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What is an Aging Life Care Professional ™?

We are still the same, but our name has changed to better reflect what we do and who we are. Our national association, formerly known as National Association of Professional Care Managers (NAPGCM), is now  the Aging Life Care Association™ (ALCA) and care managers are now refered to as Aging Life Care Experts™.

Conflicting demands on your heart, time, and energy can make it hard to care for an aging relative. If this sounds familiar, you could benefit from the services of an aging life care expert.

An aging life care expert provides relief. They work with you and your family member to develop a realistic care plan. The goal of the plan is to maximize your loved one’s independence, safety, and quality of life. A solid care plan addresses family resources. This includes making sure you are not called upon to do more than you are able.

An aging life care expert is a guide and an advocate. These experts are typically trained in the health professions or social work. Many have specialties in elder care. They bring to their role an understanding of the

  • local healthcare system;
  • emotional and physical challenges of aging and/or disability;
  • difficulties of adult children juggling work and family;
  • common legal and financial issues that arise in later life;
  • local housing options and other senior or disabled services.

Aging life care experts use a holistic approach. They begin with a thorough assessment of needs and capabilities. They can often resolve uncertainties and dispel family disagreements. Their emotional support may help your loved one come to terms with this new phase of life.

An aging life care expert’s input may save you time and money. After looking at money and other family resources, they can recommend appropriate housing situations. They can identify veteran assistance and other benefits. They can avoid duplication of medical services and potentially catch problems before a crisis blooms. They can also monitor the quality of care.

An aging life care expert works independently as the client’s advocate.They are not paid through referral fees. Nor are they employees of hospitals or insurance companies. In some cases, their services can be reimbursed by long-term care insurance.

If you think you and your loved one could benefit from the services of an aging life care expert, give us a call at Raleigh Geriatric Care Management, 919-803-8025, http://www.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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Is it Elder Abuse?

By Hilary Wright

Abuse isn’t happening just to toddlers and young children, but is becoming more common among the senior citizens in this country. Unable to take care of themselves, they must rely on a professional or family caregiver to help them from day to day. If you have a loved one who must depend on care from someone other than yourself, you may want to know the tell-tale signs of the many forms of abuse that they may be afflicted with. 

Sometimes, an elder may report an incident of physical abuse; however, they often won’t, so you’ll need to look for other behavioral and emotional signs, like depression or withdrawal from family and friends, changes in behavior, i.e., mood swings or appearing frightened and teary eyed. Sometimes, the abusers themselves will give clues to possible abuse by their refusal to take the elder to the doctor when needed, by not allowing family and friends to see the abused person alone, by giving explanations which are found to be inconsistent with the abuse symptoms.  They may have bite marks and scratches themselves, from an elder fighting back.

Signs of physical abuse:

  • Cuts, lacerations, welt marks (a possible sign of using restraints)

  • Burn marks from cigarettes

  • Malnutrition or dehydration

  • Hair loss from someone grabbing/pulling hair

  • Sores on the body, open wounds

  • Weight gain or weight loss

  • Poor skin conditions

  • Unexplained injuries, such as fractures and breaks

  • Bruises, scratches, bite marks, finger prints

  • Frequent trips to the emergency room

  • Black eyes, broken fingernails

  • Over or under medicated

As much as people don’t want to think about it, sexual abuse does occur among the elderly. It’s considered sexual abuse when something happens either without their consent or when an elderly person is incapable of making such a decision on their own. Physical signs of sexual abuse may include:

  • Bruises around the breast or genital area

  • Cuts or lacerations around the breast or genital area

  • Clothes with blood stains or tear marks

  • Soreness around breast, genital, or anal areas

  • Difficulty with walking or sitting

Some older people may report sexual assault, while others may withdraw from family and friends, flinch at certain quick movements, or be frightened by the opposite gender. The abuser will usually have a story that will not match the physical or emotional evidence noted by family members, and they will generally not allow family or friends into the home or to be around the abused person alone.

Not all abuse can be seen with the naked eye. There’s also emotional and psychological abuse that occurs when a person is demeaning and dehumanizing to another person. Psychological and emotional abuse can also make someone withdraw into depression or even deny that anything bad is actually taking place. You may catch the abuser talking down to the person, calling them hurtful names, and begin to withdraw the elder from visiting with family and friends.

