Long Distance Caregiving

Carol O’dell

If you’re a long-distance caregiver, then you know the drill. You call all the time. You coordinate care from 400 miles away. You spend long weekends or vacation time visiting your loved one and hoping before you open that door that they’re OK. Worry comes with long-distance caregiving, and so does guilt, but you try really hard to make it work — and you dread the day that won’t be enough.

You are not alone. According to a recent Caring.com poll, nearly one-third of all caregivers do not live with or, in many cases, even near their loved ones. Here’s a look at a few challenges long-distance caregivers face, and tips to help manage care from afar.

Feeling emotionally connected to your family members.

Sometimes phone calls or visits filled with doctor appointments and home chores don’t allow for heart-to-heart talks. As much as there is to cover, make the time to just sit for a few minutes and allow a natural conversation to emerge.

Set up a weekly phone-chat date for the times that you’re apart. Have it at a time when you both can look forward to it and nothing competes. After you discuss some of your “to-do” list items, begin to share something personal about your own life. Ask their advice on something — anything — from the color shoes you should wear to your cousin’s wedding to whether you should get a bigger car. Let them feel as if they’re a part of your life as well.

Getting shut out.

Many long-distance caregivers, particularly those helping someone with moderate to severe dementia, find that their visits actually aggravate their loved ones — who are confused and want to “go home” or don’t understand why you keep calling them “Dad.”

Remind yourself that you’re not just there to visit. You’re there to make sure Mom or Dad are being cared for properly. (Having a loved one with moderate to severe dementia increases the likelihood that he or she is living in a care facility.) Stay out of sight if you have to, but visit the staff, have lunch in the cafeteria, and walk the grounds. Talk to the people your loved one interacts with to find out how he or she is doing. It’s painful not to be able to connect, but remember that you’re still needed.

Knowing your loved one is safe and appropriately cared for.

Audrey Adelson, author of “Long-Distance Caregiving,” writes, “Often, long-distance caregivers obtain important information from their elder or secondhand from family members who have spoken with a member of their loved one’s treatment team. This makes it difficult to get a clear understanding of what is really going on.” How do you stay in the loop when you’re not in the area?

How to manage? By having lots of eyes. Whether you coordinate care for your loved one in his or her home or an assisted living facility, start to connect with those who interact with your loved one. Call after an appointment and ask how it went. Let them know you plan to be involved, and be sure to send a thank-you card or friendly e-mail.

Managing insurance and financial needs or making sure you can trust those who do.

Trust is a big issue for long-distance caregivers. When you don’t have people who genuinely care for your loved one and communicate with you about what’s going on, then you begin to worry, and worry, and worry.

Take the time to find professionals who can assist you and your loved one. It’s worth the time and effort. Hire an elder law attorney to make sure their financial assets are protected, or check into local resources designed for seniors and their family’s needs.

Make a plan for whatever comes next.

Long-distance caregivers dread getting “the call.” Whether it’s from a concerned neighbor or from the ER at 4 a.m., it’s difficult to know what to plan for when anything could happen. Try to laugh (or scream, or sob) when all of your planning and hard work takes a dive and you have to come up with a new plan. Change is inevitable, and when we fight that it that causes us pain.

Play “what if.” Come up with the three possible scenarios — a fall, a worsening of a condition or ailment, or a refusal to move even when that’s needed. How will you handle it? Can you go ahead and do some online searches? Can you connect with other caregivers and ask how they handled a big change and ask how it’s going now? It’s easier to face the “what ifs” when you know that somehow, some way, you will get through.

Being a long-distance caregiver comes with challenges you never thought you’d have to face. Sometimes you have to let go, just a little, of all that you can’t control. Caregiving isn’t easy, and there aren’t always solutions, so grab your rearview mirror the next time you’re in your car and look at yourself and say, “You’re doing the best you can.”

For a loved one living in Raleigh, NC, contact Raleigh Geriatric Care Management to assist with your family member. www.rgcmgmt.comRaleigh ,NC

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Remember the Studebaker? Reminiscing as Therapy for Your Parents

By  Paula Tchirkow, MSW, LSW, ACSW

Not again? You’ve heard that story about Sunday trips in the big black Studebaker at least 100 times. But you sit politely as your elderly mother recalls her grandfather’s rumble seat, running boards, chrome grill and overflowing picnic basket.

