An Alzheimer's patient once came to me after he had got out of his house and was found hours later in a ditch approximately 2 miles from his house.  Wandering is often a scary symptom of Alzheimer's disease and dementia.  It's confusing and scary for a senior who does not know where he/she is or where they are going; and is scary and worrisome for family caregivers.  Wandering can occur anytime but tends to increase in the late afternoon/early evening hours.  There are several things caregivers can do to keep their loved ones safe at home. 

Tip #1:  Use deadbolts on doors leading outside, place them high or low on doors
Tip #2:  Take locks off of bathroom and bedroom doors to avoid your loved one from locking themselves in
Tip #3:  As the sun starts to go down, close the blinds/curtains and turn lights on
Tip #4:  Install appliances that shut off automatically
Tip #5:  Keep toxins i.e. cleaners, bleach, poisons; and prescription medications in a safe, secure space
Tip #6:  Remove clutter from around the house
Tip #7:  Install a door alarm or place a motion sensor in your loved one's room at night to alert you when they are awake and moving
Tip #8:  Label doors, drawers, and cabinets; this is most helpful in the earlier stages

A professional geriatric care manager can help you in reviewing your home and finding assistance for home modifications.  For more tips and information, check out The Complete Guide to Alzheimer's-Proofing Your Home and home modification tips.

This article "50 Communication Tips and Techniques for Caregivers" was recently sent to me.  This article lists good tips and techniques for communicating with someone who experiences memory loss.  These tips and techniques include information on communicating and speaking someone who has memory loss, attention techniques, nonverbal communication tips, behavior tips and techniques, and working/communicating with others who might be involved with the senior.

Last week, I traveled from Indianapolis, IN to Litchfield, CT with my Mother to attend my sister’s wedding.  It was a long trip as we got to the airport early to deal with security, took a 2 hour flight to Newark and then rented a car and drove 3 hours to a Bed and Breakfast in Connecticut.  Along the way, we had to take our shoes off, give up our purses for a security inspection, and take escalators, elevators and a train in pursuit of a National rental car.  Everyone knows that traveling today is an exercise in both patience and logistics…b ut when you are accompanying a senior who is not steady on her feet and tends to be confused….. the patience/logistics requirements increase ten-fold.

Planning and advance preparation can help ease the journey.  In our case, I found it helpful to:

• Keep my Mother’s ticket and ID with mine, rather than risk her misplacing the paperwork.
• Consolidate all carry-on items in one bag (meds, jewelry, reading material), so there was less to keep track of during the trip.
• Dress for the security line….slip on shoes, no heavy jewelry, easy to remove jacket.
• Bring an extra sweater, as most airports are freezing.
• Pack snacks in case of airline delays, missed meals and long wait times.  The food court can be a long way from the assigned gate – a walk a senior is not up to.  If a senior has diabetes or a loss of mobility, packing snacks is essential to avoiding missed meals or long walks to the food court.
• Request a wheelchair or flag down a motorized cart to assist with transportation from gate to gate, if necessary.
• Stop when the senior gets tired and sit for a few minutes.  The airport pace is very difficult for a senior to keep up with.  This is especially true if your loved one has a loss of mobility.
• Limit information and do not provide it all at once – just focus on the next step and explain to the senior.  Discussing the entire itinerary i.e. we are catching a plane, then renting a car, then driving to Connecticut... is too overwhelming.
• Remember that the crowds, noise and fast pace of the airport can contribute to a senior’s confusion and anxiety.  Try to buffer them as much as possible by walking so that they are close to the wall and you are on the outside to take the bumps as people push past you.
• Be sensitive to their fears – dementia may cause even seasoned flyers to feel nervous about flying.
• Enlist help – ask someone else to accompany you to help with luggage, logistics and provide moral support.
• Enjoy the senior’s sense of wonder along the way – for them, a plane trip is a rare and exciting event. 

In summary, traveling with a senior should not be taken lightly.  Advance planning is key to ensuring a safe and stress-free trip for both caregivers and seniors alike. Be prepared, be patient and always remember that seniors will need extra special care and attention during the trip.

