Leaving Your Loved One Home Alone



If it has not already been debated, the possibility of leaving your loved one alone in your home is certainly bound to occur. You will no doubt have many questions to ponder as you decide upon the prospects of leaving them such as, will they attempt to go outside?, will they hurt themselves?, or will they need emergency assistance? This difficult question involves you the caregiver, and your loved one, who was once an independent person. The both of you will usually disagree with the situation, as it is normal for caregivers to feel their loved one cannot be alone, while they believe they are fine and healthy enough to be alone for how ever long. Asking other family members, health care professionals, and other caregivers for advice will go a long way to determining the likelihood of their safety being jeopardized when left alone. Some other important questions to consider before leaving them alone for the first time, or if you are questioning whether they are able to stay alone any longer include:

  • Are they capable of calling 911 or neighbors if an emergency occurs?

  • Can they distinguish friends and family from strangers if they are faced with answering the door or having someone enter the home?

  • If they are hungry, can they prepare and eat a meal without your assistance?

  • Is it easy for them to use the bathroom without your help, or do they require aid every time. Are there any other plans in place if they are not able to go to the bathroom without your help?

  • How does their behavior and temperament change from when you leave to when you return? Do they appear angered or scared at the first sign of you leaving the house?

  • In case of emergency are they able to leave the home and seek shelter outside?

  • Are they aware of smoke alarms and unusual noises, which may trigger danger, or are they likely to overlook all such noises?

  • Do they suffer from Alzheimer�s or dementia, and if so are they likely to wander off and get lost easily?

  • Are they routinely experiencing emergencies, which places their life in jeopardy? Do they suffer from epilepsy, or shortness of breath that may need to be monitored all the time?

  • Do they get lonely easily and feel deserted at the slightest moment of your absence?

  • Can they be destructive at times of stress and sickness and cause damage to themselves and your home in the process?

Depending on your answers to these questions, your decision on the possibility of leaving your loved one home alone should be clearer. If your answers gave you a sense of dissatisfaction, it is in your best interest to find assistance through a family member or home care aide who can stay with them while you are gone. But if the answers to the questions were comforting, you may still be able to leave your loved one alone, although you must regularly check up on their progress to ensure their safety in the future. This is certainly not an easy situation for all involved, but understand your own feelings and be strong-minded when making the most sensible and safe decision for all involved.

Contact Raleigh Geriatric Care Management to speak with a Certified Aging Life Care Professional™ for a no cost 15 minute telephonic consultation.    www.rgcmgmt.com

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Caregiver Family Checklist

Power-of-attorneyThe most loving gift a person can give to one’s family is to put your affairs in order before a disaster or medical emergency.  The information and documents you should have prepared:

  • All bank accounts, account numbers and types of accounts and the location of banks.
  • Insurance Company, policy number, beneficiary as stated on the policies and type of insurance (health, life, long term care, automobile, etc).
  • Deed and titles to ALL property.
  • Loan/lien information, who holds them and if there are any death provisions.
  • Social Security and Medicare numbers.
  • Military history, affiliations and papers (including discharge papers).
  • Up-to-date will in a safe place (inform family where the Will is located).
  • Living Will or other Advanced Directive appropriate to your state of residence.
  • Durable Power of Attorney.
  • Instructions for funeral services and burial (if arrangements have been secured, name and location of funeral home.)     ~Caregiver.com

Contact Raleigh Geriatric Care Management, www.rgcmgmt.com, 919-803-8025, lwatral@rgcmgmt.com


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Gift ideas for your senior loved one

As the holidays approach, purchasing a gift for an individual with hugs-079dementia can become difficult. Please be sure to keep in mind where the individual is living as to what type of gifts will be appropriate. If they are in a facility be sure to ask the staff there what is best. Below is a list of gift suggestions that can assist family members and friends with this task: Electric coffee or tea pots that turn off after a short period of time

  1. Large desk calendars to mount on the wall
  2. Medication holders—with timer to indicate time to take
  3. Photo albums with names and dates next to each picture
  4. Registration in the Medic Alert®/Safe Return Program®
  5. Simple-to-manage clothing (tube socks, easy on sweatshirts, tennis shoes with Velcro closings)
  6. Gift certificates for hair cuts and manicures
  7. Older music (especially music from the 30’s and 40’s)
  8. Tapes of sermons or church services
  9. Cuddly stuffed animals
  10. Tickets to take them to a musical event or circus
  11. Trip to a shopping mall and lunch
  12. Visit to the local senior center to participate in activities
  13. Bird feeders
  14. Tapes of bird songs
  15. Gift certificates to adult day services
  16. Hugs, Hugs, Hugs
  17. Short visits often

~Alz. Assoc.

Raleigh Geriatric Care Management, www.rgcmgmt.com, 919-803-8025

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Costs of Growing Old – Will Seniors’ Financial Planning Cover Them All?

by Kathy Birkettseniors-on-stack-of-money

Now is the time to review your senior’s financial plan for what is yet to come in terms of health and aging needs.