It’s likely that your mother has not forgotten that she told you the story before. And she’s not just shooting the breeze or living in the past. Your elderly parent is bolstering her self esteem by reminiscing. Like many older adults, she is engaging in an important psychological process called “life cycle review,” and it’s healthy.

Encouraging an older adult to reminisce is one of the easiest and most effective techniques you can use to boost their confidence and brighten their mood. In fact, it’s virtually foolproof as a method of combating mild depression or loneliness.

Go ahead, give it a try. Next time the Studebaker story comes up, engage your mother. Ask her how many people fit in the car? Did it have a rag top? How fast did it go? What were the roads like back then? And what exactly was in that picnic basket?

The vivid connection to a time when your mother or father felt more alive, happier, successful, and useful reassures them that they weren’t always in their current physical and mental state. Reminiscing helps older adults review past accomplishments and activities, thereby giving them a renewed sense of fulfillment about their life.

Although most people tend to focus on good memories, life cycle review can also help older family members become comfortable with the past. That is, the technique gives older adults an opportunity to admit and accept the parts of their lives that didn’t go as well as expected.

Both the reckoning process, and the acknowledgement of happier times, clears up minor depression, reverses feelings of isolation, and helps parents get back into a rhythm of positive reinforcement that boosts physical and mental well being. To be sure, the benefits of storytelling and review are greatly underestimated.

To discover how valuable life cycle review can be for older adults, here are 10 tips to help you get the process started:

  • On your next visit, quickly survey the home for an object to spark a conversation. For example, a cookbook may start the person talking about a favorite recipe or holiday. A piece of antique furniture, nick-knacks, old records, needlepoint projects, a piece of clothing, even a dish towel has worked as a catalyst for conversation.
  • Visit the attic. If you’re not having luck with the items that are in plain view, don’t be shy about taking a trip to the attic or basement to dig out old photos, cards and letters, maybe a wedding dress. Personal props such as these can trigger a flood of memories and conversations.
  • Use scents. Without fail, certain smells bring back memories almost instantaneously. That may be because the sense of smell is the most primitive of our senses, and the last to fail. Even older adults suffering from advance stages of dementia usually respond to smells, albeit not verbally. For instance, their eyes may brighten or a smile may appear when they get a whiff of cinnamon, wildflowers, fresh baked goods, peppermint, or coffee.
  • Create reminiscing cards. Browse magazines, newspapers, or the Internet to find images of items that you know will prompt a conversation, such as scenes from the Depression Era, amusement parks from a parent’s childhood, places they visited on vacation. Paste the pictures onto pieces of cardboard and build a catalog of visual aids. The cards can be use by family members or healthcare workers who look after your parent.
  • Don’t shrink from the unhappy memories. Recounting less-than-perfect events can be cathartic. Reflection doesn’t always have to be rosy, and often unlocking long-forgotten disappointments is uplifting. It’s a way for older adults to get worn-out burdens off their chest. For instance, you may hear from an older widow, that if she had to do it all over again, she would not have married her husband. They key is to let people freely express doubts and fears about the past, and validate—don’t judge—those feelings. Interestingly, and sort of magically, we all become less inhibited about expressing feelings as we get older. So don’t shut out the more sobering events for fear that it might depress your parent – the exercise will likely raise their spirits.
  • Do it on the phone, in person, or on the Internet if your parent is computer savvy. These reminiscing sessions can take the form of a 15 minute phone conversation; an hour-long respite over tea, maybe a look through a photo album after Christmas dinner. There is no set length of time or frequency that is ideal. The amount of time you spend recollecting is case specific, and usually depends on the attention span of the older person.
  • Encourage in-home health aids or the staff at healthcare facilities to use the technique too. It’s a great alternative to stale topics, like the weather. For parents that live in care facilities, create a personal history poster to hang over their bed. In that way, healthcare workers can refer to the poster when they visit the room. Include things like your parent’s nickname, former profession, how they met their spouse, the names of their children, grandchildren and pets, hobbies, favorite movies, songs, or books, towns and cities where they lived, or any other piece of personal trivia that will guide the staff into a rewarding conversation. Aside from prompting conversation, the fun facts help the staff envision your parent as someone other than a frail or stubborn resident.
  • Assemble a scrapbook. For parents that can physically handle this task, it’s a great way to organize memories and start a new hobby – one that can be shared by the whole family. Include photos, ticket stubs, fabrics from, say, a wedding dress, newspaper clippings, recipes, and other homespun memorabilia. For parents that are unable to create a scrapbook, adult children can put it together, and keep it handy as a conversation starter. If you’re making a scrapbook for parents with advanced Alzheimer’s disease or dementia, keep the book short and simple.
  • Allow your parents to reap the physical benefits. Recollecting good memories, and dropping old burdens, has a positive physiological effect on older adults. Research shows that sparking these memories causes blood pressure and heart rates to drop, essentially producing a calming effect. (Pet therapy produces the same effect.)
  • Document the past for the future. There’s something in life cycle review for everyone involved, especially future generations. Photos and scrapbooks are often considered family treasures, but new generations of archivist are using audio and video tapes as well. Use new technology it to capture a little bit of your family’s past, just make sure you hang on to the right playback equipment or your memories could be lost – remember the fate of eight-track players?

