I'm Katie Eller, MSW, LSW, ASW-G.  I am the Training Manager for My Health Care Manager.  I have my masters in social work and specialize in gerontology.  Throughout my career, I have worked exclusively in the gerontology field and with aging adults.  My blog focuses on families and caregivers and the joys and challenges of caregiving for an older adult.

If you want to read more about my background, please see the about us page.

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.

Retirement can be a time of increased socialization, improved quality of life, and exploration.  However, retirement can often create a new set of challenges i.e. limited financial resources and potentially redefinement of one's self-image.  By educating ourselves, we can assist our parents in attaining and maintaining a good quality of life, help them manage losses, and overall allow them to maintain their identity as an individual.  Achieving and maintaining a good quality of life is an important factor for everyone.  As our parents, and even the Baby Boomers, start to retire, a new role for them is born.  Retirement should not define them as to what they no longer do but what they are doing.  By supporting your parents in what they are doing during retirement allows them to maintain their own identity and set the standards for a quality life.  It is important to be conscious of potential losses i.e. going from an active work life to having the availability of free-time.  This surge of "free-time" can sometimes create a wave of emotions i.e. loss of self-image and identity.  Remaining active during retirement will not only assist with overall wellness, but will help the individual define their self-image and maintain a good quality of life.
Here are some resources for retirees:
Seniors Daily Online
Senior Volunteers
Florida Senior 360
Meaningful Retirement
Healthy Living during Retirement
AARP Community
Where to Live After 50
Retirement Living Information Center

On April 2nd, PBS aired a 2 hour special called Caring for Your Parents.  This documentary featured 5 American families and the impact caregiving has had on themselves and their family dynamics.  The 90 minute documentary was followed by a 30 minute roundtable discussion of aging professionals.
I thought the documentary was very interesting and insightful.  It showed the different types of situations that each family was facing, however the challenges and joys of caregiving for each individual had lots of similarities.  It is so important for caregivers to have a good support system and to take time for themselves.  The caregivers also discussed the emotional, mental, physical, and financial strains they face with caregiving.
Anyone who is a caregiver could benefit from this special feature.  PBS is offering the opportunity for people to watch the program online for free.  Log-on to       PBS: Caring for Your Parents to watch the complete program.  After watching the program, come back and post your comments on my blog for further discussion.

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!

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.

For those of us caring for aging parents, there is information, support, and shared experiences to be found in the world of books.  The New York Times just published a review of a new book called 'My Mother, Your Mother: Embracing Slow Medicine, the Compassionate Approach to Caring for Your Aging Loved Ones'.  Written by Dr. Dennis McCullough, a practicing geriatrician at Dartmouth Medical School, it champions taking a different approach when treating older patients.  Gone is the focus on high technology and strong medicine, with 'slow medicine', the focus is on family-centered care, less invasive testing and procedures, and exploration of all options (i.e. depression would not automatically be treated with strong drugs, but first one might see if having a pet or hiring a companion could relieve the depression). 

While this approach may not work for everyone, and may not be preferred in all situations, the book is worth a read for those with aging parents.  It's not all about medicine- as the review points out, some of it is simple advice like "it is always the right time to say ‘thank you’ and ‘I love you’ ", and a reminder to really listen to your aging loved ones- their voice can often tell you more about their health or state of mind than their words or actions.

To read the review on The New York Times website, click here.
To view the book on Amazon, click here.

After retirement, many seniors search for other ways to fill their days, provide mental stimulation, and make a difference.  Popular post-retirement activities include spending time with family and friends, indulging in hobbies and sports, taking continuing education classes, and traveling.  Many also choose to help their communities by volunteering some of their time for a good cause.  These activities can keep seniors involved in their communities, provide physical activity and mental stimulation, and improve their quality of life.

What kind of opportunities are available and how can I find them?  There are opportunities abound for volunteers of all ages- you just have to know where to look.  The internet is a great resource!  In addition, think about some of the opportunities that may not be listed on the internet.  Does your loved one like music?  Try your city's symphony.  Teaching?  They could become a tutor for a local literacy group.  Your city's symphony, local NPR station and public television station, zoo, museum, and humane society are all great places to start and often struggling to find volunteers.