We are constantly hearing about identity theft and what to do and what not to do.  We may know someone who has had their identity stolen or tried to work with their bank when their account numbers had been stolen. Just last week, I had a friend who had someone steal his account number from Saudi Arabia – since it was the bank’s files that were accessed, he did not lose his identity or any money. Others whose personal debit cards have been stolen lost thousands of dollars.

The older adult is a prime target for identity theft, and maybe even more so those suffering from memory loss or Alzheimer's. It could be as simple as paying with a check to one of the frequent kids who come to their door selling magazines, cleaning products or someone offering to clean their carpets “free” and entering the home. Explain to your parent and/or older friend that when someone is using their name, social security number, or credit card without their permission, it is a crime. Tell them to keep their checking account private, report any stolen credit cards or checks, always review their monthly bank statement, and never let anyone enter his/her home to give a “free” demonstration. 

Last week I attended an awareness presentation on identity theft by local police officer.

Some tips are:

• Do not have your checks delivered to your apartment, front porch, or a mailbox that is not locked.
• Do not use your debit card freely at gas stations, grocery stores, etc. 
• Shred anything that has personal information.
• Do not pay by check to solicitors at your door
• Do not let anyone enter your home
• Be very careful when buying things online. Websites without security may not protect your credit card or bank account information. Look for information saying that a website has a secure server before buying anything online. 
• Check with the Federal Trade Commission (FTC) to find out how to protect yourself from common online scams that can trick you into revealing your personal or financial information.

Remember do not share your personal information – Ask questions – Report any thefts. 

If you're caring for aging parents, you may check these two resources for more information:

Federal Trade Commission
600 Pennsylvania Avenue, NW
Washington, DC 20580
877-382-4357 (toll-free)
www.ftc.gov

Look for the booklet 'Take Charge: Fighting Back Against Identify Theft.'
AARP- Consumer Protection offers a free online course regarding identity theft.
601 E Street, NW
Washington, D.C. 20049
888-687-2277 (toll-free)  
www.aarp.org/money/wise_consumer

When is the right time to talk to mom or dad about planning for the future?  Ideally, the earlier the better.  Usually when seniors are in their 70s is the best, unless signs of dementia or another health issue arises earlier.  It is important to understand your parent's healthcare and financial wishes and goals.  For most seniors, death is not their main fear but losing their independence is.  Planning for the future and having this conversation with mom or dad is not easy, as people do not want to think about a time when they'll need help and resources in order to continue to live independently.  It's important to have this conversation before a crisis hits.  Talk with your parents about their wishes regarding medical treatments, procedures, etc in the case that they are unable to make decisions for themselves.  Information that is discussed should be put into writing, a Living Will document.  Financial planning is also important and should be discussed with mom and dad.  These actions and steps should be lined out in a legal document.  By having this discussion early, the senior is not only verbalizing their wishes and goals but being responsible by planning for their future.

According to the Mayo Clinic, there are nearly 10 million Americans that provide approximately 8.4 billion hours of unpaid care!  These caregivers are often family members.  Providing care in the home for someone who has Alzheimer's is a 24/7 job often with little relief.  I've met families who state they only get 4-5 hours of sleep at night because mom/dad will get up and mill about, or that they sleep with a baby monitor.  My grandmother used to say she slept with one ear open so she could hear what my grandfather was doing.  Caregiver stress can lead to feelings of resentment, physical health decline (heart attack or minor stroke), emotional distress, and possibly unintentional elder abuse.  I once had a wife of an Alzheimer's husband who said she knew she was at her breaking point, when she thought she was going to hit her husband and started having feelings of anger and resentment instead of love and patience.  I urge ALL family caregivers to not let the stress get to this breaking point.  It is OK to ask for and accept help.  I understand that we feel we are the best person for the job.  However, our job is also to take care of ourselves.  We are no good to our loved ones if we are stressed out and physically and emotionally distressed. 
There are several respite care options.  One is adult daycare.  The majority of adult day centers take a social approach verses a medical approach.  It's a time for seniors to get together in a social setting and do activities that promote physical and mental health.  Adult day centers allows caregivers to set their own schedule, take mom/dad there once a week or 3 times a week or every other week...this allows you, the caregiver, time to run errands, have lunch with friends, take a nap, etc.  Another respite care option is hiring an in-home companion to come and sit with mom/dad while you run errands or take some time for yourself.  Another option is having a volunteer from the local Alzheimer's Association or Area Agency on Aging come and spend time with mom/dad while you take time for yourself.  Another source of volunteers is the local university, check with the school of social work, education, or nursing. 
The goal is often to keep mom/dad at home for as long as possible.  Receiving and accepting assistance will help you achieve this goal as well as help you maintain your overall health so you can be the best caregiver.  There is no guilt or shame in accepting help from others, and all caregivers should be praised for doing this often difficult job!

