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. 

I have a passion for working with persons affected by Alzheimer’s Disease and dementia.  Prior to my position here, I worked for 5 years as the Social Service Director for a long-term care company.  I also taught a social work and aging class to social work students at Indiana University.  My blog focuses on families and caregivers, and the joys and challenges of caregiving for an older adult.

Indiana could soon pass a new law.  Silver Alerts are similar to Amber Alerts, but are for missing and endangered adults/seniors.  This proposition was put forth by Senator Pat Miller.  It would require the law enforcement training board to provide training in interacting with missing and endangered adults, including seniors with Alzheimer's Disease or dementia.  Silver Alerts could help thousands of Indiana seniors who become lost.  The Silver Alerts would be issued by the police and broadcast among media outlets.  Currently, there are 10 other states who have a similar law.  House Sponsors include Rep. Dennis Avery (D-Evansville) and Rep. Mike Murphy (R-Indianapolis).  The House of Representatives passed the legislation 98-0.  It is now on its way to Gov. Mitch Daniels for consideration.

In working with seniors and their families, end of life care issues always come up.  It is a hard decision for the senior and families to make end of life care decisions, for example, whether to continue treating an illness or disease, implementing palliative care, or inserting a feeding tube.  These difficult decisions can often be made ahead of time by the individual via a Living Will.  Living Wills allow individuals the ability to document their end of life wishes, treatment preferences, and care options.  Any person over the age of 18, who is considered competent to make their own decisions, is able to complete a Living Will.  Living Will forms can be found at your local library, the internet, or an attorney's office.  Some states develop and recognize state-specific Living Will forms.  To download your state's specific advance directives form, check out Caring Connections.

The most difficult end of life decision to make is whether to insert a feeding tube or not.  A recent article from Health Behavior News Science, addresses recent studies on this issue.  For people with Advanced Dementia or degenerative dementia, the body is unable to metabolize food properly due to the brain damage.  The biggest fear for families is wondering if their loved one is "starving to death" or experiencing pain from hunger and thirst.  Hospice studies have indicated that few people experience this type of pain.  And if pain is exhibited it is often alleviated with palliative care and pain management.  In my career, I have had several physicians state that due to the brain damage and with the body going through the end of life process, that our bodies do not feel hunger or thirst.  But will we really ever know the answer to that question??  My motto as a geriatric social worker has always been, if I've made someone as happy and as comfortable as possible while they are here with us then I've done my job.  What I do know is that the decision to place a feeding tube is an individual decision and each person's situation should be considered separately.

For more information on studies, reviews of health care interventions, and evidence of clinical trials, check out the Cochrane Collaboration.

Walker Wonder:  Brighten a Walker, Brighten a Life

The Alzheimer's Store:  Unique products for those caring for someone with Alzheimer's

Wellhaven:  Gifts for seniors and boomers

Senior Shops

First Street:  For boomers and beyond

Elder Luxe:  Age well

Cancer has affected us in some way or another.  Almost every person knows of someone who has or has had cancer.  According to the National Institute on Aging, many cancers are more common in persons 50 years or older.  Therefore, a lot of people will be caregiving for a spouse, aging adult, or another loved one.  First, learn as much about your loved one's cancer as possible.  The American Cancer Society is an excellent resource.  It is also important to learn what to expect from the cancer, the treatment process, and palliative care options.  Seek out professional and educational advice on how to assist your loved one with medication and treatment side effects, their nutritional needs, and when to illicit the help of outside resources.  Second, it is always important for caregivers to take care of themselves and their personal needs.  Caregivers need to be able to express their emotions and learn their stress levels....when it's time to take a break and when to ask for help from other family members, friends, and outside resources.  Third, attending caregiver support groups are very beneficial for caregivers.  It is comforting to be able to share your situation with someone who has a sense of understanding.  The American Cancer Society offers an online support group or check your local community for resources.  Families often have to face difficult challenges and decisions when discussing palliative care verses treatment.  Although having an end-of-life discussion can be hard, it is very important.  It will provide a sense of peace for your loved one knowing that they have expressed their wishes and knowing that their desired wishes will be carried out.

For more information about caregiving and cancer, go to www.cancer.org.  Remember, practicing good health, wellness, and preventative practices is important for everyone.

