio, where her father was the administrator and her mother was the head of the social service department.

Feil earned her master’s degree in social work from Columbia University in New York and then began her own career with the elderly. Between 1963 and 1980, Feil grew increasingly dissatisfied with the traditional methods used to work with severely disoriented elders, so she developed a new technique aimed at acknowledging and accepting their irrational perceptions of reality.

Her first book, “Validation: The Feil Method,” was published in 1982. Although validation was slow to catch on with medical practitioners, by the mid-nineties Feil’s method began to gain popularity. Since then, her technique has gradually become accepted by most geriatricians, geriatric psychiatrists, social workers, nurses and other health care providers as a crucial tool in dementia care.

My Experience with Validation Therapy

I personally witnessed this transition of medical thought as I struggled to care for my father after he was suddenly thrown into dementia due to a botched brain surgery.

My family was completely caught off-guard by this new development and we initially just tried to muddle through. I quickly found that the only way to help Dad relax and retain any sense of self-esteem was to agree with him no matter how deluded his thinking was.

 I agreed with the “fact” that he’d earned his medical degree, even though a reality check would show that WWII had interrupted his studies and prevented him from realizing this dream. I even went so far as to create a faux medical diploma to hang on his wall at the nursing home, which helped for a while.

Then he became convinced that he had received an invitation from Lawrence Welk to be a guest conductor on the TV show, which of course was airing as reruns on PBS since Welk was long deceased.

I bought Dad a conductor’s wand and numerous big band CDs to play in a stereo. He was thrilled. Dad watched the Welk reruns, merrily directing the band whenever he felt up to it. I made him a certificate of thanks from Welk for Dad’s “services” and hung that on his wall as well.

And on it went.

I knew nothing of the validation theory during these early years, but I did know my dad. I could not put this intelligent, well-read man through the horror of correcting his thinking daily when he was no longer able to comprehend why he was wrong. I knew that I needed to get into his world, which was instinctive to me, perhaps because I’m a rather whimsical person by nature.

Years later, I learned that there is a word for my approach to Dad’s altered realities: validation. This technique is now accepted as a practical way of working with people who have dementia. It helps reduce stress, improve communication, reinforce self-esteem and infuse dignity into dementia care. It increases patients’ happiness because they aren’t continually being told that they are wrong and confused by truths that they cannot understand.

The idea of validation stems from an empathetic attitude toward our loved ones and a holistic view of them as individuals. We learn to effectively validate their thoughts and experiences by making ourselves see the world through their eyes.

Isn’t “Lying” to Our Elders Demeaning?

Understandably, my mother had difficultly validating Dad’s altered beliefs about himself and the world. This was the man to whom she’d been married for over half a century. She felt that she was being disrespectful when she placated him by agreeing with his delusions.

I understood why Mom had trouble joining Dad in his world, but I also witnessed the agitation and emotional pain he went through as Mom valiantly tried to make him rejoin reality when he simply couldn’t. She eventually gave up and tried to “play along,” but she was never very convincing. I can’t fault her for that.

Validation Lends Dignity and Respect

Some of us have been told by our parents to never treat them like children when they get old. No one believes more than I do that treating an elder like a child is unacceptable. There is, however, a big difference between raising and educating a child and validating an elder who has dementia.

Children with normal developmental abilities are able to learn and grow intellectually and emotionally. As they gain experience, they gradually understand more and more about people and the world around them. Therefore, gently correcting a child is our job as parents who strive to help them develop and become well-adjusted.

The reverse is true of someone who has dementia. These individuals gradually lose their ability to understand the world as others see it and interact with it appropriately. The disease changes how the brain works and processes information, creating warped perceptions that they cannot differentiate from “true” reality. This is just one way that caring for our elders is different from caring for children.

If we, as dementia caregivers, continually “correct” their thinking, we are chipping away at any self-esteem they have managed to retain throughout the course of this disease. A caregiver’s commitment to honesty and accuracy often comes from a good place, but it can be demeaning, even cruel, for a patient to endure.

Validation is not about treating someone as a child. It’s about respecting the person with dementia and how they see the world. It’s about overcoming our own bias. It’s about adding some dignity to the last years of our elders’ lives by accepting that maybe there is more than one way to look at things.

Yes, there are times when validation doesn’t work, so we lean on redirection and distraction instead.