Alzheimer's Disease is a world of uncertainty for both the person affected and the family members.  It's important to create moments of joy within that disease and with that senior.  Alzheimer's and dementias affect each person differently, some people have personality or behavioral changes, some lose brain functioning at a faster rate, etc.; their world becomes different.  It is important for family members to pay attention and learn where their loved one is at.  This is not an easy task for family members because the senior's memory maybe affected to where they no longer recall their wife or that they have children, etc.  If we try to correct them, it causes more confusion, anger, sadness or depression for the senior.  Try to put yourself in "their world"....  I once stood in front of a mirror with a lady affected by Alzheimer's and she said "who's that old lady?"  Instead of me saying that's you (since she did not recognize herself), I merely said "I'm not sure exactly, but it's a good thing we are two good-looking ladies."  In her mind, she was in her mid-30s and could recognize herself in an old picture of when she was in her 30s, but if you showed her a picture of herself today, she didn't recognize herself.  Another lady was taking all her clothes and other belongings and gathering them up and putting them into piles, stating she was getting ready for a garage sale.  Instead of telling her it was the middle of winter and she wasn't having a garage sale, I started a conversation by asking her what she was going to buy with her garage sale money.  She said a new car and some new clothes, so we talked about cars and shopping while I helped her "decide what goes and what stays".  We had a great conversation and a fun time.  It is difficult for family members to join in mom or dad's world because it is not "our reality."  But it is their's.  It's our turn to help create memories of joy.  If their thoughts or actions are not physically harming to themselves or others, then just try to roll with where they are at.  Correcting them or trying to bring them to "our reality" will only cause emotional anguish.  The article, "Finding Moments of Joy Helps Alzheimer's Patients" gives additional tips on how to create moments of joy.

My mother moved to Indianapolis last August.  The move was difficult, as she moved away from her friends and an area where she had lived for almost 30 years.  Her move into an Assisted Living Facility in Carmel, IN meant she would receive the care she needed, but it impacted her independence when she gave up driving, downsized to a smaller apartment and lost her social network.

The past ten months haven’t been easy for either of us.  My Mother has struggled to adapt to a new place and make new friends.  I have struggled to balance work and caregiving, while maintaining time for myself and the things I enjoy.  We have both struggled to adjust to the dynamics of a shifting Mother-Daughter relationship.

Throughout it all, my Mother has conceded that she likes it here….yet has repeatedly asked me if she can move back to where she used to live.  We’ve discussed this and I’ve explain that her home in Pennsylvania is 11 hours away and that it is probably better if she stayed here, so we can see each other more often and I can help her with things.  She has reluctantly agreed that this is the best plan, but we have both felt sad that she can no longer live as she used to and that her cognitive decline has changed her life in ways neither of us imagined.

That’s why yesterday was a wonderful day and a blessing to be appreciated for a long time.  It started out innocently enough.  I took my Mother shoe shopping.  She needed some sturdy, comfortable flats for summer.  The shoe store clerk was exceptionally nice to my Mother and found a pair of stylish, yet practical shoes.  My Mother selected a summer purse she liked too – so was quite happy with our shopping expedition.  She commented as she left that she liked the shoe store quite a lot and was glad it was nearby.

