Category Archives: Power of Attorney

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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Considerations for Caregivers

By Arthur N. Gottlieb

Caregiving is not for everyone. Remember, it’s not about you. If the relationship is too emotionally charged or patience is not your best virtue, find someone else to take over the primary role of caregiver.

It is important to reflect upon your motivations for being a caregiver and to make an honest assessment of your limitations.

As a caregiver you may at times feel powerless and sad. But an experience laden with difficulty may also provide opportunities to strengthen relationships with loved ones, and for the development of one’s own personal and spiritual growth.

About Visits
Focus on the quality of interactions with a loved one, not on the quantity.

Consistency and predictability of visitations are important, especially for the homebound.

Communication Skills
Learn the healer’s art of “bearing witness.” This means listening empathically and suppressing the urge to intervene with solutions.

When speaking to someone in bed or in a wheelchair, sit down or otherwise lower yourself so that you are at the same eye level as they are. This will distinguish you from others who remain standing, essentially looking and speaking down to them with the unspoken but inherent power differential this implies.

Choose your battles wisely. Attempting to address an irrational situation with rationality is generally futile, and will increase conflict with no resolution

The hearing impaired are often too prideful to admit that they haven’t heard most of what you just said, and are hopeful that they can eventually figure it out.

Those with mild cognitive impairment are still quite capable of comprehension, but the thought process may have slowed down a little. Be patient and speak slowly.

Restoring Dignity
Asking for a senior’s opinion about a non-provocative issue may offer them an opportunity to feel respected and still relevant.

At the dinner table when others are present, if a person needs to have their food cut for them, discreetly take the plate back into the kitchen and cut it there. This will add an unspoken but important element of dignity for those being cared for.

Residential and Financial Concerns
The attitudes and behaviors of many seniors are oftentimes driven by an unspoken fear of abandonment.

When parents do not feel that their children have made wise decisions for themselves, they are naturally hesitant to turn over financial control to them.

It was not uncommon for senior women to have deferred to their husbands’ judgment when choices were being made about financial and property issues. If now widowed, they may feel more comfortable acting in accordance with someone else’s say-so for important decision-making.

It may be illuminating to discover what memories a senior has of his or her own parent’s convalescence. What would they, as caregivers, have done differently? Had they promised themselves they would never go to a “nursing home”?

When a senior is facing the prospect of moving to a continuing care or assisted living community, speak to them about what they think this will be like. Many will have a stark vision of facilities from many years ago when options were relatively limited.

About Moodiness
Seniors will experience good days and bad days due to effects of pain, adjustment to medications and or emotional issues.

Seniors who seem short-tempered may be responding to the frustrating lack of control of not being able to think as quickly, and remember as well, as they once had.

Psychology of Seniors
Understand and be prepared to recognize the issues that trigger depression and anxiety for seniors.

Be sensitive to anniversary depressions. Birthdays, anniversaries, and major holidays evoke memories of those who have passed, and independence lost.

For most, losing control of physical functioning is difficult. Experiencing the steady loss of friends and relatives leads to sadness and isolation. For those with dementia, witnessing the gradual loss of one’s own self can be the ultimate loneliness.

If a senior is grieving the loss of a loved one they think died yesterday, even if that person actually died years ago, their grief will be as deep and painful as though it just happened.  This is legitimate suffering and must be handled with empathy.

Oftentimes, a parent will have a set of expectations of how they deserve to be treated by their children based on the sacrifices they made on behalf of their own parents. When children do not meet these expectations, resentment, depression and various forms of acting out behavior are the result.

Some seniors harbor lifelong prejudices that were carefully concealed. It can be quite distressing for a caregiver to discover that their parent has “all of a sudden” developed a shocking taste for racial bias. The gradual loss of mental functioning allows one to become “dis-inhibited”; thoughts, formerly suppressed due to social constraints, are now out in the open. This applies for latent sexual desires as well, especially for men.

Denial
If the person you are caring for continually puts off medical diagnosis, they are using the defense of denial in the service of their fear. If they are never diagnosed, then they never have to face the reality of being sick.

For Senior Men
More often than not, senior men went along with the social arrangements made by their wives. If a man becomes a widower, he may feel out of place socializing with others on his own. Additionally, since women outnumber men of this age group, a man may feel he is betraying the memory of his wife when engaging in social situations involving mostly women.

Religion and Spirituality
It is important to understand what a person’s religious or spiritual beliefs are. Does he or she believe in an afterlife? Are they concerned over what is in store for them when their mortal life ends? Are they disillusioned  or angry with God?