With increasing longevity, their financial plan may need adjustment to meet future needs.

Seniors, no matter their ability or wellness, are likely to need some form of care as they age, which will cost them money.

Most seniors don’t sufficiently plan for the costs of care as they age and will need some support financially to get what they need.

Currently, about 13 million American seniors need long term care services and supports.

Most Seniors will Need Long Term Care Services

Statistically, 70% of seniors 65 and older will need some form of long term care services and supports during their lifetime.

Women will need care longer than men, 3.7 years versus 2.2 years.

The average senior will need some type of care for 3 years.

80% of long term care services and supports will be provided in the home rather than in institutions.

“Not my senior, he isn’t going to a nursing home if I can help it!” you may be saying. But long term care for aging is not just about placement in a facility.

Needing help from paid and unpaid sources for a multitude of reasons comprises long term care options for services and support as we age.

What Is Included in Long Term Care Services and Support?

When we think about long term care services and support, our minds often jump directly to nursing home care.

The truth is that long term care services and supports includes a little bit of everything. Most seniors will need something, even if it is unpaid care from family members like you.

Long term care services and supports can include:

  • Unpaid care
  • Paid care
  • Home care
  • Nursing facility
  • Assisted living facility
  • Adult or senior day care facility/program

These services might include support seniors receive to complete tasks of daily living (often referred to as ADLs) such as bathing, dressing, grooming, toileting, eating, transferring from one place to another, incontinence care and ambulation.

Other services that support a senior especially when living at home are called instrumental activities of daily living or IADLs, and are everyday tasks that need to be completed.

These jobs include even more tasks: housework, laundry, shopping for groceries, caring for pets, managing money and paying bills, making/serving/cleaning meals, using telephone, and taking medications properly.

When we stop to think of some of these items, it becomes clearer that our senior loved one will need long term care services as they age and family caregivers will be major players in getting these tasks accomplished for our seniors.

Naturally, we need to encourage and facilitate them doing as many of these things for themselves as long as possible to maintain their independence and mobility, but eventually they are likely to need assistance.

Paying for Help

Seniors usually pay for almost half of their care out of pocket, since many don’t have long term health insurance due to the high cost of premiums.

What will happen if you can’t provide all the long term care they require and they haven’t saved enough money?

Perhaps you won’t have time or personal finances to support them while meeting all their needs. Maybe you have illnesses or mobility impairments that will prevent you from assisting. Maybe it is your spouse and you are also aging and unable to complete all the IADLs for yourself.

What if you require help too? Will they go without care?

Has your senior planned financially to pay for the things they will need to age in place successfully?

A recent report has spelled out what we should all be thinking about to plan for our financial aging future. Seniors should be planning for paid care, since the number of family caregivers is expected to decline by one third by 2050.

SCAN Foundation Report

Recently, the SCAN Foundation released a report on the cost of long term care services and supports entitled Financing Options for Long-Term Care: Who Benefits and at What Cost? This report was completed in collaboration with LeadingAge and AARP and completed by both the Urban Institute and Milliman, Inc.

“This Long-Term Care Financing Initiative provides updated information to help policymakers and stakeholders create a viable set of policy solutions that will meet the needs of individuals, families, state and federal governments, and society at large.”

They found:

  • 52% of seniors over 65 will need a high level of help with everyday activities
  • Typical costs for care average $91,000 for men and $182,000 for women; this cost will increase with additional time or level of care needed

Consequences of Financial Insufficiency

Our older adults who do not plan accordingly for their future needs will face a financial burden. Family caregivers may be asked to help out with the cost of aging so their loved ones will get the care they need.

Many seniors will not be able to afford care, which will result in inadequate care and potential facility placement.

Many families will go bankrupt trying to meet the costs of healthcare and long term care services.

Family caregivers who try to fill the gaps in their senior’s financial plan will often face paying themselves for their senior’s long term care needs, which could impact their own retirement plan.

Caregivers who can’t afford to pay for care for their family members find themselves in the precarious position of providing that care themselves. Family caregiving can take a toll on their employment and many face leaving careers to become caregivers. This impacts their own financial well-being, both now and in the future.

Much Long Term Care Cost Paid by Families

It has been estimated families pay as much as 50% of the out-of-pocket expenses for long term care services for their seniors. Many seniors do not have long term care insurance, which could help with these costs of care.

Genworth Financial Cost of Care survey estimates that the cost of a year of paid long term care services and support will conservatively be between $17,000 and $87,000. One year in a nursing home will cost 2-3 times the annual household income of those over 65.

Government healthcare and insurance will be unable to provide necessary resources for many of our aging Americans who haven’t set aside enough money to fully meet their needs.

