Medicaid is one of the most misunderstood health care programs available to Americans. This is a real shame because many needy people are missing out on accessing their benefits. For caregivers of the elderly and the disabled, Medicaid’s programs can make the difference between surviving economically or being completely overwhelmed by costs of long term care for a loved one.
Spousal impoverishment rules are a godsend for older couples when one of them needs personal care services indefinitely. They offer a method to protect joint wealth and income while qualifying the unhealthy husband or wife for care services. Recent changes made by the Affordable Care Act (a.k.a. Obamacare) also significantly broaden these protections for married couples.
Unfortunately, government websites often do a poor job of explaining how these rules work and researching the regulations can leave the non-professional even more confused. Even many lawyers and social workers are uninformed about these important exemptions to Medicaid’s asset and income limitations.
When do the spousal impoverishment rules apply?
These are federal rules that apply when married couples are seeking Medicaid benefits for only one spouse. They only work when someone is needing long term care. These rules do not apply to regular Medicaid programs that provide health insurance benefits for individuals under 65 and non-disabled individuals. They also do not apply when both spouses simultaneously need long term care benefits.
What is long term care?
Long term care means that the individual needs personal assistance with usually two or more of the activities of daily living, such as bathing, dressing, toileting, eating, and transferring (getting out of a chair or a bed by themselves). Long term care can be provided in a variety of environments: at home, in an assisted living community, in a daycare center, or a nursing home with skilled medical staff on site 24 hours a day.
What are the eligibility criteria for long term care benefits from Medicaid?
Remember that Medicaid is administered by the states so each state has slightly different rules when it comes to qualifying for long term care Medicaid benefits. However, there are some general basics that are similar in all states. Individuals who have been assessed to need long term care through demonstrating their need for assistance with several of their activities of daily living will have to meet the financial criteria. These are income and asset restrictions.
What are the rules without spousal impoverishment protections?
Applicants for long term care benefits in most states must not have more than $2,205 per month in gross monthly income. Most states restrict assets at $2,000. This means that the applicant cannot have more than $2,000 between all their financial accounts, i.e. checking, savings, CDs, money markets, brokerage accounts, retirement accounts, and the cash value of life insurance. Effectively, you must have spent all your lifesavings before you can become eligible for Medicaid’s valuable financial aid.
What happened before there were spousal impoverishment protections?
Before Congress modified these financial requirements for Medicaid, married couples would have to spend all their joint wealth on one spouse’s care, leaving nothing for the other spouse to live on. This was an impossible situation for spouses and many had to have a “Medicaid divorce” to avoid the economic devastation. Spousal Impoverishments rules created a series of exceptions to the financial requirements so that the spouses could save some of their nest egg and protect some of their income.
What are the income protections for spouses?
Income protections guarantee that income in the non-applicant’s name is not counted when only their wife or husband applies for Medicaid. Income protections also help to boost up the income of a lower earning spouse when their higher earning spouse enters Medicaid. The exact amount of monthly income set aside for the non-applicant spouse will vary from state to state, but the figure will not be below $2,002 in the lower 48 and could be as much as $3,005 per month in 2017.
What are the asset protections for spouses?
Spousal impoverishment asset protections can reserve up to $120,900 for the at-home spouse. However, the details are more complex. Most states have rules that say that only one-half of the total countable wealth can be allocated to the non-applicant spouse, up to the maximum of $120,900. At a minimum, spouses will not have to spend funds that are less than $24,180.
States will often perform a Community Spouse Resource Assessment in which they count all the funds available to the couple and then determine how much can be set aside for the spouse. Sometimes these assessments are just done as part of the Medicaid application.
When to get help?
Because couples often have more money and more ways to save, they have the most to gain from working with a Medicaid planner. For example, the set of decisions around how to protect the home can be complex and are fraught with pitfalls if things are not done in the right order. Spouses of Medicaid enrollees also have a set of unique challenges when doing estate planning.
Elder Care Resource Planning is family business offering benefits planning services in all 50 states. They offer free initial consultations for families to plan for long term care Medicaid to make the most of the spousal impoverishments rules.
Patients are shelling out a larger amount of their income to healthcare providers now more than ever. In fact, according to Forbes, patient payments account for over one-third (35%) of revenue for providers.
This makes it the third highest revenue stream, with Medicare and Medicaid taking top spots. Even when patients have company-provided healthcare coverage, most still have to fork over payment for deductibles, copayments, premiums, and other out-of-pocket expenses.
With the trend in healthcare on the incline, it is safe to say that costs aren’t coming down anytime soon. Patients though can still take healthcare into their own hands and lower out-of-pocket healthcare costs by using these two tips. Read on to find out what they are!
1. Choose Generic Over Brand Prescriptions
Companies of brand prescriptions and over-the-counter medications would like you to believe that their products are the best in the healthcare industry.
And, with the number of advertisements pushing brand name medicine to consumers on a daily basis, it can seem like those companies are right.
However, the frequency of those advertisements is the only main distinction between brand and generic medicine.
According to the Food and Drug Administration (FDA), general medications are just as effective as name brand medicines in terms of safety, quality, strength, how they are administered, dosage, strength, and their performance characteristics.
The FDA also has its Generic Drugs Program perform rigorous reviews on generic medications to ensure they comply with all necessary requirements.
On top of this, the FDA inspects approximately 3,500 drug manufacturing plants per year to make sure they meet the FDA’s standards.
So, the next time you are at your local grocery store shopping for cough medicine, choose the generic brand over a name brand; it will help with your cough and your wallet.
2. When Not an Emergency, Go to Urgent Care
Both the emergency room and urgent care are places to go to when you need your illness or injury treated at that moment, however, there are clear distinctions between the two. Knowing them could save you a trip to the emergency room, which can cost as much as 40% more than your monthly rent.
Emergency rooms are for emergencies. They are facilities equipped with the latest machinery and staffed to handle the direst, most life-threatening situations, including severed limbs, heart attacks, facial wounds, and other critical injuries and illnesses.
Urgent Care Clinics
Urgent care clinics, while sounding similar to emergency rooms, aren’t intended for emergencies.
They are facilities for those who need to visit their primary care provider but can’t get in because it’s after normal business hours or appointments are booked up for the day or week.
According to Scripps, individuals can go to urgent care facilities if:
- their symptoms happen gradually and/or they already know what their diagnosis is
- fever minus a rash
- it’s painful to urinate
- ear pain
- persistent diarrhea
- throwing up
- sore throat
- Sprain or shallow cut (minor trauma)
Again, if it’s an emergency, go to the emergency room. Knowing the difference between the emergency room and urgent care could save you thousands of dollars, with you (or a loved one) going to urgent care for that sore throat instead of taking a costly trip to the ER—even when you work for a company that provides healthcare for employees.
With healthcare insurance on the up and up, it’s important to know how you can cut healthcare costs, even when you have company-provided healthcare insurance.
No matter what healthcare reduction tips you use, one of the best prevention tips is eating a balanced diet and exercising at least 150 minutes per week.
In doing so, you will save you that trip to your doctor’s office in the future. What other healthcare saving tips do you recommend? Leave a comment!
Wendy Dessler is a super-connector with Outreachmama who helps businesses find their audience online through outreach, partnerships, and networking. She frequently writes about the latest advancements in digital marketing and focuses her efforts on developing customized blogger outreach plans depending on the industry and competition.
How much notice is required if benefits change? Do insurers have to give you a heads up if your plan doesn’t meet the minimum coverage standard under the Affordable Care Act? Readers’ questions this month are centered around insurance notification requirements.
Q: My father’s health insurance coverage through his company was reduced without him being aware of the change. The insurance company continued to cover my parents’ bills until 10 months after the change. Now it’s trying to charge my parents for all of my mother’s doctor visits to manage her multiple sclerosis during that time. This will result in thousands of dollars in repayments. Can the insurer do that?
You may need to do some digging to figure out what’s going on here. Health plans can reduce the benefits that they offer or increase cost sharing during the plan year, but under the Affordable Care Act they generally have to notify enrollees 60 days before any changes become effective.
That doesn’t always happen, said Dania Palanker, an assistant research professor at Georgetown University’s Center on Health Insurance Reforms.
“It is very possible that something was done incorrectly, particularly if you have a self-funded employer that’s doing all the claims processing in-house,” said Palanker, who is a former health plan administrator.
Since the health plan continued to pay the claims for your mother’s multiple sclerosis for 10 months after the change, this may not be a notification problem, however.
“It suggests that the insurance company did a claims audit and determined that they should never have been paying these claims,” Palanker said. Such audits are common. “They do it routinely to try to identify fraud and abuse.”
Some states don’t allow insurers to retroactively adjust claims except in cases of fraud.
Your first step should be to contact the health plan to find out why the claims were denied retroactively. Then, regardless of the reason for the back charges, your parents “should absolutely complain, no matter what,” said Karen Pollitz, a senior fellow at the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)
Depending on what you learn, your dad’s human resources department may be helpful in resolving the problem, said Pollitz. Or you may need to file an appeal with the health plan, complain to your state insurance regulator or to the federal Department of Labor.
Q: As a longtime self-employed businesswoman, I’ve bought coverage on the individual market for years. I was unaware that the short-term health insurance policy I’d been sold didn’t meet ACA requirements. The pricing was similar. Don’t people have to agree in writing that they understand the limitations of those policies? Is there anything I can do?
As of last January, short-term health plan enrollment applications and related materials were required to display prominently a warning that the plan doesn’t satisfy the health insurance coverage requirements under the ACA. There’s no requirement that people acknowledge in writing that they understand what they’re buying, however. Since these short-term plans aren’t considered adequate coverage, you may have to pay a penalty just like people who don’t buy any insurance.
In your case, you may have purchased the plan before that requirement went into effect, said Timothy Jost, an emeritus professor at Washington and Lee law school who is an expert on health law.
As for remedies, fortunately the open enrollment period for 2018 starts Nov. 1. You can sign up for a more comprehensive plan at that time on your state marketplace for coverage that begins Jan. 1.
Q: I was hospitalized with a traumatic brain injury, had surgery and spent two months in the intensive care unit. Now my insurer is no longer covering some of my medical care. Does my insurer have to notify me of this change, or is it sufficient that the hospital insurance case manager verbally informed me?
Health plans have to notify you in writing when they deny a claim. But in your case, there may not have been an actual denial, Palanker said.
Hospital staff are typically in constant communication with a patient’s insurer about what services are covered, whether a particular treatment requires prior authorization from the health plan, or similar issues.
It’s not uncommon for a doctor to want a patient to remain in the hospital, for example, while the insurer maintains that it’s not medically necessary, Palanker said. The insurer may want the patient moved to an inpatient rehabilitation center or discharged home instead.
In these cases, there’s not an actual adverse determination and thus no requirement that the insurer notify you. The hospital case manager would likely be the one to inform you of the change.
You still have a right to that information. “The patient should ask the case manager what was asked of the insurer and then ask the insurer what is the basis that something is not covered under the plan,” Palanker said. The hospital’s patient advocate or caseworker can work with the patient to put together the necessary paperwork to request a determination and file an appeal with the insurer, if necessary.
Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.
Dementia is an umbrella term for a progressive age-related disorder which is primarily seen in senior patients. It is associated with deterioration of the patients’ memory, cognition, behavior and a decline in their ability to perform activities of daily living. Alzheimer’s disease is the most common type of dementia that makes up nearly 70 percent of the cases.
One in ten Americans aged 65 years and older suffers from dementia. 2017 statistics reveal that an estimated 5.3 million senior Americans are living with dementia related to Alzheimer’s disease.
According to the U.S. Census Bureau, nearly 28 percent of seniors aged 65 years and older are living alone. Seniors with dementia are at a higher risk of social isolation, leading to serious consequences for the patient.
If you have a senior loved one who is suffering from dementia, it is crucial that you engage him/her in suitable social activities to make him/her feel loved and cared for.
Here are five ways in which social interaction can affect your senior’s health positively and boost his/her longevity and mental wellbeing.
1. Social Interaction Preserves Cognitive Function
Research has found a strong connection between loneliness and impaired cognitive function. Patients with dementia are often pessimistic about their future and tend to feel lonely owing to social isolation. This happens mainly due to retirement, the death of a spouse and/or close friends, and the lack of mobility.
Numerous studies confirm that seniors with dementia who have a strong social network experience delayed cognitive impairment. Larger social circles have a protective influence on the comprehension and reasoning ability of seniors battling dementia. Seniors who have a considerable amount of support from their families are at a lower risk of developing memory-loss symptoms.
When seniors interact with other family members, relatives, and friends, they have to think of ways to converse and respond. Scientists believe that this basic exchange is a form of exercise that stimulates the brain cells and the formation of brain synapses, thus fueling the creation of new nerve cells.
Encourage and help your senior to build a social network by participating in voluntary and social service activities and cognitive rehabilitation programs. These activities can be a valuable source of social connection for your elder, making him/her feel valued.
2. Meeting People Comes with Psychological Benefits
Dementia is often associated with psychological conditions such as stress, depression, anxiety, and mood disorders. Researchers estimate that nearly 95 percent of seniors living with dementia suffer from behavioral and psychological symptoms such as agitation, aggression, depression, delusions, hallucinations, and sleep disturbances. These symptoms are commonly referred to as the neuropsychiatric symptoms of dementia.
Seniors with strong family and social bonds tend to have a positive outlook as they have someone reliable to talk to. Remaining socially active can significantly reduce the risk of psychological disorders and improve sleep quality.
Getting quality sleep is crucial for dementia patients to calm their psychosomatic symptoms of depression and anxiety. The National Sleep Foundation states that undisturbed sleep relaxes the brain and helps it focus and retain information better.
