Laurie recently posted a comment about her mom having problems mixing up her medications.  This is a very common problem.  The average person over age 65 is taking 8 prescription medications.  Someone who is battling chronic diseases may be taking many more. 

The number of medications is confusing in the best of circumstances, but clearly other challenges like declining vision, cognitive issues, or problems with manual dexterity make medication management a daunting task. 

Some of the posts in my blog can help.  See Technology in Day-to-Day Medication Management and Create Your Medication List Now.  You can also click here for our full blog list on Medication Management where you will find lots of additional advice and insight.

You can also ask question directly of a Health Care Manager by joining our Caregiving community.  Click here for that link.

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

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

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

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

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

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

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

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

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

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

To link to the complete article, please click here.

To view the book on Amazon, click here.

My Health Care Manager has introduced a new FREE service that uses a little bit of technology to connect you to a lot of geriatric care research and experience. 

If you look in the upper right hand corner of this page you will see a "sunburst" linking you to a free service called the Caregiving Community.  By joining the Caregiving Community you can ask a question of our geriatric care management team and get an answer by the next business day.  Ask as many questions as you want, whenever you want.  In addition, once a month you will receive another Caregiving Community solution selected from best questions and answers we've tackled that month.  There is no cost for the service; all you need to provide is a name and email address.  We will not share or sell your name with others and we will not inundate you with any kind of high pressure sales.

So what's the catch?  Well, we do have a company interest here.  We believe that by providing valuable information to people caring for a senior in their life those caregivers will turn to us if they ever need help.  No tricks.  We know that if we can help families with the complex issues of aging everyone wins.

We are hearing more and more about the older adults being taken advantage by a scam artists, being victims of violent crime and even human interest stories of seniors being found alone, malnourished and unable to care for themselves.  But what exactly is elder abuse? 

According to the National Center on Elder Abuse (NCEA),  elder abuse is any form of mistreatment that results in harm or loss to an older person. It is generally divided into the following categories: 

1. Physical-  physical force that results in bodily injury, pain, or impairment. It includes assault, battery, and inappropriate restraint.
2. Sexual- there is non-consensual sexual contact of any kind with an older person
3. Domestic Violence- an escalating pattern of violence by an intimate partner where the violence is used to exercise power and control
4. Psychological- the willful infliction of mental or emotional anguish by threat, humiliation, or other verbal or nonverbal conduct.
5. Financial- the illegal or improper use of an older person's funds, property, or resources. 

Other terms you may hear about are 'neglect' (failure of a caregiver to fulfill his or her care giving responsibilities) and 'self-neglect' (failure to provide for one's own essential needs.) More detailed information can be viewed at www.preventelderabuse.org/elderabuse/elderabuse.html - NCEA.

The problem of elder abuse is large and is also under-reported.  In a National Incidence Study on Elder abuse, approximately 450,000 elderly adults experienced abuse in 1996. If self neglect had been included, it would have risen to  551,000. The NCEA Estimates of Prevalence in the U.S.

• "...between 1 to 2 million Americans age 65 and older have been injured, exploited or otherwise mistreated." 
• One in 14 incidents in domestic settings (excluding self-neglect) are believed to be brought to the attention of authorities.
• In overall reporting of financial exploitation, one in 25 cases suggests that there may be five million financial abuse cases.
• For every case reported to authorities, an estimated five cases of elder abuse go unreported.

What can you do? You can enhance the awareness of elder abuse. In most states, it is required that health care professionals report suspected abuse. But even if it is not mandated is the right thing to do.  If you would like more information on mandated reporting, visit http://elder-law.lawyers.com/Elder-Abuse.html.

Also, educate yourself.  The Hartford Foundation Institute for Geriatric Nursing has created a tool to document and assess for elder abuse.  It can be found at  www.hartfordign.org/resources/education/tryThis.html. 
It can assist you in assessing and summarizing abuse and neglect concerns by assessing the senior’s appearance, indicators such as bruise and/or fractures- or with self neglect malnutrition and/or signs of depression- or in areas of exploitation, where the senior’s monies have been mishandled. 

The key is to be aware, seek information, and help the seniors preserve their dignity and their rights.  Let’s keep our seniors safe.

To read our special Update on Senior Fraud, please click here.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

These additional sites may also assist you:

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

In past blogs I've talked about the 17 dimensions My Health Care Manager uses to build the Personal Health Record.

We've spent a lot of time on some of the most used data like the medication list, provider list, and other "current state" information.  By "current state" I'm referring to information which is primarily valuable for it's current data values.  For example, when you are caring for aging parents it may be of some very slight interest which doctors your parents went to 3 years ago, but the current doctors are far more important.  The same would be true in medication management.  It's the current prescriptions and treatment plans that are most relevant.