Do you find yourself getting frustrated or trying to figure out how to communicate with your loved one with dementia?  People with dementia are also struggling to communicate and may be frustrated as well.  For caregivers, we have to remember our loved one's brain is no longer what is used to be.  It's smaller due to shrinkage, and cells are being destroyed by the disease.  Overall, humans communicate only 10% verbally.  So imagine trying to communicate with someone who's verbal communication skills are less than 10%.  That can be a tough feat!  This frustration of trying to communicate could be anxiety producing for both the senior and the caregiver.  
Staying calm is important.  90% of the way we communicate is nonverbal.  Keep in mind that people with dementia will better understand you when you communicate nonverbally e.g. gestures, showing them what you want to do, facial expressions, gentle touch, etc.  Because people with dementia rely on emotions and feelings, they will respond to your emotions.  So if you are rushed or anxious, they will pick up on that emotion and will respond by being anxious themselves.
Try to identify what is causing their anxiety.  Are they tired?  Are they hungry/thirsty?  Are they uncomfortable?  Do they have to use the restroom?  A lot of times, it is trial and error for caregivers in trying to communicate with their loved ones.  But, keep up the good work!  Your loved ones appreciate your calm and loving nature!

The following article was adapted from AgingCare.com

"Tax Tips for Caregivers: Can I Claim my Parent as a Dependent?
By June A. Schroeder, RN, CFP
It isn’t just time, but money that most caregivers donate to help maintain the ones they love.  I know.  I did it for years following willingly in the footsteps of my mom who also did it for years.  The financial toll is often insidious. You shop and include their groceries, pay for repairs and the gas for trips to the doctor, you lose time at work and pretty soon we’re talking big money. To compensate you cut back on vacations, cut or discontinue savings, don’t get your teeth cleaned or you may even take out loans to cover caregiving costs.

There are several options that might help you save money on your taxes:

Claim your aging parent as a dependent
Deduct your medical expenses
Use a dependent care credit
Open a reimbursement account at work
According to the first in depth study of such expenses released in November 2007 by the National Alliance for Caregiving and Evercare, a division of United Health Group, the annual out-of-pocket cost of elder caregiving is $5,531.  Long distance caregivers spend about $3,000 more.  These numbers are twice the previous estimates and are more than the average household spends on health care and entertainment combined.

For over a decade, there has been much talk but little action on periodically proposed national legislation to provide more tax relief in the form of tax credits or deductions for the more than 20% of Americans currently involved in caring for older relatives, spouses and friends. Both Presidents Clinton and Bush proposed a $3,000 tax credit to assist persons with long-term needs and the family members who care for them.  The most recent Bill S#2267, Americans Giving Care to Elders Act, was introduced In November 2007, read twice and sent to committee.  Caregiving is sure to become an issue in the upcoming presidential campaign, as evidenced by Hilary Clinton’s recently announced plan for caregiver relief. Until more relief comes along, it is important to understand and take advantage of the tax benefits that are available to you if you are supporting an elderly spouse, parent or relative.

Claim Your Parent as a Dependent on Your Taxes

The income of the person you are claiming cannot exceed the personal exemption of $3,400 (in 2007) excluding Social Security and tax exempt interest. They must be a relative or have lived with you for the past year, must be a resident of the U.S., Canada or Mexico, and not filed a joint tax return with a spouse.  IRS Publication 501 gives details on dependency requirements, including caregiver income phase-out levels. 

In addition, you must be providing over half of their financial support for food, housing, medical, transportation, etc.  If the person lives with you, include a reasonable percentage of your mortgage, utilities and other household costs in determining your level of support.  Those who are in an assisted living or long term care facility can qualify as dependents if the income and support levels are met.

Often more than one family member is involved in the support.  The one who is providing more than 50% of the support is entitled to claim the dependent. Be sure everyone is on the same page so you don’t run into trouble with more than one person claiming the individual.  Arranging to alternate years or establishing a Family Limited Partnership might options to consider.

Deduct Medical Expenses From Taxes

Medical expenses are deductible as an itemized deduction on Schedule A of the 1040 to the extent they exceed 7.5% of adjusted gross. 

In the words of IRS Publication 502:  “Medical expenses are the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and the costs for treatments affecting any part or function of the body. They include the costs of equipment, supplies, and diagnostic devices needed for these purposes. They also include dental expenses. Medical care expenses must be primarily to alleviate or prevent a physical or mental defect or illness. They do not include expenses that are merely beneficial to general health, such as vitamins or a vacation.