Volunteering is a great way to stay involved and it can be a fun activity for your loved one- whether they volunteer alone, with friends, or you pick a special opportunity that you both enjoy.  Some great places on the internet to begin your search: 

• Corporation for National and Community Service - oversees AmeriCorps, SeniorCorps, etc.  Many opportunities for 55+ (www.getinvolved.gov)
• SCORE - working and retired business owners and executives provide free advice to small businesses (http://www.score.org/index.html)
• VolunteerMatch.org - matches volunteers to opportunities based on location and area of interest (www,volunteermatch.org)
• Other local organizations (e.g. OASIS in Indianapolis at www.oasisnet.org)

Families caring for aging parents or other aging loved ones know that it can be a difficult balancing act- especially for the primary caregivers, who often work full-time.  In addition to being a caregiver, you want to spend time with your family and children, you want to keep your close friendships, you want to maintain your performance (and attendance) at work, and on top of all of this- you know you need to take time for yourself as well!  You can only be 'Superman' or 'Superwoman' for so long... taking time for yourself can help prevent caregiver burnout- a very real problem.

Employers are realizing that caregivers may need extra help, and many are stepping up to help their employees.  Some are offering flex-time to allow caregivers more flexibility, and others provide general referral services to things like adult day care centers.  Many are starting to offer even more extensive eldercare benefits to their employees, like access to our company (My Health Care Manager) and geriatric care management services... to read an article from the IndyStar on 'Balancing Burden of Eldercare', please click here.

If you are a caregiver to someone with Alzheimer's or have a loved one that suffers from Alzheimer's, you may know how difficult it can be for children to understand (and cope with) the disease and the changes in their loved ones.  It can be hurtful that their Grandpa doesn't remember their name or disconcerting when Grandma asks the same question multiple times in a visit.  By teaching children the basics of Alzheimer's disease (at a complexity level suitable to their age and maturity) and the signs/symptoms/effects of the disease, you can help them understand the behavior of their loved one.  The Alzheimer's Association website (www.alz.org) has a special section for kids to help them understand the disease.  It also reviews some educational books on Alzheimer's geared toward children, and even gives a list of activities for children to do with their loved ones.  This is definitely a difficult subject to address, but supplying your child with information (instead of ignoring the issue) will help them be better equipped to understand the changes occurring in their loved one and the reason for those changes.  To visit the Alzheimer's Association website for kids, please click here.  To read a news story from the Winston-Salem Journal online (with more book recommendations, a real life story, and practical tips), click here.

Incontinence can be an embarrassing and inconvenient health condition... but there is no reason why you should let it keep you from doing the things you enjoy.  It's also important to remember that you're not alone- an estimated 12 million Americans are living with incontinence.  Urinary incontinence can begin at many different points in life, sometimes after childbirth or menopause for women, or after prostate surgery for men.  The types and causes of incontinence vary, and your urologist may recommend different strategies or treatment options based on your particular situation.  However, WebMD has a page with great tips for managing urinary incontinence- whether you're in a social situation, at the gym, at work, or even on vacation.  For example, did you know that certain types of food (spicy or acidic) and beverages (those with caffeine or alcohol) can often worsen incontinence in some people?  While your parent or loved one may not feel comfortable discussing incontinence with anyone other than their doctor, you may be able to pass along some valuable resources to them- especially if you see that they are missing out on the things they love...

To get tips and get more information, visit the WebMD site by clicking the following link...  http://www.webmd.com/urinary-incontinence-oab/coping-08/default.htm

Researchers at Tufts University have updated the food pyramid for adults over 70 years of age, which was originally released in 1999.  The new pyramid not only stresses the healthy blend of food groups recommended by the USDA for all age groups, but contains recommendations specific for seniors.  It reminds older adults of the option of fortified foods, which can help many reach the recommended intake of certain vitamins. 

The updated pyramid depicts a row of water glasses, serving as a reminder to remain properly hydrated, as well as a pyramid base of physical activities to encourage active, health lifestyles.  Easy ways to enrich your diet with healthy foods are shown on the pyramid, such as incorporating canned ready-to-eat options along with fresh and home-cooked foods.  For some older adults, it can be hard to not only eat a healthy and balanced diet, but also to consume enough food.  If you or a loved one is struggling with diet, please let your physician know so they can help you improve your eating habits.

To download a PDF of the revised food pyramid, please click here.

An article about the new pyramid can be found on WebMD.