Plan meaningful activities for your senior, keeping in mind his/her physical abilities, leisure interests, past work life, and social preferences. Take your senior for a movie or a play, invite family and friends for a game of cards, or go through a photo album and talk about old times. These activities will improve your senior’s mood and reduce challenging behaviors.
3. Get-Together Offer Physical Health Benefits
Engaging in social interaction offers numerous physical benefits to patients with dementia. Participating in group physical activities improves the patients’ ability to perform activities of daily living and reduces the risk of falls.
Group activities like exercising, walking, and playing games offer social interaction opportunities and can be adapted to suit a wide range of physical limitations of seniors.
Take your senior for regular walks in the park. Encourage him/her to join yoga, meditation or exercise class. Engaging in group exercises builds a strong social circle, improves mood, boosts physical strength, and reduces the risk of age-related ailments.
4. Socializing Improves the Overall Quality of Life
Dementia can significantly impact your senior’s quality of life, causing him/her to feel isolated, agitated, frustrated, depressed, and embarrassed. Your senior’s inability to perform daily tasks and remember simple things can affect his/her emotional wellbeing as well.
Patients with dementia often land up in hospitals mainly due to fractures, urinary tract or chest infections, or strokes. These patients have twice as many hospital stays every year compared to other seniors, contributing to a total annual healthcare cost of $259 billion.
According to a research paper presented at the Annual Alzheimer’s Association International Conference, social interaction can significantly improve the quality of life of patients with dementia, ease their agitation, and reduce overall healthcare costs. Support from family, friends, and relatives can go a long way in building the confidence of elderly patients.
5. Social Stimulation Promotes Independence
Seniors with dementia need assistance with personal and domestic tasks. Moreover, they often feel frustrated about and guilty of not being able to help with household activities. This increased dependence on others and feeling of being incapacitated often makes them irritable and damages their confidence levels.
Having compassionate loved ones who celebrate happy times with them and listen to their frustrations and offer solutions can be extremely comforting for seniors with dementia. This social stimulation fosters their independence as they feel connected and secure about their support system that assists them when required.
Involving your loved one in simple domestic activities like sorting out the post, organizing the laundry, arranging fresh flowers, and laying the table for a meal can make him/her feel involved and boost his/her confidence.
Seeing a loved one live with dementia can be painful. Fortunately, personal relationships and social environment can play a principal role in improving the patient’s cognitive skills and overall quality of life. Caregivers, family members, and friends can help their ailing loved one feel more valued by being around him/her during this tough period.
There is mounting evidence highlighting the role social interaction plays in improving the lives of seniors with dementia. The above points will help you encourage your senior to engage in activities that will build and strengthen his/her social circle, enabling him/her to live a fulfilling life.
Evan Thompson, CEO and founder of Senior.One has a long standing interest in finding solutions for seniors. He helps connect senior citizens and their family members with elder care service providers and find the resources they need in one place. He offers information on nursing homes, hospice, financial planning, adult care, lifestyle and assisted living facilities in Albuquerque. He provides information on housing, medical professionals, financial planning services, and lifestyle options.
Our son, Ben, is responsible for bringing the most remarkable people into our family’s life. They’ve come in the form of teachers, therapists, bus drivers and service providers – all caregivers who have shared their life with ours. I’ve learned that there’s no good reason to wait to say thank you.
Ben was born with severe cognitive, physical and speech development issues that require 24-hour care. If not for his caregivers, I don’t think Ben or our family would be in the good place that we are today.
The relationships we’ve developed with Ben’s caregivers have helped us establish a strong network of support. We are grateful for them and their willingness to care and love him as much as we do.
They’re caregiving has extended further than their job duties. When I’ve needed advice about how to approach a situation or vented about bureaucratic issues that prevented Ben from receiving services, they’ve provided insight or a listening ear to help get me through the tough times.
They hear the words, “thank you,” from me on a regular basis, but I also attempt to do something special for them as well.
Here are 5 ways to say thank you throughout the year:
Create a care package
Put special items in a box or reusable bag to show your appreciation for their work. Bus drivers and bus monitors are often underappreciated for what they do. A care package with a box of tissues, baby wipes, paper towels and glass cleaner will make them feel appreciated and help them be prepared for eventual situations. It also saves them having to buy these items with personal funds.
Consider making a “survive the first week” box for a teacher. Send in a tote bag with lip balm, mints, aspirin, a chocolate bar and other personal items that the teacher can have at their disposal during that hectic first weeks of school.
Give a gift for the road
Therapists often drive throughout the day traveling to different schools and homes to work with clients. Purchase a small lunch bag and fill it with a drink, snack and a magazine for a treat in between clients.
Many caregivers would appreciate a gift card to a local coffee shop or cafe so they can have a moment alone.
Volunteer your time
In some cases, giving a bit of your time can help ease the pressure off a caregiver or give them the opportunity to attend a special event.
I’m active with a leadership team at my son’s school because his teacher asked me to a be a part of the group. His teacher represents the interests of the special education program, and I can show my support of her and advocate about issues that affect her class.
Make or bake something
My favorite gift is a handmade bookmark that has the poem, “You’ll never know” printed on it. Add a bookmark to a book by a caregiver’s favorite author, a paperback for the beach or a volume of inspirational poems.
Not crafty and don’t have the time to bake? Pick-up store-bought muffins or cookies. It shows someone that you care about them.
Write a note
Most of us worry about stumbling over the right words to say how we feel about someone. In fact, that apprehension sometimes prevents us from ever writing the note. But words can mean so much to the receiver. Say thank you, pick one thing you are grateful for and sign it with your name. That’s it.
At the end of each year, I write the bus driver and monitor a note telling them how much it’s meant for me to know that Ben was in safe and capable hands while on the bus.
Are you waiting to say thank you to someone special in your life? Try one of the ideas above or use one as an inspiration to develop your own unique thank you.
Doing this already? Tell us who you show appreciation to. How do you say thank you? Add your ideas in the comment section.
Vanessa Infanzon is mom to three beautiful boys. Her oldest son, Ben, is a smart, funny and determined 14-year-old. He doesn’t let anything stop him from doing what he loves – swimming, being outdoors and eating out. Vanessa is also a contributing writer for Ross Feller Casey.
The National Alliance for Caregiving and AARP issued a joint report that said “a 49 year old woman caring for a 69 year old female relative” is the average caregiver. They are also women with children and a job. The majority of the estimated 40 million caregivers are members of the sandwich generation. These are people sandwiched between caring for their own children and taking care of their parents. Throw in partners and grandchildren and you are sandwiched in multiple full time roles. The addition of the caregiver role along with these other demands associated with this profile makes being a caregiver all the more challenging.
The challenge of balancing multiple responsibilities is real and great. Here are some management tips to keep in mind:
- Don’t be afraid to say no when you are asked to do something you know you cannot do. You are entitled to do this without heaping guilt on yourself.
- Create a list of priorities. Set daily and weekly priorities. Keep in mind while doing this that inherent in these caregiver profile is the possibility that things can change or a crisis can arise. Give yourself permission to reprioritize as circumstances change. Allow yourself some flexibility as needed.
- Remember to take care of yourself. The biggest mistake caregivers make is forgetting to take care of yourselves. If you burn out then you will not be capable of helping anyone else. If you don’t want to do it for you do it for the other people close to you that are a part of your daily life.
- Give yourself permission to ask for help. No matter how efficient and superhuman you are there are going to be moments that arise when you will need help. It does not mean you are a failure. It is important to identify other people that you can call on when needed. It may be a relative, a neighbor, a friend, or someone from church. Try using Peapod or hiring someone to help with cleaning. If you need help with caregiving consider consulting a geriatric care manager to help you assess and find the help that is needed. There is a national site to consult that will help link you to people in your area @ https://www.aginglifecare.org/ALCA/About_Aging_Life_Care/Find_an_Aging_Life_Care_Expert/ALCA/About_Aging_Life_Care/Search/Find_an_Expert.aspx?hkey=78a6cb03-e912-4993-9b68-df1573e9d8af
A key aspect for caregivers to be successful is to create a mindfulness plan. This means to incorporate techniques in your daily life that will help nurture and recharge yourself. Here are some suggestions on what you can use in your caregiver self care regime:
- Take care of your body. (Eat well, get enough sleep, and exercise as best you can)
- Focus on the present. Celebrate the little victories and positive things that happen each day. It may be something small like helping a loved one get dressed or go outside. They are still victories and are worth celebrating.
- Find a kindred spirit to talk to. Identify someone in your life that you can go to and talk candidly about the good and bad things that are going on in your life. Pick someone you trust and can laugh and cry with if needed. If you don’t have someone like that in your life consider finding a counselor or therapist that can be there to offer you this all important emotional support. Chat rooms online are also a great place to get support and hear from others with shared experiences. They can empathize and may have helpful tips culled from their personal experience.
- Include joyful activities in your role as a caregiver or a parent. Choose activities you enjoy doing. Play music and dance with your kids and the person you are taking care of. If your care recipient can’t dance then pick songs you both like and sing. Find things that bring all parties pleasure and make your time together more meaningful.
- Collaborate rather than confront. This basically means pick and choose your battles. Often times caregivers will find that there are many ongoing battles particularly with people with dementia or medical problems that cause loss of mental or physical function. This creates loss of independence. Feelings of depression and anger can emerge that frequently are focused on caregivers. If the care recipient insists it is Tuesday and you know it is Thursday don’t challenge it. If they are wearing clothes that don’t match let it go. As long as what they do or say is not compromising health or safety try not to confront them.
It’s incredibly stressful to have someone you love in the hospital. Not only are you worried about their health, it almost seems like hospitals were designed to be as stressful as possible! Constant interruptions, florescent lights, beeping and blinking machinery, and incredible levels of crowding guarantee we’re all on edge.
Sometimes, especially with teams of medical staff coming and going at random, I wonder if my son is getting the best care. Are these staff members familiar with his medical history? Do they have all the information they need? Are they ordering tests he doesn’t need and skipping over ones that might be more appropriate? Medical staff are rushed and exhausted…and only human.
After more than a decade of being in-and-out of hospitals with my son, I feel confident in my ability to advocate for him to get the best care possible.
I always keep a notebook with me. I take notes when I’m talking to the doctors, including their names and titles, so I can keep track of things. I ask questions of the doctors at the time, but I also have the details I’ll need to look things up on my own later and ask follow-up questions.
I ask staff members if it’s okay to contact them with questions and how they prefer to be contacted. If someone is okay with me emailing them questions I make sure not to abuse the privilege and be respectful of their time.
I stay calm. Yes, it’s an emergency for me and my son is my top priority. But I recognize that’s true of just about everyone in the hospital. Hospital staff need to balance the needs of all of their patients, so I’m firm in asking for the care he needs, but also remember that things can’t always happen on the timeline I’d like.
I’m persistent. It’s tough to find the right balance of making sure things aren’t forgotten without becoming that mom.
I’m open to suggestions. My son and I know his health best, but we’re in the hospital for a reason — these people are experts, too. It can be difficult, but I try to make sure we’re working with his medical team and not just trying to convince them to take the course of treatment we think is best.
I appreciate the staff. Hospital staff are people. They have good days and bad days, too. I try to remember this, thank them for their help, and cut them slack when they drop the ball. Treat others like you’d like to be treated.
After three months of using hot compresses to shrink the stye on my daughter’s eyelid, it wasn’t getting any smaller. My daughter is prone to this sort of growth, called a chalazion. This one would have to be removed surgically, like the one she had removed from the same eyelid two years earlier. But there was… (more…)
Before there were nursing homes and social security legislation, the elderly lived in almshouses which also housed insane, homeless and inebriated people. Living conditions in these facilities were horrendous and dangerous. Thankfully, after some legislation passed nursing home numbers began to rise and gave seniors a better environment to live. Although there are still problems that occur, nursing homes are adopting new innovations and technologies to increase the quality of care for the elderly population.
The number of people older than 60 is set to hit one billion by the end of the decade, according to the United Nations Population Fund and HelpAge International. These increasing numbers show us the importance of the future of nursing home. With new advances, nursing homes are working towards a more active, social and healthy lifestyle that seniors can enjoy as they age.
For seniors that don’t require nurse care full time, independent living is becoming a popular choice. This allows the elderly to live in a senior facility and still have the ability to make independent choices on mobility, activities and food preparation. The elderly are also starting to co-house with one another allowing them to share the responsibilities and bills. With user-friendly technology such as alarm sensors that detect floods, carbon dioxide leaks and if someone falls makes these options viable for seniors who are still active.
Senior can be lonely and miss their family while living in nursing homes but video technology is helping them to connect. Services such as Skype or Facetime allows seniors to see and talk to their families, friends and even doctors. Technology advancements in wearables and mobile health are also helping seniors. Wearables can help healthcare providers to monitor heartbeat, hydration and physical activity. Mobile health can help remind seniors about medical appointments, insurance, records and taking medication.
Technology will continue to impact the way the elderly population are cared for. Caregivers need to stay updated with all the options in order to choose the best for their family members.
Adventist University’s Online Master of Healthcare Administration degree program
There are many compelling reasons that surround my move back home to live with my elderly mother—none the least of which is the near accidental overdose from the many Rx prescriptions whose labels she can no longer read.
Ask yourself these 4 questions to determine if you might need a little help in sorting out your own Rx mess.
1) Does your eyesight still allow you to easily read the Rx labels so you know the proper dosage to take?
2) Can you hear well enough over the telephone to place renewals for your Rx? Keep in mind automated phone robots—not the pharmacist—usually take and confirm your orders.
3) Do you have an organized system for dispensing meds so there is no confusion over did I already take my pill, or did I forget to put it on the tray?
