Five Myths About Medicaid’s Long-Term Care Coverage

While Medicare gets most of the news coverage, Medicaid still remains a bit of mystery to many people. The fact is that Medicaid is the largest source for funding nursing home care, but there are many myths about exactly who qualifies for it and what coverage it provides.  Here are five myths followed by the real story.

1. Medicare will cover my nursing home expenses. Medicare’s coverage of nursing home care is quite limited. Medicare covers only up to 100 days of “skilled nursing care” per illness. To qualify, you must enter a Medicare-approved “skilled nursing facility” or nursing home within 30 days of a hospital stay that lasted at least three days. The care in the nursing home must be for the same condition as the hospital stay.
   
2. You need to be broke to qualify for Medicaid. Medicaid helps needy individuals pay for long-term care, but you do not need to be completely destitute to qualify. While in general a Medicaid applicant can have no more than $2,000 in assets to in order to qualify, this figure is higher in some states and there are many assets that don’t count toward this limit. For example, the applicant’s home will not be considered a countable asset for eligibility purposes to the extent the equity in the home is less than $536,000, with the states having the option of raising this limit to $802,000 (in 2013). In all states, the house may be kept with no equity limit if the Medicaid applicant’s spouse or another dependent relative lives there. In addition the spouse of a nursing home resident may keep one half of the couple’s joint assets up to $115,920 (in 2013).
3. To qualify for Medicaid, you should transfer your money to your children. Medicaid law imposes a penalty on people who transfer assets without receiving fair value in return. This penalty is a period of time during which the person transferring the assets will be ineligible for Medicaid, and the length of the penalty period is determined, in part, by the amount of money transferred. The state will look at all transfers made within five years before the application for Medicaid. That doesn’t mean that you can’t transfer assets at all — there are exceptions (for example, applicants can transfer money to their spouses without incurring a penalty). However, before transferring any assets, you should talk to an elder law attorney. 
   
4. A prenuptial agreement will protect my assets from being counted if my spouse needs Medicaid. A prenuptial agreement only works to keep property separate in the event of death or divorce. It does not keep your property separate for purposes of Medicaid eligibility.
5. I can give away up to $14,000 a year under Medicaid rules. You can give away up to $14,000 a year without incurring a gift tax. Under Medicaid law, a gift of $14,000 or any other significant amount could trigger a penalty period if it was made within the five-year look-back period.

Elderlaw News, Mary Markovich

5 Benefits of Coffee (Who Knew!?!)

by Paula Spencer Scott

1. Coffee Slashes Your Risk of Developing Type 2 Diabetes

The health benefit: The more coffee you drink, the less likely it is you’ll develop type 2 diabetes, numerous studies have shown. For example, postmenopausal women who drink at least four cups of coffee a day are less than half as likely to develop type 2 diabetes as those who don’t drink coffee, according to a 2011 study of more than 700 women by the UCLA Schools of Public Health and Medicine.

In fact, every additional cup is thought to reduce the excess risk of type 2 diabetes by 7 percent, according to Australian researchers in a 2009 Archives of Internal Medicine meta-analysis of 18 different studies, which linked coffee drinking and diabetes prevention.

How it works:
Coffee is thought to improve the body’s tolerance to glucose by speeding metabolism and improving insulin tolerance.

The UCLA researchers discovered one possible molecular mechanism for this. Coffee consumption increases blood levels of a protein called sex hormone-binding globulin (SHBG), which seems to offer protection against type 2 diabetes in those who have a certain type of genetic mutation. (Decaf coffee didn’t show this effect, however.)

If you’re already showing signs of prediabetes, of course, you’ll want to refrain from dunking doughnuts in that joe.

2. Coffee Can Counter Cancerous Cell Damage

The health benefit:
Coffee was once believed to cause cancer — but that was before researchers factored in such related behaviors of frequent sippers as smoking and drinking alcohol. Today, there’s mounting evidence that coffee may be protective against certain cancers, possibly by enhancing DNA repair.

Some of the best evidence concerns liver damage and liver cancer, which strikes more than 18,000 Americans a year. Multiple studies have found an inverse relationship between coffee consumption and liver cancer risk, including a 2007 meta-analysis of nine different studies.