Today, many families are separated by distance and may see each other only a few times a year.  For those with aging parents, the holidays spent together can often be when adult children notice changes in their parents or loved ones.  You may notice that your mom seems forgetful or has had a change in cognition, your father has less mobility than the last time you saw him, or maybe your aunt's arthritis symptoms have worsened.  This can be a difficult situation, especially for long distance caregivers.

It's important that their geriatricians or health care providers be notified of changes in their behavior, symptoms, or overall well-being.  You can ask your loved one to accompany them to doctor visits, or employ the help of a geriatric care manager if you are unable to be there.  This will help you understand the situation, their diagnoses, and the treatment plans given to them by the doctor.  Encourage them to ask their doctor questions if they don't understand their doctor's recommendations or their prescribed medications, especially if they have multiple prescriptions.  Many of us are not familiar with the health care system, and it can be daunting.  Geriatric care managers can help explain the situation, help you weigh your options, and work to make sure that your loved ones are getting the quality of care that they deserve.

It can be hard to be a caregiver, and it can also be hard to realize that you may need to step into that role.  Don't be afraid to ask your friends and family for support. 

Have a wonderful holiday season.

The Alzheimer's Daily News website recently featured a short article on planning ahead for long-term care.  The source was our very own Indianapolis Area Vice President, Jeannie Keenan, RN.

Stories about this topic have been fairly prevalent in the news recently.  Many of the baby boomers have not planned ahead when it comes to providing care for their aging parents.  This could be paying for the cost of a retirement community or assisted living facility for their parents; it could be bearing the cost of bringing eldercare services into the home.

As our parents age, it can be difficult to address the often emotional issues of failing health, loss of mobility, cognitive decline, or just the need for a little bit of extra help or a smaller, more manageable living space.  Seniors may be reluctant to move and sometimes their adult children may not agree on what is best for their parents.  This underscores the importance of one of Jeannie's tips: Begin talking about the issues and the future early.  It is much easier to plan ahead than to be caught off-guard.  Planning ahead offers you more time to complete thorough research of the options, prepare financially for the future, and come to a decision with which the whole family can be pleased.

While this article focuses on the financial aspects of long-term care, many other variables can be involved in the issue including family dynamics, a parent's medical needs, a parent's wish to continue aging in place, or the adult children's desire to relocate parents closer to them.  A geriatric care manager can assist families as an objective third party, knowledgeable about local facilities and their capabilities and reputation, and familiar with all of the living options available for seniors based on their particular needs and desires.

Click here to read Jeannie's planning tips.  You may also learn more about Jeannie Keenan by clicking here.

A recent study published in the Journal of the American Medical Association by John Robbins, M.D. et al identifies an algorithm for identifying the five year risk of a hip fracture in postmenopausal women.  While the study is limited to one gender and further studies are needed to assess the implications and use of the algorithm, it underscores the importance for seniors to remain vigilant in maintaining their mobility and maximizing their safety.

The factors affecting the 5 year risk are as follows: “age, self-reported health, weight, height, race/ethnicity, self-reported physical activity, history of fracture after age 54 years, parental hip fracture, current smoking, current corticosteroid use, and treated diabetes.” 

What can you do? 

• Be aware of the factors, and do your best to engage in health activities like remaining active, exercising, and refraining from smoking. 
• Do a home safety check.  Remove items like throw rugs that are easily tripped over, resulting in a fall, and possibly a fracture. 
• Check with your doctor to assess your risk for a hip fracture and work with him/her to decrease your risk.

For a home safety checklist from the CDC, please click here.
To read more about the study published in the JAMA, please click here.

Today, November 14, is World Diabetes Day- the first ever!  A resolution passed in December of 2006 by the United Nations created an annual United Nations Day for World Diabetes starting in 2007.  For more information on the day of recognition, please visit the World Diabetes Day homepage.

It just so happens that two recent studies have highlighted some of the issues affecting diabetics...

A diabetes study in the Journal of General Internal Medicine (set for the December issue) found that of diabetic seniors, 92% have at least one other chronic condition.  Even more worrisome: almost 50% have three or more other chronic medical conditions in addition to diabetes.  Seniors often make managing their other chronic conditions a priority and fail to properly manage their diabetes.  Many of the other conditions in seniors were triggered (or aggravated) at least in part by their diabetes.  The study stresses the importance of holistic care and taking a 'whole-person approach' to disease management. To read more about the study, click here.