Behavioral signs of psychological abuse:

  • Continuously emotionally upset or disturbed

  • Nervous behavior and a repetition to their actions

  • Negative attitude

  • Agitation or anger

  • Rocking back and forth, sucking their thumb, or even biting (themselves or others)

Financial abuse occurs when a caregiver takes advantage of an elderly person financially, either through stealing money, lying about how much the elder needs for certain care, or cashing the elder’s checks without permission.

Signs of financial abuse:

  • Caregiver withholds money from the elder

  • Checks are cashed without permission of the elder

  • Personal belongings begin to disappear

  • Power of Attorney begins to be misused

  • Caregiver isn’t actually providing the services that are needed

  • Elders aren’t taken to the doctor when needed

  • You notice unusual items being charged on a credit card

  • You notice the elderly person requesting a transfer of assets or funds

  • There’s sudden and abrupt changes in a will

  • They are not aware of where all their money has gone

  • Suddenly, they are unable to pay their bills

  • They are unable to buy clothes, food, and other necessities

  • You notice withdrawals of a lot of money at the same time or within the same week

Another form of abuse is neglect and abandonment, occurring when an elderly person isn’t being cared for properly, like not being fed, bathed, or properly medicated.  Ignoring an elder is also considered a form of neglect and abandonment, because the caregiver refuses to give them any sort of care. The signs of neglect and abandonment can sometimes be noticed with a simple inspection of a loved one, where you may see things like untreated sores or bed sores, malnutrition and/or dehydration, unsanitary living conditions, or dirty bed linens and clothes. You may also notice a strong odor coming from a loved one, due to the lack of continual hygiene, or obvious weight loss or weight gain. Sometimes an elder will actually begin begging you for food, or tell you they have some medical or dental need that hasn’t been tended to.

Although it’s no excuse, caregiver abuse, either by a family member or by a professional, often occurs due to caregiver burnout, caregiver stress, substance abuse, emotional and mental issues of their own, economic conditions or living arrangements. This doesn’t mean that all caregivers are abusers, because very few are; but it’s better to be informed and educated for the safety of your loved one. If it’s a family member who is a caregiver for someone disabled or elderly, you can take some preventative measures in order to prevent it from occurring, or to at least notice it at the very earliest stages. Educate yourself on the signs and symptoms of caregiver stress; make sure the caregiver is receiving help from others, so they don’t have to do everything on their own, which can quickly lead to caregiver burnout; and investigate other living arrangements, in order to take an elderly loved one out of a toxic, ultimately unsafe environment. Elderly people don’t have to be a target for others, especially by those who are supposed to care for them. Older people can also take some important steps on their own in order to make sure they remain safe from abuse of all kinds:

  • Don’t live with a family member who is or has been abusive in the past.

  • Speak to friends often, especially when you feel as though you are being taken advantage of.

  • Review your will. If changes are made, be sure it is because you want them to take place, not because of pressure from family members.

  • Have friends and/or neighbors visit you often.

  • Seek legal advice when making decisions.

  • Have your Social Security or pension check deposited directly into your account.

  • Speak directly to your attorney first before signing a Power of Attorney.

  • Don’t sign anything until you’ve read it. If you have difficulty understanding the legal terms, make sure to seek out an attorney and have them explain it to you.

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Older Adults and Alcohol

A national 2008 survey found that about 40 percent of adults ages 65 and older drink alcohol. Older adults can experience a variety of problems from drinking alcohol, especially those who:

• Take certain medications
• Have health problems
• Drink heavily

There are special considerations facing older adults who drink, including:

Increased Sensitivity to Alcohol
Aging can lower the body’s tolerance for alcohol. Older adults generally experience the effects of alcohol more quickly than when they were younger. This puts older adults at higher risks for falls, car crashes, and other unintentional injuries that may result from drinking.

Increased Health Problems
Certain health problems are common in older adults. Heavy drinking can make these problems worse, including:

• Diabetes
• High blood pressure
• Congestive heart failure
• Liver problems
• Osteoporosis
• Memory problems
• Mood disorders

Bad Interactions with Medications
Many prescription and over-the-counter medications, as well as herbal remedies can be dangerous or even deadly when mixed with alcohol. Medications that can interact badly with alcohol include:

• Aspirin
• Acetaminophen
• Cold and allergy medicine
• Cough syrup
• Sleeping pills
• Pain medication
• Anxiety or depression medicine

Drinking Guidelines for Older Adults
Adults over age 65 who are healthy and do not take medications should not have more than:

• 3 drinks on a given day
• 7 drinks in a week

Drinking more than these amounts puts people at risk of serious alcohol problems.

