Yet sometimes, the senior individual is so fearful of losing control that he or she does just that – loses control. Consider the man whose children know nothing about his wealth, insurance, wills, or any of the other documents the prudent person would possess. When they try to raise the subject they are brushed off. Moreover, as he ages and becomes less able to attend to a large swath of everyday living activities, he is unwilling to get or accept needed assistance. Is it because the person is unable to pay for services? Is it because the mental capacities are diminishing and he doesn’t recognize the peril?

The Grandfather: We’ll call him James. James was well known in the neighborhood as a lifelong resident, father, grandfather, and surrogate grandfather. Always happy for company, he kept sodas and ice cream bars at the ready for neighborhood kids. And he always had plenty of your favorite brand of beer in the refrigerator. Every Saturday he cooked up a feast, “in case someone should stop by.” Needless-to-say, lots of family, friends and neighbors did.

James had four living children, all adults, several with children of their own. Three of his children lived nearby. He also had health issues that prevented him from keeping up with household chores. His children and older grandchildren – as well as some neighbors – often helped with cleaning. And they always made sure the dishes were washed, put away, and the floor swept before leaving on a Saturday. His daughter lived 40 miles away, yet for years she would drop by after work to see how things were going and to provide caregiver assistance.

Over time, though, James’s health problems increased, even as his family became less and less able to meet his physical needs. One son and his family moved away through job relocation. James had to have his leg amputated due to complications of diabetes, and his needs increased.

After considerable discussion regarding their own commitments and time, and James’s increasing needs, the adult children decided to hire someone to assist their father on a regular basis. Although James could pay for services, the kids determined to take money out of the equation by jointly sharing the cost of cleaning and support services. However, James wanted none of it. Objections ranged from, “the kids can do it,” to “the house is fine,” “the person was hard to get along with,” “unreliable,” or “didn’t do a good job.”  After a series of failures, the children finally gave up.

James eventually had to have his other leg amputated and at that point his children moved him to a nursing home. It is futile to dwell on what might have been if James had been more willing to accept homecare support. Still, there are lessons to be learned – in particular, for the aging senior. Namely, recognize that your adult children have other lives, priorities, families and commitments. Let them help in the ways that they can, because in most cases they want to help. And give them the tools to work with. Have the discussion about finances, wills and other important papers including banks, brokerages, legal advisers, and medical providers. Talk about other special concerns such as how you feel about certain medical interventions in an emergency. It is almost a given that, as we age, ailments and health complications will arise. But by being open with your loved ones, many of these problems can be minimized or avoided.

Elders want to travel – to vacation, visit family and friends, fulfill a dream, go again to a place in memory. This may seem impossible or difficult at best. He’s blind. She has dementia. He has Alzheimer’s. She can’t go down the street without getting lost, how is she going to make it to the wedding 2,000 miles away?

Given, elder travel is different from the backpacking days of our youth, but it doesn’t have to be gone. Accompanied senior travel makes the world safer, larger, brighter, and a lot more fun for the individual.

A woman we’ll call Michelle contacted our office. Her husband Al had Alzheimer’s Disease and she needed someone with him so he would be safe while she was away at work. His car keys had been taken away, but Al was not one to sit around; he liked to go out and about. And he had one passionate desire: to see Pearl Harbor.

Born in 1925, Al’s father woke him the morning of December 7, 1941. Pearl Harbor had been bombed! “Boy,” he said, “you best go down to the post office and sign up to go fight.” Only 16, Al had to wait a couple of years before serving four years in the army. He later graduated from the University of Maryland, married and raised a family. He was involved in the Boy Scouts, sharing his pride in the “Great U.S. of A.” And someday, he said, he’d see Pearl Harbor.

When our Companion, Gary, met Al, they hit it off immediately. When Gary wasn’t available, his wife and fellow employee Bonnie filled in. (There has to be consistency of care givers or the Alzheimer’s victim gets confused.) Al knew one of them would be there if Michelle couldn’t be.

Al knew he’d never get to Pearl Harbor. Michelle knew differently. She knew she couldn’t handle Al alone, and that she needed a little ‘down-time’ herself. She and Al asked Gary and Bonnie if they would accompany them on a trip to Hawaii.  Four months later the four of them left for the two-week cruise. Unexpectedly, Al noticed a gravelly-voice singer on the beach, with a box in front that read, “If inquisitive to hear, put some $ in the box.” Al put money in and sat mesmerized as the singer sang.

