ElderCare Transitions

Let’s talk about…Driving.

If there is a topic to discuss that is perhaps even more emotional than moving from your home, it is giving up the keys to the car.  There is so much represented by one’s ability to drive –freedom, independence, responsibility, status.  It sometimes serves as the great divide among seniors – those that can still drive and those that cannot.  The question I like to ask is “Just because you still have a license – does that mean you should still be driving?”

Frequently, children of older adults will confess in conversation – “I know he/she shouldn’t be driving anymore, but if I tell them they have to stop, they’ll kill me.”  Does that sound familiar?  If so, you are not alone.

I like to say there are two categories of seniors who should stop driving:

• Those that are cognitively impaired with a form of dementia and
• Those that have physical limitations that create dangerous situations on the road

The first category is perhaps the easiest to address. It is the one that can also be provided by third party intervention.  When someone is under a physician’s care, the physician is bound by law to report a driver that is no longer competent to drive – due to the effects of a CVA (stroke), a head injury (TBI), a neurological condition or the presence of dementia (to the degree it affects their functional abilities).  In those cases, you may deal with the aftermath of the decision, but the anger at you as the decision-maker can be avoided.  The aftermath of the decision can be somewhat predictable –you should expect that there will be anger, hurt, hostility, depression…the list will go on.  What is important to realize is that the decision to revoke a license is based on the very criteria that was necessary to earn the privilege to drive in the first place. 

The second category is not as clear-cut - and is almost always a talk that is very difficult to have without significant emotional reactions from all involved.   There are two links below that provide great information and discussion. 

http://seniordriving.aaa.com/

https://www.nia.nih.gov/health/publication/older-drivers

On a personal note, I faced both situations with my own parents.  My mother was still angry and in part blamed me for “telling the doctor things that weren’t true”.  But her physician was wonderful about pointing out that his decision was based on HIS findings.  She was still angry, followed by sadness and frustration – but our community and my mother were safer with her off the road.

In my father’s case, his physical limitations, vision and diminished reaction time made him a liability on the road – not to mention that his top speed was 25mph.  That in itself was an invitation for a road rage incident.  In his case, the conversation was different.  What turned it around was my reminding him that he was a pillar of his community, a man of honor and integrity, admired by so many – and never once had someone told me “your dad is a helluva driver!”   Continuing to drive was not as important as preserving a lifetime of good works.

If you need help starting this conversation, let’s talk!

Let’s talk about…Medicare and Medicaid.

These two programs are both government programs that do very different things and yet I frequently hear people use the terms either together or interchangeably.  It is very important as you age OR if you care for a loved one who is aging, that you understand what the programs are and what the critical differences are.

Let’s cover Medicare first.  By definition:

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). 

Medicare has Parts A & B – generally speaking Medicare part A is what covers your hospital stay and if necessary, any rehabilitative stay for recovery from surgery/accidents/fractures.  You may choose to complete rehabilitation in an acute rehab facility or a skilled nursing facility (SNF).  Part B covers outpatient costs, physician visits, etc. 

Now, let’s define Medicaid.  By definition:

Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.

The website for finding the answers to any questions you may have is https://www.medicare.gov/ .

What is most important for you to understand is that these funding sources are available for hospital stays, rehabilitation stays and for people who require skilled services in a skilled nursing facility or within the home.  If you peruse the website referred to above, you can get a better understanding of what a “skilled service” is...or more importantly, what a “skilled service” is NOT.

As many seniors strive to “age in place”, you may notice areas of need. Providing light housekeeping or assistance with personal care “just to get the day started” or providing meal preparation or doing laundry or managing medication may be just what an aging loved one needs to stay in their home. There are many agencies that provide in-home assistance.  And while the help listed above is necessary and can be provided in your home, it is NOT a skilled service and therefore, would be considered private pay.

The same is true for personal care homes and assisted living facilities.  These facilities are not providing “skilled services” by definition – and are private pay.

Understanding Medicare and Medicaid funding and how you financially cover your health costs as you age requires a thorough understanding of the funding sources and a thoughtful plan.

If you need help starting that conversation, let’s talk!

Let’s talk about…Holidays & Reminiscing.

It’s no surprise that as the holidays near, older family members like to reminisce about the past.  Funny stories, favorite memories, most loved traditions are all a part of the holiday season and the special place the holidays hold in their hearts. 

