As nature is hitting us with all forces across the nation, hurricanes, tornados, fires & floods; a key resource for eldercare is a emergency supply kit. 

Each older adult’s needs and abilities are unique, but every older adult (and caregiver) can take important steps to prepare for all kinds of emergencies and put plans in place, even when residing in a retirement community.  Start by evaluating personal needs when making emergency plan. A commitment to planning today will help prepare the older adult for any emergency situation. Consider how a disaster might affect your individual needs.

• Plan to make it on your own, at least for a period of time. It's possible that you will not have access to a medical facility or even a drugstore.
• Identify what kind of resources you use on a daily basis and what you might do if they are limited or not available.
• Get an emergency supply kit.  (http://www.ready.gov/america/getakit/index.html)
• If you must evacuate, take your pets with you, if possible. However, if you are going to a public shelter, it is important to understand that animals may not be allowed inside.
• Plan in advance for shelter alternatives that will work for both you and your pets; consider loved ones or friends outside of your immediate area who would be willing to host you and your pets in an emergency.

When preparing for a possible emergency situation, it's best to think first about the basics of survival: fresh water, food, clean air and warmth.

Recommended Items to Include in a Basic Emergency Supply Kit:

• Water, one gallon of water per person per day for at least three days, for drinking and sanitation
• Food, at least a three-day supply of non-perishable food
• Battery-powered or hand crank radio and a NOAA Weather Radio with tone alert and extra batteries for both
• Flashlight and extra batteries
• First aid kit
• Whistle to signal for help
• Dust mask, to help filter contaminated air and plastic sheeting and duct tape to shelter-in-place
• Moist towelettes, garbage bags and plastic ties for personal sanitation
• Wrench or pliers to turn off utilities
• Can opener for food (if kit contains canned food)
• Local maps

Medications and Medical Supplies
If you take medicine or use a medical treatment on a daily basis, be sure you have what you need to make it on your own for at least a week, maybe longer.

• Make a list of prescription medicines including dosage, treatment and allergy information.
• Talk to your pharmacist or doctor about what else you need to prepare.
• If you undergo routine treatments administered by a clinic or hospital or if you receive regular services such as home health care, treatment or transportation, talk to your service provider about their emergency plans. Work with them to identify back-up service providers and incorporate them into your personal support network.
• Consider other personal needs such as eyeglasses, hearing aids and hearing aid batteries, wheelchair batteries, and oxygen.
• Include copies of important documents in your emergency supply kits such as family records, medical records, wills, deeds, social security number, charge and bank accounts information and tax records.

For more information on special needs, see Disaster Preparedness For People With Disabilities  from FEMA, and Disaster Preparedness for Seniors by Seniors from the Red Cross.

Keep in mind a disaster can disrupt mail service for days or even weeks. Consider direct deposit by calling the Go Direct toll-free helpline at (800) 333-1795 or sign up at www.GoDirect.gov. Sponsored by U.S. Department of the Treasury and the Federal Reserve Banks, this option will ensure you get your social security or SSI payment on time each month.

Preparing makes sense. Get ready now.

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.

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. 

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. 

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.

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.

Hard to believe that there could be a document more important than a will, but there is one.  Its called a Power of Attorney and it gives someone the legal authority to handle certain matters in the event a person does not want to handle them on their own.  Let's say that an elderly father is having difficulty managing and keeping up with his monthly expenses.  He might "give" a Power of Attorney to his daughter to write checks out of his account and pay his bills.  In this example, the father is the "principal" and the daughter is the "agent" or "attorney-in-fact".  The authority provided under a Power of Attorney can be fairly limited, as in the example above, or fairly significant, such as providing someone with the authority to make gifts, negotiate securities and real estate, or transfer funds. 

You might have also heard the term "Durable Power of Attorney".  A regular Power of Attorney is used when the principal is still competent and is usually given out of convenience.  The power provided under a regular Power of Attorney is revoked should the senior become incapacitated.  To prepare for the possibility in the future that the principal may not be competent due to disability, incapacity, or the normal aging process, they should provide someone now with a Durable Power of Attorney.  This document provides an attorney-in-fact the ability to manage some or all of their affairs should the principal become incapacitated or incompetent and remains effective until they pass away.
 
As an adult child and caregiver, it will be important to ensure that your parent has a Durable Power of Attorney.  In the absence of one, a court would appoint a guardian to manage the incompetent person's affairs.  This process can be expensive, time consuming, and to some it can be humiliating.  So, as is the case with other legal documents I’ve discussed, plan for the future now so you and your parent have the peace of mind that all of their affairs will be taken care of in their best interest and consistent with their wishes.  You should consult with an eldercare lawyer to be sure that all state-specific legal requirements are met (for example, it may be necessary to have more than one durable power of attorney if your parent has assets in a number of states).   At a minimum, Powers of Attorney documents name the person granting the authority, the attorney-in-fact, an alternative attorney-in-fact, the list of powers to be granted, the terms and circumstances of the power granted, and the signatures and seals as required by each state.  Most major financial institutions have their own forms for power over certain accounts, so be sure to coordinate your efforts with any banks or brokerage firms.