For families, diabetes can affect multiple generations.  It's important to take preventative measures like eating a healthy diet and being active.  Once diagnosed with diabetes, it's important to take care of yourself!  A recent study in Australia suggested that more than 60% of those diagnosed with diabetes are wearing the wrong size shoe.  The wrong size of shoe could increase the chance of having foot problems, which (especially for diabetics) can even lead to amputation.  Please encourage those with diabetes in your family to have their feet properly measured to ensure they are wearing shoes the correct length AND width for their feet.  For more on this study, please click here.

It's important for seniors to work with their health care provider or geriatrician to manage their diabetes.  As the first study finds, many seniors have other chronic conditions in addition to diabetes.  For these seniors and their caregivers, a geriatric care manager or eldercare manager can partner with them and their other health care providers to approach their disease management in a more holistic fashion.

A recent study has suggested that correcting vision problems in seniors residing in nursing homes may reduce their symptoms of depression.  Not only were their symptoms of depression reduced, but also their involvement in social interactions, activities and hobbies, and reading increased.  Of course this doesn't pertain to only those seniors living in retirement communities.  Correcting poor vision can be a relatively easy and quick way to positively affect quality of life in the short term.  To read the study synopsis, please click here.  The study is specific to refractive errors, but other common conditions in older adults include glaucoma, macular degeneration, and cataracts.

While I've already mentioned the link between falls and certain types of loss of vision, this is one more reason to make sure the older adults in your life have recently had their vision checked by a health care professional.  Aging can often mean a change in vision, and it is important to proactively address this, as some common conditions can be treated (e.g. the refractive errors in the study, cataracts, etc).  Caregivers may often be the first to recognize the signs, and your loved one's geriatric care provider or health care professional can recommend a specialist if your loved one does not have an optometrist or eye doctor.

With the Hollywood writers strike, some of those writers may be treating this time as a much-needed break from the daily grind, as they are only required to work 20 hours a week manning the picket lines.  Unfortunately, as most caregivers know, caring for aging parents is a full-time job.  And this is often on top of the full-time hours put in at a paying full-time job.  It can often be tiring, emotionally and financially draining, and very hard.

 

For family caregivers that are in need of a well-deserved respite, don’t hesitate to ask for help...  Don’t hesitate to take a well-deserved break!  Accept the help that your family and friends offer or hire outside help to give you a few hours (or a few days) of help each week.  Caregiver burnout is real – especially for working caregivers.  Understand that you must first take care of your own health, and that asking for help or accepting help may make you a better caregiver in the long run by reducing your stress levels and allowing you some respite.

 

Providing care for a loved one, organizing their health care and managing appointments, checking on their home safety, spending time with them to prevent isolation, AND doing all of the other duties that come with the territory is extremely time consuming, sometimes confusing, and sometimes stressful.  If you find yourself ‘in over your head’ or just needing some advice, you may consider enlisting the help of a geriatric care manager.  Geriatric care managers can help facilitate communication within your family, give you advice on avoiding caregiver burnout, and offer tips and tricks to help you manage the health conditions of your loved one (whether it be helpful ways to remind your mother with diabetes to check her blood sugar, tips on communicating with a senior suffering from Alzheimer’s, ways to improve your father’s quality of life or help manage your uncle’s arthritis, or a better way to manage the multiple medications prescribed to your grandmother).

Today is the last day of National "Talk About Prescriptions" month - so hopefully you have spoken with your aging loved one- especially if they are taking multiple medications. However, I would also like to encourage everyone to talk about another kind of prescription- not for a medication, but for glasses or contacts.  Our vision deteriorates as we age and this can affect our mobility.  Home safety is incredibly important for preventing falls- and one key to preventing falls is recognizing a change in vision.

A recent study proves that worse vision or 'visual field deficit' is associated with falls- especially peripheral vision deficits.  The study also provides information about the occurrence of falls among older adults and the association of falls with a greater likelihood of hospitalization, nursing home admission, and death.  The bottom line: making sure your loved one has regular exams by a health care professional- including vision exams- is a smart move!  You may also speak with your geriatrician or health care professional for more information on preventing falls.  To read the study abstract issued by the  Institutes of Ophthamology at Johns Hopkins School of Medicine and the University College in London, please click here.