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A sibling’s guide to caring for aging parents

BY BONNIE LAWRENCE

Caring for an aging parent alone is complicated. When your brothers and sisters are also involved, and when care, medical and financial decisions must be arrived at together as a team, caregiving can become even more complex. Your siblings can be enormously helpful and your best support. But in many families, they can also be a source of stress. No two families are ever alike.

In this column, we’ll talk about how to identify the family dynamics that can impact shared caregiving, ways your siblings can help, how to increase your chances of getting that help, and how to deal with emotions that arise.

A visit home. Often, around this time of year, adult children returning home for a visit realize for the first time that their parents are far more frail than they expected. Although Mom or Dad always report they are “just fine” when you make those weekly phone calls, during a visit, you realize that this is not the case. Your parents suddenly seem much older, and you see the memory lapses, or shortness of breath, wavering balance, multiple prescription containers, or other signals of waning health.

Reactions differ among your siblings. Perhaps your sister, who lives two hours away, is angry that her mother is not the source of emotional support she used to be and doesn’t want to accept what she sees; your brother, who lives across the country and only gets home once a year, is stunned by changes he didn’t expect.

You and your siblings talk in whispers about what should to be done to ensure Mom’s safety and care. There is no money for assisted living, even if your mother would agree to it. Someone needs to step up, to see what can be done, to make decisions, to find some help, or even to live with your Mom to keep her as safe and healthy as possible. And it’s determined, often by default, that one person — perhaps the one who lives the closest, or doesn’t have kids, or is the oldest — will take on the role of primary caregiver.

Why sibling tensions can surface as parents need care

People are living longer — but not necessarily in good health. Their adult children may be caring for them for years or even a decade or more. Siblings or step-siblings are coping with a major emotional passage that stirs up childhood feelings and conflicts. But it’s made more challenging when there’s no model for working together as a team to handle the practical, emotional and financial issues that go with caring for someone who is no longer able to be independent. Some families are able to work out differences; many others struggle.

Consciously or unconsciously, needs arise for love, approval, or being seen as important or competent as a sibling. The disagreements now are over care for your parent: who does or doesn’t do it; how much; who’s in charge. At the same time, your parent is very aware — and most likely not happy — that he or she has become so dependent on you.

To help your family navigate through this situation, we offer this advice:

1. Think about, and talk about, family history and dynamics, and how they might affect caregiving. When we get together with our families, many of us tend to slip into our old roles. Maybe one person was the “responsible” one, one was the “social” one, one was the “helpless” one. But do those roles define you today? And more importantly, can you take a fresh look at who your siblings are now in the context of how these roles and assumptions can affect care for your parents?

2. Consider that care for a parent is a shared responsibility. A key concern is who will be the primary care provider(s) and what support other family members can provide. Since this is a role that can progress to more than a full-time job, this is an important decision. Rather than letting assumptions become default decisions (e.g., Barbara is oldest so she will be in charge, or Max needs a place to stay, so he’ll take care of mom), really consider who is most able, willing, skilled, and emotionally prepared to fill this role. Then consider what other family members can contribute in time or money.