4) Do you have a way to keep track of when renewals are due? Or are you surprised when you find an empty bottle and no pills left for today’s dosage?
I am sick at the prospect of taking on this role by myself. But after the brother living nearby trains me, it becomes part of my new weekly routine soon enough.
Studying his approach to counting, sorting, chopping and calling for the renewal of these pills, I feel confident that I can reorganize the grocery sack housing my mother’s entire health regiment.
3 Steps to Streamlining Your Rx Mess:
Step 1- Familiarize yourself with the pills.
- Know your pills by name and the reasons why each is taken.
- Know when and how the pill should be dispensed…with water, food, or on an empty stomach?
- This should be obvious, but be sure your doctor knows all of the medication you are taking in case one pill has a reaction with another. Especially important to communicate if you have more than one doctor—or are meeting for the first time a physician who is new to you.
- Laminate your pill chart (at end of post) and keep it in your wallet.
This will be essential information to provide at every doctor visit.
- Recognize the grooves and sizes that distinguish all white pills from each other. After the first time you drop your med tray (it happens!), spilling pills everywhere, you will know just how to put it all back together again.
Step 2- Streamline Rx Storage
- A shoebox holding a dozen prescription bottles upright works for me.
- Sorting the bottles in alphabetical order will make your inventorying much easier when it comes time for renewals later.
- On top of the bottle cap, write the renewal date due in Sharpie pen.
- Keep the blade for chopping pills inside this box as well.
- The shoebox is for storing the Rx bottles.
The med tray is for holding the day’s dosages.
Different sized med tray dispensers range from one time a day for 7-days to multiple times of the day for 7 days. The latter is what I use—and here is why I love it. There are four vertical rows, with 7 cells across in each row. The first two rows are yellow. The two rows beneath are blue. Guess what? Since I do not need to dispense meds four times a day, I re-label the slats to give me two weeks worth of pre-planned pills. Now I can load the tray with A.M. and P.M. meds knowing that the yellow is for week 1 and the blue is for week 2. Time saver for sure!
Step 3- Remember Renewals
- Do not put a nearly empty pill bottle away without red-flagging it.
Forgetting that tonight’s dinner pill was never renewed can be further complicated when it requires a doctor’s approval which—this being Friday—you will not get until Monday.
- Post renewal dates on top of standing bottles for a better alert.
- Laminate a version of the following Rx chart for your purse or wallet.
Pills, Powders, and Potions Chart
Laminate prescription chart to keep in handbags, and wallet for appointments.
|Date Last Modified:
||Primary Care Information
|Name of Patient
||Name of Doctor
||Front office name(s)
||Suite #, City, Zip
||1st Pharmacy choice:
||2nd Pharmacy choice:
(add strength mg)
||Date Last Filled
|List in alpha order
|↑Pharmacy to fill Rx
(check this box↓)
|↑Pharmacy to fill Rx
(check this box↓)
|Needed for refill
||Make a note for pills cut in half
||Write on tops of bottles for ease
||Write on tops of bottles for ease
Now that you have taken stock of your Rx collection and sorted that mess from your grocery sack storage, you should be well on your way to managing your prescriptions with greater ease and care. With your new system in place, it will be a breeze if and when someone else needs to take over for you.
“What to Ask When Hiring a Caregiver?” will be the next blog posting here.
Being a caregiver for someone who has a memory deficit can be extremely challenging. It becomes even more difficult when that person is unaware of their dementia or any other limitations associated with it. Dementia can directly impact a person’s ability to follow directions, can compromise their safety, impedes problem solving and abstract reasoning. It can cause them to be impulsive or unrealistic about their abilities. There are things you can do and approaches you should avoid as a caregiver facing these parameters.
From an emotional standpoint it can be extremely frustrating for a person with dementia to be told they should not be doing tasks they believe they are very competent to manage. Any caregiver trying to create a safer environment may be on the receiving end of angry outbursts and defensiveness from the person with dementia whom they are trying to keep safe and protect. Here are some suggestions about how caregivers can approach working with a person with dementia who is unaware of it:
Communicate in a calm manner.
Be as empathetic and supportive as you possibly can. Be aware of the tone of your voice and the message you are sending and how it is or is not being received. Also be aware of your body language and facial expressions and what they convey.
If you find yourself starting to get angry or stressed remove yourself or take a time out for your own sake rather than arguing.
Take a break from the conversation or task at hand. If it safe to remove yourself from the person you are watching give yourself a few minutes to take a deep breath, regroup your thoughts, and calm down.
Try to separate the person from the disease.
This is tricky but important. Remind yourself the person with dementia is not intentionally trying to be contrary. The disease is causing their memory loss or inability to do the things they used to. Sometimes recognizing why someone is behaving in a negative way helps you get to be in their shoes and makes you feel less attacked and more understanding.
Don’t engage in arguments about who is right or wrong.
That won’t help anyone. All that does is reinforce the deficits the people with dementia has causing them to dig in and not do what you need them to do. Does it really matter if they think it is Thursday and you know it is Friday? The best thing to do is to distract or disengage from that conversation and focus on something that is neutral or something you know they will enjoy. People with memory problems may confabulate, or make up answers to explain things that happen. Just let them say their version of events and then move on to something else.
Try to pick tasks you can do together and work as a team.
Everyone wants and needs to feel wanted and useful. Maybe they can help put laundry in the washing machine or put dirty dishes in the dishwasher. Even if they make a mistake you can always pull the dirty dish out later if the dishes were clean.
Try to create as positive a relationship as you can.
Be friendly and warm with the person you are caring for. They will be more apt to work with you than against you if they sense you are on their side or feel friendly towards them. You can do this by trying to give them as much control as possible about things that need to be done, and when and how they should be done. This makes them feel better when they believe they are making these decisions.
Give them two choices that are both acceptable options.
For example, lay out a blue and red shirt ask them to pick the one they want to wear that day. Do you want chicken or tuna for lunch today?
Break down the task that need to be done in as few and simple steps as you possibly can.
Make it as easy as possible for them to do chores or tasks. Have the watering can out and put water in it and the flower on the counter.
Don’t infantilize the person.
Don’t talk around them or about them when they are in front of you as if they were not there. Talk directly at them using their name. It is important to continue to reinforce people and their names to enhance memory.
Don’t remind them what they can’t do and reinforce what they can do.
Nobody wants to hear all of the things they can’t do. It is human nature to crave approval from others. Maybe grandma can’t play guitar anymore but she still has a beautiful voice. Pick a song you know she can sing and ask her to sing it for you.
Validate their fears or concerns.
Try to express your understanding about any fears, frustrations or anxiety they discuss. Be as empathetic as possible and validate their feelings as best you can. If they express fear for example, tell them “I know you were scared by that loud noise, I would be too. I am going to see what I can do to make it stop or make the noise less loud.”
You may have heard from a friend or family member that seniors are the at the biggest risk for scams. It’s a commonly touted idea that because seniors have more economic freedom than other classes of society, because they worked more years on average, that scammers target them assuming they have lots of money to spare.
As it turns out, this isn’t just an urban myth. The hyperlinked article shows the results of research conducted by the North American Securities Administrators Association (NASAA). The results show clearly that seniors are the most targeted population group per capita. “It is imperative that we detect and prevent senior financial fraud before criminals who prey on our most vulnerable citizens steal from and devastate them,” said NASAA President and Minnesota Commissioner of Commerce Mike Rothman.
The good news is that are steps that seniors and their caregivers can take to seriously reduce their risk. The first step is free. Check out the infographic in this post and teach the senior to identify the most popular type of scams. By identifying and understanding how they work, the senior will be able to be more alert to the risk when a scammer contacts them. There are also identity theft protection services that can help provide aid to seniors after-the-fact. If their online security was breached, services like LifeLock will stop the damage and restore the senior’s credit.
If the senior uses a landline it is a good idea to look into some form of Caller ID. This might seem unnecessary to those who grew up using cell phones, but many seniors still don’t know who’s calling until they pick up the phone. This places them at increased risk to pick up for a scammer. If the phone screen/attachment read “Unknown Number” rather than the actual digits of the caller, they would be on high-alert and more likely to pick up a scam.
The combination of software protection like the caller ID and identity theft services, along with the manual identification of risk factors with the senior, should substantially reduce their risk of being scammed. There’s no need to frighten them with heavy statistics about their scam risk — the best approach is always to frame the problem in a positive light, by showing them how much they stand to gain by making sure they’re well-protected. This approach will increase the chances they’re receptive to understanding the risk factors.
Community Manager, LifeLock (a Symantec company)
For every 100 million Americans who live with chronic pain, there are that many caretakers. The National Alliance for Caregiving and AARP conducted a national survey looking at family caregiving in the United States. The average caregiver renders 21 hours a week of unpaid care, has been caregiving for about 5-1/2 years, and can expect to maintain that level of care for an additional 5 years.
There are burdens for the caretaker just as there are life changes for the pain patient. Coming together is the beginning. Keeping together is progress. And working together is success.
Ulf Jakobsson, professor of the Center for Primary Health Care Research at Lund University in Lund, Sweden, explained, “Beyond the pain, there may be adverse effects on daily activities and quality of life for patients and their families. Some of these effects may include disruption of an individual’s ability to concentrate, be productive, socialize, or sleep, and may lead to feelings of isolation, depression, and anxiety.”
For the Pain Patient
It’s really easy to get lost in your pain. Yes, it can be all consuming but do not let that stop you from living. There are actions you can take every day to help you find your new normal. Start here.
Move. Try simple exercises or yoga. Movement helps loosen your muscles which can decrease your pain while allowing you to feel productive. Instead of taking the elevator, take the stairs. Every little bit helps. Depending on your pain levels, you can work with a physical therapist to avoid further injuring yourself. The main goal of physical therapy is to educate patients on the mathematics of stretching and strengthening, which in turn, aids in managing your chronic back pain — eventually accelerating your tissue healing — leading to recovery.
Invite. Ask your caretaker to attend a doctor’s appointment with you. Ironically, sometimes, if a caretaker doesn’t hear the information directly from a medical professional, they may not fully grasp the depths of your pain. Yes, they observe you on a daily basis, but it’s different. They may only see that you need guidance and may not understand why. Bringing them along to your appointment will allow them to hear straight from the horse’s mouth. It may even help them to appreciate how you feel on a daily basis when you ask for help.
Join a Support Group. Even if your caretaker apprehends your chronic back pain a little more, they may never completely relate to what you are going through. That’s why finding a local or virtual support group where people with your condition gather can be helpful to speak with like minded people who feel your pain, every day.
For the Caregiver
Guadalupe Palos, a licensed clinical social worker, registered nurse, and clinical research manager at MD Anderson Cancer Center in Houston, Texas , shared, “Caregivers of people in pain face a unique danger — it’s very easy to make the pain experience the center of the entire family’s world.
“For example, the atmosphere in a home often may be linked to whether the person in pain has a good or bad day. If it is a bad day, the caregiver’s reactions may range from being overly protective to silent anger. Whatever the reaction, it may affect other family members and even the person experiencing the pain. If the caregiver uses empathy and maintains a sense of calm, the family world is safe. But if the reaction is negative, it contributes to the chaos of the pain experience.”
Stay Calm and Be Supportive. Palos says to encourage the patient to become a self-advocate for their pain management. If they are included in their care, it may distract them from concentrating on their pain.
Communication is Key. Speaking, watching and listening are three crucial ingredients necessary to care effectively. Palos also explains that direct verbal communication between the patient and caregiver offers a better evaluation for greater pain management.
Take Time for Yourself. This is not being selfish. This is a way to keep your sanity. You are just as important as the patient you care for and you can’t properly care for another if you neglect to care for yourself.
“There are some simple things, including (a) doing something for yourself every day, such as meditating, taking a walk, or talking to a close friend; (b) not isolating yourself because of your caregiver role: (c) accepting the help that people offer; (d) bringing humor into your life; and (e) finding your spiritual self,” Palos concluded.
All for One and One for All
When you’re a full-time caretaker, it’s easy to think that your job is to sit stationary in the house with the patient watching television or waiting on them. Get creative. Find ways to get outside the house and do things that meets each of your internal needs and breaks up the in-house routine.
Get Busy, Together. Engage in normal activities that the pain patient and caregiver alike can do unitedly. Think outside of the box. Consider seeing a movie together, allowing the caretaker to choose what you see. Or try a mediation session where you both can get your zen on while bonding in a unique fashion. Regular meditation can work to lower the body’s level of pain as well as improve sleep.
Get Active, Together. Start small. Instead of driving to that appointment or errand, try walking there together. It doesn’t have to be a sprint, just whatever your bodies can handle. If walking to an appointment will not work due to your location or the patient’s pain levels, go for that leisurely walk around your neighborhood with one another. The vitamin D and wind on your faces should improve your mood and allow you to take that break from the household monotony.
Lifestyle Coach and Certified Personal Trainer Simone Krame says, “Fitness is not always running the marathon or pushing ourselves to the extreme until we puke. It’s about moving in a way that feels good. It’s about getting that energy flowing and the endorphins moving – doing something that helps us. Our bodies are the physical homes for our spiritual selves, and we must take care of them in order to live a healthy lifestyle.”
So whether you’re the caretaker or the patient, instead of working against each other, work with one another. For the one in 10 Americans who live with chronic pain and their associated caretakers, this one’s for you. After all, we cannot accomplish all that we need to do without working together.
Macey Bernstein is a content specialist with a passion for crafting useful and actionable content that improves the lives of her audience. She is a dedicated reporter with a nose for news, a love for community, and a reputation for impeccable ethics. From writing press releases and legal briefs to event planning and execution she displays exceptional skill in journalism and creative direction. Macey is a graduate of the West Virginia University School of Journalism with a bachelor’s degree in journalism and public relations. For more information visit her Website.
