I’m Jean Bandos, MSN, CNS, APRN, BC.  I’m a gerontological clinical nurse specialist with vast experience in care management of the older adult. I’ve spent the majority of my career assisting the older adult and their families navigate the health care system. In my blog, I’ll share some eldercare resources and assist in spreading the word on “tips” for caregivers of aging parents.    

 To learn more about me, please visit our website.

In today’s world, adult children are faced not only with the effects their elderly parent(s) aging, but now they have to understand how the economy may affect their aging parent’s financial situation.  Every time we turn on the TV, we are inundated with how bad the economy is and what is happening to our savings. But are you aware that older adults are struggling with excessive credit card debt, and that bankruptcies are increasing among the elderly?

So what can you do to assist your aging parents?  How do you help yourself, as the caregiver, make plans for the future?  Start by asking some general questions, such as:  
 

• Is your parent worried about his/her finances?
• Is anyone currently assisting your parent with day to day finances?  If yes, are there any concerns about how the finances are being handled?
• Does your parent currently have someone providing him/her with advice on business or finances?  This could be a lawyer, trust officer, personal friend, family member, etc.
• Does your parent have health and financial powers of attorney?  Have the appointees been informed?  
• Is the current income stable and sufficient?
• Does your parent know what his/her sources of income are? (e.g. Social Security, pensions, investments, family support)
• Does your parent have adequate insurance coverage? Does he/she understand what’s covered by the policy/policies?
• Does your parent have long term care insurance? If yes, does he/she understand what the policy covers? 
• Are your parent’s estate documents (e.g. wills, trusts, and beneficiary) current? 
• Does your parent know where important documents are kept?  Your parent (and caregivers) should know the locations of documents like birth certificates, divorce papers, death of spouse, remarriage, estate documents, and advance directives?
• Is your parent’s advance directives document current and active in his/her state of residence?  (e.g. if your father has advance directives including financial power of attorney and moves across state lines, he needs to contact a lawyer and make sure it is still current with state of residence regulations).

Resource sites:

• The Medicare official site is www.medicare.gov.
• A site to help you as a consumer to under Medicare Benefits visit: Medicare Consumer Guide: http://www.medicareconsumerguide.com/medicare-overview.html.
• To find out more information about long term care insurance go to: www.medicare.gov then go to ‘search tools’ then go to ‘plan your long term care needs’.

May is Stroke Awareness Month and I’ve posted a couple blogs recently about strokes.  Some new guidelines were just released and I think they’re very important.  A national stroke coalition called the Brain Attack Coalition (BAC) has adopted a new message this month: “Stroke strikes fast.  You should too.  Call 9-1-1.”  This should be a mantra for all caregivers, families, and friends of seniors.

If you recognize the signs of a stroke in your aging loved one, call 9-1-1 immediately.  Stroke victims need to see a health care provider immediately.  How can you recognize a possible stroke?  See my previous blog on the ‘Act F.A.S.T.’ method which has you answer a few key questions: Face – does one side droop? Arm – does one arm drift down if raised? Speech – is speech slurred or strained? Time – if you answered yes, it’s time to call 9-1-1!

The BAC is chaired by the National Institute of Neurological Disorders and Stroke (NINDS), which is a part of the National Institute of Health (NIH).  For more information see the NIH announcement here or see the NINDS stroke page here.
 

HBO is doing a documentary series on Alzheimer's starting this Sunday, May 10.  Titled 'The Alzheimer's Project', the series is comprised of four parts.

1. The Memory Loss Tapes
2. Grandpa, Do you know who I am? (with Maria Shriver)
3. Momentum in Science
4. Caregivers

Caregivers for those with cognitive decline or Alzheimer's can find free help from their local Alzheimer's Association.  Whether you're looking for ways to better communicate with someone with Alzheimer's, ways to reduce your caregiver stress, or even seeking other local resources, the Alzheimer's Association is a great place to start your search.

Local Alzheimer's Associations often give conferences for caregivers.  Topics often covered include communication, home safety, and well-being.  Presenters have extensive experience in geriatrics and caregiving topics.  In addition, you can connect with other caregivers for support.