Restore and Maintain Balance
It is essential for you, as a caregiver, to leave time for your own introspection and emotional balance. Engage in activities that serve to cleanse toxins and stress from the body and spirit.

Engage the help of others when necessary to de-stress and achieve perspective.

Rest and relaxation are critical in order to prevent “caregiver burnout.”

Raleigh Geriatric Care Management Aging Life Care Professional  www.rgcmgmt.com

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Geriatric Care Manager—>Aging Life Care Professional

WHAT IS AN AGING LIFE CARE PROFESSIONAL?

An Aging Life Care Professional, also known as a geriatric care manager, is a health and human services specialist who acts as a guide and advocate for families who are caring for older relatives or disabled adults. The Aging Life Care Professional is educated and experienced in any of several fields related to aging life care / care management, including, but not limited to nursing, gerontology, social work, or psychology, with a specialized focus on issues related to aging and elder care.

The Aging Life Care Professional assists clients in attaining their maximum functional potential. The individual’s independence is encouraged, while safety and security concerns are also addressed. Aging Life Care Professionals are able to address a broad range of issues related to the well-being of their client. They also have extensive knowledge about the costs, quality, and availability of resources in their communities.

Aging Life Care Professionals become the “coach” and families or clients the “team captain,” giving families the time to focus on relationships rather than the stress. In Raleigh, Durham, and surrounding area, contact Raleigh Geriatric Care Management, an Aging Life Care member.


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What to Do When Parents Must Live Separately: 6 Tips to Help Them Cope

By Dave Singleton, Caring.com author

After decades of living together, one parent needs more care than the other can provide. It’s not only hard on the parents; it’s a devastating situation for children and loved ones, too. You want to help, but you feel helpless in the face of what amounts to a forced separation.

What can you do to ease the trauma and provide support for parents facing this circumstance? Recently, I spoke with two eldercare experts who’ve counseled dozens of families and offer these six practical tips:

  1. Determine in advance how the relationship will continue.

    “Before anyone makes a move, encourage your parents to map out how the marital bond will carry on,” says Mary Koffend, president of Accountable Aging Care Management. Of course, if a parent has dementia or Alzheimer’s, it could be impossible for them to make such a plan. But assuming they can, “if Dad now lives in assisted living, then maybe Mom comes over every day for dinner.” Or perhaps she joins in on a regular activity that they can both enjoy on-site, such as discussions, book clubs, craft sessions, games, gardening, playing cards, or watching television.

  2. Ensure that the facility supports the couple.

    “The key is to promote the couple’s identity as a couple as much as possible, or desirable, for both partners,” says Cheryl Woodson, author of To Survive Caregiving: A Daughter’s Experience, A Doctor’s Advice. “Make sure the facility is convenient for the healthy partner in terms of transportation, access, and schedule.” If transportation to and from the new living facility is an issue, arrange in advance for a loved one or paid caregiver to drive, so that your parents get time together. “Even if it’s brief, at least they talk a bit, kiss good-bye, and off one of them goes,” says Koffend.

  3. Help your parent with feelings of guilt and inadequacy.

    Chances are the parent remaining at home feels tremendous guilt as well as sadness over the separation. “A parent might feel like he’s no longer honoring his wedding vows, or that he isn’t doing enough,” says Koffend. You can be supportive by being the voice that reminds Dad that he’s doing all he can. Give him a dose of what Koffend calls “reality therapy” — in other words, talk him out of wishing for what can no longer be. “Help parents understand the choices they are faced with, and reaffirm that they made the right choices, emotionally and logically,” says Koffend.

  4. Get your parents outside help if needed.

    Sometimes your best efforts might not be enough, and you need to engage outside support. “No matter how cooperative the facility is, no one can understand how bereft these couples may feel,” says Woodson. “Families should encourage the healthy partner to talk to clergy, behavioral health professionals, and/or to participate in support groups with other spouses in similar circumstances.”

  5. Help foster private time, if desired.

    Contrary to popular opinion, the need for intimacy doesn’t end when a separation like this occurs. It might be a little awkward for family members to address (understatement!), but help the couple work through whatever issues might be present in order to get deserved privacy. “For example, if a spouse can’t leave the facility for whatever reason, kids can step in and have a very straightforward conversation with the facility’s administrators about arranging alone-time for the couple,” says Koffend. It’s important to understand the concerns of the facility, which might be liable for falls or health issues that occur under their watch. Koffend cites one example of a wife who brought Viagra to her husband in an assisted living facility, which resulted in him having a strong adverse medical reaction. Address concerns and see if you can set fair boundaries.