“No, Dad, you can’t drive right now because I misplaced the keys. Let’s go see if there’s some music on TV.”

“No, Mom, there isn’t a war happening here in town. That is going on far away from us and we’re safe. Let’s change this news channel to Discovery and see what’s on.”

“I’m sorry you’re seeing bugs crawling on your bedroom walls. That must be very upsetting. I’ll call the exterminator and we can go have a cup of tea in the living room while we wait for them to show up.”

Dementia presents countless challenges that call for stellar patience and every tool at our disposal. It may seem backwards at first, but validating your loved one, rather than correcting them, is life-enhancing for both of you. It’s an expression of kindness and respect that will help them feel heard and prevent you from starting unnecessary arguments you will never win.

Source: AgingCare

Repetition and Alzheimer’s

Repetition and Alzheimer'sA person with Alzheimer’s may do or say something over and over — like repeating a word, question or activity — or undo something that has just been finished. In most cases, he or she is probably looking for comfort, security and familiarity.

Causes

The main cause of behavioral symptoms in Alzheimer’s and other progressive dementias is the deterioration of brain cells which causes a decline in the individual’s ability to make sense of the world. In the case of repetition, the person may not remember that she or he has just asked a question or completed a task.

Environmental influences also can cause symptoms or make them worse. People with dementia who ask questions repeatedly may be trying to express a specific concern, ask for help, or cope with frustration, anxiety or insecurity.

Because people with Alzheimer’s gradually lose the ability to communicate, it’s important to regularly monitor their comfort and anticipate their needs.

How to respond

  • Look for a reason behind the repetition.
    Does the repetition occur around certain people or surroundings, or at a certain time of day? Is the person trying to communicate something?
  • Focus on the emotion, not the behavior.
    Rather than reacting to what the person is doing, think about how he or she is feeling.
  • Turn the action or behavior into an activity.
    If the person is rubbing his or her hand across the table, provide a cloth and ask for help with dusting.
  • Stay calm, and be patient.
    Reassure the person with a calm voice and gentle touch. Don’t argue or try to use logic; Alzheimer’s affects memory, and the person may not remember he/she asked the question already.
  • Provide an answer.
    Give the person the answer that he or she is looking for, even if you have to repeat it several times. If the person with dementia is still able to read and comprehend, it may help to write it down and post it in a prominent location.
  • Engage the person in an activity.
    The individual may simply be bored and need something to do. Provide structure and engage the person in a pleasant activity.
  • Use memory aids.
    If the person asks the same questions over and over again, offer reminders by using notes, clocks, calendars or photographs, if these items are still meaningful.
  • Accept the behavior, and work with it.
    If it isn’t harmful, don’t worry about it. Find ways to work with it.
  • Share your experience with others.
    Join ALZConnected, our online support community and message boards, and share what response strategies have worked for you and get more ideas from other caregivers.

Source: Alz.org

Early Diagnosis of Alzheimer’s Is Crucial for Effective Planning and Treatment

November is National Alzheimer’s Disease Awareness Month—an important opportunity to shed light on a condition that is often misperceived as untreatable. Alzheimer’s disease (AD) is the sixth leading cause of death in the United States, but dementia from Alzheimer’s continues to be underdiagnosed and underreported. In fact, according to a U.S. survey conducted by the Alzheimer’s Association, almost half of patients with AD are already in the moderate to severe stages by the time they are diagnosed. This lack of attention to the early stages of Alzheimer’s is unfortunate, because there are things we can do to help those who are starting to experience memory loss and support the people who are caring for them. Although a cure does not yet exist, available treatment options can help to slow down the progression of symptoms, especially if diagnosed early.

Caring for Someone with Alzheimer’s Disease

AD poses real challenges not only for the people diagnosed with the disease but also for the 15 million Americans who assume caregiving responsibilities. The multitude of obligations can have a huge impact on caregivers, with one out of every two of them developing major depression. The economic burden of providing care is huge as well. In 2016, the annual cost of care was $230 billion in the U.S. alone.

Many of my patients and their caregivers are hoping and waiting for a cure to become available. Even though there are novel drugs and other interventions in various phases of research and development, patients’ mental states continue to deteriorate with each passing day as their families wait for a disease-modifying treatment. The road to development and approval of a new drug is long and rigorous, and only a small percentage of medicines ever make it to market. This is time that Alzheimer’s patients simply cannot afford to waste.

