There is more to the people in our lives than we can see

I went to a funeral this weekend and it reminded me how little we know about the people in our lives. As the different people stood up and told stories about how this gentleman had affected their lives, the richness of who this man had been, came alive. I realized how much more I could have learned about him and the life he had led. I truly have missed out in not getting to know this person better.

I remember when I visited my aunt and one of her caregivers showed me a picture of my aunt on her phone. This caregiver considered my aunt her best friend. I was close to my aunt and had never even heard about this person. How could this be? Was I not asking the right questions or not showing an interest in my aunt’s life? I thought I was but now I don’t know. There was much more to her than I realized. I only saw her in relationship to who we were to each other. I didn’t see the many people she touched and how she affected the world.

It would be wonderful if we could take some time out and find out something new about the people we love. Try to see them as the world sees them. Find out more about how they make a difference in the world. Or if you can, try to see their world through their eyes. The people in our lives matter in more ways than we could ever imagine.

Have a kind and respectful day.

Having patience with a senior loved one

I understand that it isn’t easy to be patient with a loved one that is aging or has a physical or mental limitation. I know that I have tried to hurry along a loved one with little success. But it is important to understand that our loved ones aren’t doing this to annoy us. They are just at a different stage of life. As a people age, the need to be in a rush and to get a lot done changes. Older seniors have more important things to focus on, the work of aging. There are two main tasks that need to be accomplished: Keeping control over as much of their life as possible and legacy work. The need to keep a sense of control and power over one’s life is necessary as the seniors begin to experience significant losses. Seniors are losing their health, their abilities and those around them begin to die. As people come to terms with what they are losing, the need to hold on to what power they can becomes even more important.

This is why when you come in and try to take over our loved one’s life, it is not seen as being helpful, but as you trying to dominate the person. We rush our loved ones and try to make them go at the speed that we prefer. The need to rush and get things accomplished is our agenda, not theirs. It is important to remember that the senior is not in a rush. He or she is trying to enjoy and appreciate the time remaining.

Not only are seniors trying to keep control but another even more important task needs to be done. Legacy work. This is when the aging are trying to make sense of and to make peace with how their lives have gone. They want to be remembered. They want to be able to tell their story and to know that someone is listening. When seniors repeat a story, it serves many purposes. The need to make sure our families will remember our history so they can share it with future generations and the need to re-tell the story themselves so they can make sense of what has gone before. If you can, take the time to reinforce that the senior in your life matters and that he or she has made a difference.

Some day, we will all be in this stage of life and will need to accomplish these tasks as well. This is no different from a toddler needing to learn to walk or a teenager learning independence. This is just a part of life. Perhaps we could be a little more patient and understand that these life tasks do not happen in a hurry. Maybe there is something we can learn along the way if we slow down, listen and connect with the seniors in our lives in a more profound and meaningful way.

For more information about how to communicate in a way that respects the journey of the senior, read David L. Solie’s book, How To Say It To Seniors.

Have a kind and respectful day.

Long Term Care Insurance, An article from Lauren Gershen’s Newsletter

Here Lauren’s interview at http://kindethics.com/2010/01/interview-with-long-term-care-insurance-expert-on-nov-27th-11am-pacific/?preview=true&preview_id=1478&preview_nonce=7efffc855d

In the years following World War II, there were many babies born which created what has come to be called the Baby Boom. Comprised of persons born between 1946 and 1964, “baby boomers” are one of the largest segments of our society.

With the oldest boomer quickly approaching retirement age, it’s time that boomers asked themselves some important questions: How are you preparing for retirement? Is it possible that you could outlive your retirement savings? Have you faced the possibility that you may need long term care at some point, either in your home, in assisted care, or in a nursing home?

Here are some facts to consider:
• 60% of Americans who reach age 65 are expected to need LTC services at some point, while 40% of those receiving LTC services now are ages 18 to 64, says OPM [Office of Personnel Management].
”A federal case for LTC”
Employee Benefit News, 02/01/03
• The national average cost of a year in a nursing home is $57,700.
Nursing Home Cost of Care Survey
Conducted by Evans Research, an independent research firm, 7/31/03
• Many of the Baby Boomers over age 55 mistakenly believe they are adequately covered for long-term care expenses through their workplace benefits packages. However, their health plans may only cover very limited long-term care expenses. As a result, many Boomers unknowingly face the risk of having their accumulated assets depleted by long-term health expenses that follow an unexpected event in their lives.
”Conning’s Industry Insight: Long Term Care Insurance.”
Issue #4, June 2002

Sobering facts, to be sure. And yet, many of us stubbornly cling to the belief that we will never need long term care. Above all, this shows how vital it is that we become better educated.