We can begin to open the dialogue about finances with our senior loved ones and discuss the plan for the future so that strategies can be put into place to meet the coming need.

They will need it so now is a good time to decide what can be done to make paying for the care they will need a reality.

Call Raleigh Geriatric Care Management, www.rgcmgmt.com, 919-803-8025 for a FREE 15 minute telephonic consultation.

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Driving Dilemmas: Risk vs. Independence

by Dwyer

images (3)Driving a car is a symbol of independence and competence and is closely tied to an individual’s identity. It also represents freedom and control and allows older adults to gain easy access to social connections, health care, shopping, activities and even employment. At some point, however, it is predictable that driving skills will deteriorate and individuals will lose the ability to safely operate a vehicle. Even though age alone does not determine when a person needs to stop driving, the decision must be balanced with personal and public safety. Driving beyond one’s ability brings an increased safety risk or even life-threatening situations to all members of society. Statistics show that older drivers are more likely than others to receive traffic citations for failing to yield, making improper left turns, and running red lights or stop signs, which are all indications of a decrease in driving skills. Understandably, dealing with impaired older drivers is a delicate issue.

The road to driving cessation is anything but smooth. Each year, hundreds of thousands of older drivers across the country must face the end of their driving years and become transportation dependent. Unfortunately, finding other means of transportation has not noticeably improved in recent years, leading to a reluctance among older drivers to give up driving privileges and of families to remove the car keys. The primary issue facing older drivers is how to adapt to changes in driving performance while maintaining necessary mobility. Despite being a complicated issue, this process can be more successful when there is a partnership between the physician, older driver, family or caregiver.

Dramatic headlines like these have ignited national media debates and triggered the pressing need for more testing and evaluation of elderly drivers, especially with the swell of the Baby Boomer generation: “Family of four killed by an 80-year-old man driving the wrong way on Highway 169.  86-year-old driver killed 10 people when his vehicle plowed through a farmers’ market in southern California. 93-year-old man crashed his car into a Wal-Mart store, sending six people to the hospital and injuring a 1-year-old child.”

According to the Hartford Insurance Corporation, statistics of older drivers show that after age 75, there is a higher risk of being involved in a collision for every mile driven. The rate of risk is nearly equal to the risk of younger drivers ages 16 to 24. The rate of fatalities increases slightly after age 65 and significantly after age 75. Although older persons with health issues can be satisfactory drivers, they have a higher likelihood of injury or death in an accident.

Undoubtedly, an older adult’s sense of independence vs. driving risk equals a very sensitive and emotionally charged topic. Older adults may agree with the decline of their driving ability, yet feel a sense of loss, blame others, attempt to minimize and justify, and ultimately may feel depressed at the thought of giving up driving privileges. Driving is an earned privilege and in order to continue to drive safely, guidelines and regulations must be in place to evaluate and support older drivers.

Dementia and Driving Cessation
Alzheimer’s disease and driving safety is of particular concern to society. Alzheimer’s disease (AD) is the most common cause of dementia in later life and is a progressive and degenerative brain disease. In the process of driving, different regions of the brain cooperate to receive sensory information through vision and hearing, and a series of decisions are made instantly to successfully navigate. The progression of AD can be unpredictable and affect judgment, reasoning, reaction time and problem-solving. For those diagnosed with Alzheimer’s disease, it is not a matter of if retirement from driving will be necessary, but when. Is it any wonder that driving safety is compromised when changes are occurring in the brain? Where dementia is concerned, driving retirement is an inevitable endpoint for which active communication and planning among drivers, family, and health professionals are essential.

Current statistics from the Alzheimer’s Association indicate that 5.3 million Americans have Alzheimer’s disease (AD) and this number is expected to rise to 11-16 million by the year 2050. Many people in the very early stages of Alzheimer’s can continue to drive; however, they are at an increased risk and driving skills will predictably worsen over time. The Alzheimer’s Association’s position on driving and dementia supports a state licensing procedure that allows for added reporting by key individuals coupled with a fair, knowledgeable, medical review process.

Overall, the assessment of driving fitness in aging individuals, and especially those with dementia, is not clear cut and remains an emerging and evolving field today.

Physician’s Role in Driving Cessation
While most older drivers are safe, this population is more prone to vehicle accidents due to decreased senses, chronic illness and medication-related issues. The three primary functions that are necessary for driving and need to be evaluated are: vision, perception, and motor function. As the number of older drivers rises, patients and their families will increasingly turn to the physicians for guidance on safe driving. This partnership seems to be a key to more effective decision-making and the opinions of doctors vs. family are often valued by older drivers. Physicians are in a forefront position to address physical, sensory and cognitive changes in their aging patients. They can also help patients maintain mobility through proper counseling and referrals to driver evaluation programs. This referral may avoid unnecessary conflict when the doctor, family members or caregivers, and older drivers have differing opinions. (It should be noted that driver evaluation programs are usually not covered by insurance and may require an out-of-pocket cost.)