There will be a caregiver's conference on May 15th in Indianapolis, and I encourage you to attend.  For more information, visit the local Alzheimer's Association website. 

For information on events in your city and state, visit the national Alzheimer's Association website.

**The following post is from my guest blogger, Natalie Langley, MSW.  She is a Geriatric Care Research Analyst for SCANS (for more on SCANS, please see Eric Tinsley's blog by clicking here).**

There are several barriers that can impact the older adult’s ability to achieve good nutrition.  The following checklist can help to ensure older adults are getting the proper nutrition. 

Determine if there is a problem that impairs their ability to eat:

1. Have a physician/pharmacist review side effects of medications.
2. Are their teeth/dentures in proper condition?
3. Are there any physical limitations relating to pain and arthritis?
4. Is there a decrease in a sense of smell and taste?
5. Are finances a barrier?
6. Is their eyesight failing?
7. Do they have weakness and are not able to carry grocery bags?
8. Is forgetfulness or dementia present?

As a caregiver or an older adult, make sure to enlist people and programs within the community to help with meal assistance.  One way is to contact your local Area Agency on Aging for meal programs for older adults, such as Meals on Wheels.  This program offers deliverable meals for older adults in their homes.  For a list of local Area Agencies on Aging, you can visit www.n4a.org. 

Another good resource for meal assistance is Seattle Sutton's.  This is an Illinois based company, but they have locations everywhere.  They offer healthy, prepared meals for a reasonable price.  To find a location near you, please visit their website at http://www.seattlesutton.com/.
 

Over the last year, I have written several blogs on aging in place for older adults and their caregivers.  Today, in honor of Stroke Awareness month (April), I wanted to raise your awareness about this concern, which is a preventable health issue. I recently attended an educational session on stroke prevention and would like to share the National Stroke Association’s efforts to educate the public on recognizing stroke symptoms.  Most of us think of stroke as a disease of old age – one that is debilitating and causes lasting disabilities. But it can strike at any age. 

Did you know that 80% of strokes are preventable and that by acting in time, the long term of effects of strokes could be minimized?

Here are some simple tips to follow to prevent a stroke: 

• Know your blood pressure.      
• If it’s high, work with your doctor to lower it.
• Find out from your doctor if you have atrial fibrillation
• If you drink alcohol, do so in moderation.
• Find out if you have high cholesterol. If so, work with your doctor to control it.
• If you are diabetic, follow your health care provider's recommendations carefully to control your diabetes.
• Include exercise in the activities you enjoy in your daily routine.
• Enjoy a lower sodium (salt), lower fat diet.

Look for my next blog entry, where I’ll share with you an easy-to-remember way to recognize the symptoms of a stroke.  This is important for caregivers, aging adults, grandchildren – everyone should be able to recognize stroke symptoms so that quick action can be taken.
 

**The following post is from my guest blogger, Natalie Langley, MSW.  She is a Geriatric Care Research Analyst for SCANS (for more on SCANS, please see Eric Tinsley's blog by clicking here).**

If you are a veteran, a surviving spouse of a veteran, or a caregiver of a either, I'm sharing some important information on veterans benefits today.  Veterans or surviving spouses of veterans who may now or in the future need caregiving assistance in the home, assisted living, or long term care facility you may be eligible for the Aid and Attendance Benefit.  Veterans Financial (not affiliated with the Veterans Administration) is an organization that can help veterans and their families obtain any eligible benefits.  Veterans Financial is accredited by the Better Business Bureau (BBB). 

The Aid and Attendance benefit is a benefit paid in addition to a monthly pension.  You may be eligible for the Aid and Attendance benefit if the veteran or the surviving spouse:

• Requires the ongoing aid of another person (caregiver, home health aid, or another) in order to perform basic personal functions required in everyday living (i.e. bathing, eating, dressing, etc.)  -OR-
• Is bedridden  -OR-
• Is a resident in a long term care facility or nursing home due to cognitive or physical incapacity    -OR-
• Is blind, or nearly blind

For more information on Veterans Financial, Inc. please visit:
www.veteransfinancial.com or contact them at 800-835-1541.