First, it’s important to understand what long term care is. Long term care provided under a tax qualified policy is defined by federal law as care for a person who requires assistance with at least two of six activities of daily living - bathing, continence, dressing, feeding, toileting, transferring - for a condition that is expected to last at least 90 days; or care for a person who has severe cognitive impairment, such as Alzheimer’s disease.

It’s important to recognize that includes many types of situations that can result in the need for long term care at any age, not just limited to senior citizens.

Next, it’s time to seriously examine some difficult questions.
Who will provide the long term care we may need? Many of us think our spouses or other loved ones will care for us, regardless of the level of care we need or the level of skill our families have in health care delivery. But, depending how events unfold, that may be impractical or even impossible.
Who will pay for the long term care we may need? Many people believe they can self-fund their long term care needs. But even the most effective savers should calculate how long their assets might last if drawn upon to pay the costs of long term care.
Others believe the government will pay for the long term care they may need. But today, Medicare will only pay some of the expenses for up to 100 days in a skilled nursing home if you qualify at all, and will only pay for certain types of skilled care in your own home. And what will happen to Medicare benefits when baby boomers begin turning 65 in 10 years is an open question.

Long term care insurance can help you provide for yourself.
It is critical that baby boomers understand that the cost of a long term care insurance policy today can be quite affordable, especially when compared to the cost of long term care. But each year the purchase is delayed, the higher the rates generally become.

Compare the cost of long term care insurance premiums paid over even 10 or 12 years to as little as one year in a nursing home, and you’ll see how valuable long term care insurance protection can be in terms of dollars and cents.

Finally, there’s the knowledge that, if you need long term care, with long term care insurance you will have choices about where you receive care, that you will have coverage to help pay for that care, and that the responsibility for providing care may not fall to your family. These choices can also help preserve your financial independence and your dignity, and those are priceless.

Lauren V. Gershen CLTC
Planning For Quality of Life
Long Term Care Planning & Insurance Specialist
LGershen@aol.com
(760) 777-9061 Office
(760) 777-9062 Fax

Visiting hours – When to follow the rules and when to break them

There are no visiting hours at nursing homes. You are allowed to visit your loved one at any time of the day or night. Don’t let them tell you that you are not allowed. In fact, I encourage you to stop by either very early or very late to check on how your loved one is being treated by the night nurses.

There are visiting hours at hospitals to make sure that the patients have enough quiet time to heal. Sleep and rest are crucial for the person that is recovering from an illness or surgery. There also needs to be time that the nurses and other staff can get their work done without you being in the way.

In general, I respect visiting hours. But I know that there are times when visiting hours should be respectfully broken. When someone is dying, there should be open visiting as you will want to spend every precious last moment with your loved one before they die. Or, you may want to ask if you can be of help keeping the patient calm when the person is afraid or is sundowning so the nurses have time to care for all of their patients on the floor. Or perhaps you can help when the person needs to be in restraints. It is great if you can sit with the person to keep them relaxed or distracted and reduce the need for restraints. There may be cultural reasons as well to stay after hours as many people feel safer when someone from their culture/family is present.

If you are going to be there after visiting hours, then you have to be there to help, not to get in the way. If you are constantly bothering the nurses and making it hard for them to take care of the many different patients they have to see that night, then you are being a problem. And the nurse has the right to ask you to leave. Visiting a patient is not a right but a privilege. If you are impeding in the healing process of your loved one or other patients, then the hospital can ask you to leave.

In the early days after my mom’s stroke, my brothers and I took turns sleeping on the floor beside my mother’s hospital bed. My mom was a difficult patient. She would scream out for help, she was afraid of hospitals and she was also very obese. I was able to help comfort my mom so she didn’t bother the nurses as much and I was also able to help the nurse turn her when needed. Nowadays, I wouldn’t advise helping to move a patient. As family members, we haven’t been trained in how to lift appropriately and may put ourselves at risk of injuries. I made sure that I didn’t get in the nurses way and tried to help in anyway possible.