Not all doctors agree that they are the best source for making final decisions about driving. Physicians may not be able to detect driving problems based on office visits and physical examinations alone. Family members should work with doctors and share observations about driving behavior and health issues to help older adults limit their driving or stop driving altogether. Ultimately, counseling for driving retirement and identifying alternative methods of transportation should be discussed early on in the care process, prior to a crisis. Each state has an Area Agency on Aging program that can be contacted for information, and referrals can be made to a social worker or community agency that provides transportation services.

Resources do exist to help physicians assess older adults with memory impairments, weigh the legal and ethical responsibilities, broach the topic of driving retirement and move toward workable plans. The Hartford Insurance Corporation, for example, offers two free publications that make excellent patient handouts: At the Crossroads: A Guide to Alzheimer’s Disease, Dementia and Driving and We Need to Talk: Family Conversations with Older Drivers. These resources reveal warning signs and offer practical tips, sound advice, communication starters, and planning forms. Other resources can be found through the Alzheimer’s Association. Physicians can also refer to the laws and reporting requirements for unsafe drivers in their state and work proactively with patients and their families or caregivers to achieve driving retirement before serious problems occur. Ultimately, assessing and counseling patients about their fitness to drive should be part of the medical practice for all patients as they age and face health changes.

Driver’s Role in Driving Cessation
“How will you know when it is time to stop driving?” was a question posed to older adults in a research study. Responses included “When the stress level from my driving gets high enough, I’ll probably throw my keys away” and “When you scare the living daylights out of yourself, that’s when it’s time to stop.” These responses are clues to a lack of insight and regard for the social responsibility of holding a driver’s license and the critical need for education, evaluation and planning.

Realizing one can no longer drive can lead to social isolation and a loss of personal or spousal independence, self-sufficiency, and even employment. In general, older drivers want to decide for themselves when to quit, a decision that often stems from the progression of medical conditions that affect vision, physical abilities, perceptions and, consequently, driving skills. There are many things that an older adult can do to be a safe driver and to participate in his or her own driving cessation.

The Centers for Disease Control and Prevention suggest that older adults:

  • Exercise regularly to increase strength and flexibility.
  • Limit driving only to daytime, low traffic, short radius, clear weather
  • Plan the safest route before driving and find well-lit streets, intersections with left turn arrows, and easy parking.
  • Ask the doctor or pharmacist to review medicines—both prescription and over-the counter—to reduce side effects and interactions.
  • Have eyes checked by an eye doctor at least once a year. Wear glasses and corrective lenses as required.
  • Preplan and consider alternative sources and costs for transportation and volunteer to be a passenger

Family’s or Caregiver’s Role in Driving Cessation
Initially, it may seem cruel to take an older person’s driving privilege away; however, genuine concern for older drivers means much more than simply crossing fingers in hopes that they will be safe behind the wheel. Families need to be vigilant about observing the driving behavior of older family members. One key question to be answered that gives rise to driving concerns is “Would you feel safe riding along with your older parent driving or having your child ride along with your parent?” If the answer is “no,” then the issue needs to be addressed openly and in a spirit of love and support. Taking an elder’s driving privileges away is not an easy decision and may need to be done in gradual steps. Offering rides, enlisting a volunteer driver program, experiencing public transportation together, encouraging vehicle storage during winter months, utilizing driver evaluation programs and other creative options, short of removing the keys, can be possible solutions during this time of transition.

Driving safety should be discussed long before driving becomes a problem. According to the Hartford Insurance survey, car accidents, near misses, dents in the vehicle and health changes all provide the chance to talk about driving skills. Early, occasional and honest conversations establish a pattern of open dialogue and can reinforce driving safety issues. Appealing to the love of children or grandchildren can instill the thought that their inability to drive safely could lead to the loss of an innocent life. Family members or caregivers can also form a united front with doctors and friends to help older drivers make the best driving decisions. If evaluations and suggestions have been made and no amount of rational discussion has convinced the senior to cease driving, then an anonymous report can be made to the Department of Motor Vehicles in each state.

According to the Alzheimer’s Association, strategies that may lead to driving cessation when less drastic measures fail include:

  1. Family meetings to discuss issues and concerns
  2. Disabling or removing the car
  3. Filing down the keys
  4. Placing an “Expired” sticker over the driver’s license
  5. Cancelling the vehicle registration
  6. Preventing the older driver from renewing his or her driver’s license
  7. Speaking with the driver’s doctor to write a prescription not to drive, or to schedule a formal driving assessment

Finally, it is suggested that family members learn about the warning signs of driving problems, assess independence vs. the public safety, observe the older driver behind the wheel or ride along, discuss concerns with a physician, and explore alternative transportation options.


There are a multitude of solutions and recommendations that can be made in support of older drivers. Public education and awareness is at the forefront. An educational program that includes both classroom and on the road instruction can improve knowledge and enhance driving skills.