Medical expenses include the premiums you pay for insurance that covers the expenses of medical care, and the amounts you pay for transportation to get medical care. Medical expenses also include amounts paid for qualified long-term care services and limited amounts paid for any qualified long-term care insurance contract.”

If you buy equipment or make home improvements, they may be deductible IF they are for relief of sickness or disability not just convenience or transportation, i.e. ramps, railings, wheelchairs.  You can also include in medical expenses what you pay for prescribed medicines and drugs.  Long term care facility monthly fees attributable to medical expenses are also includable.
Keeping good records, including mileage and supplies, may allow you or your parent to qualify for some tax relief yearly or to plan ahead to consolidate expenses for another year.  A strategy dubbed “doubling up” on deductible expenses uses the standard deduction one year and itemized deductions the next.

Dependent Care Credit

You may be able to claim this credit if you pay someone to care for your dependent or your spouse who is not able to care for him/herself.  To qualify, you must pay these expenses so you can work or look for work.  The credit can be up to 35% of your expenses.  IRS Publication 503 contains full information and worksheets and also discusses the employment tax rules for household employers.  Your state may be one that also provides tax credits or deductions which build on the federal credit.

Reimbursement Accounts

If you are working at a company that offers a plan that allows for pre-tax deduction of dependent care and/or health care expenses, you can use those dollars for items not eligible for the Medical Expense Deduction or for relief if you will not be able to itemize.  Tax law changes have added non-prescription medications, like aspirin and cough medicine, to the list of reimbursable items.  Some plans require you to “use it or lose it” each year while others allow a carry-over to the next year for unused funds.  Be sure to check out the details and plan accordingly.

Caution: Tax Liability?

Having a formal agreement about caregiving in exchange for the family homestead or some other deferred benefit, might be construed as “taxable compensation” as evidenced by the 2003 federal court decision in United States vs. Dieter.   Mary Dieter’s receipt of the home was treated as “taxable compensation for services rendered.”  In another circumstance, if the care recipient goes on Medicaid, such an exchange could be considered an illegal divestiture.  Understand the laws and plan accordingly.

In conclusion, if you don’t already, with a few adjustments, you may be able to qualify for some of the tax advantages listed in this article depending on your income level and situation.  Furthermore, the state in which you live may offer benefits as well. Learn what you can and consult a qualified professional for planning and preparing your taxes. 

 

--------------------------------------------------------------------------------

June Schroeder is a Certified Financial Planner (CFP®) with Liberty Financial Group in Wisconsin, and has been working in financial services since 1979. Schroeder is also an RN, having received her degree from UW-Milwaukee in 1969. She served for 7 years as the Director of Economic Security for the Wisconsin Nurses Association, making her uniquely qualified for her role as a certified financial planner. She has written extensively for local publications as well as CNBC.COM. She has taught courses and lectured nationally on financial planning for universities and colleges."

Does your parent have a will?  If you die without a will, a person's estate will be distributed according to state law.  This distribution may or may not be your parent's wishes.  Dying without a will is called "intestate."  Every state is different, and each state has laws written for intestate death.  In most states, if you are married spouses are typically awarded 1/3 to 1/2 of the estate.  The other part of the estate is typically divided amongst one's children.  If no children are present, the estate is divided amongst other living relatives.  If you are not married, have no children, and no living relatives then one's estate will go to the state.  Any held joint accounts, will go directly to the person co-named on the account.  Any life insurance policies or trusts will go to the designated beneficiary.  KEEP IN MIND, if the beneficiary is deceased or is considered incompetent, it will take a lot of time, money, and court proceedings to award those monies elsewhere.  It is a good idea, to always review these policies annually to verify the beneficiary and their competency.  As a side note, if a person is not married but has a significant other/partner, the significant other/partner will not inherit anything from the estate without being named as the beneficiary in the insurance policy or will.

To ensure your wishes regarding your estate are carried out accordingly, plan your estate outcomes with a will and/or trust.  For more information, check your State website for intestate law.