However, 10 of the 17 dimensions deal with "longitudinal data".  That is, data that should be measured over time.  If you are primary caregiver it is very easy to miss major changes because they happen incrementally. 

It's just like watching children grow up.  Parents, who see their kids every day, know they're growing, but its the Aunt from across the country who's stunned by how much they've grown each Thanksgiving.  Parents can get a sense of this themselves by looking at pictures.  So it is with eldercare.  The people closest to the situation need to take an actual "snapshot" of the key data items and periodically look at those for problem areas.

My Health Care Manager does this through the use of a formal assessment.  At least annually and at every major health event key areas like Activities of Daily Living, Socialization, and Cognitive Skills should be assessed, scored, and tracked. 

As the complexities and concerns of aging continue to challenge older adults and their caregiving family members, the resulting stresses call for the best possible family communications.  Luckily for our family, effective and frequent communications have come naturally.  But for many of the situations we have encountered in our helping others, due to life-long reasons and attitudes, communications are difficult and incomplete.  Sometimes it is the senior who shuts off attempts of family members to discuss key issues including housing preferences, medical support, finances and health care support.  And at other times adult family members don’t communicate effectively and build defensive barriers in the process.

Here were our major challenges with Mother:

• Deciding to stop driving.  Following her rehabilitation from her broken hip it would never be “life as usual.”  Fortunately, she recognized the changes and voluntarily offered to stop driving and sell her car.  Had it not gone the way it did, we would have faced the difficult challenge of convincing her to part with an extremely important part of her independence.
• The decision to sell the house and move to a senior living facility went well even though we had promised her she would never have to move in her earlier situation.  We were fortunate to be dealing with a logical and fully functioning senior.  I now see cases where the housing decision, if opposed, threatens to destroy family relationships.
• The third big decision was for her to turn her finances over to me.  We phased it to have  her write checks as long as desired until she voluntarily agreed that it would be even better if all aspects of her finances were handled for her.
 
Our Web site, www.myhealthcaremanager.com, has helpful hints for effective family communications.  We also featured communications in one of our Update emails.  You can read the Family Communications issue of the Update by clicking here.  You can also subscribe to the Update eNewsletter to receive future monthly issues by clicking here.

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!

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

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

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

 

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.

Don't procrastinate any longer.  Create your medication list or, if you are a caregiver, create one for your aging parents.  If you want help and advice get a geriatric care manager. 

This first job is easy to start.  Even if you are going to enlist help from a geriatric care manager or other in home services, having this list will only speed up their ability to help you or your loved one.  The medication list is the first step in any program of medication management.

Click on this link for a FREE quick spread sheet from one of my previous posts - Medication List Spreadsheet.

Make copies of the list and let your doctors know, it's critical.

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

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

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

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

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

I thought I would spent the next few blog postings covering a few related topics that are on the top of the minds of all caregivers – how to identify when Mom or Dad is making questionable investments or being taking advantage of through various financial scams.  I will discuss several of the more commonly-used practices of each so that you as a caregiver will be on the alert.

I’ve received a number of questions lately about STOLIs, or stranger-originated life insurance policies.  STOLIs are a type of life insurance policy in which another person provides the senior with a one-time cash payment and agrees to pay the policy premiums.  In return, that “stranger” is named as the beneficiary of the policy.  The senior gets immediate access to cash and has no premium to pay.  The stranger gets the policy payout once the senior passes.  The stranger can also sell the rights to the future benefit under the policy to a third person, usually an investment group or hedge fund.

If these STOLI arrangements make you feel a little uncomfortable, they should.  These schemes literally are investments in someone else’s death.  They thwart the true purpose of life insurance, which is supposed to provide the surviving family members the ability to pay off the debts and expenses of the deceased – not for the sole intention of providing someone else with the ability to seek a profit from another’s passing. 

Some have argued that STOLIs are really just another form of viaticals in which an insured sells off its rights to the policy benefit for something less that the benefit itself to get access to cash to pay for needed medical expenses.  The most common use of viaticals is by those with terminal illnesses.  The key difference between STOLIs and viaticals is that in the latter, the insured person knows they are going to pass soon and the policy was pre-existing.  Under a STOLI scheme, a senior is encouraged to enter into a policy simply to receive immediate cash outright regardless of their current health situation and investors then hope for and hedge on a person’s early death because it will result in higher profits.  

While STOLIs fly in the face of public policy, they are currently legal in most states thanks to, among other things, a wrinkle in the NAIC Model Viatical Settlement Model Law.  At least one state has recently outlawed them, and several states are currently considering legislation to do so, recognizing that these STOLI policies violate states’ laws regarding "insurable interests" that are designed to prevent a person from buying an insurance policy that has no interest in that person’s continued good health. 

My advice is to be on the watch for any large sums of money that Mom or Dad suddenly come into possession of, and to be sure that you are aware of all of the various types of insurance that they have currently in place.