3. To help reach the goal of effective shared decision-making, hold a family meeting. Family meetings are a way for siblings, parents and other concerned relatives or friends to try to clarify the situation, work out conflicts and set up a care plan that, ideally, all can agree upon. If the meeting is likely to be contentious, or if you want an experienced, objective voice to guide it, involve a facilitator such as a social worker, counselor, geriatric care manager or trusted outside party who will ensure that all participants have a chance to be heard. You may need more than one meeting. And although emotions might run high, it’s possible to conduct a productive meeting by following a few guidelines:

  • Set an agenda for the meeting and keep to it.
  • Focus on the here and now. Try not to bring up past or unrelated issues.
  • Share your feelings with siblings instead of making accusations.
  • Listen and respect the opinions of all participants. Give everyone time to speak.
  • Share all information. If possible, get a professional assessment of your parent’s condition from a doctor, social worker or geriatric care manager and send the report to all participants before the meeting.
  • As time goes by, use email, online care-sharing tools, conference calling and/or in-person family meetings to help keep everyone abreast of care issues and information.4. Understand and respect that your brothers and sisters might have different ideas about the care your parent needs. It’s hard to accept that your parent now need your help. Unless there’s a sudden crisis like a stroke, adjusting to this new reality takes time. Some adult children have to work through their denial that anything serious is wrong. Others might feel reluctant to get involved, fearing they are “meddling” in their parent’s life.

    Yet, to the primary caregiver, the person who is present day-to-day, it’s clear that his or her parent is less and less able to handle everyday needs. They see that Mom requires assistance with grocery shopping and cooking, that transportation and bill paying are problems, or advancing memory loss or fading eyesight or painful joints keep her from normal activities. Her needs are evident and most likely will become more intense.

    Working through differences: communication plays a critical role.

  • If you’ve held family meetings, everyone concerned should have a clear idea of the medical status of your parent. Focus on the facts.
  • REALLY listen to what your siblings have to say. Be willing to compromise and to try new solutions, as long as no one’s safety is jeopardized.
  • For the doubters, it may be helpful for them to spend a weekend or even a day as a sole caregiver, to get a first-hand view of the issues.
  • Be straightforward about financial issues. Finances are a key component in long-term caregiving, affecting where your parent lives, whether paid outside help is available, whether placement in a facility is a suitable or desirable option, or whether home care is manageable with family support. Overseeing bill-paying and dealing with Medicare and other health care bills is a job in itself, and can be delegated as such.
  • Let your siblings know that their help is needed and wanted (if, in fact, it is — see below). Be direct and specific about what tasks you need help with. Even if they live far away, siblings can help with finances, can provide virtual companionship to your parent with frequent phone calls and Skype, or can provide occasional respite or substitute care.
  • Keep communication lines open.

Tips for gaining the support of your siblings

  • Accept your siblings for who they are. Not everyone thinks, feels or acts the same way, especially when a situation is this emotionally charged. Try to keep your own expectations and expressions of “should” in check, and instead, strive to accept and work with your siblings’ personalities and abilities.
  • Be aware of how you ask for help. If you’re angry and frustrated when you’re talking with your siblings, it will come through in your voice. Their reaction will be defensiveness or anger. Likewise, making siblings feel guilty may lead to resentment and tension that will not be productive in solving the problems at hand.
  • Figure out what you really expect from your siblings. Do you think they should provide more hands-on care? Help with errands? Visits? A day or week of respite? Financial support? Help with decision-making? Analyze whether you’re able to give up control to allow a sibling to help you, or if you’re unconsciously communicating that you don’t trust the care that someone else provides.Some caregivers really don’t want help, or can’t rely on help from siblings who are undependable or unavailable. If you’re in this situation, admit it to yourself, accept that you’re on your own, and work to make the care as efficient as possible while still attending to your own health and well-being. If other relatives or friends are willing, ask for help from them or from religious communities your parent might have been involved in. Check for resources in your community. When people offer to help, say yes.
  • If what you really want is recognition and appreciation from your siblings for all that you do, you can ask for that. (You also need to express your own gratitude when you do get some help.)
  • Seek advice from someone outside the family. A mediator, social worker or geriatric care manager may help get past long-standing emotional roadblocks, family competition, controlling behavior, denial, or other issues interfering with successful resolutions.

Conflicts over legal, financial and inheritance issues.

With Durable Powers of Attorney or an Advance Health Care Directive, your parents can designate who will be in charge if they become incapacitated. Sometimes this creates tension among the adult children. If at all possible, this should be discussed at a family meeting and clarified for everyone concerned. An advance directive will outline the types of care that your parent desires at end of life. With this information in writing, a difficult situation is made a little more tolerable.

Some families compensate the primary caregiver for their work, particularly if he or she has cut back on employment to care for their parent. How much the compensation is and who pays it can be covered in a Personal Care Agreement, which is a written contract. This can be reviewed periodically to ensure it reflects any changes in care.