Information adapted from Severns Associates, Pathfinders in Elder Law
www.severns.com

Family members are finding themselves in the "Sandwich Generation"...still working full-time, raising children, and caring for an elderly parent.  Alzheimer's Disease costs businesses "more than $67 billion dollars each year."  $40.5 billion of that cost is due to "family caregiving resulting in absenteeism, productivity losses, and replacement worker costs."  These statistics are a red flag to businesses of what is to come...the amount of people living longer is growing and the number of individuals with Alzheimer's Disease will more than double in the next 30 years. 
Family members who provide some form of care to an aging parent are more at risk for developing physical illnesses and stress which can affect a person's mental health, overall well-being, and work productivity. (Teepa Snow, Dementia Care & Training Specialist)

Providing a safe, structured, and supportive environment to the person with Alzheimer's Disease can be difficult especially if one lives in an area with limited resources.  Caregivers are often trying to handle "home situations" during the day while at work...dealing with insurance companies, managing home care staff, running home on your lunch break to check on mom or dad, etc.  US businesses are starting to realize the tremendous effort families are working with in being a caregiver.  Some businesses are adding additional resources to their employee benefits program to assist family caregivers. 

As a caregiver, is the company you work for equipped to provide assistance and resources to you?  I'm interested to hear how businesses are addressing this important issue.

Maybe it's the latest social event, health craze, or the Baby Boomers wanting a fit, active life but today's seniors are anything but sedentary!  Seniors want more than just bingo...they want activities and social events that are fun, physically active, and socially stimulating.  Whether they are aging in place or have made the move to a retirement community/assisted living/other living option, seniors are getting involved!  If you're a caregiver, think about introducing your aging parent to some of the activities listed below.


Some of the activities today's seniors are involved in include:

1.  Travel clubs - On a flight to Scotland last year, I sat next to a retired couple who joined a senior travel club a couple years before.  They told me a story of getting married after high school, working their whole lives, and raising a family.  They rarely traveled during this time, so they decided it was time to see the world.  They had been to every US state except for 2 (but those were on the "to do" list) and had been to numerous countries in their travel club.  This is a goal I hope to achieve myself one day!

2.  Political events, campaign assistance

3.  Wellness and fitness clubs/activities

4.  Charity or volunteer work

5.  Dance classes (ballroom dancing, salsa, etc)

6.  Nintendo Wii game parties

7.  Creative arts classes (theater, artwork, pottery, glass blowing, etc)

8.  Trying new foods and restaurants

9.  Attending local theater events, the symphony, or historical museums

10.  Monte Carlo Night (casino games)

11.  Shopping excursions to nearby cities

12.  Book clubs

13.  Investment clubs

14.  Indulging in new hobbies (photography, coin collecting, golf, etc)

15.  Learning how to play a musical instrument

16.  Cooking classes

17.  Becoming a senior companion

18.  Winery tours

19.  Computer classes

20.  Happy hour events

The following article is from Agingcare.com:  The Community for Caregivers and is in addition to the previous blog, Caregivers and Stress.

"Don't Let Caregiving Ruin Your Other Relationships
by Carol Bradley Bursack
In the 1970s, there were ongoing debates about whether a woman could balance a family with a career. The discussions centered on being a good wife, mother and employee.  The question seldom posed, in those days, was how, besides being a wife, mother and career woman, could a woman also be a good daughter?

Today, we hear about the toll elder care takes on families as routinely as we heard the former arguments in the ‘70s. Adult children are being faced with choices (or seemingly, assignments) they never thought about before. They are raising children or teenagers and holding down a job, when suddenly they find that their aging parents need an ever-increasing amount of attention.

Why is elder care more of an issue now than in the past?  For one thing, people are living longer than they used to and, often, they are not living with good health. Yes, we all love to point to the 93-year-old guy out there playing golf everyday, and these people exist. I know a couple of elders like that and they are a joy to behold.

However, many elders today are stroke survivors, or are suffering from diabetes, lung problems or dementia. Sometimes they have a combination of these ailments, and others, which likely would have caused death even a decade ago. Now, medical advances provide lifesaving options. Many of these people live – some even living fairly good quality lives – but they need assistance from family or paid attendants.

--------------------------------------------------------------------------------
We have partnered with ElderCarelink.com to provide a free referral service that helps you find everything from Home Care and Assisted Living to Financial Planning and Personal Emergency Responses. Let us assist you.
--------------------------------------------------------------------------------
 Another piece of the puzzle is that many people have chosen to have children at a later age, thus putting them in a position where they have young children and older parents at the same time. This can be a delightful combination, as long as the elders are reasonably healthy, but when they are not, the adult children of the elders, also parents of young children, can be faced with very difficult choices. These are the people now famously known as the Sandwich Generation.