Cancer-prevention researchers are finding similar benefits of coffee drinking versus other forms of the disease. In 2011, for example, a Harvard team found that women who drink several cups of coffee a day (caffeinated or decaf) have a lower risk of endometrial cancer. Another 2011 Harvard study reported that for men who consumed six cups of coffee a day, their risk of lethal prostate cancer was fully 60 percent lower than lesser coffee drinkers, and their risk of any kind of prostate cancer was 20 percent lower.

Other studies have linked coffee drinking to a reduced risk of colon cancer, rectal cancer, oral cancer, and esophageal cancer.

How it works:
Coffee contains hundreds of chemical compounds — among them antioxidants and anti-inflammatory compounds that can decrease markers for the damaging process of inflammation. The highly active antioxidant compound methylpyridinium, for example, is found almost exclusively in coffee (both caffeinated and decaf types), due to the beans’ roasting process. Espresso has two to three times the amount of this anticancer compound as a medium-roast coffee, according to the German researchers who identified it in coffee.

3. Coffee May Lower Your Risk of Dementia

The health benefit:
Scientists still don’t fully understand what causes the brain changes associated with Alzheimer’s disease, but they’re learning more about risk factors for dementia – and a hearty coffee-drinking habit seems to lower the risk.

When researchers in Sweden and Finland tracked coffee consumption in a group of more than 1,400 middle-aged subjects for an average of 21 years, they found a clear connection. Those who quaffed three to five cups a day were 65 percent less likely to have developed dementia than the two-cups-or-fewer crowd. (Drinking five or more cups a day also seems to reduce the risk, although this group was too small to allow researchers to draw statistically significant results.)

How it works:
Researchers believe the antioxidant properties of coffee may work to reduce vascular forms of dementia. Drinking coffee is already known to be protective against type 2 diabetes, a chronic disease that raises the risk of dementia. (Having diabetes together with depression, for example, doubles dementia risk.)

Another theory: Animal studies indicate that the caffeine in coffee may improve the efficiency of the blood-brain barrier, thwarting the negative effects of high cholesterol on cognitive functioning. Caffeine added to rats’ water improves their cognitive functioning and reduces by half the amount of abnormal amyloid protein in their brains, which has been linked to Alzheimer’s disease.

It’s also possible that coffee drinkers simply have more energy and move more; researchers point out that exercise is protective against dementia, too.

4. Coffee Protects Against Parkinson’s Disease

The health benefit:
It seems pretty clear that coffee helps lower the odds of developing Parkinson’s disease. When researchers looked at almost 305,000 participants in the National Institutes of Health – AARP Diet and Health Study, they found that those who consumed the most caffeine had the lowest risk of Parkinson’s, echoing earlier studies.

They also ran a meta-analysis of previous studies and found that this held true for both men and women. (Some earlier research had claimed a gender difference, with more benefit to men, probably due to smaller numbers of people studied.)

Why it works:
Researchers aren’t sure what the protective mechanism at play is, or even whether it’s the caffeine or other protective compounds that are behind the benefit. Genetics may play a role: One 2011 study found that subjects who carried certain types of a gene called GRIN2A received more neuroprotective benefits against Parkinson’s from coffee (although coffee drinkers with all forms of the gene still had a lower risk of developing the disease).

5. Coffee May Buffer Depression

The health benefit:
Another large study links long-term coffee use with a reduced risk of depression. Researchers at the Harvard School of Public Health tracked 50,000 nurses in the Nurses’ Health Study for more than a quarter century. In 2011, they reported that those who drank four cups of coffee or more per day had a 20-percent lower risk of developing depression, compared with those who rarely or never drank it. Those who downed two to three cups a day had about a 15-percent lower risk.

A much smaller study in Finland linked coffee consumption to a decreased risk of suicide in men when 7 or less cups a day were consumed. (Then the risk went up after 8 cups a day. There’s also some evidence that coffee protects against depression, too.

How it works:
Nobody’s sure, but one theory is that coffee drinking causes a short-term boost to energy and mood. The caffeine in coffee is probably the substance causing this effect — the Harvard researchers saw a similar decrease in depression among those who drank caffeinated soft drinks and ate chocolate, both of which contain caffeine.

Brain receptors that respond to caffeine are found in the basal ganglia, the part of the brain where neurotransmitters critical to depression are concentrated. Repeated low-dose stimulation of these receptors may help protect against the development of depression.