A diagnosis will spur family members to start a conversation about planning for the future—a difficult, yet necessary discussion that they may have shied away from without a clear understanding of their loved one’s health. Timing is crucial because this planning phase must be done while the patient is still capable of sharing their wishes and competent to execute all the necessary legal documents, such as medical and financial powers of attorney, a will, advance health care directives, trusts, etc. These preparations enable the family to understand their loved one’s preferences for long-term and end-of-life care and give them the legal authority to see them through once their loved one has lost the ability to handle their own affairs.

The Treatment Journey

While there are no treatments available that can prevent, cure or change the underlying progression of Alzheimer’s disease, there are medications that can help minimize symptoms for a while. Once again, early diagnosis is key since each prescription is approved for different stages of the disease. These medicines can help people living with AD maintain their cognitive abilities and continue functioning at higher levels longer.

In addition to pharmaceutical treatments, there are also lifestyle choices that can help lower the risk of developing the disease and stabilize the symptoms of AD for those who already have it. These activities include regular physical exercise, stress management, proper diet, and prompt treatment of medical conditions like hypertension and high cholesterol. These lifestyle modifications can have a huge impact on a person’s brain health.

If you are concerned about a loved one’s memory, encourage them to go see a doctor. The good news might be that there is nothing to worry about, but if a problem is detected, ask about available treatment options. Early diagnosis and proactive treatment could help some of the 5.5 million Americans who are currently living with Alzheimer’s disease and their loved ones.

Source: AgingCare.com

Hallucinations, Delusions and Paranoia Related to Dementia

Hallucinations, Delusions and Paranoia Related to DementiaHallucinations, Delusions and Paranoia Related to Dementia

According to the Alzheimer’s Foundation of America, the major psychiatric symptoms of middle stage Alzheimer’s disease and other forms of dementia include hallucinations, delusions and paranoia. About 40 percent of dementia patients experience delusions, while hallucinations occur in about 25 percent of cases. When a senior is experiencing hallucinations and delusions, their caregiver often wants to help them understand that these beliefs and experiences are not real.

 “It is not helpful to argue or rationally explain why something happened,” says Lisa P. Gwyther, associate professor in the Department of Psychiatry and Behavioral Sciences at Duke University and director of the Duke Aging Center Family Support Program. “It just frustrates the person. They somehow know that you are not taking their thoughts and feelings seriously.”

While reinforcing reality seems like the logical and kind thing to do, this natural instinct can be wrong. Family caregivers can ensure they’re prepared to handle these challenging behaviors by learning the differences between them and proper coping techniques for each one.

 Understanding the Differences

Hallucinations, delusions and paranoia are symptoms of disease and not a normal part of aging. While they may seem similar, they are actually very different.

Hallucinations are false sensory experiences that can be visual, auditory and/or tactile. These perceptions cannot be corrected by telling a patient that they’re not real. Examples include a dementia patient hearing music when none is playing or seeing bugs on a surface where there aren’t any.

Delusions are fixed false beliefs that are not supported by reality. They are often caused by a faulty memory. Examples include accusing caregivers of theft and infidelity.

Paranoia is centered around suspiciousness. Elderly individuals often project hostility and frustration onto caregivers through paranoid behaviors.

Coping with Hallucinations

When it comes to handling a senior’s hallucinations, Dr. Marion Somers, author of “Elder Care Made Easier: Doctor Marion’s 10 Steps to Help You Care for an Aging Loved One,” suggests joining them in their version of reality. Ask them about what they are experiencing as if it is real so that you can more effectively defuse the situation. Refrain from trying to explain that what they are seeing or hearing is all in their head. “Otherwise, you’re going to aggravate them, and you don’t want to increase the level of agitation,” says Dr. Somers.

Reassure them by validating their feelings. Say something like, “I see that you’re upset. I would be upset if I saw those things, too.” Tell them that they are safe with you and you will do whatever you can to help them feel secure.

A comforting touch, such as gently patting their back, may help the person turn their attention to you and reduce the hallucination, according to the Alzheimer’s Association. You also can suggest that they move to a different room or take a walk to get away from whatever may have triggered the experience.