Whatever the circumstances are that propel people into elder care, the problems that can come from it are myriad. All you have to do is click on the Agingcare.com community forum and you’ll quickly see that many caregivers, both men and women, find themselves feeling pulled in so many directions that they can no longer find their soul.

They fear for their own health – mental and physical – as they try to take care of the needs of three generations, the most demanding often being the elders. Caregiving for a sick elder, especially one with dementia, can become so all-consuming that the caregiver’s other relationships suffer.

First to go is the time, or even the energy and desire, to maintain friendships. Even maintaining friendships that go back years can seem like just one more thing to do when a caregiver is so swamped with demands.

So, caregivers stop seeing friends, hence friends stop asking them to do anything fun. Friends get tired of being turned down. And caregivers forget that life was once fun. They are too busy giving care to everyone else to even notice the loss.

Then there are the children at home. I had two young sons when I started going through my two decades of elder care, seven elders total. One of my sons has multiple health issues. I believe I gave my sons as much attention and care as any mother could, but I was always torn. It seemed someone always needed me. A child was sick and an elder’s personal alarm was set off. What should I do? How should I handle it?

Or I’d just be having fun with my sons, and I’d get called away on an emergency. My sons got used to me telling them that we had to stop what we were doing, be it playing music, reading or a craft, because I had to run to Grandma’s and see what’s wrong, since her personal alarm was set off. Or I had to meet the ambulance at the emergency room, because Grandpa fell at the nursing home and broke his arm. Or I needed to reschedule my uncle’s doctor appointment, because he was had gotten the flu.

Certainly, it doesn’t hurt children to know that elders need care, and children need to share their parents with the older generation. Likely, my kids had a little too much of that, but they survived. However, some children have much tougher issues than mine had to face. Some have grandparents with dementia living in their home, verbally or even physically abusing them. Or a single mom and her kids find it more economical to live with the grandparents, but the grandparents end up sucking up all of Mom's time. The parent – the caregiver to generations – can’t see a way out, so the family stays. But the relationships with the children are damaged.

And then there are the marriages. I hear from many caregivers who have supportive spouses, but I also hear from many who do not. The spouse feels neglected. The spouse never liked the elder, and now that the elder needs a lot of care, the spouse becomes even more resentful. The stress in the marriage can be intolerable for both sides. Marriages can and do break, under the stress of caregiving.

How much do caregivers owe their aging parents? Do they owe their health, their financial future, their family relationships? Where does “honoring your parents” begin and end?

I don’t believe anyone owes their own health, their marriage or their children’s emotional well-being to the elder that raised them. In most cases, the elders, if they could think straight, wouldn’t want that kind of sacrifice made for their benefit. However, often they’ve gotten to a point where they don’t recognize what they are demanding of the caregiver, so they resent not getting every need met and make that resentment well known.

This is where caregivers must take a stand. They must look for outside resources such as their state aging services for some direction. They must learn to balance their love and their time, giving as much care as possible to the elder, yet making sure that they have time, patience and energy for their children, their spouse and even their friends. If they don’t do this early on, breaking the pattern will become harder, though not impossible, as time passes.

Certainly, if the elder’s life is coming to a close, the whole family should gather around in support. But if elder caregiving is a long-term situation, the caregiver should look for balance. She needs to set boundaries as far as the elder care goes.  If she does not, all relationships that matter will be damaged, even the relationship with the elder. The caregiver who feels she has given up everything for everyone else will find that no one got what they needed. If the elder care situation sucks the life out of all other relationships, everyone loses.

For over twenty years author, columnist and speaker Carol Bradley Bursack cared for a neighbor and six elderly family members. Because of this experience, Carol created a portable support group – the book “Minding Our Elders: Caregivers Share Their Personal Stories.” Her sites, www.mindingourelders.com and www.mindingoureldersblogs.com  include helpful links and agencies. Her newspaper column, “Minding Our Elders,” runs weekly, she speaks at many caregiver workshops and conferences and has been interviewed by national radio, newspapers and magazines. She is the moderator of the AgingCare.com forum."
 