Family Money Fights

 

by Carolyn Rosenblatt

Let’s imagine that you have an aging loved one who has cognitive impairment. You are aware that your loved one is “slipping.” You tell yourself it’s OK. You do nothing more than try to pay closer attention. You may ignore the fact that if your loved one has dementia, it’s not going to get better. You ignore the reality that if a person develops dementia, he or she is not going to be able to manage money for very long and that alternatives must be in place. Then something happens that brings you to a crisis.

It may be loss of money to a scammer. It could be huge mistakes in careless spending. It could be that bills aren’t paid and the utilities are cut off. Whatever the event, it brings you and your family to the boiling point. Some are angry. Others may still be in denial. A family fight breaks out. Siblings accuse each other of wrongdoing. The elder accuses you of plotting against him. It’s a nightmare.

If there is one recurring theme we see in working with families who have aging parent issues, it’s conflict about finances.

Whether siblings are arguing with each other over how to pay for a parent’s care, or it’s about Dad mishandling the checkbook after being diagnosed with dementia, it’s a source of enormous distress. Part of the problem is that when an aging parent’s mental capacity begins to decline, it is subtle, uneven, and can be hidden for a time. Most families are in denial about cognitive impairment. It’s just too painful for so many to accept and take in.

Adding to the stress of a parent’s cognitive impairment is the consequence of denial: Money issues arise and no one is prepared to deal with them.

Here are some suggestions for avoiding those nightmare fights over money that can be prevented by planning ahead.

1. If you have a loved one with cognitive impairment, whether officially diagnosed as dementia or not, be sure you have the critical legal documents you need properly prepared and signed. You need a durable power of attorney for finances and an advance healthcare directive. Do not wait. Eventually, your loved one may be unable to sign any legal document. Lack of signed legal documents can force you into court for a guardianship (conservatorship in California) and cost time and money you don’t need to spend.
2. Educate yourself. You need to know what assets your aging parent has, what debts exist, and whether any arrangements, such as long-term care insurance, are available to help with the cost of care. You need to know what income your parent receives and how that income is being spent. If you or your family members are able to contribute to the cost of caring for an aging loved one, including providing some care yourselves, be sure you write down the agreements as to who will do what. Strive for equity. Most of us can do something to help, even from a distance.
3. Seek advice from a qualified financial advisor to use any assets you have in the best way possible to care for your loved one. He or she may seem fine now, and able to manage independently. With cognitive impairment, this independence will not last. It is typically, with any form of dementia, a progressive and deteriorating condition. Not everyone is ready to handle the behavior changes, the need for constant supervision, and the need for helping with activities of daily living that dementia causes. It costs a lot to hire help and give family relief from the often burdensome responsibilities of long-term dementia care.
4. Have a family meeting to discuss the need for care and the sharing of responsibilities. Someone needs to take leadership and develop an agenda for topics that should be discussed. Identify them and be sure everyone has the same information well before the meeting. Everyone should be allowed the chance to speak and give his or her views. If there is no one in your family who is good at leading a discussion, get outside help from an experienced mediator,  geriatric care manager, or social worker. The cost of help is well worth it in guiding your family to good decision making.
5. Include your aging loved one, even with cognitive impairment, in the planning process as much as possible. This does not mean that you allow an impaired person whose judgment is not intact to make all the decisions. Ask your loved one for his or her preferences. Respect your parent’s values as much as possible. And use your own good judgment to keep your elder safe. He may not be able to see or understand his own cognitive problems and may think he is fine to manage money, drive, live alone, etc. If he can’t see the problem, step in and assume the necessary role of parenting your parent.

No one needs to experience the heartache of family fights over aging parent finances. With smart planning, you and your family can weather the storm of a parent’s cognitive decline with dignity. And you can know that you’ve done everything possible to make this part of your aging parent’s life the best it can be.

Making Nursing Home Visits Meaningful

By Sarah Wood, Caregiver.com

Oftentimes, as nursing home residents decline, they lose the ability to communicate. Sadly, this is a time when families stop visiting as often because they don’t know what to say or how to make the visits meaningful for the family, as well as their loved one. Sometimes, just being present can be satisfying.

Here are some tips for the families.