If you are going to be there after hours, be polite, be appreciative, be helpful and be respectful of the healthcare staff. They are allowing you a privilege to be there after hours so make sure you say thank you.

Have a kind and respectful day.

“What to look for during your annual visit to elderly relatives” by Mary Twomey MSW. Thanks, Mary and the Center of Excellence in Elder Abuse and Neglect

Special thanks to Mary Twomey, MSW, Co-Director, Center of Excellence in Elder Abuse & Neglect for this wonderful article.

For many of us, the holidays offer a once-a-year time to visit with elderly relatives who live at a distance. These holiday visits are a good time to assess what assistance parents or other elderly loved ones might need. There are many things to consider. Does an elderly loved one require help with chores or housekeeping, personal care, shopping and meal preparation, money management, transportation, medical checkups, or medications? Are they isolated or, do they live with others? If living with another, are they dependent on that person for care? Is that person an appropriate caregiver? During your visit, keep an eye out for warning signs of self-neglect, or abuse or neglect by others. If, before you make your trip, you suspect that your loved one needs extra assistance, plan a longer stay so that you can visit local aging service organizations during regular work hours. Allow enough time during your visit to accomplish necessary tasks.

Make the most of your visits by taking some private time with the elder to discuss future planning. Allow time for them to express anxieties. You can decide together what needs to be done and who can help. Be observant while you are visiting. Realize that you may need to arrange a visit to a doctor for a full evaluation.

Remember that 75-90% of elder abuse is committed by family members. Don’t let denial become an obstacle to planning that could prevent future emergencies. This is not the time to hide your head in the sand, setting the stage for future regrets. Some warning signs of elder abuse are:

Self-Neglect – If the senior lives alone and does not have anyone providing assistance, self-neglect may become an issue. Some things to look for include:
• Senior appears confused
• Senior is no longer able to handle meal preparation, house cleaning, laundry, bathing, or timely bill payment
• Senior seems depressed
• Senior is drinking too much or is overusing drugs
• Senior is falling frequently
• Senior appears undernourished, dehydrated, under-medicated, or is getting care for problems with eyesight, hearing, dental problems, continence, etc.

Neglect or Abuse by others – If the senior lives with others or ostensibly has people helping with care, neglect or abuse may become an issue. Some things to look for include:
• Presence of “new best friend” who is willing to care for the senior for little or no cost
• Recent change in banking or spending patterns
• Caregiver isolates older person from friends and family
• Caregiver has problems with drugs, alcohol, anger management, and emotional instability
• Caregiver is financially dependent on the older person
• Family pet seems neglected or abused
• You find an abundance of mail and/or phone solicitations for money (“You’re our lucky winner!”)
• Senior seems afraid of the caregiver
• Senior has unexplained bruises, cuts, etc.
• Senior has “bed sores” (pressure sores from lying in one place for too long)
• Senior appears dirty, undernourished, dehydrated, over- or under-medicated, or is not receiving needed care for problems with eyesight, hearing, dental issues, continence.

What should you do?
• If you suspect your older loved one is at risk, call your local Adult Protective Services or Office on Aging or go to www.centeronelderabuse.org for more information.
• Seniors may not be aware of a gradual decline and may be reluctant or unable to plan for needed care. Support and guidance from family members can help prevent serious accidents and/or future health complications. Noticing and correcting problems can help keep seniors safely in their homes.
• Learn more about common geriatric conditions, medications and markers of abuse. Refer to Geriatric Pocket Doc, a compact guide book for non-physicians. For info, visit www.centeronelderabuse.org and click Geriatric Pocket Doc in the bottom right corner.
• Introduce yourself to responsible neighbors and friends. Give them your address and phone numbers in case of an emergency.
• Ask your elderly loved ones directly if they are afraid of anyone, if anyone is taking things without their permission; if anyone is asking them to do things they are not comfortable with, or if anyone is putting them down.

RESOURCES:
Center of Excellence in Elder Abuse and Neglect: www.centeronelderabuse.org. A program of the University of California Irvine, the CoE conducts research, training, advocacy, and direct services on the issue of elder abuse and neglect.