If an inheritance is in question, or if someone feels they should get a larger portion of an inheritance because of their caregiving duties or other reasons, this is another source of potential conflict. Be aware that your parent’s will is his or hers to direct as they like, and is not necessarily representative of who was the “good” son or daughter or who did more or less for their parents.

Sharing care among siblings is a reality that millions of Americans manage on a daily basis. By taking steps to foster positive communication and support one another as much as possible, the challenging role of providing care for elderly parents can be a fulfilling, rewarding experience, which ultimately can bring siblings closer together.

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Holiday Stress and Caregiving

~Michael Plontz

While everyone else is enjoying the hustle and bustle and the joy of the holiday season, there are many caregivers out there who just want the whole thing over with.  Caregiving creates a level of stress unmatched by most endeavors.  Add to that the extra stress of family gatherings, gift buying, cooking, and other obligations and it is almost unbearable.  How can caregivers better cope with this stress on top of stress?

The following tips may help you weather the holidays much better:

  1. Start your own tradition. Often we feel bound by past holiday traditions, but it doesn’t have to be that way. Instead of having 20 family members and guests in your home, and cooking for all of them, try a different approach.  Suggest that someone else host Passover or Easter dinner. Or, if your home is the only appropriate one, enlist the help of friends and relatives for everything from cleaning to preparing food.  A potluck is a great idea—you can even assign specific dishes to ensure that a complete dinner is provided.

  2. There are great ways to shop non-traditionally as well. The Internet is a fantastic way to shop for food and gifts without leaving home. Another way to shop from home is using catalogs (many people feel uncomfortable about putting credit card numbers out in cyberspace). If you would rather go out, use the catalogs to make lists of specific gifts for each person. That way you know exactly where to go and exactly what to get.

  3. Make sure you leave enough time to enjoy the holidays. It shouldn’t be all about the hustle and bustle.

  4. The motto “Everything in moderation” should be your guide through the holidays. There are many temptations abundant throughout the season—alcohol, sweets and rich food. Go ahead. Have some. Just don’t over-indulge. It may make you sick or uncomfortable even through the following day.

  5. Be prepared for unexpected circumstances. Something may come up, and probably will, so what can you do? If you can, change the situation. If you can’t, accept it and move on. You cannot control life no matter how planned out you believe you have things. Laugh a lot…

  6. Try to keep up on your regular exercise routine, or start one, during the holidays. Walking five times a week is a great way to stay in shape. There is also something about pounding the pavement that helps release frustrations and clears your head. If your looking out your window and the snow is flurrying and drifting, find an alternative. Many health clubs have indoor tracks. If that doesn’t appeal to you, check with the nearest shopping mall. Some open early just for walkers.

  7. Ideally caregivers should have a daily, weekly, monthly and yearly break.

Daily-Half an hour of yoga, meditation, needlepoint, reading, etc.
Weekly-A couple of hours spent away from the house at the mall, library, coffeehouse, etc.
Monthly-An evening out with your friends, a play, a concert, etc.
Yearly-A well-planned (and well-deserved) vacation.

Planning ahead for these breaks is imperative. You may need to arrange for respite care for your loved one.

It can be done. You can care for your loved one, attend to your daily activities, and enjoy the holidays. We all do what we can, and nobody should expect more than that from us. Especially us. Happy Holidays.

In Raleigh, NC contact Raleigh Geriatric Care Management, www.rgcmgmt.com

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Stress and the Holidays: Coping Strategies to Keep you Sane

By Helen Hunter,

Every year, the media bombards us with advertisements showing the “happy family” gathering for the holidays. People from different generations are together, having a wonderful time, sharing traditions of old and creating new ones as well.

It is not that way, though, for a great number of individuals. For those who don’t have families of their own, or for those who live alone and have relatives living far away, holidays often bring heartbreak and depression. Those who have been used to family celebrations in the past and no longer have that to look forward to cannot accept the “change” in the tradition, especially if they keep hearing about others who are getting together with their own families.

There are two things to remember that can help get you through the holidays. The first thing to realize is that it is okay to cry. This can be a tough time for many. It is natural to feel depressed when your friends are having the ideal family gathering. Allow yourself to express your inner feelings.