1. Visit with your loved one in the facility sensory room.
2. Prepare for the visit ahead of time. Bring items of interest with you. For example; if your loved one had a love of pets, you could bring your family pet to visit. If he or she had a love of a certain kind of music, bring a CD to play while in the room.
3. Talk with your loved one about events going on in the community or family. Don’t assume they can’t understand. Just hearing your voice will bring comfort and keep them connected with the outside world.
4. Bring their favorite foods and spices for the visit, but make sure to adhere to the diet recommended by the dietitian and physician.
5. Reminisce about past life experiences. Bring in old family photographs. They may enjoy just listening to your memories. If they are able to respond, this may spark a memory.
6. On their calendar, take a highlighter and mark the date of your next visit. This will remind them that you will be returning soon.
7. Personalize their room. Now is the time they need the most stimulation. Look how you can make their room pretty while at the same time reflecting their personality. You could put up sports banners, add family photos, put pictures on the walls, a CD player at bedside with favorite CDs, plants, decorator pillows and pretty afghans, knickknacks that are meaningful to them, lotions and perfumes or colognes, fake fish tanks (real ones if someone can take care of it), wind chimes over the bed.
8. Bring a book of their favorite author and read to him or her during your visit.
9. Bring flowers from your garden.
10. Try aroma therapy. You can purchase candle warmers and electric aroma therapy machines. Use smells that they would like, but be aware that medications can make them nauseous. Light scents such as lavender may be preferred.
11. Provide hand massages and back rubs. Oftentimes, the only touch they receive is by the facility staff. Having a massage can be really uplifting, especially when being touched by a loved one.
12. Include children in the visit. Bring things for the children to do. It could be a children’s book that the child can read to the resident. If there are animals or bird cages in the facility, plan your visits there.
13. Don’t be afraid to laugh and share humorous stories. Bring funny cartoons and funny stories to share. It’s ok to laugh.
14. Bring cassette tapes or CDs of the religious services from their local church. Share the church bulletin with them.
15. Bring the local community paper and read what is happening in their local community. It will help them still feel connected.
16. Share events happening in your family.
17. Read poetry.
18. Share a meal with them. Many facilities allow families to purchase a meal and eat with the loved one in the dining room.
19. You could do a makeup session or fix their hair. You can bring pretty nail polish and do a manicure.
20. Share a scrapbook or photo album.
21. Go for a stroll together. Nothing is like a visit outside. Many facilities have lovely patios.
22. If your loved one is able to take a drive in the car, go on short outings. Suggestions would be: a ride around the community, zoo, restaurant, park, church, local store or a pet shop. Call ahead to make sure the destination is wheelchair accessible.
23. Bring to family gatherings, such as weddings, holiday dinners and religious events.
24. Bring games they enjoy, cards, checkers, chess, word puzzles.
25. Bring crafts they enjoy, such as yarn or cross stitch.
26. Bring a video of family events such as weddings, graduations, baseball games, dance recitals, or share a video with them of a movie you enjoyed.
27. If they like to read, but now are unable, purchase books on tape.
28. Begin a project that you can work on each time you come. For example, if they loved to garden, you could begin a flower press book and dry the flowers. Once they are dried, you could make a collage together and hang the picture on the wall.
29. Assist your love one with writing a letter to a friend or relative.
30. Help fulfill their final wishes. It may be contacting a long lost friend, or giving away a valuable. Listen to “what they want” and don’t make judgments. There are organizations that grant last wishes of the elderly. It may be a hot air balloon ride or a dinner with all of their loved ones.
31. Exercise with them. There are several video tapes for elderly in wheelchairs. It could be simple arm lifts, walking or hand exercises.
32. Place calendars in their room with large clocks. Don’t assume they can’t tell time.
33. Hug a lot.
34. Create a tactile blanket with different textures and items of interest to touch
35. Bring items related to the season, such as pumpkins, poinsettias, spring flowers.
36. Decorate their room for the seasons, with decorations and scents specific to the holiday or season. Take down old decorations.
37. Bring fresh fruits and vegetables.
38. If the facility has a community kitchen, cook a meal together. Some facilities have activity rooms where you could have a large family gathering.
39. Follow the nursing home’s schedule for visits. Generally, it is better to visit in the afternoon. In the morning, many facilities are busy providing care and getting residents dressed. Phone ahead to let staff know you are coming. Follow through.  If you say you’re coming, please show up when you said you would. Always knock before entering the room. Always state who you are. With dementia, they may forget your face. Feelings are the last to go, they may feel terrible if you say, “Mom, this is Sally”. But instead, you could say, “Hi Ruth, my name is Sally and I came to visit with you.”
40. Get to know the staff. Find out what’s new about your loved one.
41. Let your loved one express their feelings and accept them. They just need someone to listen. You don’t have to have all the answers. Your presence is present enough. Enjoy the time you do have and the tender moments together. Try to leave negativity at home. Make your visits joyful and pleasurable. Don’t rush in, act bored, put down the resident, make them feel guilty about their health, or act like you would rather be somewhere else. They know!