Eldercare Locator: Since 1991, the Eldercare Locator, a nationwide toll-free service provided by U.S. Administration on Aging, has helped older adults and their caregivers find local services for seniors. You may visit the website at www.eldercare.gov or speak to an Information Specialist who has access to a database of more than 4,800 entries. The toll-free Eldercare Locator service operates Monday through Friday, 9:00 a.m. to 8:00 p.m. (Eastern time) and can be reached at 1-800-677-1116.

AARP: AARP provides caregiving worksheets and tips on “Long-Distance Issues” http://assets.aarp.org/external_sites/caregiving/planAhead/long_distance_issues.html

Center of Excellence in Elder Abuse and Neglect
University of California, Irvine Program in Geriatrics
www.centeronelderabuse.org 714-456-5530

Advance Directives Part 3 - Now that you have filled it out, what should you do next?

Now that you have filled it out, what should you do next?

1. Well, the first thing you have to do is sit down with your first choice and your alternate decision makers and discuss what you would want if you were injured, disabled or dying. Remember that this form goes into affect when you are too mentally disabled, unconscious or sedated to speak for yourself.

2. Then, you have to give all of your decision makers a copy of your advance directive. You also need to give copies to all of your doctors and your local hospital. You should keep a copy at home either by your bedside, taped to the inside of your medicine cabinet or on your refrigerator. You can also keep one in your car or in your purse. People won’t know what you want if they can’t find your instructions. Doctors get frustrated when the family says, “The patient has an advance directive, but we don’t know where it is.”

3. The next time you go to your doctor, bring him a copy and discuss what you have written with him. Ask him if he would be willing to respect your choices. This is where you can really get into trouble. Some doctors won’t follow what people have written in their advance directives, so you better know right now if he is one of those doctors. Also, some doctors are too afraid to talk about death. If you don’t think your doctor would not respect your wishes or if they are too uncomfortable talking about dying, then find yourself another doctor. I am serious about this. Doctors go against people’s instructions and prolong the suffering and dying of patients in every hospital. If you find yourself in this situation, with the doctor refusing to follow the advance directive, then the bioethics committee at your hospital should be able to help you. If you are the loved one and you are unwilling to follow what is written in the advance directive, then you shouldn’t be the decision maker. Have the doctors use one of the alternates.

How to get an advance directive and other resources.

1. The easiest way to get a free advance directive is to go to the front desk of any hospital. Just tell them you need one or more for your family and they should give them to you free.

2. You can go online to caringinfo.org for a free, state specific form. These are also free.

3. If you need one in a particular language, then do a google search with your state and language and see what comes up. Only a few languages are available, I am sorry to say.

4. Your doctor’s office should have one for you, but unfortunately, many doctors don’t keep them in their office.

5. You can also order one from Five Wishes. This is a very good document for explaining what you would want in certain situations. The document costs $5 each and can be ordered in bulk (25 copies or more are $1 each) at 888-5-WISHES or www.agingwithdignity.org. These forms are valid in 40 states including: Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, The District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska,
New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Vermont, Virginia, Washington, West Virginia, Wisconsin and Wyoming.

Quick Version for How To Fill Out Your Form:

Whom should you pick?
1. Pick someone who will understand what the doctor is saying.
2. Pick someone who knows you well and has listened to you tell them what you want.
3. Pick someone who won’t fall apart in a crisis.
4. Pick someone who will do what you have asked, even if it difficult to do.
5. Write down who you don’t want to be your decision maker.
6. You can pick two or three people to work together as your decision makers.
7. Your spouse may not be your best choice and you may want to choose someone else.

What would you want?
1. This form goes into effect when your brain isn’t working anymore, not just when you are dying.
2. Don’t be too specific about the particular treatments you want or don’t want because you don’t know what the medical situation will be when you need this form.
3. Write out a “Meaningful Recovery Statement” describing what kind of life you would want, if you were disabled and couldn’t think anymore.
4. Tell the doctors what they should do if you were going to live in a terrible condition as well as if you were dying.
5. Write down anything else you want them to know about where or how you want to die, organ donation preferences or autopsy instructions.

Have a kind and respectful day.