This is in response to Linda's comment:  Caregivers do feel some sort of an emotional downtime after the loss of the loved one they have been caring for.  I have always taught caregivers the importance of taking care of themselves and keeping in touch with their friends/families and interests.  I have seen lots of caregivers put their whole life into caregiving and spend practically 24/7 caregiving.  Unfortunately, I have seen those caregivers lose friends and interest in other activities.  When their loved one dies, the caregiver doesn't know what to do with themselves...emotionally, socially, etc.  Caregiving for a loved one is a gift you can give that person, and that time is cherished.  If your loved one was in hospice care, hospice will maintain caregiver contact for one year post death.  This is often helpful to families and can be beneficial to the grieving process.  All caregivers are to be applauded for their love, time, and dedicated work!

AARP has joined together with AARP's Ambassador of Caregiving to form a new online resource and community for caregivers.  For more information, check out AARP newsletter and AARP's caregiving community.

I receive daily emails from the Alzheimer's Daily News, a wonderful resource of research updates, and information and education on Alzheimer's Disease and other dementias.  The following article was in one of my emails this week, and I just had to pass along.  What are your thoughts?

Stay with me Today!
by Richard Taylor

"I think there is too much emphasis on helping people with dementia hang on to yesterday (something caregivers need) vs. helping people living with dementia being, understanding, and appreciating today (something all human beings, especially people living with failing cognitive skills need). We need less memory books and videos, and more cues, memory aids and support to know and understand what is going on around us and within us today.

So what if we forget a 1,000 times a day? We still need to live in it. We still need to understand it and feel a sense of ownership of it. Otherwise, what is left for our minds to work on, to understand - yesterday? Twenty or fifty years ago?

It takes more time to enable and support us with our struggle to understand today. And it takes increasingly more time and effort to support our need and want to stay in today. Helping us hang onto yesterday requires less time. Make us a book of family photos, put a shadow box outside our room with things from our past in it, give us some old dolls or clothes to fondle or wear - then leave us alone, go about the rest of your day.

The emphasis on memories and yesterdays unintentionally tells our ever-confused hippocampus to focus on the past and pay less attention to today. Today seems to take care of itself as far as we are concerned. Other people make decisions for us, lay out our clothes, dress and wash us, take us to the bathroom, buy our groceries, cook for us, and keep calling us inquiring what they can do for us that we haven't or can't do for ourselves today. So why not spend some time relaxing and drifting out of today and listening to old tunes, watching old movies, talking about the past and let today take care of itself?

Regardless of how many plaques and tangles we each have in our respective brains we are all still what we think we are (Rene Descartes was right, sort of). Think about yesterday and guess who you are? When others around you treat you as if you were simply a carbon copy of yesterday or the past five or ten or twenty years, when others see us as evolving and growing old as they see themselves evolving and growing old, they are naturally inclined to see in us their own need to enjoy the past, but live in the present. They sometimes escape to the past to avoid the problems of today, but then they must return to today. There is no pressure on us to return to today, because there is less and less need for us to return.

Not so!

Spend more times thinking of creative ways to support and enable us to stay in today, to understand what is happening around and to us, to structure activities so we must make our own decisions - today!

"Make it so." Please!"

The following article is from washingtonpost.com:
"FRIDAY, Dec. 19 (HealthDay News) -- Much has been reported about the stress and burden of caregiving, but a new study suggests there may be a flip side to taking care of someone you love as they age -- a decreased risk of death.
"We found that caregivers who spent an average of 14 or more hours a week caregiving lived longer and reduced their risk of dying by about half," said study author Stephanie Brown, an assistant professor in internal medicine at the University of Michigan in Ann Arbor. She added that even after they controlled the data to account for things such as age or previous illness, "there was about a 36 percent reduced risk of dying in the seven-year time period."
Results of the study were published in the current issue of Psychological Science.  The study included 1,688 couples who lived on their own, not in assisted living or a nursing home. All of the study participants were over 70.
The researchers gathered health and demographic information as well as information on how much each spouse helped the other with normal activities of daily living, such as eating, dressing, managing money and taking medications.  Eighty-one percent received no help at all with their daily tasks, while 9 percent said they received less than 14 hours a week of help from their spouse. Ten percent reported receiving more than 14 hours a week of help from their spouse.  Over the seven-year study, 27 percent of the study volunteers died.
When the researchers analyzed the data and controlled for factors such as age, race, gender, education level and net worth, they found that providing care for your spouse for more than 14 hours a week was associated with a significantly decreased risk of death compared to those who provided no spousal caregiving.
"Other studies caution against caregiving, but our study suggests that the actual act of caretaking may not be harmful," said Brown.  "This study shows that the burden of caregiving can sometimes be lightly born," said Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York City. But, he said that the results might be different depending on the type of care a spouse has to provide. Taking care of someone with early-stage Alzheimer's disease, who can still function fairly well and still behaves normally for the most part is much different from taking care of someone in the middle stages of the disease, who may be aggressive or may not sleep well.
Brown believes that the decreased risk of death comes from physiological benefits from caregiving instead of psychological ones. The authors suggest that stress regulation may play a role in this benefit. Helping others is associated with a release of oxytocin, a hormone that may help buffer the effects of stress, Brown explained.  Kennedy said the survival benefit is likely caused by both physiological and psychological factors...  Plus, he said, having a partner to care for provides structure and a sense of purpose."  (Serena Gordon)