People with dementia are not always able to communicate that they are in pain.  Therefore, it is important for health care providers, caregivers, and friends to recognize the signs and symptoms of pain. Remember that pain is treatable and pain should be addressed if it is suspected.

What should a caregiver look for?

• Facial Expressions: Does your loved one frown or grimace, close their eyes tightly, wrinkle their brow or blink rapidly, especially in response to specific activities?
• Verbalization: Does your loved one moan, sigh, grunt, ask for help or repeat a phrase, or become abusive?
• Movement: Are they rigid or tense, fidget, rock back and forth, or do they resist movement?
• Mental Status Changes: Have they become more confused?
• Behavioral Changes: Does your loved one have changes in appetite, sleep patterns or changes in routines?  Are they combative or seem distressed? Are they more irritable?

Document when you see these changes occur.  Do the changes happen with a specific activity? Are the changes worse at night versus the morning? Do the changes get better after a specific activity such as eating or sitting in a specific position?

Bring as much information as you can to your health care provider.  They can work with you to evaluate the pain and determine a pain regimen that works for your aging loved one.

**The following post is from my guest blogger, Natalie Langley, MSW.  She is a Geriatric Care Research Analyst for SCANS (for more on SCANS, please see Eric Tinsley's blog by clicking here).**

Where can I go to find the right doctor for me?

Finding the right physician is one of the most important health decisions you will make.  Whether you do not currently have a doctor or you are unhappy with your current doctor, there are several resources available that can help you find the right health care provider for you.  To start, you want to make sure the physician you choose is in your insurance network.  If not, you may call the insurer and ask if they would consider adding this physician to their list. Whether you are a senior looking for yourself or a caregiver looking for your aging loved one, the following is a list of helpful websites for locating a physician. 

American Medical Association 
www.ama-assn.org   

National Institute on Aging – Age Page on Finding a Physician
http://www.nia.nih.gov/NR/rdonlyres/67530CA6-7AC1-4C45-BB8D-27D0E3C54A65/7441/Choosing_A_Doctor.pdf

American Board of Medical Specialties
www.abms.org 

American College of Surgeons
http://www.facs.org/public_info/yourhealth/findadoc.html

Diabetes and Heart/Stroke Physician Recognition Program
http://recognition.ncqa.org/

Healthfinder
www.healthfinder.gov 

Medline Plus
www.medlineplus.gov

American Geriatrics Society Foundation for Health in Aging
http://www.healthinaging.org/public_education/physician_referral.php
 

1. Keep the bathroom warm and inviting. 
2. Refer to the shower the way the individual with the disease refers to the shower.  Generations ago, people referred to taking a shower as “washing up”, “the wash room”, “sponge bath”, etc.  Rather than saying, “OK, Mom, it is time for your shower”, say “Mom, let’s go wash up before dinner.”  Learn what they called the shower back when they were younger, because they may be more likely to understand you if you use those terms.
3. Provide towels for them to cover up for privacy and warmth during the bathing process.
4. If they did grow up using sponge baths, try using that method.  Even though it may not be the method you use, that may be what the person with Alzheimer’s remembers and understands. 
5. If the person doesn’t want to shower because they don’t want to change their outfit, buy several of the same outfits in the same color so they will be able to put the “same” outfit back on after they are clean.
6. Include the person as much as possible during the bathing experience.  Give them a washcloth to hold on to.  This will allow them to think they are a part of the process. 
7. Fill up the tub with only a few inches of water.  Make sure the water is not too hot – their skin may be more sensitive.
8. Use a handheld shower head and make sure the spray is not too intense.  The harder the water comes out, the worse it could feel on their skin (since it may be sensitive).
9. Offer praise to the person for their efforts in helping
10. Have activities ready if the person becomes agitated, such as playing soothing music or singing their favorite songs. 
     