The second thing to remember is to control the holidays, do not let them control you. This requires planning. If you know that you will be alone on the holiday, start planning ahead for what you will do. Here are some suggestions for things you can do to sidestep the holiday blues:

  1.  If you cannot be with family, try to spend time with friends or neighbors instead.
  2. Get away from the source of the depression. If your home reminds you of past holidays spent with a loved one, go on a cruise, or take a vacation to another part of the country, or go abroad.
  3. Get involved with an activity. Volunteer at a local senior center, church or community center that serves meals on the holiday, or give your services to a hospital. If you know that someone will be alone and cannot get out for the holiday, visit. If the person lives far away and you cannot physically visit, make a phone call. In helping those who are less fortunate than yourself, you can forget some of your own troubles.
  4. Invite others who are also alone to your home to share the holiday. You can prepare a meal for them, or you can go out to a restaurant. Company always helps ease depression.

Be gentle to yourself, especially if you have recently lost a loved one. If you do not feel like celebrating, don’t! If you do wish to celebrate, keep it simple. Remember the TRUE reason that we celebrate the holidays!

The important point to remember here is that if the old traditions cause heartbreak and depression, change the tradition – start a new one!

Also, be sure to review your expectations and be realistic. Not everyone is jolly, generous and loving all through the holiday season. As Wayne A. Van Kampen from the Bethesda PsycHealth Reporter wrote, “ Somehow (during the holidays) persons feel pushed into hiding, covering over, or denying the reality of sadness, fear and tension. Perhaps what is needed most is simply a more honest embracing of ourselves, others, and the realities of life.” Not everyone will have a happy family gathering just because it is the holiday season. Old resentments are likely to resurface, no matter how hard we try, when people are thrown together for an extended period.

In addition, there are a number of strategies that can be used in planning the holiday celebration.

These strategies include the following:

  • Delegate responsibilities and activities so that one person is not taking on more than can be accomplished without help.
  • Do not assume responsibility for the entire household’s holiday happiness.
  • Work minute by minute on your attitude. Postpone becoming angry and show understanding and calmness. This technique should be used not only during the holiday period, but every day!
  • Any task that you have chosen to do, whether it be the cooking, cleaning, gift wrapping, card addressing, organizing, decorating or shopping, is to be viewed as a choice that you made. Try to have fun in tackling these tasks, which will make the holiday easier and keep your spirits positive.
  • Start traditions that make the most sense to you in your life now. It doesn’t always have to be done the same way every year.
  • Do things together as a family that you all truly enjoy.

Make the holiday season a time for you and your loved ones to have fun and to share special memories. When the entire season is over, sit down, relax and count your blessings. Remind yourself as to how lucky you are. When you make an effort to have a joyous, stress-free holiday, you can avoid the stress. The key is to plan ahead, and to ask for and accept help from others.

Raleigh Geriatric Care Management www.rgcmgmt.com

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Holiday Family Gatherings: A Time for Enjoyment & Meaningful Discussions

Once again we’re preparing for families to come together over the holiday season. We long to see how our seniors are doing, especially those who are far away from us and living independently.

Are they ok? Have they been eating well? Is the house in good repair? Are they paying all the bills on time? Have they been keeping things from us?

Hopefully, during our visit with them to celebrate a time of family sharing we will be able to observe them for any signs that they need a little bit more help. There are many things we should be on the lookout for in their home, their own health and appearance, the car, the home and the yard.

Another important thing we should do while we are visiting our senior loved ones is talk.

“Talk about what specifically,” you ask?

Serious Discussions with Parents & Other Senior Loved Ones

We might find some discussions hard to begin and others may be taboo in your family or culture. Unfortunately, once your parents reach a certain age (and you as well) it is recommended that these uncomfortable discussions happen and the answers clearly brought out into the open.

Whether you want to or not, some things are just better to know.