The AAA Foundation provides several safe driving Web sites with tools for seniors and their loved ones to assess the ability to continue driving safely.  These include AAAseniors.com and seniordrivers.org.  They also sponsor a series of Senior Driver Expos around the country where seniors and their loved ones can learn about senior driving and mobility challenges and have a hands-on opportunity to sample AAA’s suite of research-based senior driver resources. Information on the Expos is available at aaaseniors.com/seniordriverexpo.

AARP offers an excellent driver safety program that addresses defensive driving and age-related changes, and provides tools to help judge driving fitness. Expanding this program or even requiring participation seems to be a viable entry point for tackling the challenges of driving with the aging population.

CarFit is an educational program that helps older adults check how well their personal vehicles “fit” them and if the safety features are compatible with their physical characteristics. This includes height of the car seat, mirrors, head restraints, seat belts, and proper access to the pedals. CarFit events are scheduled throughout the country and a team of trained technicians and/or health professionals work with each participant to ensure their cars are properly adjusted for their comfort and safety.

Modification of driving policies to extend periods of safe driving is another solution. Older drivers nearing the end of their safe driving years could ‘retire’ from driving gradually, rather than ‘give up’ the driver’s license.  An older adult can be encouraged to relinquish the driver’s license and be issued a photo identification card at the local driver’s bureau.

The Alzheimer’s Association proposes several driving assessment and evaluation options. Among them are a vision screening by an optometrist, cognitive performance testing (CPT) by an occupational therapist, motor function screening by a physical or occupational therapist, and a behind the wheel assessment by a driver rehabilitation specialist. Poor performances on these types of tests have been correlated with poor driving outcomes in older adults, especially those with dementia. Requiring a driving test after a certain age to include both a written test and a road test may be an option considered by each state.  Finally, continued input and guidance will be necessary from AARP, state licensing programs, transportation planners, and policymakers to meet the needs of our aging driving population.

It is appropriate to regard driving as an earned privilege and independent skill that is subject to change in later life. In general, having an attitude of constant adjustment until an older individual has to face the actual moment of driving cessation seems to be a positive approach. Without recognizing the magnitude of this transition, improving the quality of life in old age will be compromised. Keeping our nation’s roads safe while supporting older drivers is a notable goal to set now and for the future.

In Raleigh , NC, contact Raleigh Geriatric Care Management, member of The Aging Life Care Association for a free 15 minute telephonic consultation, 919-803-8025

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Holiday Help: Relieving Caregivers’ Stress

by, Cheryl Smith, Caregiver.com

Who doesn’t feel overwhelmed sometimes by the bustle of the holiday season? Add to that the responsibility of caring for a frail elderly loved one, and burnout is simply a concept waiting to become reality. But wait. If you’re one of the 22 million households providing care for a family member or friend, there is hope. Stress doesn’t have to take the starring role in your family festivities this year.

If you’re like the increasing number of Americans who are trying to offer a sense of dignity to your parent(s), include them in seasonal events and help them stay in their own home, safety is your number one priority.

Most accidents happen at home in unsupervised situations. This season, enlist the help of older children or a spouse, playing games with (Great) Grandma and (Great) Grandpa while you change beds, do the laundry and other chores. Instead of decorating to the hilt, keep holiday décor simple. Eliminate the need for extension cords on the floor and “declutter” your notion of decoration: use colorful paper garlands strung high instead of breakable objects placed within reach. Remove anything a child or a frail elderly person may stumble over. Replace candles with bright centerpieces of fruit or flowers. Keep candy to an absolute minimum to prevent sugar highs and lows.

With the emphasis on “good cheer” during the month of December, the options are many. But don’t wear yourself out trying to make the holidays “happen” for everyone. If you don’t get yourself in a situation where you “overdo” you’ll be more alert to hazards—even emotional ones. Holidays bring emotions to the surface because they hold the most intense memories for your loved ones, and some may not be pleasant. You may find that tears fall for no apparent reason, or that a frail elderly parent suddenly seems gruff or annoyed just when you think everything is fine. Sometimes, the emotional stress of the season makes a frail aging parent seem distant, just when you want to draw them close. We never know what precipitates these reactions; we only have to deal with them. That’s not an easy task, but first and foremost, a caregiver must keep her own emotional balance.

Set a few guidelines as to what you expect from yourself. From the very start, set your intention to be positive during the holidays, and to respond with calmness to upsetting scenarios. Sure, things may come to the boiling point at times, but the resolve not to react in like manner will bring the most effective results. People don’t intend to be grumpy, distant or to give you a hard time. These behaviors may simply be a way of asking for help. The best way to give it is by remaining patient, offering consistent encouragement, and setting safe boundaries.

