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.

I work for a Geriatric Care Management company – My Health Care Manager.  I work with RN’s that have in-depth geriatric experience.  I read about geriatric care and caregiving on a daily basis.  I even give talks on Caregiving to employer groups in Indianapolis. So, I thought I was prepared, I thought I was handling things well, I thought I was the “exception” – the caregiver who takes everything in stride, who gets enough rest and who effortlessly achieves work/life balance without giving it a second thought.  That was until last weekend.

Last weekend, I crashed.  I was tired and irritable, got in arguments and cried without provocation.  I had finally had it.  I was tired of trying to be all things to all people – a devoted daughter, an attentive friend, a dedicated employee and a caring partner.  I was tired of not finding time for myself, tired of not curling up with a good book, tired of doing too much laundry and tired of sorting through tax records.  I was tired of answering my Mother’s questions over and over, I was tired of grocery shopping and most of all I was tired of being responsible.   

With shock, I realized my energy was all but depleted and I couldn’t believe the depth of my tiredness both physically and emotionally.  So, I crashed and slept a lot, read books and a caring partner took me out to dinner, cooked dinner for me and took my Mother and me to lunch.  He stepped in to prop me up and I was grateful for his help.  By Monday, I was feeling much better and ready to face the world.

When I spoke with a close friend about what happened – she wasn’t surprised and pointed out that my Mother had moved here six months ago.  She reminded me that I had been on the go ever since. I hadn’t realized how much time had passed or even thought about it, but realized she was right.  No wonder I was tired and cranky and motion sick from my merry-go-round life.

It was a rude awakening and I realized that I needed to follow some of the advice I often share with others. So I expressed my concerns to several friends and two volunteered to take my Mother on an outing (without me).  I worked less.  I engaged an Accounting Firm to help me with some financial tasks.  And a very thoughtful partner continued to provide encouragement and support as well as “date nights” and flowers.  And, most importantly, I gave myself a break!  I read books in the evening and let the laundry pile up.  I treated myself to an extravagant spring purse and savored chocolate covered blueberries.  It didn’t take much to bring the balance back to my life, but I learned a valuable lesson. 

So, the next time I give a talk about Caregiving – I’ll admit I didn’t follow the rules espoused in my carefully crafted Powerpoint presentation.  I’ll share my story.  I hope my experience will help others recognize that trying to be all things to all people is a useless endeavor, especially when it means you lose yourself in the process.

 

Every so often we come across a product that turns out to be really useful in caring for aging parents.  Sometimes these are even fun for the family, as well.

One such product is the Presto Printer.  This printer works by itself to receive emails with no special Internet connection required.  There is a corresponding service that assures that no SPAM gets through and that it's easy to send messages, pictures, and more.  For more details click here for a PDF brochure. 

This can really help the family stay in touch and reduce feelings of isolation for seniors - improving well-being.  It's also away for grandchildren or even great grandchildren to take an active role in caregiving.

We've had enough success with this, we're able to pass along a special offer from Presto - two months free service.  Go to www.presto.com/myhealthcaremanager to take advantage of this deal.

There are several innovations available to help seniors organize and remember to take their medicines.  Although not necessary for many older adults managing multiple medications, some can benefit by having their medicines pre-sorted and dispensed in pouches that are organized by time of day and day of week.  We’re moving to a system like this as Mother’s filling a 28 compartment pill tray with 14 prescribed medicines and OTC pills each week becomes even more challenging with her aging.  This pre-loaded dispensing solution has been used in nursing homes and some hospitals for several years, but some companies are now offering the program to individuals in their residences.  But before making any change of this type, be sure to check the Medicare Part D prescription medicine plan to be sure the vendor is recognized in the insurance company’s plan. 

Other higher-tech aids are in development that include pill trays that automatically open at the right time and track results (although it is impossible to remotely know if the pills were actually taken).  We’ll be seeing more use of technology in assisting with eldercare- something I imagine caregivers will welcome wholeheartedly.  Many developments are underway by inventors and large health technology companies, and I’ll use a future blog to describe some of the more promising ones.

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

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

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

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

How many times have I heard this phrase and nodded my head in agreement?  But how many times have I put this into practice?  Not many, I fear. 

 

Until now…..until I became a caregiver.  Until I realized that obsessing over the small stuff will serve no purpose.  It won’t slow my Mother’s dementia.  It won’t give me peace of mind and it won’t make either of us happier or less frustrated.

 

So every day I look for “stuff” to put in the “small stuff” category.  Almost everything is finding a home here – unless it directly affects my Mother’s health and wellbeing.  For instance, when my Mother loses her purse and her wedding ring and her keys – I just help her look for them, knowing we’ll find them hidden in the laundry hamper or dresser.  Or when my Mother confuses the date, calls me repeatedly about the same issue or can’t remember what she had for lunch – I let it go.  Because worrying about it isn’t going to make it better.

 

I’m still sweating though – thanks to a maniacal personal trainer at the exercise club I just joined.  My thrice weekly workout is intended to help manage stress …..but I refer to it as “sweating the big stuff” – specifically the BIG Treadmill, BIG Elliptical Trainer and BIG Weight Machines!

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.

Even though Mother was safe and secure in Independent Living (IL) in a Continuing Care Retirement Community (CCRC), we quickly realized that managing her prescription and over-the-counter (OTC) medicines was a challenge of its own.  With 10 prescription medicines and 4 OTCs, the variables of continuing supply with many expirations and prescription renewals combined with generic vs. brand names, dosages and time-of-day preferences were an overwhelming task for her … and her caregivers!  Fortunately, we devised a Weekly Schedule and medicine reconciliation program that allowed her to manage her own meds (with our assistance) that has now become a My Health Care Manager computer-based decision aid.  However, loading her pill tray every week and managing the time for her diabetes blood sugar tests and consumption of the pills became (and remains) an ongoing challenge.  Until becoming exposed to the issues of polypharmacy and older adults, I didn’t understand that normally-prescribed medicines and dosages affect many seniors differently – sometimes even causing symptoms such as confusion and loss of balance.  Even multiple medication regimes that were tolerated in the past can at any moment cause problems or unwanted symptoms.

When trying to get my hands around the multiple medications challenge, it became clear that no single health care provider had information on everything that was being taken by Mother.  Each knew what he or she had prescribed, but the rest of their knowledge was based on answers given to the common question, “What medicines are your taking?” at office visits.  Often confused over generic vs. brand names, dosages, and omitting OTC products, older adults often can’t be counted on to correctly answer this important question.  In developing My Health Care Manager’s suite of decision aids, we added a letter that the senior can choose to send to all of their health care providers (or only to the ones they designate). The letter lists the providers, their prescribed medicines, and any other OTC products being taken by the senior.  Several doctors have remarked that this simple summary of information is not available from any single source in our health care system.  You might try this important task on your own if you are immersed in eldercare.  We’ll have more on managing medicines in my next blog.