This summer has already been a scorcher, and sadly, deadly for the most vulnerable populations, including our elders.
Arizona’s record-breaking heat wave has already claimed lives, and the rise in heat-related deaths, especially among the older population, is expected to increase.
While there is a robust public awareness campaign when it comes to leaving kids and pets in hot cars, it seems there is not as much of a focus on the dangers of heat exposure in the elder population. Some urban communities offer cooling stations and free fans for the poor and elderly, and these are important initiatives. But making resources available and getting people to use them can be two very different things.
I live in the Deep South, where air conditioning for the most part is seen as a necessity. However, as a kid in southern California, there were apartments we lived in that didn’t have air conditioning, and our family cars never had air conditioning. Entering a car that had been sitting in a sunny parking lot on a sweltering summer day for hours, felt like an oven, taking your breath away. I remember my skin sticking to the hot vinyl covering of the back seat, and my father would keep a couple of rags handy so he could touch the steering wheel without getting burned.
My less-than-fond memories of the heat were on my mind recently, after I spent two weeks tending to what was my parents’ condo in New Mexico. Yes, parts of New Mexico get insanely hot (such as Roswell) but my parents lived in mountainous Ruidoso, and though it’s only an hour and a half from Roswell, the difference in climate is surprising. While Roswell may be roasting in the 100s for most of the summer, Ruidoso usually maxes out in the low 80s. Summers are typically pleasant, moderate affairs, at least until monsoon season begins.
But not so this year. The high temperatures spiked into the 90s most days that I was in Ruidoso, and the condo does not have air conditioning. I survived the heat wave with just fans, but it was not pleasant. I’m in my early 40s and in reasonably good health. The heat left me feeling lethargic and sleep was difficult. It didn’t help that I caught a summer cold on top of it all. I would hate to think about handling that type of heat 30 years from now, while likely dealing with other chronic health issues.
The thing about heat is that it can be a stealthy killer, and its effects can sneak up on a person. I’m a big water drinker, so staying hydrated is a no-brainer for me, but I remember how hard it was to get Mom to drink enough water when I was her caregiver. Older generations grew up used to doing without, and may think it’s petty to complain about something like the heat.
I ran into a related problem with my mother. She insisted upon turning off the heat overnight, even though the temperatures could drop well below freezing during the winter. Mom also insisted upon leaving all of the windows open a crack, because she feared carbon monoxide poisoning. (A carbon monoxide monitor did not dissuade her open window habit.) As she was recovering from cancer, she said on one particularly frigid night that she’d like to leave the heat on. I nearly collapsed from shock. I kept my composure while being supportive of her “decision” that I had suggested dozens of times before. And it worked. Mom kept the heat on low during the night, which helped her sleep better and aided in her recovery.
It’s not enough to buy your elder loved one an air conditioner or make sure the furnace is in good shape. I’ve read far too many accounts of older people who had air conditioning, but refused to use it, due to financial concerns or just distrust of modern conveniences. I would encourage family caregivers to check in daily with their older loved ones who live in extreme climates, and see how they are doing. For long-distance caregivers, a neighbor or friend may be willing to stop by and make sure the home is at an appropriate temperature. It’s so easy to take these things for granted, but heat waves and cold snaps are still costing people their lives.
The busy summer vacation travel season is well underway, as families and friends gather for special occasions, trips of a lifetime, and everything in between. Whatever means of transportation is required, traveling with an older parent or loved one can add layers of complexity to a journey – not to mention assistive equipment such as walkers and wheelchairs – but sometimes a necessarily leisurely pace can allow everybody involved to relax and truly enjoy themselves, no matter what time of year you and your elderly companion hit the road.
Flying With a Senior Companion
Unpredictable delays notwithstanding, flying usually gets you to a destination faster, but it requires more organization and patience than other modes of transportation. Even though TSA regulations in the United States seem to be a moving target, concessions have been made to seniors (75-plus) and their companions that expedite getting through security checkpoints. Here are a few additional tips to ensure safe and healthy travel with seniors:
- First, confirm with your loved one’s physician that he or she is cleared to fly, and has had current flu and pneumonia vaccines. Request a doctor’s note explaining any surgical implants or paraphernalia, such as needles. If applicable, a TSA disability notification card can make it more expedient to get through security.
- At the time of booking, request any desired assistance (wheelchair, electric cart, pre-boarding privileges), and reconfirm a day or two before departure.
- Select seats in advance, when allowed. An aisle seat toward the front of the plane offers easier boarding and deplaning, but being near the toilets may be desirable for long-haul flights. Compression socks are recommended on flights longer than a few hours, even for travelers without risk of deep vein thrombosis (DVT).
- Check in for the flight online 24 hours in advance, or call customer service for help choosing an optimal seat.
- Pack light, but plan to check bags if an aircraft change is part of the itinerary.
- Get to the airport a full hour earlier than suggested for your departure time.
- Keep your older traveler’s prescription medications separate from other belongings for easy screening. On-board baggage limits don’t apply to medical supplies, equipment, mobility aids and assistive devices. Liquids exceeding 3.4 oz/100 ml are permitted. (Visit www.tsa.gov for further details regarding U.S. departures.)
- If your travel companion has dietary restrictions, order a special meal in advance, when offered, or bring his or her food on board.
- Apply hand sanitizer liberally, and use antibacterial wipes to disinfect hard surfaces around his or her seat.
Tips for Traveling Abroad with Seniors
International travel with a senior may seem especially daunting, but once you dive into the planning process you may find the prospect isn’t as scary as you think. Many nations show great respect to older people, and as world populations age, it has become easier than ever for seniors to travel the globe.
Expert Valerie Grubb, author of Planes, Canes, and Automobiles: Connecting With Your Aging Parents Through Travel and the popular blog Travel With Aging Parents, has traveled extensively with her own mother. “Narrow sidewalks and ancient tourist sites can make some destinations in Europe tricky when vacationing with a parent in a wheelchair,” says Grubb, “so I strongly suggest doing a little research on accessibility before just showing up. That said, Mom and I particularly enjoy Paris and London, and have found local businesses and people to be incredibly helpful as we navigate around the city.”
Here are a few more tips to keep in mind:
- Several weeks in advance, make sure any vaccines recommended for the destination are up to date.
- Ensure passports are valid for at least six months after the return date and request any necessary visa(s) well ahead of time.
- Have a doctor provide a list of generic names for prescription drugs, as overseas pharmacists or physicians may not recognize all pharmaceutical brand names.
- Travel insurance for seniors is costly, but it can be a lifesaver. Not only can a senior who takes ill be reimbursed for all or part of a trip, but a policy including evacuation insurance can help get him or her to appropriate medical care in case of an emergency.
- Consider upgrading your cellular service to a roaming plan that provides full use of your phone for the duration of the trip, so you’ll be able to search the internet freely and call a hospital or ambulance immediately should the need arise. (In the European Union, call “112” for a police, fire or medical emergency.)
Traveling With Older People – The Basics
Destination, type of travel, and health and mobility are all mitigating factors that come into play when planning a trip, but a list of tips for traveling with seniors is a great place to start:
- Do plenty of advance research and don’t hesitate to inquire about senior discounts – for travel, hotels, food, entertainment – both domestically and internationally.
- If he or she wears prescription glasses, bring a backup pair, as well as sunglasses for bright days. (Fitover and clip-on styles are great options.)
- Hearing aids? Don’t forget spare batteries.
- Use a smartphone to photograph all identification, medical cards and prescription bottles in case of loss or theft.
- Keep meds in original packaging, and bring a week’s additional supply.
- Pack a tote with favorite healthy snacks and beverages, and items such as playing cards, a book, travel pillow, and sweater or blanket.
- Even for seniors who don’t have cognitive impairment, a wearable GPS device or ID bracelet bearing your name and contact phone number can bring peace of mind.
- A ground-floor hotel room or one near an elevator may be best for seniors with mobility issues. Confirm that rooms identified as “ADA compliant” include grab bars and space for wheelchair maneuverability, as needed.
- Don’t overschedule, and remain flexible to allow for naps or restroom stops. Whether due to medications, a specific condition, or simply age, older travelers are more likely to tire earlier. Symptoms of Sundowners Syndrome may be more pronounced when seniors with dementia are away from familiar surroundings.
- To take some of the pressure off you and your family, consider hiring a professional caregiver to accompany you on your travels.
If time isn’t an issue, a road trip is the easiest and most straightforward way to travel with seniors. Although protracted hours on the asphalt can be exhausting, driving provides the option to stop anywhere and for as long as desired: unplanned detours to must-see sights (Wall Drug or World’s Largest Ball of Twine, anyone?) require little more than a flexible schedule.
While bus and train journeys offer less spontaneity and little or no privacy, they eliminate driving responsibilities, often provide Wi-Fi connectivity, and a restroom is always nearby.
North American cruises are a popular vacation option for seniors because they take a lot of the preparation and trepidation out of travel: most ships and destinations are well equipped to cater to the social, medical, and mobility needs of older passengers. For people who live near one of the nearly 30 U.S. and Canada departure ports, embarking on a cruise is only slightly more onerous than navigating Costco on a Saturday afternoon.
While getting to overseas points of origination requires more time and effort, international cruises can offer senior travelers and their companions exotic experiences that don’t skimp on safety, comfort, or the convenience of English-speaking staff.
One More Tour, With Honor
Seniors who served in the U.S. military may be eligible for an all-expenses-paid trip to Washington, D.C., to visit the National World War II Memorial and other sites that pay homage to their sacrifice during wartime. Honor Flights are made possible by generous donations from corporations, individuals, volunteers and airlines – including Southwest, the organization’s official carrier.
Since 2005, the non-profit Honor Flight Network (consisting of two groups that joined efforts in 2007) has flown tens of thousands of veterans to one of the three D.C.-metro airports, where arrivals are greeted by representatives from Heroes’ Welcome, an Honor Flight sub-group. A friend, family member or volunteer guardian typically accompanies vets.
As of May 2017, there are 131 hubs in 45 states, making it easier than ever for a veteran to get to an Honor Flight departure point. The program is primarily available to World War II and terminally ill veterans, but is also increasingly open to veterans of the Korean and Vietnam wars. To donate, apply or learn about self-funded tour participation, visit honorflight.org.
For more information
Traveling with an Elderly Parent
Caregiver Tips for Traveling with the Elderly
4 Ways to Soothe Sundowner’s Symptoms
Caregivers Traveling with Families
7 Tips for Safe and Healthy Travel with Seniors
Honor Flights Offer Veterans One More Tour with Honor
As people age, it’s not uncommon for their personalities to change and for them to become more controlling. It’s usually the result of medication, pain, the frustrations of having difficulty doing things that were once easy and changing family dynamics. While it can be frustrating and even unpleasant at times to deal with, there are things you can do to make the situation better and more bearable.
Kurt Kazanowski MS, RN, CHE, has more than 30 years working with seniors, first as a nurse, and now in hospice and homecare.
His advice for dealing with a controlling aging loved one:
1. They want to control something.
Everyone wants to feel they can control their own lives, but there comes a point when we all lose grip of it. Our independence slips away, and we need help for the simplest things. That can be a defeating concept. It is a challenging reality with which to come to terms. Be sensitive to this in your aging loved one. Being surrounded by support and understanding only makes it easier.
2. Medications can change personalities.
Keep in mind when your loved one began their medications. Take note of any personality changes within two weeks, one month and a few months span. If you notice the personality changes coincide with the new medication and not another variable, speak with their health care provider about options.
Medications manipulate the chemical balances in our brains, and when that occurs, our moods and behaviors can shift. Offer the idea of starting one medication at a time to see how your senior changes in accordance to the new meds. This way, it is easier to pinpoint which medication causes which side effects.
3. Pain can make people act out.
When you are not feeling well and your body is in pain, it can cause you to lash out at those around you. If your senior parent is doing this, offer to find them relief in the form of therapy or medication. Occupational therapy can be a great tool to overcome painful patterns of movement and seek some relief.
4. Consider family dynamics.
Was your aging loved one always in charge of the family? Did they always dictate how things were going to be done? They might still be trying to exude this power over the other family members. If you are a child and the primary caregiver, your parent might still be trying to act out these old dynamics.
Controlling behaviors are considered abuse. Try to talk with your parent about how their actions make you feel. It is not too late to do this, and as your dynamic changes to caregiver, it can be a good time for healing past wounds.
5. Use positive reinforcement patterns.
Reward the positive behaviors of your loved one. Do not reward, or punish, the negative behaviors. Using reinforcement patterns is one method to motivate your controlling loved one to better actions. If they are becoming upset or angry, offer them kindness and suggest to discuss it. If they don’t respond respectfully, leave and tell them you will come back when it is a better time. It may sound harsh, but it is better than scolding them or getting upset yourself.
6. Talk, if they are willing.
Sometimes your controlling parent or loved one lashes out to get attention, like small children. They want someone to give them some more attention and care. Ask them how you can help. Genuinely speak to them. Most importantly, listen to what they are saying. They may just want to vent their frustrations to someone that cares. We can all understand that.
7. Grant them the little victories.
For them to feel they still have control, let them make decisions when possible. If you are going out to eat as a family, let them select the restaurant. Ask their opinion about important life matters to include them in situations. Help them find a creative outlet so they can focus their controlling energy into projects. Knitting, painting or sewing are some good options that require creative choices for them to control themselves.
8. Bring in the backups.
If nothing else works, you do have other opportunities. Don’t fret. You need to set your boundaries with your loved one, and if they do not respect that after a point, you can seek other help for them. There are assisted living and nursing home options. That way, there is a professional caregiver that will deal with the daily tasks for them. You can then take the personal family member role and see them whenever you see fit.