  6. Expect the unexpected.

    Finally, “Don’t assume that this transition ends once the initial decision and move are over,” says Koffend. “Be prepared for whatever your parents’ needs are afterward, when there’s sadness or frustration on either side.” For some who’ve spent years caring for a spouse, the transition to living alone can be jarring and rudderless. When primary caretaking is replaced by a facility, you might need to help the parent remaining at home to feel needed and purposeful, whether by encouraging her to see friends or volunteer or simply by facilitating more involvement with her spouse’s new life at the facility. “Help your parent realize they have a practical role in the care and upkeep of their spouse who’s now living in a new place,” says Koffend. “It gives purpose to the visits, even if it’s as simple as bringing a few products and a hairbrush to help maintain physical appearance.”

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Should You Tell a “Fiblet” to a Parent With Dementia?

From our earliest days we are taught never to lie, especially to our mother or father. However, a recent survey of aging experts reveals that telling a “fiblet” can actually be therapeutic when adult children are faced with telling painful truths to aging parents who have a cognitive impairment such as Alzheimer’s disease.

The National Association of Professional Geriatric Care Managers (NAPGCM) recently surveyed 285 professional geriatric care managers about the most common and difficult situations faced by families who are helping aging parents. Geriatric care managers help these families deal with some of the most sensitive and challenging issues.

More than 90 percent of the professional geriatric care managers surveyed said they have used or recommended the “fiblet” strategy to relieve stress and anxiety and protect the self-esteem of an elderly person. The situation cited most by experts in the survey as an appropriate and helpful use of a “fiblet” is when a senior is refusing clearly needed care or assistance at their home. For example, telling an aging parent with Alzheimer’s that a paid caregiver is coming to their home for their spouse’s benefit or for another concrete role can help the elder maintain pride and reduce anxiety.

The following were identified by care managers as situations when it can actually be therapeutic to tell a “fiblet” to an aging parent:

  • When they are refusing needed care and assistance at home. Telling them the caregiver is there for their spouse’s benefit or for another concrete role can help them maintain pride and reduce anxiety (identified by 83 percent of those surveyed).
  • When they can no longer safely drive, yet insist on doing so. Telling them their car is in the shop getting repaired can reduce confrontations (68 percent).
  • When knowing the cost of in-home care prevents them from accepting the needed service (68 percent).
  • When it would only cause worry and stress to tell them about family problems they can’t solve, e.g., unemployment, financial upheaval, divorce, drug abuse, incarceration (64 percent).

According to the National Institutes of Health, as many as 5 million of the 43 million Americans age 65 and older may have Alzheimer’s disease, and another 1.8 million people have some other form of dementia. Americans feel increasingly challenged by the need to communicate difficult information to aging family members with dementia.

“A therapeutic ‘fiblet’ is just that—it is therapeutic because it calms and reassures, reduces anxiety and protects self-esteem,” said NAPGCM President Emily Saltz. She added, “You would use a ‘fiblet’ only with parents who have a cognitive impairment such as Alzheimer’s disease.”

Geriatric Care Managers Share Their Experiences

As part of the survey, geriatric care managers were asked to provide comments about their own experiences in recommending the use of a “fiblet.” A universal theme of the comments was that family members should navigate this clearly delicate area with help from a support group or from an experienced professional care manager. Care managers also stressed that one should only use a “fiblet” to protect and support a family member rather than for personal benefit or gain.

The following are from among more than 200 stories collected through the survey about geriatric care managers’ experiences of using a “fiblet” in the course of their practices:

  • “I’ve used therapeutic ‘fiblets’ in many instances, but probably (most often) when the death of a loved one is beyond a person’s capacity to understand. For example, if a person is looking for a deceased loved one, I tell them that I haven’t seen that person today but when I do, I’ll tell them that the person is looking for them. This serves to validate their experience and provide reassurance that someone cares.”
  • “When an adult son was diagnosed with cancer, the decision was made to not inform his frail, memory-impaired nursing home-bound father of the diagnosis. At the same time, the son increased his visits to his father during treatment, as he had more free time available for visits. The son and father enjoyed more time together without stressing the father with a scary diagnosis.”
  • “A client wanted to see their mother who had passed away many years ago. Instead of telling her that her mother had died and causing her to grieve again, we told her she was out and would return later. She accepted that and went on with her day.”

Source: The National Association of Professional Geriatric Care Managers (NAPGCM). NAPGCM was formed in 1985 to advance dignified care for older adults and their families. Geriatric care managers are professionals who have extensive training and experience working with older people, people with disabilities and families who need assistance with caregiving issues. For more information, visit http://www.caremanager.org. –

Raleigh Geriatric Care Management in Raleigh, NC  www.rgcmgmt.com

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Spouses Who are Caregivers

Family caregivers usually are fulfilled by their choice in life to provide much needed care for a loved one who needs that care.