Al passed away three years later. But for three years, he had pictures to look at and talk about – from a place in history, a place he always wanted to go to but feared he wouldn’t be able to – with family and friends.

What Gary and Bonnie did with Al and Michelle was a continuation of what they were already doing with their clients, accompanying them wherever they wanted to go. And why not? This trip was just a little longer.

You may ask: What is a caregiver? What does a caregiver do?

According to the Area Agency on Aging of Pasco-Pinellas, Inc., if you are you providing unpaid assistance to a spouse, relative, or friend who is ill, disabled, or needs help with basic activities of daily living you are a caregiver. If you help with rides to the doctor, shopping, meals, bill paying, bathing, grooming, dressing, walking or transferring to a wheelchair, housekeeping, managing medications, or arranging services to be provided by others, you are a caregiver.

Talk to your immediate family about you being the caregiver. Make sure they understand that you will not be able to spend a lot of time with them and let them be involved in your decision. Then reach out to the extended family.

Stage Two – Finding Help

If you have been a caregiver for months – or longer – on a regular basis, you are the primary caregiver. It has become clear that this is not going to be a short-term illness with a quick recovery. If you also hold a full-time job, caregiving may be exhausting you already. What is your loved one’s prognosis? How many more years of caregiving lie ahead?

Now is the time when you must find relief for you, the caregiver. Clearly, the loved one needs to have continuity of care, but if you do not find support for the person needing care there will soon be two people in need. As the flight attendants instruct, “put your mask on first.” If you don’t take care of your health you will not be able to provide the support your loved one needs.  Look to family, friends, faith communities, and caregiving agencies for additional assistance.

Stage Three: Heavy Care

You may have been providing care for years to someone whose mental or physical health is deteriorating – now at a more rapid rate. If the person for whom you are caring has Alzheimer’s disease or another degenerative disease, wandering at night may become a risk. But you cannot work ‘around the clock’. Your first responsibility must be to care for yourself. Caregiver burnout helps no one. Your second responsibility is to protect your care recipient, maintaining a safe and loving environment.

Stage Four: Letting Go

Letting go focuses on the meaningful and positive experiences you shared with your loved one.  It also acknowledges the grief that comes with loss of a loved one – whether through death, placement in a nursing home or mental deterioration. In this final stage, you have come to an end of the cycle of caregiving as you have known it. You will be experiencing grief in your loss, both of the care recipient and of your own role as caregiver. Still, your life must go forward as you reconnect with the world around you. No doubt, your caregiving experience will have given you new perspectives as you resume former activities and, quite possibly, pursue new directions as well.

For some, a remedy for this loneliness could be to have a companion animal; an animal that would provide stress relief and a whole laundry list of other positives. Research shows that it is a win-win situation for both human and non-human animal, especially if that animal comes from a shelter, rescue or foster home (http://www.ehow.com/how_2086105_benefit-from-companion-animals.html).

According the Saunders Comprehensive Veterinary Dictionary, a companion animal is one that is “kept by humans for company, amusement, psychological support, extrovert display and all of the other functions that humans need to share with animals of other species; companions who will not take emotional or psychological advantage of the person…”

For many seniors, the companion animal can serve as a substitute for their children who have grown and moved from home.  Or, it can stand in for the offspring the senior never had.  Having a companion animal can increase the senior’s socializing and allow him or her to be independent without being lonely. When we encourage this bond, we are looking out for the best interest of our loved one; no different than promoting exercise and proper nutrition.

In the Beck & Meyers annual review (http://www.annualreviews.org/doi/abs/10.1146/annurev.pu.17.050196.001335?prevSearch=companion%2Banimals&searchHistoryKey), it states that “one long-recognized but often ignored value of animal contact is that many people find joy and even humor in interacting with animals. Animals often permit people to laugh at themselves or at their surroundings…Laughter, or at least encouragement to find humor, is a recognized medical intervention…”

Having a companion animal can give seniors a reason to get out of bed; the animal needs to be fed and cared for. Having that animal can improve cardiovascular health, lower triglycerides and lower depression brought on by the effects of loss – health, memory or a loved one.

Although many landlords, homeowner associations and senior living facilities allow people to have companion animals, it is best to check in advance if the establishment you are dealing with does in fact allow animals. Also make sure to carefully choose a type and breed of animal appropriate to the loved one.