Kurt Kazanowski is an author, speaker, coach and consultant in the areas of aging, hospice and home care. He is a native of Detroit, Michigan, and has over three decades of experience in the field of healthcare. He received his bachelor’s degree in nursing from Mercy College of Detroit and practiced as a public health nurse for many years. Today, Kurt is the owner of two successful personal care home health companies – Homewatch CareGivers in Michigan where he lives and First Home Care in Moscow, Russia.
Kurt is also the author of A Son’s Journey.
It hardly seems fair that as soon as we pay bills, review statements, manage family calendars and school cubbies for the month, all of this ironing out will inevitably become all bunched up again when next month’s paperwork requires the same attention.
When it’s our own personal finances, it is easier to put aside organizing—waiting until we have the time. This could be months down the road for busy people because let’s face it, who isn’t overextended these days?
But, when we find ourselves in the position to manage the finances and household bills for our elderly parents, this is one job that requires careful attention to detail because you will need to account to siblings, attorneys, and the IRS eventually.
Here is the approach I took to getting my mother’s financial house in order.
First, the visual of the mess I walked into. My father managed the finances for the duration of my parent’s fifty-four year marriage. My mother preferred to manage the home and these roles worked well—until he died. She upended any system he put into place and when I arrived on the scene it was mine to figure out from cascading mountains of paperwork. Literally.
For the thirteen years after his death, she would open the mail, then re-stuff the statements into shoeboxes that would line bookshelves, bureau drawers, and stay tucked beneath beds when there was no more room on tabletops.
Can you see it? The scope of what these thirteen years of statements amounted to ended up taking me a few years to unravel.
Perhaps you are wondering what could be so important from that long ago that I would even need to bother taking the time to sleuth through it all.
I can tell you the moral of this story in one line—do not throw away any paper until you understand what it means to your parent’s financial picture. It will not matter that you will need to dig through 200 empty checkbook cartons because the first one you opened had $50 cash hidden inside. It will not matter that you have amassed eighty-five bankers boxes filled with decades of statements to sift through at your leisure while you work to make sense of the portfolio and uncover where any assets might be hidden.
Do your due diligence. You will sleep better at night knowing that you unearthed every account, every safe deposit box in town, every long term CD you stumble upon just because you are willing to do the job the right way.
The wrong way would be to hire a clean sweep crew who will charge you an attractive rate and send strangers in to cart away all the mess you don’t have time to deal with. They are counting on this. It’s how they make their living because they will find cash that is hidden in places you never looked.
Believe me, your obligation is to understand the paper trail before you beginning shredding. I toiled summer after summer when school was out to piece together fractions of clues to find money that was never listed on spreadsheets or statements.
Glad I did. We were running out of cash near the end and I was at the beginning of looking into a reverse mortgage to stay afloat for however long my mother’s decline would last. It was only then that I found the bulk of her wealth in the form of stock certificates from the 1940s that had never been registered. Imagine if I had just shredded these like everything else. They were in the eighty-fifth box of papers and did not look familiar to me. Thankfully, Charles Schwab knew just what they were.
Stage 1: Sort Paperwork into Categories: Long-Term, Short-Term, Monthly
Long-Term—understand old history
Every statement I uncover from every dark corner of my mother’s house that is not dated within the past 12 months, is filed as long-term—something I can peruse later when I have the time to gain some insight about accounts that are active, or have merged, or have been cancelled in the years since my father’s death.
I never recommend bankers boxes for permanent storage, (think flooding!) but temporarily, they are an affordable way to clear clutter from the house.
Label carefully, this will save you oodles of time when you are searching later.
Bundle years for each new box: “Archive 1990-1995”, “Archive 1996-2000.”
Short-Term—monitor recent history
Every statement dated within the past 12 months is filed as short-term—these will be immediately transferred to your filing system once it is set up.
Label as current year: “Active 2017.”
I make an alarming discovery once I go through archives vs. active accounts—my mother’s home insurance has been forcibly terminated for failure to pay. Somehow it got missed and once this happens, you are dead in the water.
You cannot return to the insurer who carried your policy for 35 years, and you cannot reinstate a home policy without a new roof inspection. It will not matter if your roof does not leak—ours was still good—there will likely be some work needed when it comes to old houses. So if you do not have the financial reserves, be careful to never find yourself in this predicament.
Monthly—alpha and chrono order for filing active accounts
I still work with paper. Online banking is great for quick pay, but I am more comfortable perusing month-to-month statements when I need information.
I buy a short filing cabinet and unload the entire contents of the “Active” box—all mail pertaining to the current year—and I sort paperwork into piles in alphabetical order using yellow sticky notes to post the alphabet along the hallway wall, filing each statement accordingly.
Assign a hanging folder by labeling a Post-it note with the company’s name found on the statement. Be sure to file most recent month on top, with subsequent months behind it.
A binder can also work when you have fewer accounts to manage, following this same alpha and chrono set up. However, the girth can make this weighty.
Discarding—be careful about what you throw into the garbage
I follow the sage advice to not throw anything into the garbage that has identifying information: your name, address, social security number, credit card numbers, telephone, birth date, checking account number, any financial statements, even credit card offers you consider to be junk mail.
Be prudent. When you are certain you understand what these papers mean to your parent’s wealth, shred or burn your important papers. For the kind of bulk paperwork my mother has, I choose a shredding service which has very affordable rates and will send a truck to our house. Many times, churches, or local community centers will offer neighborhood shred days. The best part is seeing your heavy load turned into confetti within seconds.
Daily Drop Spot—keeping the household organized
When paperwork arrives before I have the time to address it, I like to use a safe drop spot where I know it will still be waiting when I look for it. Mine is a basket with a lid. I reserve a “man drawer” in the kitchen for my husband. My students tell me their busy Moms create a cubby for their backpack storage, plus a personal In/Out two-tiered box with a colored folder for each child so permission slips and homework are always in the same place.
Avoid the Financial Scavenger Hunt—
One thing that could have saved me immeasurable time was to have a list of where safe deposit boxes were held (and keys located) or CDs with their maturity dates. The more we can organize, the more of a gift it will be to those left behind.
Once you figure out what your needs are, it is so much simpler to find the system that will work best in managing the paper trail.
“How to Streamline Your Rx Collection” will be the next blog posting here.
Risk of heat-related health problems increases with age
With summer here and the temperatures rising, it is important to understand the health risks that excessive heat can bring and know the signs of heat-related illnesses. Older adults and people with chronic medical conditions are particularly susceptible to hyperthermia and other heat-related illnesses. The National Institute on Aging (NIA), part of the National Institutes of Health, offers advice to help combat the dangers of hot weather.
Heat stress, heat fatigue, heat syncope (sudden dizziness after exercising in the heat), heat cramps and heat exhaustion are all forms of hyperthermia. Hyperthermia is caused by a failure of the body’s heat-regulating mechanisms. The risk of hyperthermia can increase with the combination of higher temperatures, underlying general health, and individual lifestyle.
Lifestyle factors that can increase risk include not drinking enough fluids, living in housing without air conditioning, lack of mobility and access to transportation, overdressing, visiting overcrowded places and not understanding how to respond to hot weather conditions.
On hot and humid days, especially when an air pollution alert is in effect, older adults, particularly those with chronic medical conditions, should stay indoors in cooler places. If possible, people without air conditioners or fans should go to places that do have air conditioning, such as senior centers, shopping malls, movie theaters and libraries. Cooling centers, which may be set up by local public health agencies, religious groups and social service organizations in many communities, are another option.
There are many factors that can increase risk for hyperthermia, including:
- Alcohol use
- Reduced sweating caused by medications such as diuretics, sedatives, tranquilizers and certain heart and blood pressure drugs
- High blood pressure or other health conditions that require changes in diet. People on salt-restricted diets may be at increased risk; however, salt pills should not be used without first consulting a doctor.
- Use of multiple medications. It is important, however, to continue to take prescribed medication and discuss possible problems with a physician.
- Age-related changes to the skin such as poor blood circulation and inefficient sweat production
- Heart, lung and kidney diseases, as well as any illness that causes general weakness or fever
- Being substantially overweight or underweight
Heat stroke is a life-threatening form of hyperthermia. It occurs when the body is overwhelmed by heat and unable to control its temperature. Signs and symptoms of heat stroke include a significant increase in body temperature (generally above 104 degrees Fahrenheit), changes in mental status (like confusion or combativeness), strong rapid pulse, lack of sweating, dry flushed skin, feeling faint, staggering or coma. Emergency medical attention is critical for a person with heat stroke symptoms, especially an older adult.
If you suspect that someone is suffering from a heat-related illness:
- Call 911 if you suspect heat stroke.
- Get the person out of the heat and into a shady, air-conditioned or other cool place. Urge them to lie down.
- If the person can swallow safely, offer fluids such as water, fruit and vegetable juices, but not alcohol or caffeine.
- Apply a cold, wet cloth to the wrists, neck, armpits, and groin. These are places where blood passes close to the surface of the skin, and the cold cloths can help cool the blood.
- Encourage the individual to shower, bathe or sponge off with cool water if it is safe to do so.
States, territories, tribes, and tribal organization may be able to help eligible households pay for home cooling and heating costs. People interested in applying for assistance should contact their local or state social services agency.
The NIA’s AgePage on hyperthermia in English or in Spanish contains additional information and resources. It can be viewed online athttps://www.nia.nih.gov/health/publication/agepages. Free print copies of the AgePage are available through online ordering or by calling1-800-222-2225.
About the National Institute on Aging: The NIA leads the federal effort supporting and conducting research on aging and the medical, social, and behavioral issues of older people. The Institute’s broad scientific program seeks to understand the nature of aging and to extend the healthy, active years of life. For more information on research, health and aging, go to https://www.nia.nih.gov/.
About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments and cures for both common and rare diseases. For more information about NIH and its programs, visit https://www.nih.gov/.
If you are caring for a loved one who is bed or chair-limited for most of their waking hours, this post is for you. You may be lucky enough to not have dealt with a bedsore (pressure ulcer) yet, or maybe you have. The most frustrating thing about bedsores is that their very presence is simply an accompaniment to another debilitating disease which has severely limited mobility or circulation in the first place. It’s like the double whammy you and your loved one never asked for.
Seemingly innocuous to start, bedsores can quickly spiral out of control, becoming deeper, more macerated, and infected. Proper aid and assistance from an attentive doctor, wound care specialist, and home health nurse is a must for tending to a stage 2+ bedsore. Is it possible to prevent pressure ulcers from forming in the first place, even if your loved one spends all day in bed? Absolutely. These strategies can help:
Get the right kind of mattress
If your loved one is “bed-ridden,” chances are they have a hospital bed in the home that mechanically raises up and down in which they can sleep, watch TV, eat, etc. If they are still sleeping on a regular bed and sitting up with pillows and other props, this tip is even more important.
Your average mattress is made of materials like foam, cotton batting, puffed-up polyester, and springs. Lying or sitting on the average mattress over time lets the bony points of the body add more and more pressure to internal tissues, causing breakdown and skin irritation. This is what leads to a bedsore.
Simple upgrades to your bed with memory foam toppers, gel padding, or an alternating pressure pad can completely transform blood circulation and weight distribution. A recent 2017 study looking at bedridden spinal cord surgical patients found that a whopping 82% of them developed sacral ulcers (on their bottom) when just a preventative wound dressing was used while only 36% did who were given a gel mattress to lie on. Depending on your health insurance and medical provider, an order can be written for a specialty mattress by your doctor and fulfilled by a medical equipment company; or you can look at a local bed/bedding store and online.
Use barrier cream
Did you know the start of a pressure ulcer can simply look like a reddish or dark discoloration on the skin? Recognizing the signs of the beginning of a bedsore and taking action right away can make a huge difference for the future of your loved one’s health. Barrier creams include a family of gels, creams, and ointments which can be applied to early pre-bedsore areas, healed bedsores, and closed stage 1 bedsores to treat and prevent further breakdown.
You can ask both a doctor or home health nurse about barrier creams they recommend or look online to see what other people have found successful – some popular choices include Corona Cream, EPC (Extra Protective Cream), and MediHoney. The goal is to provide a barrier between contaminants and moisture which can lead to skin irritation and breakdown – this is especially important for bed-limited folks who are incontinent.
While an alternating pressure pad or other specialty mattress can do some of the work of repositioning and disbursing your loved one’s weight while they spend time in bed, manual repositioning is just as important. With a couple thin to medium-width pills tucked up under your loved ones back and bottom, you can make sure their weight is shifted from side to side at least every 2 hours. This helps keep blood circulating and relieves pressure of bonier points of the body.
To some caregivers’ surprise, the heels can be a somewhat hidden place that bedsores develop, simply from feet lying and rubbing on the bed all day. Medical professionals encourage caregivers to “float the heels” of the people they care for by propping a pillow or rolled up blanket under the ankles to keep the heels from actually touching the bed. Johns Hopkins Medicine also shares that patients and caregivers should avoid using “donut” pillows to prevent pressure ulcers as they actually force more pressure from bones onto internal tissues, especially around the tailbone area.
Modify your loved one’s diet
Caregivers know what a challenge eating and diet can be when it comes to preparing food for your loved one and helping them eat. The disease or condition which impairs your loved one’s mobility may also impair their ability to eat or swallow, or cause them to take medicine that suppresses their appetite. When it comes to preventing bedsores, however, diet can be an important ingredient.
In addition to protein, vitamin C, zinc, calcium, and potassium aid the body in vascular circulation, strengthening skin, and tissue repair. Whole foods like broccoli, beets, citrus fruits, lean chicken, quinoa, nuts, and milk can help deliver some of these critical tissue-building vitamins and minerals. Supplements like Juven powder may alternatively aid the body with tissue repair as well.