No matter what the weather may be, it is always wise to discuss disaster plans with your aging loved ones. In some of my past blogs, I discussed risk for the older adult in winter weather and some strategies and safety tips for dealing with winter, which can be especially important for the elderly.  One reference cited was the Hartford and the MIT Age Lab, which created an informative booklet: It Could Happen to Me: Family Conversations about Disaster Planning.  This booklet is based on research and was written to help older adults better prepare for natural disasters. No matter what the weather may have in store for you in your part of the country, one of the tips that Hartford recommends is to have on hand an Emergency Supply Kit.  Whether you’re a caregiver or a senior, take this safety tip and create an Emergency Supply Kit today.

Your kit should include: 

• Water, one gallon of water per person per day for at least three days, for drinking and sanitation
• Food, at least a three-day supply of non-perishable food
• Battery-powered or hand crank radio and a NOAA Weather Radio with tone alert and extra batteries for both
• Flashlight and extra batteries
• First aid kit  - make sure have supply of Prescription medications so don’t need to go out.
• Whistle to signal for help
• Moist towelettes, garbage bags and plastic ties for personal sanitation
• Wrench or pliers to turn off utilities
• Can opener for food (if kit contains canned food) 

Community and State Information:

An online interactive guide to finding disaster preparedness resources in your community.
www.ready.gov/america/local/index.html

When our weather changes,  everyone is worried about the “winter dangers”  such as broken bones from falls on ice (especially for older adults with mobility issues) or breathing problems caused by cold air, but cold weather is very risky for older people. The winter chill can lower the temperature inside the body and that can be deadly if not treated quickly.  A dropped body temperature, hypothermia, can be caused by staying in a cool place.  The normal body temperature is 96° F and it only takes a couple of degrees below the body’s normal to be dangerous such as causing an irregular heartbeat leading to heart problems and death.

It is very important for a senior to know his/her surroundings and prepare for the winter months.  Changes in the older adult that accompany aging make it harder for them to know when they are getting cold.  It is also harder for the body to warm itself. So it is very important for older adults to pay attention to the weather and how cold it is going to get.

Some general safety recommendations from the American Geriatric Society are:

1. Stay indoors when it's very cold outside, especially if it's also very windy; and keep indoor temperatures at about 65 degrees or above
2. If you have to go outside, don't stay out in the cold or the wind for very long
3. Wear two or three thinner layers of loose-fitting clothing. (They are warmer than a single layer of thick clothing.) Always wear: a hat, gloves or mittens (mittens are warmer), a coat and boots, a scarf to cover your mouth and nose and protect your lungs from very cold air
4. Stay dry; wet clothing chills your body quickly
5. Go indoors if you start shivering- it's a warning sign that you're losing body heat.
6. Know the warning signs of hypothermia: lots of shivering; cold skin that is pale or ashy; feeling very tired, confused and sleepy; feeling weak; problems walking; slowed breathing or heart rate. *Note: Don't rely on shivering alone as a warning sign, since older people tend to shiver less -and some, not at all-as their body temperature drops. Call 911 if you think you or someone else has hypothermia.

For safety reasons, remember: stay warm, keep your thermostat set above 65, and have a plan if you lose power. 

**The following post is from my guest blogger, Natalie Langley, MSW.  She is a Geriatric Care Research Analyst for SCANS (for more on SCANS, please see Eric Tinsley's blog by clicking here).**

Brrr, its cold outside, what can we do?

The winter months are often a barrier when it comes to being able to go outside and enjoy the weather.  For seniors, this can restrict the ability to go outdoors for exercise and entertainment.  Caregivers may be struggling to find activities for their loved ones to keep their spirits high during the winter months and avoid isolation.  Below are some helpful ideas to help keep your aging loved one engaged.

• Reminisce with the person.  Take out vacation, family, or wedding photo albums, and share memories
• Watch classic movies
• Play games or cards
• Invite friends/family over for tea and snacks
• Visit the library
• Have the health care provider recommend simple exercises for your loved one, which could help improve balance and mobility 
• Attend a musical/play
• If arts and crafts are interests, go to the craft store and start a project (sew a blanket, paint a picture)
• Play CDs of all the person’s favorite songs