Later at dinner, she looked at me and said “Can I stay here?”  I responded by saying of course she could stay here, that she lived here now…in Carmel….about five miles from my house.  She responded by saying “Good, I like it here and I like having dinner with you and going shopping.”  Her comments were sincere and something I’ve longed to hear for ten months.  I quietly thanked God for helping her become comfortable in a new place.

Everyone needs a place to belong and a place to call home.  I believe my Mother has finally come to think of Carmel, Indiana as home and I am grateful and thankful that she is happy to be here. 

Got a headache, back pain, high cholestrol levels, etc?...then pop a pill.  That is often the "magic" solution in today's health care system.  According to the American Heart Association, 32 million Americans take 3 or more medications daily.  Seniors often take double or triple that amount and sometimes more.  The problem is, is that with all medications come potential side effects and then to treat those side effects people are often prescribe another medication and so on.  Another problem is that seniors often have multiple physicians who often are not aware of what the other physicians' treatment plans are and what medications they are prescribing.  According to Medco Health Solutions, a pharmacy benefits manager, "the risk for drug errors is 7 times greater in seniors than in people under age 65."  CNN.com released an excellent article this week titled "Is Grandma drugged up?"  This article tells a story of a 66 year old woman who was experiencing confusion and slurring of her words.  Her family took her to the emergency room where the possibility of a stroke was ruled out; she was admitted to the hospital and was diagnosed with Alzheimer's Disease.  Her children believed that the diagnosis was incorrect, as she has been functioning independently.  They took their mother to a geriatrician at the University of Oklahoma for a second opinion, where they were told that she most likely did not have Alzheimer's Disease but was overmedicated.  Dr. Jerry Gurwitz's philosophy is "that any new symptom in an older person should be considered a drug side effect until proven otherwise."  Not only do medications have side effects but they also interact with other medications causing contraindications, enhancing side effects, etc.  It is important to always keep a current list of medications, including prescriptions, over-the-counter medications, herbal medications and supplements.  All medications, not just prescriptions, can interact with each other, as well as, food/beverages and other substances i.e. tobacco.
There are several ways caregivers can assist in medication management.  If you feel that your parent is being overmedicated, talk with your primary care physician or geriatrician, and pharmacist.  There are also several online tools you can use to check your medications for interactions.  Here are two online tools:  PDRhealth.com and drugdigest.org.  Educating yourself on what medications cause potential problems for seniors is a good way to become an advocate for your parent.  As well as knowing the suggested lists of medications to avoid if a senior has a specific diagnosis.  My Health Care Manager also reviews seniors' health history and medications and can consolidate that information into one locale to assist families in managing their parent's health care.

Recently, a colleague made me aware of a free, on-line publication about Alzheimer’s, The Alzheimer’s Daily News - http://alznews.org.  I signed up for the daily e-mails with some trepidation.  I wasn’t sure just how much I wanted to know – given my family’s history.  However, I finally decided that knowledge is power and signed up for the newsletter.  Some days the articles make me sad, some days they make me afraid, some days they give me hope and, thankfully, most days they help me cope. 

Yesterday’s edition contained a story about a keynote address presented by Jolene Brackey, the author of Creating Moments of Joy for the Person with Alzheimer's or Dementia.  I thought the advice she offered was some of the best I’ve read and plan to order her book.  Her talk focused on everyday situations and realistic approaches.  One of the best bits was her comment about body language.  Her point is that a person with dementia or Alzheimer’s may not be able to communicate as they have in the past…but that they can still read body language.  Therefore,  it is important for caregivers to convey a relaxed and open posture and positive mood.  What a great idea and something caregivers should try to achieve, although it may take some practice!

To link to the complete article, please click here.

To view the book on Amazon, click here.