If you plan what you will be doing before your visit, you will have a successful and rewarding experience.

3 Creative Ways to Get a Loved One to Accept Help

 

~Paula Spencer Scott

Is your loved one resistant to having any kind of help from “outsiders” (often, anyone who isn’t you)? Sometimes the person you’re trying to help can be your biggest impediment to help!

Here are three strategies to get around that block:

1. Consider what kind of help the person traditionally made an exception for. So, for example, someone who never hired help but always followed the advice of clergy or a doctor might be open to hearing the need for certain kinds of assistance from one of these professionals. Or someone who grew up with cleaning help or a cook may be open to that kind of household help, which would at least free you up for caregiving chores.

2. Make the presence of help sound commonplace. Some people are more accepting if they know it’s what their peers do: “Jane’s parents have a maid, Mom” (even if that person is really a personal aide).

3. Appeal to prestige interests. Some people are swayed by exclusivity or impressive credentials: “This is the best neurologist/geriatric care manager/moving consultant in town, Dad.” Or, “It usually takes six months to get an appointment with this doctor, but she has an unexpected opening and can see you next week.”

 

How to Grieve/5 Myths That Hurt

by Paula Spencer Scott

Grief is a natural response to loss, and it can unfold in many ways. Unfortunately, well-intentioned onlookers — dubbed “grief police” by grief expert Robert Neimeyer, professor of psychology at the University of Memphis — often say things that mistakenly imply to the bereaved that there’s a “right” way to grieve.

Consider these all-too-common grief myths:

Myth #1: It’s possible to cry too much.

Everyone grieves differently. There’s no single correct way to express the pain, sorrow, yearning, and other aspects of the transition of adjusting to the death of a loved one. Intense responses are sometimes seen as “losing control,” when in fact they’re simply how that person is actively (and productively) processing the loss.

Myth #2: If you don’t cry now, it’ll be worse later.

Some people never cry. Tears or outward expressions of anguish simply aren’t everyone’s grieving style, says psychologist Neimeyer. This doesn’t mean they’re grieving less intensely than a visibly shaken individual, or that they loved the person who died any less. Nor does a lack of obvious emotion mean the griever has an emotional block or problem or will face a longer, more difficult adjustment to the loss.

Myth #3: Grief is something you “get over.”

Most people never stop grieving a death; they learn to live with it. Grief is a response, not a straight line with an endpoint. Many psychologists bristle at words such as “acceptance” or “resolution” or “healed” as a final stage of grief. The real stages of grief involve tasks of processing and adjustment that one returns to all through life.

Myth #4: Time heals slowly but steadily.

Time is the commodity through which a grieving person sorts through the effects and meaning of a loss. But that process isn’t a steady fade-out, like a photograph left in the sun. Grief is a chaotic roller coaster — a mix of ups, downs, steady straight lines, and the occasional slam. Periods of intense sadness and pain can flare and fade for years or decades.

Myth #5: Grieving should end after a set amount of time.

Ignore oft-quoted rules of thumb that purport to predict how long certain types of grief should last. A downside to six-week or eight-week bereavement groups, says Sherry E. Showalter, a psychotherapist specializing in grief and the author of Healing Heartaches: Stories of Loss and Life, is that at the end of the sessions, people mistakenly expect to be “better” (or their friends expect this). “Everyone tells me the same story: ‘I failed Grief 101,’ because they still feel pain,” Showalter says. “We grieve for a lifetime, because we’re forever working to incorporate the death into our own tapestry of life.”

Learning how to grieve is ultimately part instinct, part stumbling along, part slogging along — a bit like learning how to live.