Animals have been part of our homes since we started living in villages some 12,000 years ago. As Beck & Meyers state, “Interaction with companion animals may well be one of our more successful strategies for survival”. The benefits of having that animal in the home could quite well be the key to our loved ones aging successfully.

A Personal Care Agreement (sometimes called a Personal Services Agreement) can be an effective way to avoid misunderstandings that could otherwise arise.

According to an article, “How to Prepare a Home Care Agreement With a Family Member,” Joseph L. Matthews, http://www.caring.com/articles/care-agreement, a Personal Care Agreement should include the following basic information:

• “When the care will begin.
• What tasks you’ll perform. Be specific and thorough, but also include the term “or similar tasks to be mutually agreed upon by the parties.” This gives you both some flexibility, so that you won’t feel like you need to rewrite the agreement every time you change the tasks you perform.
• How often, and for how many hours, you’ll provide this care.
• How much you’ll be paid, and when the payment will be made.
• How long the agreement will stay in effect. This can be a set time, like six months or a year, after which you can both decide whether you want to make any changes. It may be simpler, though, to make the contract open-ended, described with a phrase such as, “This agreement shall remain in force until terminated in writing by either party.” In that case, either of you can end the arrangement at any time simply by writing a signed, dated note saying that the agreement is over, and giving the note to the other person.
• A statement that the terms of the agreement can be changed only by mutual agreement, in writing, by both parties.”

A Personal Care Agreement, “can also help avoid misunderstandings with other family members about who’s providing care and how much money is changing hands. If the agreement doesn’t solve a particular disagreement with family members, you may be able to add something to the document, or change its terms, to address the problem.

“If the person you’re caring for is receiving state assistance for in-home care, the agreement can prove to the state exactly where some of the money is going, which the state program might require.

“If the person ever needs to enter a nursing home and wants Medicaid to pay for it, the agreement can show that these payments to you were legitimate, not just an attempt to “hide” funds in order to qualify for Medicaid’s services.”

Developing a Personal Care Agreement not only helps to avoid family conflicts by laying out who will provide necessary care and how it will be paid for. By focusing the family on the need to make arrangements for their parent/s, many potential conflicts can be identified and resolved before they become problems.

Finally, long term care insurance may provide for such care if there is a formal, reasonable agreement.

New Elder Communities Take Root Where We Already Live.

Written By:

Christopher Van De Moortel, President

Aging in Place and Senior Villages are beginning to sweep the country. Each “village” may vary slightly in their approach to helping seniors remain in their homes, but most have a combination of volunteer services and third party providers. From roofing contractors to picking up a prescription, their mission is to redefine how we live out our days: at home, in our homes, and not in nursing homes.

Na Hoaloha in Hawaii began in 1995 with the mission of helping those who fall through the cracks of the state and federal systems, using a neighbors helping neighbors framework. In 2001 in the Beacon Hill neighborhood of Boston, older citizens got together and created a network of services provided by volunteers, non-profits, and for profit third party companies. Since then the concept has continued to move down through New York City; Philadelphia; Washington, DC; Richmond, VA; North Carolina; and to the west coast. Senior Villages are the new paradigm in caring for the elderly. They have grown up from within their communities and in many cases you’ll see seniors helping seniors.

In the greater Washington D.C. area we have a number of Senior Villages. Capitol Hill, Palisades, Northwest Neighbors Village, Bannockburn, Chevy Chase, Burning Tree, Cabin John and Somerset to name a few. In some cases there are fees charged to residents of these villages to pay for the coordination of volunteer services and referrals to third party providers. Often, discounts are extended from those providers to residents within the village.

Home care for older adults in senior villages has tackled much of the physical environment (getting your groceries, going to the doctor, fixing the roof, etc.). We also must address the things that are less tangible like communication and socializing. In the senior village model, for the people that have all their needs taken care of – the laundry done,  a ride to the doctor, groceries delivered, and Junior helping Dad shower – many of these needs are being met through a combination of volunteers and vetted third party providers.

Caring for the elderly at home, in senior villages or not, requires a multi-pronged approach. While online communities  can help mitigate feelings of isolation and depression, and sharing photos of grandkids via email can bring a smile to the face and help seniors stay connected to family, there is another kind of interaction missing.