Anyone who has dealt with an aging parent or a senior friend that has cognitive decline knows how hard it is to discuss those difficult topics such as driving, advance directives and/or their wishes to age in place. These conversations usually happen during a crisis situation, e.g. the senior has fallen and been admitted to the hospital,l or suddenly their car has a huge dent in the back end. As I discussed in my last blog, there is no easy way to begin discussions about the senior’s ability to drive when he/she has memory loss. It is even harder to conduct these conversations when you have not been involved with the senior on a routine basis. Whether it is regarding their driving ability or their end of life wishes, as an adult child you have to remember to preserve your parent’s dignity while assisting them to talk about their decisions.

If at all possible, do not have these conversations during a crisis. Plan a convenient time to have these conversations with your loved one. Remember that you want to keep the conversations positive- thinking of solutions; progressive- how the issue will be addressed over time; and productive- not argumentative. It is important to keep the senior engaged.

Decide beforehand who is best to conduct the conversation. This is a discussion for the family members, but a decision needs to be made.  For instance, if it is regarding the senior’s driving skills, the person to deliver the message needs to be aware of how the senior is currently driving. Is the area of concern a one-time accident… or is it a daily roller coaster ride?

Decide on the best time to have these conversations. You want everyone to be calm, not filled with apprehension. You want it to be convenient for all of the people involved in the discussions.  For instance, in regards to advance directives, you do not want to hold these discussion in a hospital room while waiting for surgery. The conversations regarding your parent’s wishes regarding durable power of attorney or health care representative should be held prior to any illness.

It is best to pick the topic of discussion and have it prior to the crisis. Regarding advance directives, the earlier you can have these conversations, the better. Everyone - no matter what age they are - needs to decide on their own health care decisions… especially their wishes if they become unable to make decisions for themselves.  The financial power of attorney also needs to be decided before the senior has cognitive decline.

Develop a personal conversation plan for each topic that you would like to address and solicit professional support as needed. For example, if your parent has a relationship with a lawyer from drawing up their will, encourage your parent to talk with the lawyer about advance directives, including durable power of attorney. You may even help them set an appointment with their lawyer. Hopefully they will allow you to attend, but if not, ask them how it went and talk to them about your wishes.  

There is no clear-cut right or wrong time to have these difficult conversations. The key thing to remember is to have the conversations before your parent is unable to have them. 

Some good resources are Alzheimer’s Association’s website www.alz.org and the National Institute on Aging.  Click here for the NIA’s Caregiver Guide for more tips on communication or visit http://www.nia.nih.gov/NR/rdonlyres/C2F11D41-E5FE-435D-9C9D-A3489319D4AD/6531/Caregiver_Guide307.pdf.

When your other family members do not give you (the main caregiver) enough help or support, or do not agree or criticize your actions, what do you do?  Roles and responsibilities of adult children caring for their parent changes over time.  Statistically, the adult child who lives closest to the aging parent assumes the role of the main caregiver.  Most often this adult child is also a daughter.  This person often feels a sense of joy and pride in being able to assist mom or dad but also often feels overwhelmed, alone or deserted by the rest of the family.  The responsibility of caregiving is often not shared equally among the adult children or the rest of the family.  Some family members may be in poor health and physically unable to help, financially unable to help, have demanding jobs or live far away.  Family members who do not have the day-to-day experience of caring for an aging parent may not know what it's "really" like to care for mom or dad, or may not know enough or understand mom or dad's health conditions. 
All family members need to do their homework about mom or dad's health conditions. For example, knowing the symptoms of dementia will help give adult children a better understanding of mom or dad's actions. 
It's important for the main caregiver to recognize and acknowledge when you need a break or need some more help.  Remember...you need your family.  Keep other family members informed of what's going on with mom or dad.  Try Lotsa Helping Hands a handy web tool for keeping families connected.
Some family members and even the main caregiver cannot always commit the amount of time they truly want to towards mom or dad for multiple reasons.  Having a Health Care Manager to assist with eldercare management is a welcomed relief for several families and especially for the Sandwich Generation, adult children in the workforce raising their own family and trying to care for an aging parent.

I've had a few questions lately about technical help in dealing with memory loss.  There are some good tools to assist seniors and caregivers with things like medication management, appointments, self monitoring reminders, falling concerns, and even mobility. 