You cannot make everyone happy at all times, but you can take responsibility for your own emotional highs and lows. Preserve a few moments each day all for yourself. Take a half-hour break while your children entertain the frail elderly with Christmas music from the 30s, 40s and 50s or interview their grandparents about favorite holiday memories. You might enlist the services of a home-help organization to do some of the household chores while you go grocery shopping or simply take a walk. Professional caregivers can also help alert you to signs of stress or special needs that you might not recognize on a day-to-day basis, curtailing accidents or emotional spills.

Keep in mind that a frail person may tire more easily during the holiday season, need more sleep as the days grow shorter, and also need their own “space.” Ask for their help; ask them to let you know what they need and how they want to celebrate. Their answers may surprise you. Above all, an older frail person may crave our respect and our admiration. When we praise the good things they’ve accomplished in life, make certain they know that we appreciate their legacy, and tell them we’re happy they’re with us, things will be a lot easier. If they seem only to complain more, well, just grease the wheel with a little praise for yourself. Send positive messages to yourself out loud and mix in a few more affirmations for them.

The holidays are a great time to slow down instead of speed up. Think about all the things you can let remain undone instead of all the things you need to do. Give yourself a challenge to match the tempo of your frail elderly relatives or friends, and see if you don’t enjoy the season more. And after all, isn’t that what the holiday season is all about?

Contact Raleigh Geriatric Care Management for a 15 minute no cost telephonic consultation:  919-803-8025.  www.rgcmgmt.com

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Moving in With Family: Issues to Consider

_77183535_77183027~Helen Hunter

Too often, the decision to move into a family member’s home is made when a crisis develops or as a last resort. Sudden illness or injury strikes and the family is left without a plan for long-term care for their loved one. Experts suggest that all families discuss the possibility of the need for long-term care, and the possibility of family members living together as a solution to the daily care situation. The following are some items to discuss with all members of the family before making such a move.


Is the home “elder friendly”? It is necessary to review the setup of the home, in terms of stairs, additional bedrooms, bathrooms and general safety issues. If home modifications are needed, they should be completed prior to the move.


How much care will the relative require? Daytime supervision, medication management, meal preparation and entertainment are just a few examples of important issues to consider. Assess the level of assistance needed now and in the foreseeable future. If the relative is in poor health, who will be in charge of providing the care? Will other family members share in the caregiving duties? Establish basic rules and a care routine to help prevent conflicts and caregiver burnout.


How do family members get along with each other? How are conflicts dealt with? All families have their share of problems and each family handles them differently. The loss of independence is difficult for anyone and reactions or behavior change is to be expected. It is important to be able to talk about how everyone is feeling and encourage the relative to continue with a life of their own. Communication skills, including active listening, are necessary in handling and resolving conflicts successfully.


How will the change in household expenses be handled? An increase in family size usually means an increase in family expenses. Will the relative contribute? Are there other family members who can help with financial support?


What is expected of the relative? What responsibilities will they have for care of the home? If there is a separate apartment, will everyone dine together? What about family outings – will the relative always be included?

Avoid the feeling that the situation is permanent.

Start with a limited “trial period,” then review the situation.

Once the move has been made to live together, it is very important for all family members to have continual open and honest communication with each other on all matters. Don’t hold in your feelings – both positive and negative feelings need to be shared.

If the health condition of the relative changes, and additional care is needed, it is crucial for the family to review the daily plan. If the situation requires help outside the family, there are a number of alternatives that the family and the relative can explore together. Make sure that the relative is included in decision making, if they are able. Some other options for care include: daily home health aide or homemaker care, which would also provide respite relief for family caregivers, home based community care programs, friends and neighbors, church outreach programs and dividing the care responsibilities among the family by rotating care, with the relative going to others’ homes, or by allowing other relatives to come into the home to provide the daily care.

Families who maintain open and honest communication and are willing to share in the financial and caregiver responsibilities for a needy relative can successfully reside together in the same home. Support can and should be a two-way street. Where better to get the daily support that we all need than from our family!

Contact a Geriatric Care Manager/Aging Life Care Professional™ www.rgcmgmt.com for a free 15 minutes telephonic consultation.

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Holiday Gatherings – Successful Visits when Alzheimer’s Joins the Family

Often we need a few strategies to make the most of family visits and holiday reunions.

These strategies will vary with the stage of the disease, early or more advanced.

Because Alzheimer’s disease affects so many older adults, this disease may be joining your family too, if it hasn’t already.

There are few families unaffected by dementia and Alzheimer’s disease.

Helping Family Members Cope

Learning all you can about the disease, its progression, what to expect at each stage along the journey and how to handle the duties of caregiving will help you but also help you make other family members understand the challenges of providing care.

During the holidays it is a good time to increase awareness of long distance family members and siblings who haven’t had to deal with the day to day tasks and even the many changes in your senior loved one.

Children and teens in the family should be informed about what to expect when they visit and how to handle situations that might arise. Children are usually empathetic and nurturing to seniors but if they can be prepared for their visit, they will be able to react more appropriately.