3 Creative Ways to Get a Loved One To Accept Help

~Paula Spencer Scott

Is your loved one resistant to having any kind of help from “outsiders” (often, anyone who isn’t you)? Sometimes the person you’re trying to help can be your biggest impediment to help!

Here are three strategies to get around that block:

1. Consider what kind of help the person traditionally made an exception for. So, for example, someone who never hired help but always followed the advice of clergy or a doctor might be open to hearing the need for certain kinds of assistance from one of these professionals. Or someone who grew up with cleaning help or a cook may be open to that kind of household help, which would at least free you up for caregiving chores.

2. Make the presence of help sound commonplace. Some people are more accepting if they know it’s what their peers do: “Jane’s parents have a maid, Mom” (even if that person is really a personal aide).

3. Appeal to prestige interests. Some people are swayed by exclusivity or impressive credentials: “This is the best neurologist/geriatric care manager/moving consultant in town, Dad.” Or, “It usually takes six months to get an appointment with this doctor, but she has an unexpected opening and can see you next week.”

7 Smart Tips for Communicating With Someone Who Has Low Hearing

Does your loved one seem to ignore what you say half the time? Maybe you’re not being heard. Fully one-third of adults over age 65 and about half of those over age 85 have significant hearing loss.

To improve your odds of getting your message across:

1. Realize that you don’t have to SHOUT! It’s kind of condescending, when you think about it, which starts communication off on the wrong note. Shouting also actually makes enunciation harder to understand.

2. Deliver your message face-to-face, rather than from across the room or from the next room. We all use lip-reading to some extent to help us hear.

3. Turn off the TV or radio to eliminate background noise. Even the low hum of the dishwasher or a leaf blower outside can muffle your words.

4. Don’t rely on hearing aids working perfectly. If you find that someone with a hearing aid is having trouble hearing well or isn’t using it, ask questions to find out why. Is it uncomfortable? Is ambient sound interfering?

5. Especially with someone who has dementia, avoid talking while coming up from behind him or her. You may not be heard until you’re right upon the person, causing your loved one to be startled and flustered — and not comprehend a word you’ve said.

6. If the person has vision problems, ask the eye doctor just what his or her range of vision is. For some people, there’s little peripheral vision (on the sides), so you must be positioned squarely in front to be seen and understood.

7. Speak slowly and clearly. You don’t have to dumb down your speech to robot tones, but try not to rush through your sentences, either. You’ll be more easily heard by any listener, of any age or health condition.