Saying this, I should quickly add that these are all fairly new and nothing has yet emerged standard practice.  This may be due to the reality that memory loss and related conditions of dementia are typically progressive diseases.  Meaning, a technology that works this month likely will not work in six months.  For example, one caregiver we were working with purchased an electronic pill dispenser.  Each time a medication was to be taken an ever more persistent alarm would sound to remind their loved one to take their medicine.  Some of these devices can even use a phone connection to dial a central database and report the activity of the unit.  This worked well for time, but one day their parent decided that this device was annoying, unplugged it, and put it under the bed.  Any attempts to reset the unit resulted in some similar behavior.  A new approach had to be found.

So for caregivers caring for parents with dementia, simply be prepared to monitor and make adjustments with any solution you might consider.  Technology can be a temporary suppport tool.  The news is better if your parent is not dealing with significant cognitive problems.  In this case, technology can be a real and lasting support tool.

There is no easy way to confront your loved one about their driving skills – especially when they view it as their last means of independence. But yet we hear horror stories of older adults causing a terrible accidents. We wonder ‘will that be my parent? When do “I “ step in and take their keys?’ Then we ask questions and get answers like “just hide their car keys” or “tell them the car is in the shop and they will forget about driving!” You know, they don’t forget and they find those hidden keys…

Then we expect their physician to magically have the answer to this difficult decision. In reality, there are no easy decisions or ways to address this most difficult issue. But the Hartford Financial Services Group, Inc. and the MIT AgeLab conducted a research study and created a guide to help people dealing with this specific situation http://www.thehartford.com/alzheimers/.

The Hartford Brochure  - “At the Crossroads” is a wonderful resource for anyone who is having conversations and/or thoughts about stopping a person with dementia from driving (http://www.thehartford.com/alzheimers/brochure.html). This guide was developed to assist people with dementia and their families prolong independence while encouraging safe driving. http://www.thehartford.com/alzheimers/

This guide provides suggestions for monitoring, limiting, and stopping driving while addressing the following areas:
• Why dementia and driving is a difficult issue
• Assessing concerns about driving behavior
• Monitoring driving behavior
• Easing the transition from driver to passenger
• Having positive and productive conversations
• Seeking help from outside sources
• Understanding how family relationships affect driving decisions
• Advice from caregivers who made this decision

The guide also covers many warning signs including but not limited to a decrease in confidence while driving; difficulty turning to see when backing up; easily distracted while driving; incorrect signaling; and scrapes or dents on the car, mailbox, or garage.

A key recommendation is to document and share with other family members and health care providers the frequency, type, and severity of accidents/incidents and any patterns of change. Remember that everyone has isolated incidents, but it is when there are patterns that conversations and decisions need to be made. However, if your loved one is confusing gas and break pedals or stopping in traffic for no apparent reason – it is time for immediate action. 

These additional sites may also assist you:

• American Occupational Therapy Association [301-652-2682]
  www.aota.org/olderdriver
  Excellent general information, self assessments, and important links
• National Highway Traffic Safety Administration [1-888-327-4236]
  http://www.nhtsa.dot.gov/
  Has fliers about many medical conditions that affect driving