If you have a health problem or take certain medications, you may need to drink less or not at all.

Source: NIH National Institute on Alcohol Abuse and Alcoholism

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Helping Children Understand Alzheimer’s

By  Michael Plontz

Your loved one has been diagnosed with Alzheimer’s.  The first thing you want to do is find out all you can about the disease, and all about what you can do to take care of your loved one.  It’s a bitter pill to swallow, but, at least you’re an adult and you can understand what’s happening.  What about your children?  How can you help them cope?

The way in which Alzheimer’s may affect children has to do largely with their relationship with the person before.  If they are close to the loved one, the mentally debilitating illness could cause fear, anger, sadness, and confusion.  If the loved one is living in the home of the caregiver, it can cause these feelings to intensify.

Fear is usually the first emotion to surface.  From the fear of their grandparent or other loved one arises feelings of anger, guilt, and jealousy.  All of these feelings can lead to sadness and even depression.  Also, feelings of despair and helplessness may result from the loss of the loving relationship between child and loved one.

The best thing you can do for your child or teenager is to be completely honest and keep the lines of communication open.  If children don’t understand, they could act out by doing badly in school or withdrawing or becoming impatient with their loved one.  Physical or psychosomatic ailments such as stomachaches or headaches may manifest themselves as well.  They may have to be reminded several times that Alzheimer’s is a disease, and that the disease is what’s affecting grandma or grandpa.

It is helpful to have answers ready for an inquisitive child’s difficult questions.  The following questions are just the tip of the iceberg, but it’s a start.

Q – Is grandma crazy?

A – No. Alzheimer’s is a disease. Older adults are prone to illnesses that may make them forget things or act differently.

Q – Is it my fault?

A – Certainly not.  If grandma told you that, it is just the disease talking.

Q – Can I, or my mom or dad catch Alzheimer’s disease?

A – Alzheimer’s is not contagious, so, no, you can’t catch it like you would a cold.

Q – What will happen next?

A – Here the parent must judge how much information the child can handle.  The best thing to do is reassure them that you love them mo matter what happens.

With teenagers the questions will probably be a bit more complicated.  They can see things from different perspectives.  The best thing to do is to inquire about how they’re feeling, and what can be done to make them feel better.  Regardless of the age of the child, open communication is the key to success in weathering the Alzheimer’s storm.

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Who’s Most Likely to Feel Caregiver Stress?

~Paula Spencer Scott

Does caregiving actually cause stress? Some surprising new research says no, the real source of the stress lies within the person, not the situation.

After looking at more than 1,200 female caregiving twins, Peter Vitaliano, professor of psychiatry and psychology at the University of Washington, concluded that how stressful caregiving is for you psychologically is more a matter of your genes and your upbringing. Caregiving itself does not cause stress, he says. This new study appears in the Annals of Behavioral Medicine.

Who’s most at risk, according to this research? People who:

  • Have a history of depression. “Like putting salt in a wound,” says Vitaliano.
  • Grew up with parents who showed a lot of avoidance and fear in response to big stressors (like losing a job).
  • Lack resources to help them cope, like social support and finances.

The study also found that caregiving can cause anxiety, which is in turn linked to depression.

This all may sound like splitting hairs. Though this research confirms Vitaliano’s earlier work debunking a causal connection between caregiving and stress, it flies a bit in the face of many, many other studies that link them. There’s even a name for it: caregiver stress syndrome.

This study didn’t specifically look at Alzheimer’s caregiving, whose duration and unique challenges can wear down even the best-adjusted family member. I wonder, would the results look different?

Bottom line: It doesn’t strike me as terribly helpful to be told your stress is the fault of your genes or your family history. If you’re feeling it, you’re feeling it. It’s nobody’s fault — the real question is what to do about it.

File this info in the nice-to-know category. Then go hide in the bathroom for a little deep breathing, a few bites of dark chocolate, and a wish for some respite time to come your way this week.

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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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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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A sibling’s guide to caring for aging parents

BY BONNIE LAWRENCE

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

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

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

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

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

Why sibling tensions can surface as parents need care

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

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

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

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

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

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

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

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

    Working through differences: communication plays a critical role.

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

Tips for gaining the support of your siblings

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

Conflicts over legal, financial and inheritance issues.

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

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

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

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

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