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

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

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

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

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

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

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

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

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

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

Discharge from the SNF was a big benchmark in Mother’s rehabilitation from her broken hip.  But even with 3 children in the same city sharing eldercare duties, going back home found nearly everything had changed.  Just choosing a home health agency became a case in point.  Dispatched from the SNF with a long list of home health agencies but with no recommendation – only a small step better than tearing out the Yellow Pages – we had to figure out which one to use.  (We didn’t know that thousands had gone before us in making decisions – some right and some wrong.  Additionally, we didn’t know that there were ways to check out the candidate home health agencies to help in the decision.)  The agency we went with sent one worker who had the misfortune of an unreliable car and getting stuck in snow, so with two misses we requested a more reliable worker to assist Mother.  In the second week of the coverage I was surprised by Mother’s advising me she had fired the worker because “she just sat there and made notes in her notebook.”  So we were back to square one.

Luckily Mother offered that she didn’t feel safe driving her car anymore, and we had it sold in a week!  (Giving up driving remains one of the most difficult situations a family has to resolve.)  Still struggling with mobility issues (moving around with difficulty and a walker), we were preparing for 7 day, two shift coverage (around $20-28 thousand a year at $14-18 per hour for qualified companions with no health care services) to let her stay in her home.  Since we had already inspected her home for environmental safety, that plan could have worked.  But Mother perceptively guessed that her opportunities for social interactions would rapidly decline, and she offered that she would be willing to consider a retirement community for more security, easy access to old and new friends, and the peace of mind that she was in a supportive and protective environment.

Having promised her when she was mobile and independent that she would never be forced to move to a “retirement home,” it was now time to consider alternative living options once she brought it up.  I’ll share this next passage in my journey as a caregiver in my next Blog.

Please share any experiences you have had with home health services by posting a comment below.

The admissions process was handled well at the SNF, and we met the director, marketing liaison, and director of nursing in a welcoming visit.  Thankfully Mother came in during the week, as many of these managers are often not available on Friday evenings, or over the weekend, the interval following frequent Friday afternoon discharges from hospitals to geriatric care facilities.  But the first night experience was still ahead, and my experience in care management was only beginning.

Visiting a sobbing Mother the next morning, I learned that she thought help would arrive quickly after she pushed her “Help” button, and it didn’t come for over an hour after her 4am page.  Her accident was totally avoidable, but staffing during third shift was so low that timely rounds and responses were nearly impossible.  After a one-on-one meeting with the director and a frank discussion of expectations and responsibilities, her page was answered promptly from then on.  Fortunately we were right there and not timid in asking for improved service.  My thoughts now focus on those families that don’t have the good fortune of being in the same city during a crisis or rehabilitation.  Eldercare from fifty or over a thousand miles away nearly always stresses both caregivers and their parents sometimes beyond belief.

Learning that Medicare covered the first 20 days in the SNF when preceded by 3 nights in the hospital, we concentrated on making her stay as comfortable as possible.  We quickly moved in her credenza and chair from her home, her TV, and her CDs and stereo.  This turned out to be a great idea, and others facing a similar situation should seriously consider doing it – even if the SNF doesn’t encourage it.  Next came physical therapy (PT) and occupational therapy (OT) to increase her mobility.  Luckily she didn’t need speech therapy (ST).  PT was performed by in-house employees (it is often outsourced), and all went well toward her 30 step benchmark test.

For more information on Medicare coverage of Skilled Nursing Facility care, please click here.

Standing alone in her closet, my then 91 year old Mother’s femur suddenly broke and she fell.  Alone, and up to that moment living well independently in her home, she pulled herself to the phone and made the 911 call.  My wife and I were 2,000 miles away when the call came, and the next flight out got us back to the hospital just after the orthopedic surgeon had spiked her femur and placed an artificial hip cap.  Up to that point, all of the decisions were made for us, and thankfully they were good ones.  Now it was our time, with no map or experience, to navigate the health care maze that older adults and their families have to face alone.

The hospital’s case manager met with us and advised that Mother was going to be discharged after her third night (afterwards, but not at the time, it was clear that her capitated Medicare reimbursement would reach its end so it was time to go) to a rehabilitation facility that we could choose from a list she provided.  Miraculously, a skilled nursing facility (SNF) sales liaison appeared and assured us all details would be handled and a bed awaited Mother.  We were lucky.  Later we learned in another experience that ongoing relationships with the SNF sales liaisons and the case/discharge managers are well lubricated relationships – but thankfully referral fees are illegal.  But the big questions of how well matched the SNF was for Mother, the short or long-term nature of the facility (a big factor in short term rehab motivation), in or out-of-plan for supplemental insurance coverage, the staffing ratios of the SNF (patients divided by nurses and other skilled assistants), and the state’s and Medicare’s results from surprise audits were lost in the emotion of the family decision.

We’ll pick up with the first night in the SNF in my next blog, and you will soon understand what motivated me to create and found My Health Care Manager, as a consumer-side rather than provider-side, professional advisor for older adults and their families for navigating the issues and options of aging and eldercare.  But, in the meantime, please share your experiences and advice as a caregiver or senior from similar encounters involving home safety issues, falls, or unexpected hospital stays.