It is imperative to include dementia support and caregiver support in this new paradigm of senior living – what we call Caring for the Caregiver. Even with all the help for seniors, the primary caregiver is often overlooked. By addressing the primary caregiver’s emotional needs first, aging in place is easier.

In my opinion, assisted living for seniors in an institutional setting just doesn’t fit the bill anymore.

Senior Friendly Exercise Right at Your Backdoor

Gardening is an excellent form of low impact exercise for senior citizens, the disabled, and people recovering from injury. Although some heavy tasks are inappropriate for people with compromised physical ability, many others offer a great opportunity to stretch muscles, improve muscle-tone, and gently increase heart rate. Planting seeds, pulling weeds, and pruning flowers are great occupational therapy activities. Raking leaves or planting a small tree can help maintain muscle, improve your balance, and increase your heart rate.

Of course, most people don’t begin gardening for physical stimulation. Young and old alike find gardening to be therapeutic for both mind and body. Yes, gardening can actually improve your mood. When you’re at peace psychologically, you generally feel better physically. With so many things that a garden offers, from color therapy and aroma therapy to the meaning of flowers, it is hard to feel blue when you are surrounded by green.

Moreover, you can reap nutritional benefits by planting food you know will be local and organic. In the metro Washington, DC area peach and pear trees perform very well. Blueberry and Aronia bushes deliver powerful doses of antioxidants. Herbs like Basil, Lavender, Rosemary, Parsley, Oregano, Thyme, Peppermint, Chamomile, and Lemon Verbena soothe the senses and make wonderful teas. Many will come back perennially, adding spice to your dishes and your life, year after year.

Always consult your doctor before engaging in physical activity to determine the level of exercise appropriate for you. If you hire a landscaper to perform the laborious tasks and manage the lighter garden upkeep on your own time, you can maintain a beautiful garden forever.

Tips for the Alzheimer’s Caregiver

A recent article by Melanie Haiken, Caring.com Senior Editor, www.caring.com/blogs/, addresses the subject: What to do when the doctor isn’t listening to you or the person you’re caring for, not carrying out your wishes when it comes to treatment and medication choices, or recommending drugs or treatments that seem inappropriate for much older patients. Here are a few examples.

• Sarah says her mom’s doctor tries to make her feel guilty when she asks to remove a medication from her mom’s regimen or refuses a procedure. Her mom, who is 90, is in late-stage Alzheimer’s, so she decided not to give Aricept and to refuse a colonoscopy, but had to fight those battles with the doctor who disagreed.
• Eileen feels it’s important to honor her mom’s decision not to take Aricept for her advancing Alzheimer’s, and told a story of her mom being admitted to the ER for a sprained ankle, then falling off the bed while having X-rays and shattering her heel and arm.
• Joseph says it is important to find a doctor with geriatric experience, and you may need to change doctors if the relationship is not working. If you do not know any doctors in your area with geriatric experience, you might try asking someone at a local senior center or assisted living facility; they usually have experience working with local doctors with expertise in aging.
• Jan reminds everyone to get an irrevocable POA for medical decisions and make sure you or someone else attends all medical appointments to advocate for the elderly patient.

Sometimes the problem does not lie within your control; what is wrong is that the doctor is not listening to you or not taking your loved one’s age or situation into account when making treatment decisions. In many cases, it is like a bad relationship; communication has broken down and you and your family member are not getting what you need.

Here are five signs it may be time to “break up” with your doctor:

1. You feel the doctor blames, ignores, or criticizes you or the person in your care
2. The doctor doesn’t respond to your feedback, or becomes defensive or unpleasant
3. It seems the doctor isn’t taking your family member’s pain or other symptoms seriously enough
4. You find out about treatments that can help that the doctor hasn’t told you about
5. The doctor doesn’t explain treatment options clearly, resulting in mistakes

If you have had a truly unpleasant exchange with your doctor, it is your prerogative to find a new doctor and ask the staff to fax over the request for records.

You will breathe a sigh of relief once you are dealing with a doctor who listens respectfully, answers your questions, accommodates your requests, takes your family member’s symptoms seriously, and works with you to develop a treatment plan you can all feel good about.

“Visit companions are commonly present in older adults’ routine medical encounters, actively engaged in care processes, and influential to patients’ satisfaction with physician care.”

Source:Consumer Reports on Health, October 2008, from the Archives of Internal Medicine, Medical Visit Companions as a Resource for Vulnerable Older Adults, 7/14/08