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

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

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

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

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

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

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. 

Do You Have Your Advance Directives Written??

 Over the last months, I have had the opportunity to assist several families that were thrown into dealing with their loved one’s end of life wishes. Each family story is different, but the common theme was “the elder parent “ had not discussed nor written down his or her end of life wishes. 

 One father’s wishes were to not have CPR and to not return to the hospital if he had an exacerbation of congestive heart failure. From code status and hospital admission, these wishes sound easy. But since the elderly parent had not discussed these wishes with his health care providers and family, the family wasn’t able to fully advocate for his rights.  When he had an exacerbation of his heart failure, the nursing home transferred him to the hospital. After being admitted, he had tests and treatments that prolonged his life. After several weeks, he died in the hospital.  If he had discussed his wishes, named a health care representative, or created a living will, the family could have advocated for his wishes and prevented this last hospitalization.  

 It doesn’t matter what age you are… if you wait until the last days of your life to make others aware of your wishes, your wishes may not be carried out.  Not because your loved ones don’t care, but because they will not have enough time to understand what you are requesting and be able to appropriately advocate for your rights. I cannot emphasize enough the importance of letting those close to you know your wishes and writing them down.

Have you had those conversations with your parents – with your children?

 If these conversations do not happen, the end of life decisions become very difficult and many times will divide a family at a time when they should be together.  Don’t let this be your family.  Do your research- and ask the hard questions. 

 An excellent site to visit is Aging with Dignity.  It will assist you in addressing those hard to discuss topics ( http://www.agingwithdignity.org). Aging with Dignity is a non-profit organization that was established to provide practical information, advice and legal tools you need to assist you in identifying and documenting your wishes and those of your loved ones.  The document called the “Five Wishes” is legally valid in 40 states.  You can obtain a copy at http://www.agingwithdignity.org/5wishes.html.

Another site is Partnership for Caring http://www.caringinfo.org/  and (1-800-989-9455). The Partnership for Caring has downloadable advance directives requirements for all 50 states, or one may call for advance directives documents. 

There is never a good time – but anytime is the right time.  Talk now.

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.

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.

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.

Again facing an important issue with no trusted advisor, we began meeting with the sales representative for the nursing home where she had several friends.  (Little did we know how many options exist even once a “retirement home” direction is chosen.  Now it’s clear that there are major differences in the economics, quality, safety, security, staffing, meals, ancillary services, transportation options, continuing care availability and long term options among the retirement community  and alternatives.)  So our meetings quickly focused on Mother’s health and economic situation that could meet their entrance requirements.

We didn’t even look at many of her alternatives to living alone.  We now know the options include an independent living community (IL), a continuing care retirement community (CCRC), a “senior-friendly” apartment or condominium, a neighborhood shared home, and several others.
And within the options are many varieties including for-profit or not-for-profit, public or private, local or nationwide chains, and the “scorecards” they all receive from their respective state boards of health.

In the economics criteria alone, we now understand there are monthly rental, deposit, and equity plans with varying percentages of returns if occupancy is ever terminated.  We were fortunate to pick “the gold standard” in our community, and they had a one bedroom unit available within the next 90 days after some desired renovations were completed.

Now we had to figure out which plan was best for our situation.  The variables were the percent, if any, of the initial deposit returned if the person moves out or dies, the costs and credits if the person moves from Independent Living to Assisted Living or Full Health Care, and other important items.

We included Mother in the discussions so the ultimate decision was hers, and with her supporting the move we signed the papers and started planning the downsizing and move for the next 3 months.

Our experience with the decision to move into a Continuing Care Retirement Community was very good, but we hear and are involved with many situations that don’t work out as well for caregivers and their aging parents.  Really working on our family communications throughout the decision process and including her in all decisions turned out to be one of the most valuable lessons learned.

A recent study has suggested that correcting vision problems in seniors residing in nursing homes may reduce their symptoms of depression.  Not only were their symptoms of depression reduced, but also their involvement in social interactions, activities and hobbies, and reading increased.  Of course this doesn't pertain to only those seniors living in retirement communities.  Correcting poor vision can be a relatively easy and quick way to positively affect quality of life in the short term.  To read the study synopsis, please click here.  The study is specific to refractive errors, but other common conditions in older adults include glaucoma, macular degeneration, and cataracts.

While I've already mentioned the link between falls and certain types of loss of vision, this is one more reason to make sure the older adults in your life have recently had their vision checked by a health care professional.  Aging can often mean a change in vision, and it is important to proactively address this, as some common conditions can be treated (e.g. the refractive errors in the study, cataracts, etc).  Caregivers may often be the first to recognize the signs, and your loved one's geriatric care provider or health care professional can recommend a specialist if your loved one does not have an optometrist or eye doctor.

Baby Boomers, like me, are often referred to as the Sandwich Generation.  We often find ourselves caring for children and caring for parents at the same time.  In my case, my child is grown, so I don’t experience this on a daily basis, just once in awhile.

 

Several weeks ago I became a Grandmother to beautiful Ava Lane.  A precious baby, born in Washington DC, my son and daughter- in-law’s first child.  I eagerly made plans for my first “Grandmother Visit” …..one that will be oft repeated in the months and years to come.  I called USAIR, scheduled time off from work and bought lots of cute, pink baby clothes.  But making a trip to DC meant leaving my Mother “on her own” in Indianapolis.  Not that she is really on her own, as she lives in an Assisted Living facility, but it did mean I wouldn’t see her for a week.   This made me uncomfortable, as I typically see her several times per week.  I truly did feel like a sandwich then – being cut in half!!

 

Thankfully, I have a caregiving support network in place which allowed me to make the trip without worry.  I made arrangements for my Mother’s Geriatric Care Manager to visit and call while I was away.  Additionally, the companion stopped in twice in my absence and a good friend made a visit too.   I was fortunate to be able to enjoy a joyous time with my family, knowing that I had “people on the ground” in Indianapolis to look out for my Mother and who could be available in case of an emergency.  My peace of mind was greatly enhanced by their assistance.

 

I encourage everyone to establish a caregiving support network.  It is just not possible to go it alone.  I returned from my “Grandmother” trip refreshed and happy and know that by taking good care of myself, I’m better able to care for my Mother.

Today is the last day of National "Talk About Prescriptions" month - so hopefully you have spoken with your aging loved one- especially if they are taking multiple medications. However, I would also like to encourage everyone to talk about another kind of prescription- not for a medication, but for glasses or contacts.  Our vision deteriorates as we age and this can affect our mobility.  Home safety is incredibly important for preventing falls- and one key to preventing falls is recognizing a change in vision.

A recent study proves that worse vision or 'visual field deficit' is associated with falls- especially peripheral vision deficits.  The study also provides information about the occurrence of falls among older adults and the association of falls with a greater likelihood of hospitalization, nursing home admission, and death.  The bottom line: making sure your loved one has regular exams by a health care professional- including vision exams- is a smart move!  You may also speak with your geriatrician or health care professional for more information on preventing falls.  To read the study abstract issued by the  Institutes of Ophthamology at Johns Hopkins School of Medicine and the University College in London, please click here.