Advance Directives Part 2 - What would you want if you were unable to speak for yourself?

Next let’s look at how to tell the doctor what you would want, if you were unable to speak for yourself.

What would you want?

1. The first thing is to remember that this form goes into affect when you are too mentally disabled, unconscious or sedated to speak for yourself. This form will be used when you are injured, sick and/or when you are dying. Too many people, including doctors, think of this form as only a dying form. For some people, this form will be used for years when they have become mentally ill or disabled.

2. The next thing to decide is what you would want in certain medical situations. Should you be specific or vague about the specific medical treatments you would want? I would encourage you to be vague. You won’t know the exact medical situation you might find yourself in and you may have guessed wrong when you wrote down don’t do this or don’t do that. Here is an example: A patient might write on his or her advance directive that they never want to be put on a ventilator. How will this statement be interpreted by your doctors? The doctor will not put you on the ventilator because if he does, then it is considered assault and battery to give someone medical treatments against his will. This recently happened to an elderly gentleman. The gentleman wrote that he didn’t want to be hooked up to a ventilator, but what he meant was, he didn’t want to live on a ventilator. This became a problem when he needed to be hooked up to a ventilator for 4 days in order to recover from an infection. He didn’t need it forever, just for a few short days. But because he was too specific, the doctor couldn’t save him. So be careful when you request certain medical choices. Make sure that what you have written would work in all situations.

3. So, now that I just scared you, you are probably worried about what to write in this section. I have a solution. It is called a “Meaningful Recovery Statement.” You need to explain to the doctor, “What kind of life would you want to live if your mind no longer worked well or if it didn’t work at all?” Now for some people, any condition is okay as it is God’s will to determine how we live and when we die. But for others, you can’t think of anything worse than living in a nursing home, wearing diapers, having other people feed you and not being able to recognize your loved ones. But how will your doctors know what you want if you don’t tell them? Doctors know how to practice medicine. But what they don’t know is what would make for a “meaningful recovery” for you. So you have to tell them.

Here is my “Meaningful Recovery Statement”:
“I value a full life more than a long life. If I have lost the ability to interact with others and have no reasonable chance of regaining this ability or if my suffering is intense and irreversible, even though I have no terminal illness, I do not want to have my life prolonged. I would not then ask to be subjected to surgery or to resuscitation procedures, to intensive care services, or to other life-prolonging measures, including the administration of antibiotics, blood products or artificial nutrition and hydration. I also believe that the financial and emotional burden on my family should be considered in making these types of decisions.”

Because I have written this in my advance directive, the doctors will know what is important to me. Of course this doesn’t have to be your statement. Write one that is meaningful to you and attach it to or write it on your advance directive.

One more thing, please address the issue of terminal versus non-terminal situations. If you are terminal, then it is important your doctors know where and how you would want to die. If you are only severely disabled, but not going to die soon, then you need to let them know what kind of life would be tolerable for you. The best way to be protected is to write it down.

We have just gone over the main sections. Of course you can write down anything else you want the doctor to know about you. You might want to tell them where or how you would want to die, if you would like to donate your organs or if you are for or against an autopsy. This is your form, so write down whatever works for you.

Have a kind and respectful day.

Advance Directives Part 1 – Choosing your decision maker

Most doctors just hand the patient this form and say fill it out. But they don’t help you fill it out or explain what the decisions mean. I am going to help you think through the process of filling out your Advance Directive.

There are two main decisions you need to make when you are filling out your Advance Directive. Who you want to make your decisions for you and what you would want. After I help you with these two questions, I will then tell you what to do with your advance directive after you have filled it out. At the end, I have included instructions on how to find a form that would work in your state.

Let’s first talk about who you would want to make decisions for you. In your state, your form might ask you to list your agent, proxy or surrogate decision maker. (These words all mean the same thing, but each state its own legal term.)

Who should you pick?

1. You should pick someone who is medically literate. What does this mean? The person should be able to understand what the doctor is saying, be able to figure out the medical words and be able to understand the medical choices being offered. If the person you thought you were going to pick would be confused by what the doctor would say, then pick someone else.