Have activities planned that children and teens can do to engage with the loved one with dementia. No one wants the kids to feel embarrassed to be with these older adults or afraid that they may have ‘made them worse’.

Tips for Visiting Persons with Dementia

Because family members want to visit as often as possible but may not have been able to for some time, they may be surprised at how quickly a person with dementia can change. Your senior loved one may not be the same as they were upon their last visit.

Helping each visiting family member and friend understand the changes and what to expect will help their visit be more enjoyable for everyone.

There are things that the primary family caregiver can do to help facilitate visits and holiday events when there is a person with dementia included in the fun.

Here are some suggestions for how to prepare not only the family but the situation to safeguard your senior loved one and help make the holidays a pleasant memory.

  1. Limit crowds – try to keep large gatherings to a minimum. Instead, opt for small group visits with 2-5 people only. Large crowds that are noisy can be overwhelming for a person with dementia. It is too hard to keep up with the questions, conversation and movement of a large group.
  2. Schedule rest breaks – be sure your senior loved one has a chance and a soothing place to take a break from the festivities. This might mean scheduling a nap and even asking guests to leave for nap time. Getting overtired and overstimulated can be a recipe for disaster, aggressive behavior and confusion for seniors with dementia.
  3. Keep the daily schedule close to everyday routine – whenever possible maintain your senior loved one’s schedule as near normal as usual. They should get up, eat meals, take baths and go to bed around the same time as usual. Disturbances in their normal pattern can also lead to behavior issues.
  4. Let people come to them, not forcing travel – for those with advanced dementia, their familiar environment is a better place to meet and greet family and friends. Invite a few over at a time and include a few for meals. Driving around to strange locations and not being able to wander around their own living environment can create confusion. Having a place to escape during a stimulating situation like holiday parties will help your senior with dementia.
  5. Let everyone know recent changes and what might be expected – behavior, memory, might not recognize them, repetitive questions, aggression, swearing, or sundowning. Explain about conversing with your senior loved one, avoid conflict and confrontation. Tell them to enter their reality and don’t correct their story telling, join in with them instead. Some people may not be happy that their senior loved one can’t remember them and would be better off being prepared.
  6. Observe for signs of overstimulation – when the crowd and the conversation gets too hard to handle for your senior loved one, it’s probably time for an exit strategy.
  7. Involve the loved one with dementia in activity – have enough to do to keep them occupied, be sure the activities are appropriate for their abilities to avoid frustration.
  8. Reminisce and recreate pleasant memories of holidays from the past – serve familiar foods, play music they enjoy, bring out decorations from their past, show family photos or play family friendly games to strike memories and allow for reminiscing.
  9. Tell family which gifts are appropriate and desired – in addition, don’t hesitate to ask for items that will help you as a caregiver throughout the upcoming year.
  10. Ask for respite during the holidays so caregivers can rest or do things during the holiday season that they enjoy away from the loved one with dementia; for example, can someone sit with your senior while you take a needed break, clean gutters, hang outside decorations, rake leaves, or clean windows at some point during their visit because you simply can’t do those type of jobs while caregiving. Maybe they can hire a weekly housekeeper so that you can spend time caring for yourself or just being with your senior loved one without worry about laundry or vacuuming.
  11. Include their favorite holiday music in the events, don’t just play today’s hits. Do members of the family play musical instruments? Did your senior play an instrument that you can offer for fun?
  12. Prepare for any traveling that you and the person with dementia will do during the season – if you have to travel or wish to, plan ahead for obstacles and prepare the way ahead to make the trip as easy as it can be for everyone who goes including the person with dementia.

Make Holidays Special for All

Most families are happy to learn about and do whatever they can to make the holidays special for their senior loved ones, especially family caregivers.

So many sandwich generation adults are spending time, not just during the holidays but all through the year, caring for their senior loved ones who need them to take on the role of caregiver.

Instead of spending time with friends, children and grandchildren, or traveling, they are caring for someone with dementia. Naturally they are happy to do it because their family members have given so much to them over the years and now they can give back.

However, it takes a little know how to achieve a reduced stress holiday that is enjoyable for everyone in the family when Alzheimer’s and dementia join the family dynamic.


Contact Raleigh Geriatric Care Management, lwatral@rgcmgmt.com, www.rgcmgmt.com, 919-803-8025  Call for a no cost 15 minutes consultation.

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November is National Care Giver Month

  1. Family caregivers are very important to the lives of many of our senior loved ones or likely will be at some time.

    Family caregivers provide a service that’s hard to match when they aren’t there to do it all!

    Unfortunately, there may come a time when they just don’t feel that they can continue giving it their all. What will we do then?

    We all need to lift some of the ‘caregiving obligation’ (certainly not burden as they don’t feel it is a burden but more a responsibility born of love) from their shoulders.