Often we begin caring for our children and then seem to naturally progress to our parents, grandparents or in-laws who may have entered a phase where some level of care from others is required.

It may be something that begins in a small way, such as bringing them food now and then or helping with things around the house. It can quickly progress to more and more tasks and supervision, all the way up to hands on care.

Sometimes, despite all our care and best efforts, it becomes necessary to transition our loved ones in a facility where they can receive more skilled care than we can provide.

Aging in place is a goal for most of us and our senior loved ones and we as caregivers try to do everything we can possibly do to help them make this dream a reality. We will help them create the right living environment with simple modifications and big renovations or even finding a more appropriate home in which to age in place.

Caregivers’ Challenges

Unfortunately, every day is not always the best day. There will be harder days than others, crises that arise along the way including injury and hospitalization. Let’s not forget the occasional (or all too frequent) disagreement about even the littlest thing that soon gets smoothed over when we remember why we are all together.

Caregiver burnout is a reality that we all face. Getting an extra hand, recognizing that we can’t do it all by ourselves day in and day out, can help. Finding respite when you can and an outlet for your feelings will help you be a caregiver longer and better.

I recently came across an interesting poll that found caregiver stress has increased from an interesting source.

Caregivers Who Are Spouses

The Associated Press – NORC Center for Public Affairs Research recently published the results of a recent poll that asked approximately 1400 family caregivers questions resulting in some surprising answers.

They found that most Americans are counting on their families to provide care for them as they age, as they have been doing themselves for other relatives or friends. Unfortunately, not many of us are planning well for our own long term care. We can readily tell you where and how we want our funeral to happen and probably have already made plans and payments for that but we can’t tell you about our goals for day to day care before that happens.

We can’t talk about what kind of a facility we might consider, where we would want to get help, what our care wishes would be, and more importantly have probably not executed any advance directives stipulating our wishes.

This poll found that eight out of ten people found caregiving to be a positive experience but one that is also extremely difficult.

The most stress is being reported by spouses who are now caregivers — not children providing care to parents or grandparents as might be thought. Spouses did promise to care for each other in sickness and in health but find this promise to be stressful to deliver.

Struggling Spouses

Spouses express the struggle that they experience when their relationship changes from companion to caregiver. They deal with not only stress but anger and frustration. It can be hard when hands-on care over grooming, feeding, wound care and other duties are taken on that were once done by nurses now are their responsibility.

While some spousal caregivers report that their marriage is strengthened by their caregiving commitment, which is a welcome outcome in the face of other stressors, spouses were more likely to report that caregiving weakened their relationship with their partner and placed an added burden on their finances.

It is reported that only about 30 percent of those over 40 who may be likely to care for a loved one in the next five years feel prepared to do so. Spouses tend to be older caregivers than those caring for parents and that could make the caregiving more physically challenging as well. The average age of a spousal caregiver is 67, compared to 58 for those caring for parents.

How to Identify and Overcome Caregiver Stress

If you begin to recognize signs that you are having what could be an overwhelming amount of stress that could be harming your health or ability to care for your spouse then it is time to take action.

  • Recognize signs of stress – being tired all the time, having difficulty sleeping, feeling unappreciated with no one to talk to or care about you, feeling depressed or hopeless, not ever feeling like there is a good day, feeling like your own life is not worth living, being ill yourself, crying often or you begin isolating yourself from others.
  • Begin taking time for yourself – sometimes you need to call someone to give you an hour, an afternoon, a day or a weekend off. There are people you can call, such as family members, volunteers from faith based organizations, organizations, home health agencies or friends. Just being alone, taking a breather, shopping, lunch with a friend, sleeping late or seeing a movie can mean a lot to your personal and emotional well-being.
  • Get a medical checkup – schedule a doctor visit for yourself. Get your preventive health checkup or immunizations to help keep you well. You can’t help others if you are not well.
  • Talk to someone – go to a support group locally or online, talk with a member of the clergy, find a friend, or keep a journal so that you can express your feelings and allow yourself to move on past those feelings.

Being a caregiver whether to your spouse, mother, aunt or grandfather not to mention caring for your own children and household will always cause moments of stress. Remember the importance of what you do every day. You are right where you are supposed to be!

Being able to recognize, though, that burnout might be lurking but you can overcome it in order to be the best caregiver possible is the first step in staying well. One smile is all the thanks you need to provide the love and care your spouse or family member needs.

Raleigh Geriatric Care Management in Raleigh, NC  www.rgcmgmt.com

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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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