Most articles and studies discuss the stress caregivers face and how it affects their health.  The stress of caregiving is often triggered by one's feelings...feelings of guilt, anger, frustration, and sadness.  It is very important for caregivers to take CARE of themselves!  Take a break, ask for help, use community resoucres and respite care options, utilize other family members, set realistic goals, see your primary care physician (take care of your physical and emotional health), say no to additional tasks, and keep a sense of humor.  For more information on caregivers and stress, check out the National Women's Health Information Center.

The holidays are a time to get together as family and friends.  A lot of adult children may not live near their aging parents or have not seen them for several months, so the holidays are a time when families do get together but it may also be a time of discovery...that mom or dad needs assistance in their daily life.  If you are visiting or spending time with your aging parents, keep your eyes open to the indicators that they may need some assistance with staying independent.

Here are some things to be aware of when visiting your aging parents:

1.  Mail and bills are piling up or mom/dad is having a hard time with money management and bill paying, when this has not been a problem in the past.
2.  Minimal groceries in the refrigerator and cabinets, or food is left in the microwave or rotting in the refrigerator.
3.  Mom/dad is wearing the same clothes over and over, clothes are soiled or not getting properly cleaned.
4.  Grooming habits have declined, not bathing/showering, hair and/or facial hair is unkept, teeth/dentures not being properly cleaned.
5.  Prescriptions are not being filled - look for empty bottles around the house or for medications that have expired.  Are medications being taken properly?  Have mom/dad show you the medication management system in use.  Where do they store their medications?  Do they use a pillbox?  Who fills the pillbox?  Is it filled correctly?
6.  Are they keeping up with preventative practices (e.g. attending routine health exams, receiving routine/recommended vaccinations)?
7.  Difficulty walking or getting around the house, gait disturbance/difficulty with balance, trouble getting up from a chair, difficulty with stairs.
8.  Forgetfulness or confusion regarding recent conversations, familiar faces, simple tasks or daily activities.
9.  Check the house for hazards (e.g. rugs that can easily be tripped on, inability to take care of the lawn or shovel snow/ice off walkways).  Install grab bars in the bathroom if needed, and smoke alarms and carbon monoxide monitors.
10.  Be alert for scammers.  Scammers often prey on vulnerable older adults.  Are people calling or coming over to mom/dad's and you do not know who they are?  Are they giving money or writing checks to people or organizations that you do not know?

If you discover that your aging parent or loved one is in need of additional service, contact your local Area Agency on Aging for resources or a professional geriatric care manager for assistance.

Happy Holidays!

I bet you don't think of a contemporary style nursing home when you hear the words "green houses?"  Green House homes are small homes that are designed to accommodate up to 12 seniors.  These homes provide nursing care and clinical support in a home-like environment while maintaining a sense of well-being and quality of life for the residents.  Green House homes are designed to look like a private residence, with additional bedrooms so each resident has their own.  The living room, dining room, and kitchen are all shared quarters.  The staff eat all meals with the residents, and families are encouraged to join in as well.  The philosophy is to provide good medical care and improve or sustain a quality of life through person-centered care.  Currently, there are 10 states participating in the Green House initiative.  The Robert Wood Johnson Foundation provides grant funding for the initiative.  Green House homes are developed and operated by long-term care organizations in partnership with The Green House Project and NCB Capital Impact.