    We need to help them seize the day and do something for themselves once in a while.

    1.  Get respite! Don’t be one of the few who actually accept respite. It is available but for you to get it, you may need to seek it out. Perhaps it is a family friend who can sit with your senior loved one in the afternoon or overnight so that you can have a break. Maybe it is an organization who can provide a sitter or substitute caregiver for a period of time so that you can get relief.

  2. Take a vacation – a day, weekend or week or maybe longer! Pay for in-home care, arrange with a respite organization that provides this service, or send your senior loved one away to family or a care home for the time you will be away. You won’t do it often but deserve it, so don’t feel guilty about it. Your senior loved one’s safety is your top concern but your well-being should be important to you as well! Some families ‘share’ the senior loved one every three months or so relieving the other family member for a while so that each able person in the family becomes the primary caregiver at some point during the year. What a great way for families to pitch in not to mention enjoy their senior loved one!
  3. Take a walk, take a bubble bath, listen to your favorite music (not just theirs) or reach out to friends on the phone.
  4. Don’t be afraid to treat yourself with an hour nap or participating in a personal hobby during the day.
  5. If you feel like the multitude of other family caregivers who have difficulty managing the stress associated with caregiving or feel sad or depressed, seek professional help to care for yourself and learn coping strategies.
  6. Cook a meal that you want to eat, not just what you think everyone else wants.
  7. Get a good night’s sleep by having someone else listen for your senior loved one or attend to their overnight needs once a week.
  8. Stop and smell the roses, listen to the birds sing outside, or smell the fresh air! It only takes a moment to remember what you are there for and why you are a family caregiver!12193740_978884885502022_1286582822711477986_n Contact Raleigh Geriatric Care Management, 919-803-8025 for a FREE 15 minutes telephonic consultation. www.rgcmgmt.com

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Nip Depression In The Bud: Warning Signs to Look For

By Mary Damiano

depressionWhile caregivers are defined as the people taking care of those needing help, they sometimes overlook the fact that caregiving responsibilities can take a toll on their own health.

In addition to physical ailments, caregivers are at risk for depression. Depression can strike anyone, at any age. Caregivers need to be especially aware of depression because of the great load they carry. Many caregivers work at a full-time job and take care of a family in addition to their caregiving responsibilities. They often sacrifice their own health, well-being and social life in order to do everything that needs to be done.

One common denominator among caregivers is the desire and the belief that they must do everything themselves. Often, caregivers do not ask for help, opting instead to inadvertently play the part of the martyr. This leads the caregiver to become overwhelmed and an overwhelmed person is fertile ground for depression to dig in and take root.

The great strain caregivers face on a daily basis can lead to depression. One way to stop depression before it strikes is to be aware of the warning signs. According to the Administration on Aging, here are some red flags that depression might be creeping in:

  • Sad, discouraged mood

  • Persistent pessimism about the present, future and the past

  • Loss of interest in work, hobbies, social life and sex

  • Difficulty in making decisions

  • Lack of energy and feeling slowed down

  • Restlessness and irritability

  • Loss of appetite and loss of weight

  • Disturbed sleep, especially early morning waking

  • Depressive, gloomy or desolate dreams

  • Suicidal thoughts

If you feel yourself exhibiting these behaviors, do not discount them. They should be taken as seriously as you might treat a fever that won’t go away or a persistent cough.

Below are some expert tips on what caregivers in particular can do to stop depression before it gets out of control:

Talk regularly with family, friends, or mental health professionals— it is very important that you do not isolate yourself. Join a local support group, or find one online. Share your feelings so they don’t build up and escalate into problems.

Set limits— this can be hard for caregivers, because they are used to taking on everything that needs to be done. It’s okay to say no to taking on more than you can handle.

Eat nutritiously, exercise regularly and get enough sleep— this can be difficult because of the irregular schedules caregivers must keep. But think of it this way: your body and mind are machines, and they must be properly maintained in order to function at their best. Nutritious food, exercise and sleep are the things that fuel these machines. Just as you would not let your car run out of gas, don’t let your body run out of its fuel.

Let go of unrealistic expectations— caregivers often have unrealistic expectations of themselves, and therefore push themselves to meet these goals. Accept the fact that you can’t do everything. Ask for and accept help, from friends, family and local agencies. Whatever you do, don’t be a martyr.

Keep a sense of humor— we all know that laughter is the best medicine, so go ahead and take a few spoonfuls daily. Relax with a funny movie or TV show. Put on a comedy tape to listen to while you do your chores. Find the humor in everyday things.

For a free 15 minute telephone consult addressing caregivers and their aging loved ones, call 919-803-8025.  Visit Raleigh Geriatric Care Management.

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Filed under adult children of aging parents, aging life care association, aging life care professional, Alzheimer's Disease, assessments, care giving, care planning, caregiver burnout, caregiving, Depression and the elderly, Geriatric Care Management