Will doing all of these things 100% secure that your loved one never experiences a pressure ulcer ever? No, but they can make a huge difference and help you catch and seek treatment for a pressure ulcer far before it becomes health-threatening. Caregivers know knowledge is power when it comes to caring for someone – we hope this bedsore knowledge saves you and your loved one headaches (and pain) in the future.
Joe Fleming, Vive Health
Caring for someone suffering from Alzheimer’s is one of the most taxing for caregivers. To best look after your patient, you need to obtain as much knowledge about the disease as you possibly can. Even if you read every book out there, you’ll still be shocked with the unpredictable and sensitive nature of Alzheimer’s patients. In addition to their behavior, you’ll have to bear with their inability to communicate adequately and express how they feel, which makes the job even more difficult.
Here are some tips that can help you out
It’s tough watching the mental decline of a loved one but at some point, you’re going to need to accept that your loved one is now being affected by an irreversible condition – there is nothing you can do to bring themselves to their normal selves. What you CAN do is slow down the process and make these years as comfortable for them as possible.
Part of accepting that your loved one has Alzheimer’s is quit asking them the question “Do you remember?” They don’t – and it isn’t their fault. By forcing them to remember something that they can’t (because they are mentally incapable of it) will only cause further frustration.
Acceptance also means accepting that this person you are now looking after, isn’t the person you once knew. Again, it’s important to remind yourself that this mental deterioration is no fault of their own – they are helpless. There’s an element of loss that arises with Alzheimer’s, it puts family caregivers in an awkward place. On one hand you have to accept that your loved one isn’t the same but you have to remember that this IS the person you love, whether they remember it or not.
Connect with the patient
It may be easier to just let the patients be on their own because of how aggravating managing them can get but don’t let their anger outbursts intimidate you. Choosing to let the patient be alone with their confused thoughts will only lead them to isolation and eventually depression – both of which will worsen their condition.
You need to find ways of connecting with patients in a way that doesn’t stress them out. Try using meaningful items in their hands. Try placing a photo from a family vacation in their hands to see if they respond. Don’t ask anything at the beginning, see if the photo captures their interest. You may need to help them out a little by providing a few hints. If you don’t see them respond then move onto the next meaningful item. Don’t pressure them and don’t let the fact that they don’t remember weigh down on you.
Try communicating with your loved one through therapy. Alzheimer’s patients are unable to express themselves with words as their language abilities are one of the first to be affected by their disease. Look into pet, music and art therapy to get them to open up to and unleash some of what goes on in their minds.
Do not upset them
Can you imagine what it must feel like to just have remnants of your life and the people in it floating around in your head? Obviously, Alzheimer’s patients experience immense confusion and have a tough time trusting those around them. No one seems to understand what they are going through and they aren’t able to explain it. On top of that, people around them are always asking them to perform tasks which they aren’t usually able to do. Of course, they are going to be frustrated.
It’s important for caregivers to try and understand what Alzheimer’s patients are going through. You don’t need to understand it completely but you need to be able to empathize with them at the least.
Don’t make the situation worse in any way. This means that you need to avoid arguing with them because it will irritate them and force them to act out. You can’t win an argument with a person that isn’t going to make logical sense – so don’t bother, they won’t understand. It will cause them to become distrusting for you and can force them to become withdrawn.
Avoid bringing up topics that can upset them. If you do end up upsetting them unintentionally then be sure to distract them with something immediately.
Alzheimer’s patients get annoyed by a variety of triggers. These triggers can be the room being too noisy or the presence of someone they don’t like in the room. Identify these triggers and make sure the patient is as comfortable as can be.
Look after yourself
When looking after someone else, we tend to forget ourselves. Keep in mind that if you aren’t keeping your health in check then you won’t be able to look after your loved one. Caregiving requires a lot of patience and you’re going to need some down time every now and then to ensure that your physical and mental needs are being addressed.
Do take some time out to refresh your mind. Try taking up yoga and meditation to be able to block out any negativity that you may have building up in your mind and to enable you to go to your ‘quiet place’ when it’s needed.
Sherley Alaba is an eagle-eyed wordsmith; a writer and translator, always interested in ways which can help individuals (especially youth and women) reach their full creative potential. Her focus has been on writing, producing and editing stories on business, finance, interesting personalities, entrepreneurs, culture, the environment, gastronomy, lifestyle, and social issues.
Featured image via Pixabay
Caregiving involves lots of moving pieces. A CareMap can help you understand how it fits all together so you can find ways to improve your daily life.
The Atlas CareMap is a hand-drawn representation of a caregiver’s network. It illustrates the caregiver’s own support system, highlights what is working well, and often reveals duplication or gaps in care and resources.
You can learn more at Atlas of Caregiving.
As aging parents creep past retirement age and into their 70s and 80s, adult children are faced with the same conundrum: how can they enable their mothers and fathers to stay in their homes longer, rather than send their loved one to a retirement home or similar facility?
According to the AARP, 30 million households provide care for an adult over the age of 50, and that number is expected to double by 2040. Failing to plan ahead now could cost tens or even hundreds of thousands of dollars, not to mention precious time, comfort, and dignity. Take the following tips to heart so you can create a caregiving strategy for your loved ones that will keep them living how they want for as long as possible.
No one wants to have the care discussion with their parents, many of whom want to maintain their independence. Nonetheless, in order to avoid costly, embarrassing, and potentially fatal consequences, this necessary conversation must begin with honesty and compassion.
Effective caregiving plans include family members, close family friends, and other loved ones; they also designate a single “team leader” or point person who facilitates discussions and keeps communication forthcoming. Remember not to make any decision unilaterally. Apart from creating negative emotions, legal consequences may follow if the parent disputes the child’s action.
You may want to consider hiring someone to help with this planning. A geriatric care manager can assist your family with this.
Make a List, Check It Twice
Create checklists for personal information, home maintenance, health, finances, and transportation. These checklists should include all essential information, any necessary phone numbers, the location of documents or other important paperwork, and a division of labor. Allow multiple people — including your parents themselves — to divvy responsibilities where appropriate to ensure that no one person feels the full burden of caregiving.
On the topic of lists, good protocol calls for creating what’s known as a Vial of L.I.F.E. (Lifesaving Information for Emergencies) checklist. Be sure it includes hospital preferences, allergies, medical conditions, insurance information, and emergency contacts. This list can prove essential information in critical situations if the parent cannot respond or otherwise provide the necessary details.
There are organizations available to handle questions about elder care, such as the AARP, or your local government. The Eldercare Locator can provide a variety of services in your neighborhood, and the official Medicare website will inform on free or reduced-cost healthcare offerings.
Should you choose to hire an in-home care provider, there are additional things you want to consider to make sure your loved one is best cared for.
The Power Is Yours
One of the most important and immediate tasks to complete when planning your loved one’s transition plan is designating a power of attorney and arranging for decision-making processes to occur in the event of incapacity.
The documents that must be created are the Durable Power of Attorney for Health Care — which you probably know as a “living will” — as well as a Physician’s Order for Life-Sustaining Treatment (POLST), the Durable Power of Attorney for Asset Management (or Finance), and the will itself.
- The powers of attorney provide for a trusted person like a child to make legal and health care decisions for a loved one who is physically unable.
- The POLST replaces a Do Not Resuscitate directive and allows individuals to decide whether or not emergency responders and other medical professionals should provide certain treatments.
- A will establishes how one’s assets and estate will be distributed. It’s quite possible your loved one already has a will in place.
Many families will also want to create a living trust, which places the control of an estate’s assets with a legal entity. Both of these allow for assets to bypass legal probate, which can be a lengthy and stressful process.
Make Use of Technology
Technology has made it easier for families to anticipate and ameliorate concerns for elderly family members. Try utilizing these techniques to provide convenient care for your loved one.
1. Home Delivery
Amazon Prime or similar home delivery services are fantastic ways to ensure that household goods never run out. Paper products, incontinence products, hygiene items and toiletries, cleaning supplies, and even some dry goods can be delivered right to the doorstep in just a day or two. A “wish list” can be created to provide a handy source for the necessary items, and family members can order off the list and pay directly, circumventing any complicating factors.
2. A Pre-Paid and Pre-Programmed Phone
Gone are the days of leafing through books filled with chicken scratch handwriting, trying to find the right phone number. Buy an inexpensive phone and pre-program essential phone numbers with simple, easy-to-understand labels. For example, emergency services, doctors, family members, and neighbors can be programmed, saving valuable time in a critical situation. Keep it simple so you can teach your loved one how to operate the device.
3. Keep Pills on Lockdown
Many senior citizens take multiple pills a day, and forgetting dosages or mixing medicines can be a fatal hazard to the elderly. Even though most pill containers are labeled, aging parents become easily confused; these containers are also unsafe for visiting children. Buying an automatic, lockable pill dispenser means medicines are tamper-proof and only accessible when needed. Many of these also alert the parent (or caregiver) when pills are running low to make re-ordering easier.
4. Keep Information Managed and Centralized
Google Drive has an assortment of invaluable, accessible, and free tools to organize, manage, and share important materials within a family. Living wills, power of attorney documents, medication lists, pharmacy prescriptions, home security system passwords, and other important lists and information can be accessed by multiple family members. Google has downloadable apps that allow this data to be retrieved on mobile phones, convenient for trips to the pharmacy, doctor, or attorney.
A caregiver is essential for handling much of the mail delivered to the home of an elderly family member. The generation going through these life changes often relies on physical mail, instead of email, but may find it increasingly difficult to organize all they receive. Designate someone to sort important bills and other financially important items from the catalogs, magazines, and junk mail received on a daily basis. Another option is to have the important mail, such as information from banks and brokerage accounts, forwarded to the physical address of a trusted family member or power of attorney.
One out of three people over the age of 65 will experience a fall, which is the leading cause of serious injury among seniors. Purchase a monitoring system that has a medical alert button can be invaluable. It will alert emergency responders in the event of a major fall or other injury. Some come with buttons that can be worn on the body for easy accessibility, and others offer two-way communication to keep the fallen person on the line while medical assistance arrives. Consider also purchasing grab bars and benches in potentially hazardous areas, like bathrooms, foyers, and steps.
And finally, seniors with dementia are prone to wandering off. If this is a concern you have for your loved one, consider purchasing an inexpensive door chime to ring when the front door is opened. This will alert others in the house before he or she can get very far.
What steps can you take this week to create a caregiving plan for your parents? Let us know in the comments section.
Kathleen Webb co-founded HomeWork Solutions in 1993 to provide payroll and tax services to families employing household workers. Kathy has extensive experience preparing ‘nanny tax’ payroll taxes. She is the author of numerous articles on this topic and has been featured in the Wall Street Journal, Kiplinger’s Personal Finance, and the Congressional Quarterly. She also consulted with Senate staffers in the drafting of the 1994 Nanny Tax Law.
Medical laws change, but it is important to stay current if caregiving is a responsibility you’ve undertaken for a family member or if it is your profession. There are documents you will need to provide physicians with, as well as decisions to make regarding treatments and facilities.
Here are three of the big ones:
HIPAA, the Health Insurance Portability and Accountability Act, came into being in 1996 to help patients gain control over their private information. Only the minimum amount of patient information is available to entities, including caregivers, insurance companies and other health care facilities, unless otherwise directed by the patient.
HIPAA protects patients and holds people accountable for violating the law and patients’ privacy. A violator could spend time behind bars and/or pay a steep fine. However, if a patient requests that their adult child or caregiver accompanies them to a physician appointment or tests, then the provider can release the information. It is clear the patient wants this person to know about their private health information.
The physician has the right to choose who to give pertinent information to if something happens to the patient and they are unable to respond, such as permanent unconsciousness. Even with HIPAA laws in effect, you may want to talk with your patient about a written directive to avoid any miscommunication.
2. The Stark Law
If your patient or loved one is living in a skilled nursing home or assisted living facility, understanding The Stark Law is critical. To avoid conflict of interest and financial kickbacks, The Stark Law puts into effect the protection of Medicare and Medicaid patients. The law states physicians cannot refer patients to a clinic, laboratory or facility and order services in which the provider will receive financial gain in return. This includes a member of a provider’s family.
For example, a physician may be violating The Stark Law if they refer a Medicaid/Medicare patient to a nursing home owned by the physician’s adult child. You want to ensure your patient is receiving the best care and not receiving unnecessary treatment. The Stark Law works to protect patients from unethical practices by enforcing civil fines and penalties and excluding violators from federal health care programs.
If you suspect a physician or facility is violating The Stark Law, you can report the incident to the Office of Inspector General.
3. Legal Documentation Laws
As a caregiver, legal documents are an important part of your responsibility. Your role as a caregiver can be severely limited without proper legal documentation. The following are a few documents you should have on hand and provide copies to your patient’s service providers.
- Power of Attorney: As power of attorney, you can make medical and financial decisions for your loved one as needed. This document allows you to pay bills on behalf of your patient and make decisions regarding treatments when they no longer can make these decisions on their own.
- Living Will: Experts suggest creating a living will before the need arises. This document provides a written record of the patient’s wishes regarding life support and treatments and removes the emotional factor during a crisis.
- Health Care Proxy: If the patient prefers, they can assign a power of attorney to handle their financial responsibilities and a health care proxy to make medical decisions for them regarding treatments. A health care proxy is only used when the patient is permanently unconscious or is in the latter stages of a mental illness.
An elder-law attorney can explain the details of each of the medical laws concerning seniors and caregivers, as well as oversee the legal documentation you need. Before making decisions on behalf of your patient or loved one, make sure you are up-to-date with any changes to the laws.