While Mom and/or Dad may be content to reminisce, you may be feeling the stress and anxiety that frequently accompany the preparation for the holidays. Your idea of reminiscing may be muttering “Please don’t let me forget to thaw the turkey like I did two years ago” or “Remember when Uncle Mark showed up an hour late and forgot to bring the wine?” You may fill in the blank___________ with what may add stress to your holiday gatherings.

There is no doubt that the frenetic pace of our lives can make for stress throughout the holiday season.  Generations blended for a holiday gathering can add to the stress:

• Mom & Dad may be less helpful but still want to feel needed
• College age children want to visit with friends they haven’t seen for weeks – not hang with “the old people”
• High schoolers and “tweens” are busy with their social schedule(s) and social media is always calling
• Youngsters may be enamored with the newest video games available for hours of entertainment

So NOW, let’s get back to the idea of reminiscing – and how it can be a powerful and wonderful way to reach across the generations.

• Talk about the family recipes or food traditions – and have mom/dad talk about how the traditions were started when they were children.
• Go through family picture albums or scrapbooks – and talk about how special those times were.  Perhaps even share the memories of how each of you felt as your family continued to grow.
• Share thoughts of thankfulness and gratitude at the dinner table.

However you choose to reminisce with your older loved ones, know that reminiscing is a meaningful and powerful way for them to feel that their age and wisdom are appreciated and valued…that their voice is still being heard.  That may be the greatest gift they receive this season – someone to listen as they reminisce.

If you would like more ideas of how to make that happen, let’s talk!

Let’s talk about…”Senior Moments.”

Now this is a phrase that is growing in popularity and one that is recognized across generations – “Senior Moment.”   You may have used the phrase yourself – perhaps when you couldn’t find your car keys or couldn’t remember why you walked into a room.  I could offer many examples but you understand the point.  The question becomes - when is it simply a “senior moment” and when is it something more significant? 

Understanding and differentiating natural changes within the aging process, memory loss, and possible presence of dementia requires the help of professionals.  There are several screening and/or assessment tools that are used to determine if you or your loved one is having something more than a “senior moment”.  One of the most recognizable is the Mini-Mental Status Examination (MMSE).  Many physicians and their staff will incorporate this exam into their routine physicals with elderly clients or those they suspect may be experiencing cognitive changes – a condition sometimes referred to as Mild Cognitive Impairment.  Another tool that some consider a more sensitive instrument is the St. Louis University Mental Status (SLUMS) Examination.  The SLUMS provides a scoring range for normal, mild neurocognitive disorder or dementia and has some sensitivity based on the individual’s level of education. Both exams are brief and are meant to be only screening tools.  

If the results from either test suggest the presence of cognitive impairment and/or dementia, a thorough assessment should be completed.  By identifying skills that are diminished AND skills that remain intact, a plan can be developed that will enhance an individual’s ability to participate in life with purpose and dignity.

If you need help starting the conversation, let’s talk!

Let’s talk about…being a Caregiver.

To most people, a “caregiver” is someone that is hired to provide services for an individual in need.  Or some people think of a caregiver as someone who works in the facility where mom/dad/aunt/uncle is living.  One of the surprising aspects of being a caregiver is that some people don’t realize that they have become a caregiver.

It may start out very simply –

• You notice your neighbor isn’t bringing his paper in or picking up his mail as early or as regularly as he does.  So you offer to bring in the mail/paper…and running to the store is no big deal.
• You may go visit to mom and notice the laundry is piling up or the house isn’t quite as clean as it has been in the past. So you do a few loads and run the sweeper while you visit…and doing a little cooking while you're there is not a problem.
• Dad may say he’s low on groceries – so you pick up a few things for him the next time you go to the store…and clean out the refrigerator of food that’s spoiled.

Frequently, what we view as the simple chores of maintaining a home – including cooking, cleaning, paying bills, doing laundry – aren’t so simple anymore.  Whether it is physically or cognitively – the planning and energy necessary to execute these tasks becomes diminished…and you are providing the care necessary to keep your loved one going.  You are on the road to becoming a caregiver.

As the care you provide increases, challenges will arise.  Providing care and oversight for another individual requires time, effort, patience, understanding – the list goes on.

This is scratching the surface of a very complex subject.  Recognizing your role as a caregiver, assessing the need for a caregiver, identifying a capable caregiver – these are conversations family members should be having with each other.   Those discussions are critical to insure the safety of your elder loved one.

If you need help starting the conversation, let’s talk!

Let’s talk about…Medication Management.

“Medication management” may have many meanings.  Let’s talk specifically about two issues.