Family members of aging parents who have dementia or Alzheimer's Disease have a difficult job.  Individuals with dementia and Alzheimer's often show changes in personality, emotions, and social behavior.  These changes are common symptoms of the disease and occur with the cognitive decline.  Family members often feel a sense of ambivalence, having both positive and negative feelings toward their aging parents.  In a 2007 USA TODAY/ABC News/Gallup poll, "Slightly less than half of those [family members] providing help say it has caused them some stress or a great deal of stress." (USA TODAY/ABC News/Gallup poll, May 24-June 3, 2007).  Feelings of anger, resentment, and guilt are all common among family caregivers.  Lack of assistance and support from other family members and lack of time can all contribute to these feelings.  This person is your mother or father whom you love, and your feelings of anger and resentment can cause feelings of immense guilt.  Family members often express depression and a sense of sadness watching their once independent and capable parent decline.
You are not alone!  Most family members caregiving for a parent of dementia or Alzheimer's express these same feelings.  It's important to care for yourself!
Here are a few tips for caring for yourself:
1.  Take time for yourself!  Set aside time each week to go to a movie, out to dinner with a friend, shop by yourself, take a yoga class, read, golf, enjoy time by doing your favorite hobby, etc.
2.  Deep breathing exercises.  When your loved one has you frustrated, try to take deep breathes and de-stress.
3.  Set up a schedule with other family members to help out with mom/dad.
4.  Enlist the help of friends, neighbors, church members, etc. 
5.  Maintain connections with friends and your community.  Caregivers often isolated themselves from others and focus all time on mom/dad.
6.  Join a caregiver support group.  See the Alzheimer's Association for local support group information. 
7.  Educate yourself.  Learning about dementia and Alzheimer's Disease will help you understand the impact of cognitive decline on everyone involved.
8.  Call on a geriatric care manager for assistance.
9.  Be aware of your stress level.  Know your stress level and know when it's time for a break.
10.  Don't be afraid to ask for help.  Caregiving is a 24/7 job and even the best caregiver needs a break!

Let's return to the question of the impact of technology.  In particular, to the impact on a key issue facing seniors and caregivers, medication management.  We've touched on the fundamentals - preparing and communicating the medication list with simple computer tools.  What we haven't spent much time on is the day to day management of medications.

Technology can help.  For example, one of the tools My Health Care Manager makes available to seniors and their families is a weekly medication schedule.  This schedule provides a map of the all medications with the day and time and dosages they are to be taken over the course of the week.  This schedule can also provide a variety of additional information such as sliding insulin scales or even life style guidance for exercise or other activities.  In many cases our clients will actually record daily health monitoring results on the form (like blood sugars, blood pressures, and so on).  This is a great way to help aging parents and their care givers stay on top of the weekly regimen.  

There are some limits.  We have found that people dealing with Dementia (Alzheimer's disease or other forms) need the assistance of a caregiver to use a tool like this.  Often they will also need reminders through the course of the day to prompt taking their medications.  Technology can help here, as well.  There are a number of medication reminder systems emerging in the market.

 

Many families will get together this weekend for Easter.  Sons and daughters who may not see their aging parents often will travel to visit them and families will be reunited.  The holidays are often when adult children notice signs of aging in their parents, whether its a physical decline or a change in cognition. 

Encourage your parents to see their health care providers to address any changes that may inhibit their daily lives, whether it's a change in mobility or trouble with balance, or difficulty remembering things or worsening arthritis.  Proactively addressing these issues can help seniors maintain their mobility, better manage chronic illnesses, and put support systems in place prior to a crisis.

It can be difficult to bring up issues like this during a family holiday, so you may consider scheduling another visit in the near future.  Sometimes denial is the reponse to the aging process.  If your parents don't want to discuss the issues with you, you can enlist the help of a health care provider or other trusted advisor (whether it's a geriatric care manager, their long-time CPA or attorney, or even a close friend) to encourage them to proactively address the issues.

It's been said many times that caregiving is a difficult, but very rewarding experience.  Financially, however, caregiving can be costly.  Caregivers often help out with rent or mortgage payments, as well as the cost of in-home care services.  According to MetLife, the average caregiver assists with these bills anywhere from two to six years, and contributes a whopping $19,525 over that period.  While many caregivers provide only care and support and no financial system, some caregivers are contributing even more money to pay their loved ones' expenses.  This figure is independent of those paying for assisted living facilities or nursing homes, which can run around $70K/year and up.  There are often extra fees for those with dementia or Alzheimer's in addition to the normal rates.

As so many caregivers are providing financial support, this can raise questions when it comes to filing taxes.  USA Today has a timely Q&A for tax season... Yesterday they addressed the situation of a caregiver whose mother moved into assisted living due to an Alzheimer's diagnosis- and the caregiver is paying for it.  Is this tax deductible?  Yes!  For the details, please click here.