Realize that some hallucinations, such as seeing children or hearing music, can be comforting. If the individual is reassured by a hallucination, caregivers don’t need to do anything to stop it, Gwyther says. “You only need to respond to things that are scary or disruptive or keep the person from getting adequate care,” she says.

In addition to dementia, poor eyesight, hearing loss, certain medications, and physical problems like dehydration and urinary tract infections (UTIs) can contribute to hallucinations. If all other factors are ruled out and a loved one’s hallucinations are disturbing and persistent, then antipsychotic medication may be prescribed to reduce them. However, Gwyther says these medications can present a risk for dementia patients. She recommends first changing the way you communicate during these episodes and changing the activity and environment to remove or reduce triggers.

The Alzheimer’s Association offers these tips to change the environment:

  • See if any lighting or lack of lighting casts shadows, distortions or reflections on walls, floors and even furniture that could contribute to visual hallucinations.
  • Listen for any sounds, such as TV or air conditioning noise, which could be misinterpreted.
  • Remove or cover mirrors if they could cause someone to think they are seeing a stranger.

Dealing with Delusions

Delusions among dementia patients typically result from their cognitive impairment. They occur when a senior tries to make sense of a situation, but their confusion and memory problems make it impossible. “They end up filling a hole in a faulty memory with a delusion that makes sense to them,” Gwyther says. For example, if a loved one cannot find their purse, they may decide that it is missing because someone stole it.

Delusions can be frightening for the person living with dementia, but they can also be very hurtful for caregivers when they are the accused. Recognize that the elderly individual is living in a world that doesn’t make sense to them and is likely scared. Do not take any accusations personally or respond with logical explanations. Instead, reassure the person and avoid asking questions that may cause more confusion. If they are looking for an item, tell them you will help them find it. In cases where a loved one regularly misplaces an item and becomes agitated over the loss, the Alzheimer’s Association recommends purchasing a duplicate of the item to quickly resolve the issue until the original is found.

Distraction is another strategy that dementia caregivers use in response to delusional thinking, but it may not work for every patient or every delusion. If a loved one is experiencing a mild delusion, offering a favorite snack or activity or asking them to tell you about an important experience in their life may be sufficient to redirect their attention. In cases where the person is very upset, reassurance may be the only viable option. Again, it is crucial to avoid rationalizing the situation and stress your commitment to their security and happiness.

Responding to Paranoia

Paranoia is less common than delusions and hallucinations but can still be very troubling. According to the Alzheimer’s Association, when paranoia occurs, caregivers can assess the problem by considering these questions:

  • What happened right before the person became suspicious?
  • Has something like this happened before?
  • Was it in the same room or at the same time of day?
  • Can this trigger be removed or altered to avoid eliciting suspicion?

If someone is experiencing paranoia, it is important to discuss their medications (prescription and over the counter drugs as well as vitamins) with their doctor. “Sometimes medications interact with one another or the dosages are too large,” notes Somers. “That can bring on paranoia, but a doctor can address problems and adjust the senior’s regimen to minimize issues.”

Recognizing the causes for all three behaviors and understanding what a loved one goes through while enduring hallucinations, delusions and paranoia can help you both keep calm and find solutions.

Source: AgingCare.com

Ask your doctor the right questions about your Alzheimer’s diagnosis

Just Diagnosed

Receiving 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: alz.org

Your Complete Guide to Medicare Open Enrollment

Your Complete Guide to Medicare Open EnrollmentWhat is Open Enrollment?

The Medicare Open Enrollment Period is an annual period of time (October 15 through December 7) when current Medicare users can choose to re-evaluatepart of their Medicare coverage (their Medicare Advantage and/or Part D plan) and compare it against all the other plans on the market. After re-evaluating, if you find a plan that is a better fit for your needs, you can then switch to, drop or add a Medicare Advantage or Part D plan. Medicare Advantage is also known as a “Part C” plan.

You cannot use Open Enrollment to enroll in Part A and/or Part B for the first time. For more information on all of the parts of Medicare, and when you can enroll in them, visit our Medicare coverage map.

Still confused about Open Enrollment? Try taking our Medicare Questionnaire assessment, which can connect you to free professional advice about Medicare from a licensed benefits advisor (who abides by our Standards of Excellence).