~Paula Spencer Scott

Holiday, Gifts and Stress

by Jude Roberts Even if you’re not a caregiver, the threat of the holidays being right around the corner strikes instant fear, terror and major stress into the hearts of almost everyone. However, there is hope for caregivers to enjoy the holiday season and still make it a special time for their loved one as well. The key is to pace yourself, as well as to help your loved one do the same, so that neither of you will feel completely drained, depressed or overwhelmed, especially during such a special time of year. Here are some suggestions that may help you both survive the holidays: Organize Your Time Try not to schedule too many social events, one right after another. It’s better to miss out on a few holiday events than to end up with yourself or a loved getting too exhausted, which could lead to health problems for both of you. Remember, when it comes to holiday events, it’s the quality, not the quantity, that counts. Make sure that your loved one gets a chance to have some quiet time away from all the noise, stress, and chaos that is a natural part of the holidays. It’s best to spend some quiet time together, so that you both get a chance to unwind from recent events. If you end up traveling away from home for the holidays, make sure to begin packing way in advance so that you’ll have everything needed for the person you’re caring for, as well as for yourself. Make lists and check them often prior to leaving home. Remember to have any refills on medications done early. If you’re traveling by car, remember to break up the car trip with a stopover at a park or at a favorite restaurant so that your loved one can get some fresh air and feel less confined. Watch out for holiday burnout in the person you’re caring for, by taking note of unusual irritability, tiredness, or even boisterousness, depending upon their condition. Also, be aware of possible holiday burnout in yourself. At the end of the holidays, you may notice some post-holiday blues creeping into the mood of your loved one. It’s best to try and get them back into their regular, daily routines as quickly as possible, but do it gradually so that it’s not too much of a shock. Patience is always required as a caregiver, but even more patience is required during the holidays, and in order to keep yourself from stressing out too much or becoming too exhausted, it’s important to try and keep your own, personal holiday schedule under control. This doesn’t mean to deprive yourself of social events that you’d like to attend for yourself, but know what your limits are, know that it’s okay to reduce your holiday commitments down to only a few, and don’t feel guilty about telling someone “no” when asked to participate in yet another holiday function. Shopping Alternatives Shop online whenever possible. A growing number of major retailers have cyberspace shops offering a variety of goods that can be purchased without ever leaving your home. Catalog shopping is another option if you don’t want to spend hours fighting the crowds at the mall. Buy the same gift for as many people as possible on your list. If you find a gift book that would be perfect for all of your favorite friends, pick up a half-dozen copies. You don’t always have to get everyone you know something different. Use your shopping time as efficiently as you can, by creating and carrying a  business-card sized list of gift ideas in your wallet, along with a list of gifts you’ve already gotten. These lists will help you from spending so much money, and will also help you not buy so many unnecessary gifts. Preparing Your Loved One Although it’s the holiday season, try to maintain the daily routine you and your loved one are used to doing. Even before an official gathering, continually speak about the people who will be coming to visit, or who you’ll be visiting, so that the person you’re caring for will  begin to start looking forward to some social time. Play seasonal music around the house, and serve their favorite, seasonal food. Let the person observe but don’t try to force them into any activity beyond their cognitive capacity. Have them do a repetitive task, such as folding napkins or cracking nuts, that will help keep them calm. If it’s possible, have them help bake cookies, or decorate the tree. If they don’t want to, let them stay as an observer. Prior to the onset of any behavioral problems during a holiday gathering, prepare distractions such as a family album to draw the person’s attention away from their problem. Managing Visitors It’s also a good idea to prepare your visitors for how your loved one may react during the gathering, and what to expect from their condition. This way, it won’t be shock if relatives and friends haven’t seen them for a while. Make sure to prepare friends and relatives regarding the condition of your loved one, especially if they haven’t seen them in quite a while. The behavior or condition of the person you’re caring for may come as quite a shock, so it’s best that everyone is informed ahead of time so that everyone is at ease and relaxed during a holiday visit. Don’t focus on how the holidays “used” to be, but focus instead on what a wonderful gift it is to have your loved one with you for yet another holiday season. The top-two priorities for you during this time of year is maintaining health and happiness, for the person you care for and for yourself as well. If you can, go ahead and by yourself a gift, something you’ve had your eye on for quite a while. Try to take time off from other obligations and responsibilities in order to re-energize during this season. Have smaller gatherings; this will help reduce the noise and stress level for you both. It’s okay to set limits, and make sure that everyone in the family, as well as friends, understand what you need as a caregiver during this time. Don’t be afraid to ask for help, and to delegate holiday tasks among family and friends. Don’t spread yourself too thin by volunteering to help others. It’s okay to say no, and when you do, make it short and simple, and don’t apologize; it should be abundantly clear as to why you can’t do something, until you actually have extra time on your hands (and when is that reallygoing to happen?). Hopefully, family and friends will want to know what you want or need for the holidays for yourself. Definitely put respite at the top of your list as what you’d like to receive the most.

When Mom won’t use her cane

Almost always, the device makes the person feel old or disabled and is therefore ignored.

What to do:

• Enlist peer pressure. It works at any age! The more your loved one sees others (especially those perceived as peers or younger) using assistive devices, the more normal they appear. Arrange chance “encounters” with a dapper, active, respected friend of roughly the same age who use a cane. Even watching movies set in locations when canes are commonplace (lots of foreign movies set in Europe, for example) can have a positive subliminal effect.
• Talk up the benefits. Canes and walkers are seen as symbols of disability. Remind your loved one that they actually promote movement, which will increase the odds of better mobility over time. They also reduce the odds of a fall — which can cause serious injury and further limit mobility.
• Look for noninstitutional models. Many men prefer a sturdy, stylish wooden cane to an aluminum model, for example. Walkers also come in a variety of types; search online forwalker or look at medical equipment companies.
• Try compromising. Maybe your loved one will use a walker in certain circumstances (shopping) but prefers to lean on a companion’s arm in others (church).
• Supply the device wordlessly. Rather than nagging (“Get your cane!”), just provide it.
• Consider having a third party, such as a physical therapist or doctor, lay out the costs of ignoring a cane or walker.
• See a physical therapist’s tips for encouraging someone who refuses to use a walker or cane.