  1. Do they have any advance directives? Is there a living will created about which you should know? What are their wishes for end of life care? Do they have a DNR or a healthcare proxy to speak for them if they can’t? It is important to hear directly from them what they anticipate their end of life to be. What if they get into an accident or have a medical emergency? If you don’t talk openly about this eventuality it will be more difficult, especially if you are at a long distance, to make decisions in an emergency without prior knowledge. Do they have burial plans already?
  2. If they have executed these documents, where are they kept? Can you get a copy? Does the doctor know about them and do they have a copy on file? Do they need to be updated?
  3. If they don’t have them created, can you do this during your visit so all their wishes are documented in case of an emergency? Now is a good time to get important documents executed while you are there to get the necessary information. These decisions must be made before your senior is no longer competent to make his wishes known legally.
  4. Do they have a will? Who is the executor? Where is the will kept – who is the attorney? Where are the contact numbers for lawyers, doctors, and other people if you need them?
  5. Are they still competent to drive safely? Has the car been damaged since your last visit? Take a ride as a passenger to test them, even if it is without them knowing your purpose for going for an ice cream cone together.
  6. Are they declining in functional status? Does it look like they are having difficulty keeping themselves neat and tidy? Are their clothes clean and in good repair? Are they shaving? Do they have unexplained bruises? Are they appearing thin or weak? Are they having trouble balancing themselves when they walk or get up from sitting? Do they need more help?
  7. Is their home still adequate to age in place? Is it where they want to be or would they rather come closer to you, go to a senior living area or move to a smaller home that is easier to care for alone? Some seniors enjoy living in an assisted living facility where they have less responsibility and more opportunity for social engagement. Is their current home accessible to transportation services if they can no longer drive? Is their home in good repair with adequate safety modifications to prevent accidents? Can you work on some modifications while you visit and schedule other more involved upgrades for when you are not there?
  8. Are they depressed or isolated? Some seniors choose to stay home and reduce their visits to places, people and events that they once frequented for a variety of reasons. Perhaps they are afraid to drive, don’t want to go alone, can’t leave the house for too long for fear of needing a restroom quickly, or have side effects of medications that keep them from being active. Seniors need to be social, mentally stimulated and engaged to prevent boredom and loneliness. It might be a good time to get them reconnected, take them to the senior center and arrange transportation if necessary. Find things for them to be active and involved from home. Set up some technology and teach them to use it so they can use social media, Skype or Facetime to engage with distant family and friends.
  9. What about their finances? Do they have enough money to meet their needs? Are they paying their bills? Do they have a supplemental insurance policy or long term care policy which you should be aware? Are they struggling to make ends meet? Are they getting the benefit of all — well — benefits to which they are entitled?

~by Kathy Birkett

Assistance is offered with Raleigh Geriatric Care Management in North Carolina www.rgcmgmt.com to help you and your aging loved ones navigate the myriad of senior resources and services.  lwatral@rgcmgmt.com for more information. 

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Caring For An Elder From Far Away: Geriatric Care Managers

by Terry Weaver

As an adult, balancing work and elder care can be a challenge whether your parent lives next door or out of state. Add children to this, and the situation becomes compounded. Legal, financial and long-term planning for elder care is crucial, and long distance caregivers need to prepare for travel and time off from work. Face the facts, most older adults want to stay right where they are. They do not want to relocate, even if it means being closer to family. If this is what the elder wishes, as the child, you must respect their wishes.

For people who work and care for an aged family member, (particularly when that family member lives far away), one solution is to hire a professional geriatric care manager. A geriatric care manager is a professional who specializes in assisting older people and their families with long-term care arrangements. Care managers have a minimum of a bachelor’s degree or substantial equivalent training in gerontology, social work, nursing, counseling, psychology or a related field.

Prolonged illness, disability or simply the challenges of aging can significantly alter the lifestyle of older adults. Daily responsibilities can become difficult. Efficient coordination of medical, personal and social service resources can enhance the quality of life for older adults and their caregivers.

Geriatric care mangers assist older adults in maintaining their independence at home and can ease the transition to a new setting, if needed. Geriatric care managers also help:

  • Conduct care planning assessments to identify problems, eligibility for assistance, and need for services.

  • Review financial, legal, or medical issues and offer referrals to geriatric specialists to avoid future problems and conserve assets.

  • Act as a liaison to families at a distance, making sure things are going well and alerting families to problems.

  • Assist with moving an older person to or from a retirement complex, assisted living facility, or nursing home.

  • Offer counseling and support.

  • How do you know when it is time to call a professional? Look for these signs.

  • Is your loved one losing weight for no known reason? Do they fall?

  • Is the home unkempt and becoming unsafe? How are meals made? Who pays the bills?

  • Are they able to(and do they) maintain a neat appearance? Has drinking become a problem?

  • Is it safe for your parents to drive? If not, who does the driving for them?

  • Has there been a sudden memory loss or increased confusion?

Of course in order to answer these questions, you’ll have to pay a visit to your long distance loved one, or rely on information from a relative or friend who is close to that loved one.  There is no reason to feel guilty about being far away as long as you are doing everything that you can to help.  In Raleigh, NC, visit Raleigh Geriatric Care Management, www.rgcmgmt.com 

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