What you can do during the Open Enrollment Period (OEP):

  • Anyone who has (or is signing up for) Medicare Parts A or B can join or drop a Part D prescription drug plan.
  • Anyone with Original Medicare (Parts A & B) can switch to a Medicare Advantage plan.
  • Anyone with Medicare Advantage can drop it and switch back to just Original Medicare (Parts A & B).
  • Anyone with Medicare Advantage can switch to a new Medicare Advantage plan.
  • Anyone with a Part D prescription drug plan can switch to a new Part D prescription drug plan.

When is Open Enrollment?

Open Enrollment is from October 15th through December 7th every year. If you use the Open Enrollment period to choose a new Medicare Advantage or Part D plan, that new coverage will begin on January 1.

Worried about forgetting when Open Enrollment starts and ends? You can sign up for reminders here, or just add your email into the “Get Reminded” box on this page.

Why should I consider re-evaluating my current Medicare coverage during Open Enrollment?

Unfortunately, choosing health insurance is no longer a one-time decision for most Medicare beneficiaries. Each year, insurance companies can make changes to Medicare plans that can impact how much you pay out-of-pocket—like the monthly premiums, deductibles, drug costs, and provider or pharmacy “networks.” A network is a list of doctors, hospitals, or pharmacies that negotiate prices with insurance companies. They can also make changes to your plan’s “formulary” (list of covered drugs). Given these yearly changes, it is a good idea to re-evaluate your current Medicare plan each year to make sure it still meets your needs. Below are some additional benefits of re-evaluating your coverage during Open Enrollment:

  1. You can switch to better prescription drug coverage. Using Open Enrollment to switch your drug coverage—or add drug coverage for the first time—can make crucial medications that you need less expensive. It can also ensure that your drug plan still covers the drugs you need (as your prescriptions may not be included on your plan’s formulary for next year).
  2. You can save money and keep your doctor in-networkSwitching your Medicare Advantage or Part D plan can potentially save you hundreds of dollars a year—especially if your current plan’s out-of-pocket costs will increase next year. Research shows that the average consumer can save $300 or more annually if they review their Part D coverage. One way to lower your medical costs is to check that your current doctors, hospital, and pharmacy are “in-network” with whatever Medicare Advantage or Part D plan you choose. If your insurance company has changed your plan’s provider or pharmacy network for next year (and your doctor or other resources will no longer be included), you can use Open Enrollment to switch to a plan that will include your current doctors, hospital and/or pharmacy in-network, thereby lowering your medical costs.
  3. You can find a higher quality plan. Finally, check the quality of your plan using the Medicare 5-star ratings system. Plans with a 5-star rating are considered high quality and those with fewer than 3 stars are considered poor quality. If your current plan is ranked as less than a 3, consider using Open Enrollment to switch to a higher rated plan.

Next Steps: How do I re-evaluate my current Medicare coverage during Open Enrollment?

Interested in re-evaluating and/or switching your current Medicare coverage? We recommend one of the three options below:

  1. Take our quick Medicare Questionnaire. It can connect you to free professional counseling from a licensed benefits advisor at Aon Retiree Health Exchange (our trusted partner who abides by the NCOA Standards of Excellence).
  2. Use the plan finder tool on Medicare.gov. This is the official U.S. government site for Medicare.
  3. Contact your local SHIP (State Health Insurance Assistance Program). SHIPs provide federally-funded Medicare counseling through a trained staff member or volunteer.

When you have chosen a plan that’s best for your situation, you’ll need to provide your Medicare number and the date your Part A and/or Part B coverage started. This information is on your Medicare card. In general, you need to be careful about when you give out your personal Medicare information (see “5 Steps for Avoiding Medicare Scams“), but this is a situation when licensed advisors in a trusted setting can help you make a beneficial change.

Questions about Medicare?

Get answers now

Source: My Medicare Matters/National Council on Aging

Sundown Syndrome Can Worsen in the Fall

Sundown Syndrome Can Worsen in the FallFall is here, and this is the time of year when “sundowning” can be more prevalent, especially for individuals in the middle stages of dementia. During autumn, the days begin to get shorter. I notice it already, but that’s because I am outside most of the time. We will be turning the clocks back before you know it, and this will only make a bad situation worse.