First and foremost, you and your loved ones should know which medications you are taking and what problems they are meant to address.  You should also make every effort to know which medications you take are affected by what you eat and/or drink.  You should always have a complete and updated list of medications – and herbal supplements – readily available for any doctor or hospital visit.  Preparing a word document and saving it as a PDF on your phone is a great way to have it readily available; and your family member can access it if you are unable to do so.

Secondly, you should have system set-up to make sure you are taking the proper dosage in a timely manner.  There are many varieties of pill poxes/trays available.  I am always worried when I meet a client who has all the pills lined up in bottles on the counter and he/she says “I have a system”.  That is a system ready to collapse.  As we get older and have less of a daily routine, remembering “if” or “when” we took our medication is a challenge.  If medication for diabetes or high blood pressure or cardiac- related illnesses are in the mix, the risk of creating a health crisis by under-medicating or over-medicating is real.  If you or someone you love does not have a system to manage their medications, now is the time to suggest a change.

If you need help starting the conversation, let’s talk!

Let’s talk about…Power of Attorney & Advanced Directives!

For many of people, if I mention appointing a Power of Attorney, they feel as if I am suggesting they give up their independence and control.  Quite the contrary!  By identifying who you want to assume responsibility for your decision-making is a very powerful statement.  A well-crafted document is actually the best way for you continue to exercise your control and direct your decision-making if you should become incapacitated.

Many individuals have said “I am quite capable of making my own decisions!”  And that is true.  However, if the situation arises when you are:

• Suddenly incapacitated due to illness or accident
• You undergo a surgical procedure and complications arise

Who will speak for you?  More importantly, who have you spoken to that knows how you want to be treated or cared for?

Hospitals and physicians’ offices are required to ask if you have Advanced Directives – that is the document that let’s medical professionals know how you want to be medically cared for in a life-threatening situation.  It is also considered a document that advises those close to you how you want end of life care to be directed.  Again, this is a document that allows you to retain control of your life choices.

Both the documents mentioned are critical for so many reasons.  First, it allows you piece of mind that you have chosen “who” is in charge if you can’t be.  It assures you that “what” you want to happen is what happens.  And most importantly, if and “when” something happens, your loved ones are not operating in panic or crisis mode - because you put together a plan.

If you need help starting the conversation, let’s talk!

Let’s talk about... HOPE!  In most instances, we love the term “hope” – it exudes positive thoughts and feelings.  Hope can be a promise, a wish, a dream – but it cannot be a strategy.  So many times when we talk with our parents – or even our contemporaries – we include the word hope & aging in the same sentence.  Stop and think for a moment…

Did you plan for the purchase of your home by saying “I hope we can afford this.” Or “I hope we like the house.”

Did you plan your family and possibly a college education for your children by saying “I hope we can support them.” OR “I hope they turn out OK.”

The truth is, you probably did HOPE for all of the above – but you also had a plan in place for these life-changing events.  Many of us have a plan for retirement – but how many of us have a plan for AGING?  And more importantly, have we included others in our plan?

That brings me back to hope & aging - and what I hear from so many of my friends and clients:

• “Well, I hope the money lasts as long as I do”
• “Well, I hope to be able to leave something to my kids”
• “Well, I hope to be able to stay in my home forever”
• “Well, I just hope one day I just don’t wake up.”

If you have thought or even uttered any or all of the above, you are not alone.  But you also need to understand that HOPE is not a strategy.

You need to talk to the people you love, the people that matter, the people that care – and make a plan.  Planning in crisis is rarely a good plan.  Find the time to talk about how you want to age…and then talk about what will happen if it doesn’t turn out the way you HOPE it does. 

If you need help starting the conversation, let’s talk!

Let’s talk about… Why Tuesday?

Caring for a spouse or a parent can be stressful.  That is simply a fact.  That’s not to say that anyone who is a caregiver isn’t also feeling great satisfaction and joy - but neither of those feelings eliminate the presence of stress.  That said, weekends can be particularly stressful.  Schedules are less structured, activities are more numerous, support from family and friends may diminish and for a multitude of reasons, the stress levels can increase.  At the end of a busy or hectic weekend, take a day to calm down or re-group.

On the flip side – you may have enjoyed a wonderful weekend!  Family and friends may have visited, everyone’s moods were upbeat and happy - take the time to let those feelings settle around you.  Problems that need to be addressed can wait one more day.

Let’s talk on Tuesday!