Image by Unsplash
Caregiving is a rewarding activity, but it can also be very emotionally and physically draining. Compassion fatigue among caregivers is common, which can lead to burnout, depression, and exhaustion. Not only are these symptoms draining on the caregiver, but over time, they can lead to a decrease in quality of care.
Luckily, today we have boundless technology to assist in both trivial and specialized tasks. Below are some ways that technology can help ease the burden on caregivers and improve quality of care for seniors.
Technology and Senior Care
Technology is mostly associated with and marketed toward young people, mostly because they are the ones who will spend the most money on new technologies throughout their lives. But technological advances can improve livelihoods of people of all ages, especially people with dementia or limited mobility. Caregivers can utilize technologies built specifically for elder care, like remote monitoring systems and wearables that monitor blood pressure and allow seniors to call for help in case of a fall. These devices not only offer concrete benefits, but they also provide a sense of security, so the caregiver knows that there are proper safety measures in place and that they’ll be alerted immediately in the case of an emergency.
Inside the home
Accidents inside the home are not uncommon for seniors. For many, home is where they spend most of their time. When we are in our homes, we tend to be relaxed, and not as careful as we might need to be. This can lead to carelessness and injury. This is why caregivers should look into home improvements like home automation that makes sure devices are off and the house is locked when no one is there. Safety devices like hearing impaired smoke alarms and other home monitoring systems are also recommended. These technologies can help prevent major incidents, while falls can be prevented with the installation of handrails and other supportive structures throughout the home.
Many caregivers find that they cannot take care of their charge alone while still caring for themselves. This may lead to looking for assisted living situations or hiring medical assistance. Unfortunately, because social services are perpetually underfunded, the people in these positions are often at the same risk of burnout as family caregivers. This leads to many seniors being emotionally harmed by neglect or abuse.
But luckily, the Internet provides caregivers the opportunity to do extensive research on service providers. It also provides methods to report abuse and neglect, preventing others from experiencing the same. Phones and computers make it easy to record infractions and hold people accountable. There are also vast online communities giving caregivers ideas and resources for providing quality care, both with and without assistance.
It’s common for caregiving to wear people out. Technology can help you implement safety measures and automate certain tasks. How have you used technology in caregiving? Share your experience in the comments!
Jeriann Watkins Ireland
Jeriann blogs about her financial journey, food adventures, and life in general at dairyairhead.com. Check out her blog or twitter to see more of her writing!
There’s a lot of advice on how to care for someone with Alzheimer’s without, well, losing your mind.
Not a lot of it works.
I was a very earnest child. My poor parents had to deal with me taking things very literally. I still want to correct every mistake and misunderstanding. Luckily, now I have a lot less free time to waste on hopeless battles.
This attitude doesn’t work very well for life in general. It certainly doesn’t fly with someone who has Alzheimer’s.
Then I read an article about a woman whose mom moved in with her and her husband after her Alzheimer’s progressed. Her and her mother butted heads, but her husband and her mom hit it off wildly. This caused its own problems, as it can be tough to watch your husband become your mother’s new golden child.
How did he do it? He loved improv and took every moment with his mother-in-law as a new skit, a new adventure.
Something clicked for me.
I’ve never taken an improv class, although it’s on my list of things I’ve been meaning to do for years, next to learning Spanish. I’ve circled the improv classes in JCC fliers more times than I can count, but I’ve never actually signed up. But, I did have an elementary school teacher who was obsessed with improv and taught our class the basics.
And, thankfully, you can learn just about anything online.
My grandmother, unfortunately, wasn’t as fun as the woman in the story. Most of my time was still spent facing accusations and demands, but at least now instead of feeling insulted, I was working out the next best line. How could I distract her long enough to change the topic? Could I manage to make her laugh? (Usually, no, I could not).
Even if she wasn’t having a good time, my experience was much improved. Instead of trying to convince her that this kitchen that looked just like her kitchen was, in fact, her kitchen, I humored her. I made up elaborate stories about where we were and why it looked so much like her house. There were all sorts of zany reasons why we were waiting there, but don’t you worry, you’ll be heading home shortly. And then we’d get her bundled up and do the equivalent of spinner her around in a circle before a game of hide and seek so we could take her “home.”
I did particularly enjoy her stories about her trip to China as a young girl (not a real thing), the other people she met while she was on her cruise (she was in a nursing home for respite), and her complaints about her boss (her feet were bothering her from standing all day in high heels, although she was bed-ridden and had retired long before I was born).
It made the days a lot more fun and a lot less frustrating.
I never could quite get the rest of the family on board. Everyone else was still trying to convince her she was at home, those were her red shoes, that was FOX News on the TV, they already fed her dinner, and they were her daughter/granddaughter/neighbor. You can’t win them all.
But it worked for me. Maybe it’lll make your day a little easier.
As Alzheimer’s progresses, verbal communication becomes more and more difficult. Alzheimer’s has a devastating effect on the brain’s ability to recognize and process verbal language. Language impairment is considered one of the “primary components” of cognitive decline in those coping with Alzheimer’s.
For those of us who provide Alzheimer’s care, whether as family members or professional caregivers, this makes communication difficult, particularly in the mid-to-late stages of Alzheimer’s. But “difficult” is not “impossible.” In fact, there are non-verbal ways we can use to communicate clearly with Alzheimer’s sufferers, commonly known as “body language.”
But there’s a catch here: few of us are truly fluent in body language. When we’re growing up, we spend years learning how to read, speak, and write — but this is all verbal language. Most of us didn’t get class credit for learning open posture or how to maintain proper eye contact.
So consider this post a crash course in why body language is more powerful than you might think, how caregivers can become more fluent in non-verbal language, and what you can (and can’t) say by communicating this way.
Body Language Essential to Alzheimer’s Care
Human beings learn how to read body language well before we ever speak our first word. And for people who are coping with Alzheimer’s, their ability to understand body language lasts much longer than their ability to understand speech and written language.
When verbal language fails those suffering from dementia, they turn to other ways of making sense of their surroundings. Consciously or unconsciously, they start to rely on other signals to interpret the world and the people they interact with. If a conversation can’t be followed, other signals (like crossed arms, anxious tapping, or laughter) become more important than what’s being said. If someone’s shouting, it’s not what they’re shouting, but that they’re shouting that matters.
As those with Alzheimer’s come to rely on non-verbal communication more and more, even small gestures — a slight change in posture, a quiet sigh — can become meaningful and magnified. For caregivers, it’s important that we understand what our body language is saying to those in our care and how we can harness the power of body language to comfort and communicate with care recipients.
Body Language 101 for Alzheimer’s Caregivers
Becoming fluent in body language doesn’t happen overnight. Executives and politicians spend years perfecting the ways they communicate non-verbally. But by making a conscious effort to build and hone our non-verbal communication skills, it’s possible for caregivers to communicate more clearly and effectively with those in our care.
Here are some of the key ways that you can improve your body language fluency as an Alzheimer’s care provider:
- Eye Contact. Maintain eye contact to convey that you’re paying attention to a person coping with Alzheimer’s. Don’t avoid eye contact during conversation. Doing so conveys dismissiveness. Eye contact should be made at their eye level or below — not above, which gives the impression of dominance.
- Facial Expressions. Always be conscious of what your facial expressions are saying. In day-to-day conversation, it’s easy to say one thing and have a raised eyebrow or a twist of the mouth say another. When these expressions are the only thing the recipient can understand, the words your using aren’t what matter.
- Open Posture. Keeping an open posture is a key part of body language. An open posture — facing the person, chest forward, no crossed arms or legs — tells a person that you’re focused on them, open to their concerns, and engaged with them emotionally.
- Avoid Tics and Distractions. Small tics and distractions can show that you’re agitated, angry, or bored when spending time with a person. Tapping your armrest, bouncing your knee, checking your phone, or multi-tasking can communicate that you’re not invested in the person.
- Use Gestures. Using your hands and objects around you to communicate simple messages can do wonders when caring for someone with Alzheimer’s. However, it’s important not to overuse gestures, which can agitate or confuse those with Alzheimer’s.
Using Body Language to Communicate
Body language is a highly effective tool for communication, but it’s a limited one. So it’s important to know what you can and can’t communicate by using body language.
For instance, complex thoughts and directions require verbal language. There is nothing your facial expression or posture can do to tell someone with Alzheimer’s that it’s time to go to the bathroom or that someone has come to visit.
What body language can communicate, however, is much more important. Your body language conveys care, it conveys trust, and it conveys love. For a person with Alzheimer’s, these messages are extremely powerful. They make a person feel valuable, cared for, and comfortable.
Someone with Alzheimer’s might not be able to understand the words “I’m here for you,” or “You can trust me,” or “I love you.” But body language offers a way to make these messages clear. For those of us who care for those with Alzheimer’s, it’s an invaluable tool.
Visiting Angels is America’s choice in home care. Since 1998, Visiting Angels locations across the country have been helping elderly and disabled individuals by providing care and support in the comfort of home. In addition to senior home care and adult care, Visiting Angels provides dementia care and Alzheimer’s care for individuals suffering from memory disorders. There are now more than five hundred Visiting Angels locations nationwide.
Have you ever passed by one of those houses where the crooked garage doors are barely holding themselves together over the heaping bulge behind them?
Then one day, on your usual stroll of the neighborhood, those garage doors are popped wide open for the whole world to see. You shudder and gasp aloud. You don’t want to linger for too long because it is rude to stare, but you silently wonder how someone could live with floor-to-ceiling clutter that has been amassed for decades.
If you are only too familiar with this sight, let me offer you some reassurance that there is a path to purging. When I said yes to the job of caring for my elderly mother, I had no idea I was also saying yes to care for a house that had been equally badly neglected.
Driving up to my childhood home where my mother still lived nearly 35 years later, I see the lawn is no longer green, nor mowed. It resembles something out of the savannah that my father would have tackled in earnest at the first sighting of crabgrass—had he not passed away thirteen years earlier.
When my disheveled, eighty-five year old mother greets me at the door with her warm toothless smile and welcoming hug, I can tell there will be more moments like what Dorothy experienced in Oz when she said to her dog, “Toto, we’re not in Kansas anymore.”
Nothing is recognizable to me.
It’s not like we ever lived with white-glove standards growing up, but we were a tidy family if you didn’t count the mud and blood the brothers were always traipsing in.
But, on this day my childhood home is operating at the highest level of dysfunction. Of five bedrooms, four are being used as attic space where wardrobes from thirty years earlier are sprawled across the floor, mixed in with old blankets and petrified briquettes of cat doo-doo. All I can think to myself is who is going to oversee the gut job needed on this house? Tearfully, I am afraid I already know this answer.
The garage looks worse than what you might imagine.
Even more disconcerting is the pile-up of paperwork saved since my father’s death. My old bedroom is filled with envelopes containing statements stuffed into them, then packed into shoeboxes piled onto the bookshelf, or tucked into drawers, or peeking out from beneath beds.
Depression-era parents. Need I say more? Thank goodness my mother is willing to put her trust into what she calls my good judgment. Health, Safety, Style becomes our mantra for the care that will need to go into her—and her home.
Here are the ABCs to beginning any difficult task: Assess, Begin, Carry On.
Every frontiersman knew to survey the land. What is the kind of stuff piling up, memorabilia or junk? Who will miss it? I feel a sense of responsibility to the other siblings to preserve their trophies, yearbooks, and kinder artwork—theirs to ditch if they so desire.
Before you can salvage anything, you need a good staging area.
Step 1: De-clutter the garage first.
- Clear out discarded toys, bikes, and seldom used items
- Find the Salvation Army or Goodwill that will pick up
- Recycle nuts, bolts; shift furniture, find the floor, push a broom
- Get rid of rusted shovels and the plethora of old tools
- Clear off every shelf—discard paints and other chemical laden cans legally
- Shred-It will make a house call affordably, taking mere seconds to do what will take you months with your home machine that will jam frequently
Step 2: Create smart centers within your garage
- Laundry station-move an old bookshelf to store supplies
- Errand station—use labeled boxes (library donations, record store, Goodwill, Accountant, etc.) as a reminder of which errands to still run
- Paperwork station—tower plastic crates labeled for archived financial statements. Caution: never throw anything away until you understand what it means to your parent’s financial picture. I found wealth buried in the 85th box.
Step 3: Preserving childhood memories for siblings (3-piece set for each child)
- 1) 45-gallon crate 37’L 27”H to store small furnishings, trophies, plaques et al
- 2) Tri-fold board to stack on top of crate for holding Kinder art, or the like
- 3) Colored document pouch, zippered, 8.5” x 11” for important papers, flash drives, or special letters home saved by parents
- Move an old dresser cluttering a bedroom to create new hub for sibling items
Your job is not yet over. Paperwork sorting becomes my passion.
Step 4-Active vs. Archive File statements accordingly.
Active is for accounts paid in the past year. Scrutinize each to make sure your elderly parent is not experiencing financial abuse. File current month’s statement at front, older months behind.
Archive older statements from previous years. Keep these only for gleaning how money changed hands through investing or bank accounts. Cluster 2-3 years of old statements into one lidded plastic crate the size of a bankers box. Label front as “Archive 2014-2017”. Repeat this until all of your bundles are in separate bins. Once you get a handle on the Active, return to the Archives at your leisure to understand financial history.
Efficient closet makeovers will be the next blog posting here.
By Stefania Shaffer
Stefania Shaffer, a teacher, speaker, and writer, is grateful her WWII parents raised her to do the right thing. Her second book, the Memoir 9 Realities of Caring for an Elderly Parent: A Love Story of a Different Kind has been called “imperative reading”. Funny and compassionate, this is the insider’s view of what to expect from your daunting role if you are the adult child coming home to care for your elderly parent until the very end.