I really like the concept of "treating the person" not the disease.  Of course, people's medical conditions should be addressed but we shouldn't let our residential facilities get stuck in the rut of just taking care of people medically.  I once worked for a nursing home that could house over 200 residents, and I worked with some great staff members who really focused on "treating the person."  So, while a smaller residential home might provide more of an opportunity for staff to provide more personal attention, overall I think it all of our responsibility as caregivers to provide the utmost care and quality of life for our seniors.

Usually I blog about information for caregivers which are often adults.  But what about the children and teenagers who are also in the family and trying to understand grandma or grandpa's health condition?  Dementia and Alzheimer's Disease are often hard for children and teenagers to understand how the disease affects their loved one.  They don't understand why grandma doesn't know them, or why grandpa thinks they are their child, or why grandma gets angry all the time.  The Alzheimer's Association can be a great resource for information and tips on how to talk to your children and teens about this disease.  There are many children's books available that explain dementia in a way that they can understand them.  Check your local book store for more information.  For teenagers, there is a respite camp called Building Bridges.  This camp provides respite as well as educational support.  2008 was the first year for this camp and it was a great success!  The Alzheimer's Association has endorsed this camp as well.  For more information about the camp, recommended books, and additional resources, check out Building Bridges.

"Caring for an older adult can be rewarding and fulfilling but can also place great physical, emotional and financial demands on those who take care of them. In fact, a recent issue of the Journal of Immunology compared Alzheimer’s caregivers to non-caregivers, finding that caregivers aged between four and eight years faster than non-caregivers. In light of these statistics, and in recognition of November as both National Alzheimer's Disease Awareness Month and National Family Caregivers Month, the American Occupational Therapy Association (AOTA) is offering tips for caring for the adult caregiver.

Research recently published in the American Journal of Geriatric Psychiatry tested an occupational therapy home intervention, the Tailored Activity Program (TAP), that systematically evaluates and tailors activities to individual capabilities and trains families in setting up and using activities in daily care. TAP reduced behaviors that trigger nursing home placement and the amount of time families spent supervising and providing care.

“Our research shows that occupational therapists play a critical role in the care of individuals with dementia and their family caregivers,” said Laura N. Gitlin, Ph.D., director of the Jefferson Center for Applied Research on Aging and Health and professor in the Department of Occupational Therapy at Thomas Jefferson University. “Occupational therapy practitioners are uniquely qualified to evaluate individual capabilities, engage individuals with dementia in activities, help families learn specific communication, task and environmental simplification strategies and to take care of themselves.”

Laurel Cargill Radley, MS, OTR, associate director of professional affairs at AOTA, adds, “Occupational therapists can help individuals and their families promote or maximize independence, safety and function.”

Occupational therapy practitioners recommend adult caregivers:

1. Join a therapy or discussion group for caregivers of older adults.
2. Share the responsibility of caring for an older adult.
3. Ask others for help.
4. Develop a schedule that distributes caregiving responsibility.
5. Consider adult daycare or home health aides to provide occasional breaks to full-time caregivers.
6. Create moments of joy throughout the day by participating in pleasurable activities.

Additional caregiver resources can be found on the Centers for Medicare&Medicaid Services’ (CMS) new Web site, http://www.medicare.gov/caregivers/.

Founded in 1917, the American Occupational Therapy Association (AOTA) represents the interests and concerns of more than 36,000 occupational therapists, assistants and students nationwide. The Association educates the public and advances the profession of occupational therapy by providing resources, setting standards including accreditations and serving as an advocate to improve health care. Based in Bethesda, Md., AOTA’s major programs and activities are directed toward promoting the professional development of its members and assuring consumer access to quality services so patients can maximize their individual potential. For more information, go to http://www.aota.org/."
This article was originally published by the American Occupational Therapy Association.

November is National Family Caregivers Month!!  National Family Caregivers Month is organized by the National Family Caregivers Association (NFCA), an organization that educates, supports, empowers, and speaks up for the more than 50 million Americans who care for a loved one.  National Family Caregivers Month is a time to celebrate all caregivers!
NFCA is hosting a free family caregivers teleclass to teach family caregivers how to improve their communication with healthcare professionals and become better healthcare advocates for themselves and their loved ones.  The 2-hour teleclass is being held November 6 and 13 at 2:00pm EST.  More information on the free teleclass is available here. 
Check your local Alzheimer's Association chapter, Area Agency on Aging, and local senior community for caregiver events in your area.