When I became a stepmother to my then 7 year old stepson, it was easy to find people to turn to for advice.  For I lived in the midst of a community of  mothers……in my neighborhood, at work and at church.  These built-in communities provided support and guidance as I assumed the joyous role of being a Mom to a precious little boy named Michael.  That was 20 years ago and the friendships I made with those other Moms still exist. Today,  we continue to share stories about our “children,” but have excitedly expanded the conversation to include “grandchildren” and the happiness we experience as we watch our children become parents. 

As a caregiver for a parent, I find this type of community missing in my life.  There is not a natural group of people, who are caring for their parents, as readily available to talk with and exchange experiences.  Some organizations, such as the Alzheimer’s Association, offer support groups that do wonderful work.  But it is not the same as simply walking out the front door anymore.  The fact is that caring for children is much more common than caring for parents…..or at the very least…..more frequently discussed.   

I’ve found that I need to actively seek out support and this has come from many different sources.  I frequently browse the eldercare section at my local Barnes and Noble.  I talk to my RN friends and co-workers.  I subscribe to the Alzheimer’s e-newsletter.   But the outpouring of support that comes so naturally when caring for children at the beginning of life is rather hard to find when caring for parents at the end of life.

Recognizing that a lack of community and support is a common occurrence among senior caregivers, my company recently established an on-line complimentary “Caregiving Community” to provide answers to difficult caregiving questions.  The goal is to provide assistance and support to adult children who are worried or concerned about their parents.   Each month, My Health Care Manager will send members of the “Caregiving Community” an e-mail update which will focus on common caregiving concerns and practical solutions in a quick, easy to read, question and answer format.   The first issue tackled the following:  “Dad’s car has new scratches and dents.  Is it time to take the keys away?” 

I’d like to personally invite you to join the “Caregiving Community.”  Its goal is to help you….help your parents.  Please click here to join the “Caregiving Community”.  I also encourage you to e-mail your questions to CaregivingCommunity@MyHealthCareManager.com.  These will be addressed in a future issue.  Rest assured, your e-mail address will not be shared with any other organization. 

Individuals with Alzheimer’s Disease and related Dementias often have significant communication changes as their disease progresses.  Due to physiological changes in the human brain, the individual can experience changes in cognition, reasoning, sequence and application, and personality changes.  Some individuals experience varying levels of confusion and disorientation i.e. familiar places may become unrecognizable, routine chores (using the washing machine, buttoning a blouse) may become difficult.  A person’s ability to reason may deteriorate and their thoughts of “reality” may change.  A person’s ability to do things in a sequence may become difficult e.g. putting on shoes first instead of their slacks.  Some individuals with Alzheimer’s Disease and related Dementias may also experience personality changes.  All of these changes are very common. 

As these changes occur, it becomes more difficult for that individual to communicate with family and others as well as for family and friends to communicate with their loved one.  You are not alone!  Effective communication is attainable with some suggested tips:

1. It’s important to remember that individuals with Alzheimer’s Disease only communicate 10% verbally.  Because their brain is functioning in a different way now, as family and caregivers we must be patient and pay attention to their non-verbal cues.  Try to figure out the meaning behind their actions.
2. Always speak in a slow, calm voice.  Make eye contact i.e. if they are sitting down, get down to their level of eyesight.
3. Use hand gestures and non-verbal cues when communicating. Show them what you want them to do.
4. Don't argue or correct them.
5. Allow your loved one to set their own pace; avoid hurrying or rushing them.
6. Eliminate any distracting background noise.
7. Ask yes/no questions, as they are easier for them to answer.  If you always get a “no” answer, instead of saying ‘do you want a shower?’, say “It’s time for our shower now.”
8. Repeat phrases as needed.  Avoid saying “I just told you 5 minutes ago…”  Keep in mind that they truly may not remember.
9. The sense of touch is powerful thing i.e. if they don’t understand your words, give a hug or a pat on the back to communicate.
10. Keep tasks and activities simple and give one instruction at a time.

See the Alzheimer’s Association’s website www.alz.org for more tips on communication.