 Sundowning is the phenomenon where people with Alzheimer’s disease or other forms of dementia become increasingly confused and agitated during the early evening hours of twilight and sunset. This time of day can be especially distressing for dementia patients, and it places a great deal of pressure on the caregivers who try to help them stay calm and oriented. Pacing, restlessness and shadowing can become more pronounced during these times. Additionally, hallucinations, wandering, and violent or paranoid behavior can manifest in more severe cases.

There is a whole host of things you can do to minimize the symptoms of sundown syndrome. They can be simple, such as turning on all the lights in the house before it starts getting dark or slightly changing a loved one’s evening routine. There are many types of dementia, and each one manifests differently in a person. Therefore, trial and error is the best way to find out what techniques can help minimize troubling behaviors.

 Different Approaches to Managing Sundowner’s Syndrome

Symptoms of sundowning can be brought on by too much activity or noise toward the end of the day, increased fatigue, shadows caused by low light, and hormone imbalances (which can affect a person’s internal clock). Look for patterns in your loved one’s behavior that will clue you in as to what may be bothering them.

For example, if they become more tired and frustrated in the evenings, then encourage a short nap in the early afternoon (not too late, or they’ll be awake all night) and make a point of keeping nighttime activities soothing and low key. If visual hallucinations and disorientation spike after the sun has set, make modifications throughout the home to minimize shadows, reflections and distorted images that could be misinterpreted.

Sometimes medication, supplements like melatonin, increased lighting, soft music, a full-spectrum light box, and a carefully tailored routine can help minimize the confusion and agitation associated with sundown syndrome.

Unfortunately, I haven’t found anything that helps me. This isn’t meant to discourage you, but lighting up the house like a Christmas tree doesn’t work, and changing my routine has a nasty snowball effect, causing confusion and frustration in other areas of my life. Keep this in mind when you are considering changing your loved one’s routine. If you make changes, make them as subtle and incremental as possible.

Sundowning and the Season

Just be aware that the days are getting shorter and sundowning can be an issue. If your loved one is already experiencing symptoms, then they will likely get worse. It does for me and every other patient I know. It has to do with our internal biological clock. Everything gets confusing when we lose so much daylight and we have to endure all those dreary, dark and cloudy days that usher in winter. Even people without dementia can experience fatigue and mood changes this time of year.

Source: AgingCare.com

Create Your All-Star Care Team in 5 Steps

Create Your All-Star Care Team in 5 StepsIn this country, there is a growing problem regarding a lack of supportive resources for family caregivers. There are government programs, charities, and nonprofits that might be able to help intermittently, but what caregivers often need most is sound advice, regular respite and an extra set of hands.

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

 Step 1: Draft a List of Prospective Team Members

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

Step 2: Assess Each Individual’s Strengths

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

Step 3: Create Your All-Star Care Team

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

Step 4: Assign Roles for Each Member

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

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

Step 5: Add Some Pros to Your Team

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

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

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

Who Should Join Your Care Team?

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

Source: AgingCare.com

Helping Mom and Dad Make the Decision to Relocate in Older Age

Helping Mom and Dad Make the Decision to Relocate in Older AgeAt age 90, Marta’s mother still lived in the two-story farmhouse where she had raised five children. The white clapboard structure held a wealth of memories beyond measure, not to mention an attic’s worth of personal possessions, pictures and mementos of birthdays and Christmases gone by.

But Marta worried her mother could fall while walking to the barn and lay injured, undiscovered for days. The idea haunted her.

Finally the anxiety propelled Marta into sitting down with her mother to discuss the situation. “Mom, I worry about you. Maybe you should think about selling the house and moving into a smaller place closer to us.”

Like many older adults, Marta’s mother bristled at the idea of surrendering her independence and refused to budge.

What can you do when you feel your parents are jeopardizing their well-being by staying put at home? Or what about the opposite scenario,

when they announce they’re going to downsize to a retirement community that’s far too expensive for them to afford? How can you help aging family members make sensible decisions about these matters?

Try these suggestions for four common scenarios.

1. Refusing to leave the family home.

Many older adults have a vision of living at home forever. This might be because the idea of downsizing feels overwhelming or because they believe you will take care of them, bring them hot meals, drive them to appointments and so on. Or maybe it’s too painful for them to think about selling or giving away precious possessions.