2. You should pick someone that knows you very well, would know what you would want in a medical crisis and would tell the doctor what you have told them in the past. The person you have chosen will be asked to listen to the medical information and then use your values to make the medical decisions. The person is not supposed to use his or her own values, but to speak as if they were you. If the person you thought you would pick wouldn’t respect your choices or has very different beliefs from yours, then pick someone else. You want someone who will speak as if he or she is speaking with your voice, not his or her own agenda.

3. You should pick someone that won’t fall apart in a crisis. It doesn’t do you any good if the person is hysterical, can’t function or can’t stand to visit you in the hospital. You need to pick someone brave enough and who will be by your side no matter how difficult things get. If the person you thought you would pick doesn’t handle his or her own life very well, then don’t have him or her be in charge of yours.

4. You should pick someone that will do right by you even if it is the most difficult thing they ever had to do. Sometimes doing the right thing is allowing the person you love to have a peaceful death. And your decision maker needs to be able to live with the difficult decisions he or she has to make. In reality, he or she is making the decisions based on what you would want, not what he or she would want. But that doesn’t make it any easier. You have to be able to talk to this person ahead of time about what you would want in different kinds of situations. So, if the person you thought you would pick is too afraid to talk about death and dying, then he or she isn’t the right person for this job. And if he or she would refuse to follow through with what you have requested, then pick someone else.

5. You can write down whom you don’t want to be your decision maker. Depending on what state you live in, the rules vary regarding who is in charge of you when you are unconscious or incapacitated. You need to protect yourself.

6. Doctors won’t tell you this but you can pick two or three people to share in your medical decision making. But be careful that you pick people who can work together, will support each other and who you know won’t make things worse for the healthcare team. I had one lady tell me that she picked her two sons to make her decisions and that these two men had never agreed on anything. She is setting herself up for a nightmare as good decisions won’t get made and the doctor will hate having to deal with her sons. You don’t want your doctor to hate your decision maker. Please pick carefully.

7. Some people don’t pick their spouse because they know that it would be too much for their loved one to go through and that their spouse couldn’t make these most difficult decisions. If you do pick your spouse, then you need to be extremely careful about picking the alternate decision makers. The alternates will make your decisions if you and your spouse are injured in the same accident. The alternate should be just as qualified as your first choice.

I am available to speak at your organization or hospital.

Have a kind and respectful day.

Finding the money to modify the senior’s home for safety.

From http://ageinplace.com. Thanks Mark Hager for these great resources.

Here are some places to research for help paying for aging in place home modifications or services:

• Use the Eldercare locator from the US Government ( http://www.eldercare.gov/ or 1-800-677-1116) to connect with your local Area Agency on Aging. They will have the most relevant information available.
• Local cities have CDBG (community development block grants) for home repair. And/or contact the local Mayor to find local funds.
• Rural Development is also a great resource for low-interest 1% loans/forgiveable loans and grants for home repair/home mod. http://www.rurdev.usda.gov/
• Sometimes community foundations will also fund a variety of start-up programs and may know where to turn locally.
• Habitat/Rebuild Together are also up in our neck of the woods Indiana/Michigan.
• Larger churches in our area volunteering, especially the men’s groups for some handyman/home fix up.
• Reverse mortgages. Not for everyone, but can help many.
• If you’re a veteran, try the Veteran’s Administration

For more help, contact:
http://ageinplace.com
http://www.ageinplacepros.com
Twitter: http://www.twitter.com/aging_in_place
Facebook: http://www.profile.to/aginginplace
mark@ageinplace.com

Have a kind and respectful day.

Celebrate the holidays today - Take a treat to your doctor’s office or the nursing home today

You may be thinking of doing something nice for your loved one’s doctor’s office, hospital staff, or long term facility where your loved one lives. But don’t do something in December. Everyone brings the staff food and treats in December and a lot of it goes to waste (waist). The staff would love to have your bring something in October or some other month when they can truly appreciate it. And, your efforts will be noticed because it is not just one more person bringing in a treat, but you thinking of them at a different time of the year.

Here are a couple of yummy places where you can order something to be delivered.

Chocolates Gifts: http://tinyurl.com/p8abol
Cakes: http://tinyurl.com/rylvyz
Tea: http://tinyurl.com/nt5gqc
Coffee: http://tinyurl.com/l6×2d5

Have a kind and respectful day.

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