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

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

An Alzheimer's patient once came to me after he had got out of his house and was found hours later in a ditch approximately 2 miles from his house.  Wandering is often a scary symptom of Alzheimer's disease and dementia.  It's confusing and scary for a senior who does not know where he/she is or where they are going; and is scary and worrisome for family caregivers.  Wandering can occur anytime but tends to increase in the late afternoon/early evening hours.  There are several things caregivers can do to keep their loved ones safe at home. 

Tip #1:  Use deadbolts on doors leading outside, place them high or low on doors
Tip #2:  Take locks off of bathroom and bedroom doors to avoid your loved one from locking themselves in
Tip #3:  As the sun starts to go down, close the blinds/curtains and turn lights on
Tip #4:  Install appliances that shut off automatically
Tip #5:  Keep toxins i.e. cleaners, bleach, poisons; and prescription medications in a safe, secure space
Tip #6:  Remove clutter from around the house
Tip #7:  Install a door alarm or place a motion sensor in your loved one's room at night to alert you when they are awake and moving
Tip #8:  Label doors, drawers, and cabinets; this is most helpful in the earlier stages

A professional geriatric care manager can help you in reviewing your home and finding assistance for home modifications.  For more tips and information, check out The Complete Guide to Alzheimer's-Proofing Your Home and home modification tips.

This article "50 Communication Tips and Techniques for Caregivers" was recently sent to me.  This article lists good tips and techniques for communicating with someone who experiences memory loss.  These tips and techniques include information on communicating and speaking someone who has memory loss, attention techniques, nonverbal communication tips, behavior tips and techniques, and working/communicating with others who might be involved with the senior.

When is the right time to talk to mom or dad about planning for the future?  Ideally, the earlier the better.  Usually when seniors are in their 70s is the best, unless signs of dementia or another health issue arises earlier.  It is important to understand your parent's healthcare and financial wishes and goals.  For most seniors, death is not their main fear but losing their independence is.  Planning for the future and having this conversation with mom or dad is not easy, as people do not want to think about a time when they'll need help and resources in order to continue to live independently.  It's important to have this conversation before a crisis hits.  Talk with your parents about their wishes regarding medical treatments, procedures, etc in the case that they are unable to make decisions for themselves.  Information that is discussed should be put into writing, a Living Will document.  Financial planning is also important and should be discussed with mom and dad.  These actions and steps should be lined out in a legal document.  By having this discussion early, the senior is not only verbalizing their wishes and goals but being responsible by planning for their future.

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!

Alzheimer's Disease is a world of uncertainty for both the person affected and the family members.  It's important to create moments of joy within that disease and with that senior.  Alzheimer's and dementias affect each person differently, some people have personality or behavioral changes, some lose brain functioning at a faster rate, etc.; their world becomes different.  It is important for family members to pay attention and learn where their loved one is at.  This is not an easy task for family members because the senior's memory maybe affected to where they no longer recall their wife or that they have children, etc.  If we try to correct them, it causes more confusion, anger, sadness or depression for the senior.  Try to put yourself in "their world"....  I once stood in front of a mirror with a lady affected by Alzheimer's and she said "who's that old lady?"  Instead of me saying that's you (since she did not recognize herself), I merely said "I'm not sure exactly, but it's a good thing we are two good-looking ladies."  In her mind, she was in her mid-30s and could recognize herself in an old picture of when she was in her 30s, but if you showed her a picture of herself today, she didn't recognize herself.  Another lady was taking all her clothes and other belongings and gathering them up and putting them into piles, stating she was getting ready for a garage sale.  Instead of telling her it was the middle of winter and she wasn't having a garage sale, I started a conversation by asking her what she was going to buy with her garage sale money.  She said a new car and some new clothes, so we talked about cars and shopping while I helped her "decide what goes and what stays".  We had a great conversation and a fun time.  It is difficult for family members to join in mom or dad's world because it is not "our reality."  But it is their's.  It's our turn to help create memories of joy.  If their thoughts or actions are not physically harming to themselves or others, then just try to roll with where they are at.  Correcting them or trying to bring them to "our reality" will only cause emotional anguish.  The article, "Finding Moments of Joy Helps Alzheimer's Patients" gives additional tips on how to create moments of joy.

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.

What does it mean to be young at heart?  I believe each individual's definition of being young at heart is different.  It comes down to our own thoughts about our personal well-being.  Optimal well-being can only be defined by ourselves.  Optimal well-being not only involves our thoughts on our physical health, but it also includes our mental and emotional well-being, social well-being, spiritual well-being, intellectual well-being, functional well-being, etc.
I think that my 77 year old grandmother is an excellent example of how someone is young at heart.  She always seems to have a good time.  She likes to have fun, has a good sense of humor and is always on the go...going out to lunch with her girlfriends, playing in her card club, participating in church functions and community organizations, watching sports (an avid basketball and baseball fan), and playing Wii bowling.  Through a family night event at her church, she has discovered the fun and exercise of Nintendo Wii bowling.  She has taken it upon herself to learn a new technology, how to play Wii bowling.  She teaches her senior peers how to play, engages them in friendly competitive games, and crowned herself the winner of "the old ladies division."  This game has created so much fun for her and is another example of how she keeps herself young at heart.  Not only should we look to seniors on how to stay young at heart, but we should share our discoveries with others.