To help guide the decision-making process in this situation, first try to determine the reason why your parents refuse to consider downsizing. Then address the underlying reasons, either by creating a plan to help them dispose of their possessions without guilt or to shed some light on the reality of how their future will actually look if they continue living in the family home.

For instance, gently articulate your own boundaries by saying something like, “Just to be clear, if you stay here at home, I want you to understand that I will only be able to check in on you each Saturday. I’m not always going to be able to take time off work to drive you to doctor appointments and things, so this is something you should take into consideration.”

2. Proposing to move to a place that is too expensive.

Whether we like to believe it or not, most of us are subject to peer pressure. And if your parents’ friends all start downsizing to pricey assisted living or retirement communities, your own parents may start to decide they want to do that, too.

But if you know they will not be able to afford such a lifestyle—now or in the future—you can point out the financial reality of the situation. Try painting a picture for them, so they can easily relate. For instance, you might say, “That sounds like such a nice place to retire to! Have you considered, though, that, with a monthly rental fee of X and your budget of Y, if your health needs change you could be faced with a choice between paying your rent or buying prescriptions? Maybe it’s something to consider.”

3. Announcing their intention to move in with a family member.

Many parents take for granted that they will simply move in with one of the kids when they can no longer take care of themselves. However, you should use caution before agreeing to such a decision. It could come with many benefits for both you and your parents, but it’s important to seriously consider the cons as well. Adding people to your household can upset the social balance and cause marital strife, as well as creating a possible financial burden.

One alternative is to suggest that you sit down together and make a list of the possible living options available to your parents, no matter how far-fetched they may seem. Jot down:

Move in with daughter/son

  • Assisted living
  • Retirement community
  • Long-term care facility
  • Stay in home with caregiving assistance

Don’t exclude any possibility during this brainstorming session. Then ask your parents to explore each of these options (including a tour, when possible) with you before making up their mind about what to do.

4. When cognitive impairment leads to unrealistic decision-making.

One difficult scenario many family caregivers find themselves in is when an older relative is experiencing mild to moderate cognitive impairment that renders them unable to make a realistic decision about their future living arrangement, even though they maintain enough function to live independently for the time being. How can you influence them to take a sensible course for downsizing and relocating?

In this case, you might consider engaging the services of a Geriatric Care Manager, at least temporarily. These individuals assess the living situation of an older adult and make recommendations for how to proceed in the future. Often, when the suggestions come from an expert (who also happens to be a neutral third party), an older family member will feel more open to them.

Rule of thumb: Try three times, three different ways

Marta wisely tried several different angles to engage her mother in a conversation about relocating. Over coffee, she casually took note of the dirty dishes piling up and the dust collecting on some knickknacks and offered to help with the housecleaning. Her mother declined. A second time, Marta expressed her fear that her mother might fall and be injured. Again, her mother took no notice. On a third occasion, Marta brought up the idea of her mother getting a medical alert bracelet. Her mother responded by stalking off to the garden.

After the third attempt, Marta backed off from the subject temporarily. Then, one day when Marta visited, she flipped a light switch and nothing happened. Thinking the bulb had burned out, she screwed in a new one, but still nothing.

Investigating further, Marta discovered her mother had forgotten to pay the electric bill for more than a month, and her service had been disconnected. Marta’s mother sheepishly admitted the lapse and declared maybe it was time to sell up and move into assisted living.

In a best-case scenario, it wouldn’t take a small catastrophe like this to prompt an older loved one to realize he or she needs to make a change in living situation. But even if this turns out to be the catalyst that finally moves things forward, know that your efforts to have these discussions and present options will pay dividends in the end.

Source: Caregiverstress.com

10 Tips for Family Caregivers

10 Tips for Family Caregivers

  1. Seek support from other caregivers. You are not alone!
  2. Take care of your own health so that you can be strong enough to take care of your loved one.
  3. Accept offers of help and suggest specific things people can do to help you.
  4. Learn how to communicate effectively with doctors.
  5. Caregiving is hard work so take respite breaks often.
  6. Watch out for signs of depression and don’t delay getting professional help when you need it.
  7. Be open to new technologies that can help you care for your loved one.
  8. Organize medical information so it’s up to date and easy to find.
  9. Make sure legal documents are in order.
  10. Give yourself credit for doing the best you can in one of the toughest jobs there is!

Source: Caregiver Action Network