The Companion Playbook is the accompanying workbook that provides the busy caregiver with the urgent To-do list to get started today.
Having a parent or grandparent in a nursing home can be incredibly difficult, especially when so many of us have promised we’d keep them at home forever. So often residential care hardly feels like it reduces the amount of time we spend caregiving, with all the driving back and forth, paperwork, laundry, and endless errands.
And then there’s the day we visit mom and she has bruises on her. One of the hardest parts of dementia is that she can’t tell me what happened.
Before you panic and yank her out of the nursing home, read this:
Take it with a grain of salt
Her explanation, that is. People with dementia often mix up the details. Did the aide hit her or did she hit the aide? Remember that you can’t take her story at face value. I’m not saying to ignore her story, but look for some evidence before you make any accusations. Asking her what happened is just one step in figuring out what to do.
Was there a procedure involved?
Routine blood draws, physical therapy, and other minor medical procedures can leave bruising. Check with the nursing staff to find out what medical professionals she’s seen recently and what they’ve done that might cause bruising.
Check her medications
Some medications increase susceptibility for bruising, like blood thinners and heart disease medications. Even pain killers, antidepressants, and asthma medications can cause people to bruise easily. Some supplements, like fish oil and ginkgo, act as blood thinners and can lead to bruising.
Other medications can cause dizziness, leading to bumps and falls.
Check in with the pharmacist to see if this might be the explanation and if there’s any cause for concern.
Liver problems and other conditions can also lead to bruising easily. If nursing home staff aren’t sure where the bruising is coming from, make sure she’s checked over for health problems that might be causing it.
Bruising can also be a sign of vision or balance problems. Talk to her doctor and get her vision checked. Make sure there are grab bars installed in the nursing home and that she’s using a walker or cane if she needs to.
It might be benign
Older people tend to have delicate skin and bruise easily. This is especially true for women. The loss of fat under the skin increases someone’s risk for bruising, as does past sun damage and a host of other factors.
If you’ve ever hoisted an elderly person out of bed when they weren’t being cooperative, you can understand that it’s possible to bruise someone accidentally in the normal course of affairs, even when you’re being careful. It often doesn’t take much force to cause bruising in someone with delicate skin and frail blood vessels.
Talk to the nursing home staff to see if there have been any problems. Has she been resisting being helped with mobility? Has she been bumping into things? Has she been getting the supervision and support she requires?
It may be time to get her physical therapy to help her move around more safely or an investigation into what might be causing her to be uncooperative when getting in and out of bed.
Not only is it easier for elderly people to bruise, they take much longer to heal. A bruise that might heal in two weeks on a young person may still be there months later for someone who’s elderly. This can lead to occasional bruises adding up — and making it seem like a major cause for concern.
It might not be benign
Some dementia patients are placed in nursing care because they’re aggressive toward caregivers — they may be violent toward other patients, too.
Watch how the staff treat other patients to see if a certain staff member is handling them roughly. Make sure they’re lifting patients correctly. Improper lifting is dangerous to both the caregiver and the recipient!
Unfortunately, figuring out if this is a case of elder abuse or not can become tricky with dementia. The signs of abuse we look for — bruises, social withdrawal, confusion, depression, hygiene issues, and weight loss — are all relatively common among elderly dementia patients.
If the staff seem poorly trained or are constantly turning over, that’s a sign that things aren’t well run behind the scenes.
If you suspect abuse, the National Center on Elder Abuse can guide you through what to do.
Finding a safe nursing home
Even in the best nursing homes, where patients are safe and supervised, patients will get bruises occasionally. There will even be occasional bumps and falls.
We can’t protect our parents from everything — and I’ve certainly gotten my share of bruises from bumps I don’t remember. It happens.
But if you’re seeing a pattern of bruising or are noticing other causes for concern, look into it. The more time you spend in the nursing home with her, the better off you’ll both be.
If nothing seems amiss, bruising easily may be part of the new normal. Make sure staff are extra gentle with her. Icing and elevating bruises right away can help reduce marks. Long sleeves and long pants may help give the skin a little extra protection.
Thankfully, as long as bruising isn’t a sign of abuse or an underlying condition, it won’t cause long-term damage.
It’s a question I’m asked all the time by family caregivers:
Can I get paid to be a family caregiver?
It’s usually accompanied by qualifiers:
- I’m not trying to be greedy, but I had to quit my job to take care of my mom.
- My husband isn’t comfortable having a stranger take care of him.
- My insurance will pay for someone to take care of my disabled sister and I’m a trained medical assistant – can’t they just pay me?
Family caregivers often spend a large portion of their income – not to mention their savings – to care for their loved ones. You might even be taking unpaid leave or feel forced to quit your job to fulfill your family obligations. Family caregivers who quit their jobs lose out not only on a paycheck, but on retirement plans, pension plans, and social security benefits. Family caregivers are saving insurance companies and government agencies billions of dollars by providing care – shouldn’t there be a way to get paid something?
Unfortunately, there are only a few programs that will pay family caregivers. We know how hard you work and how much you deserve financial support, but most of the time it is not possible to be paid to be a family caregiver. Because health care differs so much, I can’t provide specific information. However, I can point you in the right direction to find some answers.
Government programs to pay caregivers
Each state and county provides different services for the Administration on Aging. Some programs will provide stipends, reimburse caregivers for supplies, offer training, and provide respite. Paying for Senior Care maintains a list of Area Agencies on Aging and Disability Resource Centers that’s searchable by state and county.
Guardians of children
Guardians of disabled children who are not their biological or adopted children can become subsidized guardians. This allows relatives to receive financial help to care for children and keep them out of foster care.
Structured Family Caregiving
In some states, family caregivers of Medicaid recipients can be paid through the Structured Family Caregiving program. In order to participate, you must be referred by your local Agency on Aging, which is typically run at the county level. The program is run by Caregiver Homes. Caregiver Homes is available in Connecticut, Massachusetts, Rhode Island, Ohio, and Indiana, and will be in other states soon.
- The person receiving care must be eligible for Medicaid and deficient in at least 3 of 5 activities of daily living: dressing, bathing, grooming, using the toilet, eating, walking, or getting in and out of bed.
- Caregivers and patients must live together.
- Stipends typically range between $900 and $1,200 a month, depending on the level of care.
- You will be assigned a registered nurse and a care manager who will meet with the caregiver and patient to develop a care plan and will provide ongoing coaching, training, and other support.
Medicaid varies by state, so contact your local Medicaid office to find out if you may qualify. If your Medicaid office isn’t responsive, the National Resource Center for Participant-Directed Services can help connect you to the state programs that allow the patient to decide how to spend their health care money – sometimes including the option to pay a family member for care.
Unfortunately, Medicare does not pay for in-home care or adult day services.
Private sources of support for family caregivers
Disease or condition specific organizations
Some private organizations will provide stipends or grants to support caregivers. Organizations who offer this each have their own requirements, so contact a social worker to find out more.
Sometimes parents will recognize the financial hardship their care causes family members and will pay their family members to care for them. This may take the form of an adjustment in the amount of inheritance or some other creative reimbursement. Sometimes relatives will pool their money to pay the primary family caregiver. It’s wise to write a caregiver contract and check with an elder care benefits planner or elder law attorney if you decide to go this route, as it can have implications on Medicaid eligibility, taxes, and inheritance.
There’s also the possibility that family members could share the cost of caregiving, so it’s not all falling on one person.
It’s important to make sure family members are in agreement. Finances can bring out the worst in families, especially during stressful times. You may consider family mediation services – the National Academy of Elder Law Attorneys can help you if you’re caring for an aging relative.
Long-term care insurance
Certain types of long-term care insurance will pay for in-home assistance, including family caregivers. These types of policies are relatively unusual and most exclude people who live in the same household from being paid. These types of plans tend to be significantly more expensive. Talk to your insurance agent to learn more.
What if none of these programs will help you?
Even if you can’t get paid to serve as a family caregiver, you may be eligible for programs that will cover adult day services, in-home support, or other ways to ease the financial burden.
Department of Welfare
Caregivers may qualify for other programs, including cash assistance, food subsidies, and medical assistance. Check with your state welfare office for more information.
Resources for those over 55
The National Council on Aging can help you find out if your loved one is eligible for financial assistance for medication, housing costs, and health care. Get started with their Benefits Checkup.
Social service organizations
There are numerous organizations that provide grants or emergency assistance to families. Many of these are specific to location, employment history, and condition. Organizations will provide grants for rent, mortgages, and utilities. Other organizations provide support for food, medication, supplies, and grants for home modifications to meet the needs of people with disabilities. Each agency has its own eligibility requirements, so you will need to search online by specific needs, contact a local social worker, or discuss it with hospital staff.
If you’re caring for a relative and provide for more than half of their basic living expenses, you may be able to claim them as a dependent on your taxes. You may also be able to deduct their medical expenses, even if you can’t claim them as dependents. Visit the IRS website or call the IRS help-line at 800-829-1040. You can also talk to an accountant about these options.
Working while serving as a caregiver
Some companies are more caregiver-friendly than others. Your company may allow you to work part-time, have flexible hours, work from home, or provide additional time off. Or they may not.
Under the Family and Medical Leave Act, eligible workers are entitled to 12 weeks of unpaid leave per year. Some companies even have employee assistance programs. Check your employee handbook to see if your company has set policies. Go over the options with your supervisor and HR before you make any big decisions.
Getting help is possible
It isn’t easy and it isn’t enough, but help is out there. Find out where other caregivers have found help and how it turned out.
Do you use one of these programs? Have you tried to enroll? Is there another program we should know about? Please let us know in the comments.
This article was originally published in September 2014. It’s been updated several times in order to reflect changes to available caregiver support programs.
In the United States, there are an estimated 1.4 million caregiving youth (children under the age of 18), and nearly 10 million Millennial caregivers (aged 18-34 years old). Of the millions of young caregivers, I believe every single one is an advocate. Advocacy means that you speak up for another person’s needs, views, and try to help them get support. As caregivers, advocacy is a way of life. You may speak to health or social care professionals on behalf of your family member, coordinate service care delivery, oversee your family member’s medication administration, and manage your family’s household. You are the expert on your family member’s care.
While you are well-versed in advocating for your family, you may find speaking up for yourself more difficult to do. As a young caregiver, self-advocacy can present its own set of unique challenges.
What are barriers to self-advocacy?
Lack of awareness in society & unsupportive environments: Unfortunately, many people do not yet recognize the vital role young caregivers play in our society. This lack of awareness often means that people do not understand your caring role and how it can impact all parts of your life. Society also tends to overlook and disregard the experiences of young people with caregiving responsibilities, and health professionals may not view you as a “caregiver” because of your youth.
Fear of mistreatment & associated stigma: You may stay quiet about your caring role because you don’t want well-intentioned professors, bosses, or friends to worry over you and treat you differently than everyone else. At work, your supervisor or co-workers may not understand your life as a caregiver, and you may might fear losing your job. If you provide care for someone with a socially stigmatized condition, e.g., mental illness, visible physical disabilities, or HIV-AIDS, you may fear that by speaking out as a caregiver, you will also “out” the condition of the person you care for.
No support available: In some situations, those around may already know that something is “up”, because of late or missed days at school or work. Conversely, you may be very open about caregiving. In such scenarios, people are aware of your caring role, but you find that there is little or no support available to you as a young caregiver. Supportive services may be directed towards your family member, rather than you, the caregiver.
What are ways to self-advocate?
Despite its challenges, the act of speaking up for yourself is impactful and meaningful. Every time you engage in self-advocacy, you continue to spread awareness about young caregivers. Even in the seemingly small moments, your words and actions demonstrate to society that young caregivers exist and matter.
Express your needs and desires within your family: To combat potential feelings of resentment, it is important to keep the lines of communication open in your family. You may want to engage in family group conferences to discuss current and future care plans. If you foresee sharing or shifting caregiving tasks to younger siblings, you’ll want to discuss with them the practicalities of the caring role and what this will mean for everyone in the family.
Inform doctors, nurses, and other health care professionals that you are a critical participant in your family member’s care, and express your desire to be involved in discussions.
Tell professors, administrators, work supervisors, and friends about your caring role and the ways it impacts your life. This may mean requesting a “grace period” to submit assignments, asking for flexible schedules and work hours, requesting to keep your cell phone turned on and kept with you, in case your family member needs to reach you in an emergency, etc. Self-advocacy in the workplace also means knowing your legal rights, so that you may be aware of potential issues of workplace discrimination.
Ask for help: Seek out extended family members, neighbors, or friends to help with caregiving tasks, or to give you a bit of respite. You may also wish to contact supportive organizations for help.
Monitor your own mental health and well-being: Take breaks (even just for a few minutes), practice self-care, exercise, and maintain a healthy diet. Keep up to date with your own doctor’s appointments and annual tests. You may wish to attend support groups and/or seek out a mental health professional if needed.
Get involved: Call or write your government representatives and vote. Use technology and social media to your advantage: there are several online caregiver support groups on Facebook and Twitter, and they can be a great way to meet other caregivers, ask advice, or vent! You could start a blog about your experience as a young caregiver or post videos to YouTube. You may also want to share your caregiving story through participation in caregiver research studies; this can be an impactful way to help other caregivers on a wider scale!
Remain encouraged as you seek to advocate for yourself. You serve an irreplaceable role in our society and you deserve recognition and support!
Can you think of other ways to self-advocate? How have you advocated for yourself and did you find it helpful? Please share your comments/suggestions below.
This article was originally published on the website of Christine M. Valentin, licensed clinical social worker, and may be accessed here.