At any age, people want to achieve and maintain a good overall quality of life.  For seniors, reminiscence is a great way to achieve insight and improve their personal quality of life.  Reminiscence is a process of remembering prior life events.  The goal of reminiscence is to help seniors retrieve positive events, feelings, and happy memories.  The end result creates more self-esteem, a more pliable mood state, improved coping skills, and improved social skills.  Helping seniors recall the positives from their past will aid them in their feelings and coping skills towards any current life challenges.  The main purpose is to rekindle their personal purposes which will also help restore self-confidence.
When I was in graduate school, I conducted reminiscence groups at an assisted living facility.  For my first group, I had 4 people attend.  My topic for that first group was "Summertime Vacations" and I asked people to come to the group with a story of a past summertime vacation and something from that vacation, a picture, something they purchased, etc.  Even though these individuals lived in the same building, they didn't know each other.  As I started facilitating the conversation about vacations, people started talking and laughing and saying "I traveled there too, did you go see that ...."  I enjoyed listening to everyone talk and as the group ended and people left, they stood around and kept talking and made a new friend.  My group size began to grow each time as people were enjoying themselves and were talking about it in the dining room and telling others they should come.  I set the date, gave the topic and they provided the conversation and their own props, which somtimes including a photograph, a song, a baked good, an outfit, etc.  I did this group for 4 months and ended my time there with a "Family Traditions" reminiscence group with a group of 28 participants.
I encourage everyone to take the time to reminiscence with your loved one or any older adult.  People love to talk about things that made them happy or excited them, plus you might gain a little history knowledge along the way. 

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

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

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

Family members of aging parents who have dementia or Alzheimer's Disease have a difficult job.  Individuals with dementia and Alzheimer's often show changes in personality, emotions, and social behavior.  These changes are common symptoms of the disease and occur with the cognitive decline.  Family members often feel a sense of ambivalence, having both positive and negative feelings toward their aging parents.  In a 2007 USA TODAY/ABC News/Gallup poll, "Slightly less than half of those [family members] providing help say it has caused them some stress or a great deal of stress." (USA TODAY/ABC News/Gallup poll, May 24-June 3, 2007).  Feelings of anger, resentment, and guilt are all common among family caregivers.  Lack of assistance and support from other family members and lack of time can all contribute to these feelings.  This person is your mother or father whom you love, and your feelings of anger and resentment can cause feelings of immense guilt.  Family members often express depression and a sense of sadness watching their once independent and capable parent decline.
You are not alone!  Most family members caregiving for a parent of dementia or Alzheimer's express these same feelings.  It's important to care for yourself!
Here are a few tips for caring for yourself:
1.  Take time for yourself!  Set aside time each week to go to a movie, out to dinner with a friend, shop by yourself, take a yoga class, read, golf, enjoy time by doing your favorite hobby, etc.
2.  Deep breathing exercises.  When your loved one has you frustrated, try to take deep breathes and de-stress.
3.  Set up a schedule with other family members to help out with mom/dad.
4.  Enlist the help of friends, neighbors, church members, etc. 
5.  Maintain connections with friends and your community.  Caregivers often isolated themselves from others and focus all time on mom/dad.
6.  Join a caregiver support group.  See the Alzheimer's Association for local support group information. 
7.  Educate yourself.  Learning about dementia and Alzheimer's Disease will help you understand the impact of cognitive decline on everyone involved.
8.  Call on a geriatric care manager for assistance.
9.  Be aware of your stress level.  Know your stress level and know when it's time for a break.
10.  Don't be afraid to ask for help.  Caregiving is a 24/7 job and even the best caregiver needs a break!

Many families will get together this weekend for Easter.  Sons and daughters who may not see their aging parents often will travel to visit them and families will be reunited.  The holidays are often when adult children notice signs of aging in their parents, whether its a physical decline or a change in cognition. 

Encourage your parents to see their health care providers to address any changes that may inhibit their daily lives, whether it's a change in mobility or trouble with balance, or difficulty remembering things or worsening arthritis.  Proactively addressing these issues can help seniors maintain their mobility, better manage chronic illnesses, and put support systems in place prior to a crisis.

It can be difficult to bring up issues like this during a family holiday, so you may consider scheduling another visit in the near future.  Sometimes denial is the reponse to the aging process.  If your parents don't want to discuss the issues with you, you can enlist the help of a health care provider or other trusted advisor (whether it's a geriatric care manager, their long-time CPA or attorney, or even a close friend) to encourage them to proactively address the issues.

It's been said many times that caregiving is a difficult, but very rewarding experience.  Financially, however, caregiving can be costly.  Caregivers often help out with rent or mortgage payments, as well as the cost of in-home care services.  According to MetLife, the average caregiver assists with these bills anywhere from two to six years, and contributes a whopping $19,525 over that period.  While many caregivers provide only care and support and no financial system, some caregivers are contributing even more money to pay their loved ones' expenses.  This figure is independent of those paying for assisted living facilities or nursing homes, which can run around $70K/year and up.  There are often extra fees for those with dementia or Alzheimer's in addition to the normal rates.

As so many caregivers are providing financial support, this can raise questions when it comes to filing taxes.  USA Today has a timely Q&A for tax season... Yesterday they addressed the situation of a caregiver whose mother moved into assisted living due to an Alzheimer's diagnosis- and the caregiver is paying for it.  Is this tax deductible?  Yes!  For the details, please click here.

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

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

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

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

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

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

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

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

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

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

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

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