Tuesday, September 28, 2010

Aging at Home or Elsewhere: Helping Aging Parents Make the Right Move

"Picture the scene: parents aren't eating properly, they have deteriorated medically, the bills aren't paid, the mail has piled up, the laundry isn't done, clutter is everywhere."
These are "typical crises" that prompt adult children to "run to put them (their parents) in assisted living prematurely," says J. Donna Sullivan, LCSW, and Director of Older Adult Services for the Scarsdale and Edgemont Family Counseling  Service.  "It's premature," she says, "because their parents could continue to live fairly independently for another 5-6 years if they took advantage of services that are available in almost all communities."
"What I've seen most is the deterioration of older people's health because they're physically not able to get to doctors or dentists or get their hearing aid batteries...There are services to assist them with meals, transportation, with housekeeping--but they're not getting them.  The bills aren't paid and the mail piles up because they can't see well and need new glasses and ultimately it gets to crisis mode.  These older people need care management, not assisted living."
It's common knowledge that most people who can remain in their own homes as they age do better.  Why?
  • Home is an anchor offering comfort and the familiar.
  • Feelings of independence and self-worth remain in tact.
  • The familiar neighborhood often still provides connections with others.
  • The well-known physical structure of the home instills the confidence to move about freely within its walls, contributing to mobility and physical well-being unless stairs are an issue.
This probably means it's in most aging parents' best interest when we can help them remain in their homes as long as possible (and it will no doubt make us happier too).  Thus, we may need to find out more about--then use--some of the new technology featured in the last two posts, as well as older technology like the pendant one pushes in an emergency.
If this doesn't seem doable, your parent's doctor should know the kind of living situation most suitable for your parents; or a social worker or a geriatric care manager can assess your aging parent's situation and make recommendations.
Knowing how important "home" is, raises 3 important questions:
  1. "Is it better to respect parents' wishes about where they live--even if it makes it  more  difficult for us?
  2. "How can we make it work?"
  3. "If we can't make it work, how do we--and our parents--go about finding a suitable living situation elsewhere?
"Elsewhere" will be addressed in this coming Saturday's post.

Sunday, September 26, 2010

Aging Parents--Assisted Living--NO! Home Monitoring Device--YES!

What's it really like when technology "keeps an eye" on aging parents?"
The KAISER HEALTH NEWSLETTER (Aug.24th) peeks in on an independent-living, Savannah, Georgia family's dinner-time experience--aging parents, responsible daughter--as reported by NPR (read below or click link blue link after partner for audio).  Also included are additional, helpful technology sites.              
By Jennifer Ludden, NPR News
AUG 24, 2010
This story comes from our partner logo_npr.jpg
npr_aging_series_three300.jpgEdward and Lavinia Fitzgerald in Savannah, Ga., have dinner while telecaregiver Denise Cady of ResCare, a camera monitoring service, looks on. (Jennifer Ludden/NPR)
Part three in a four-part series
The boomer generation that has grown up with e-mail, cell phones and video cameras is now using all of these things to help care for their aging parents. That's leading to some odd dinnertime scenes, like the one that plays out every evening in the ranch house of Edward and Lavinia Fitzgerald in Savannah, Ga.
They settle at their small kitchen table as their daughter Colleen Henry dishes out the homemade meat loaf, mashed potatoes and green beans that she has brought over. Edward's health is failing now that he's 83, and his wife suffered brain damage from a stroke.
"Here's your ketchup," Colleen says, as she puts the bottle on the table along with the salt shaker.
It could be dinnertime anywhere, but for one thing: There's an extra guest at this meal.
"How's the weather down there?"
That voice comes from a woman who appears on a computer monitor next to the kitchen table.
"Oh, that's Denise," Edward explains. "That's our good friend!"
Actually, Denise Cady is what's called a "telecaregiver," and for two years she has been checking on the Fitzgeralds every evening from Lafayette, Ind. She joins in the mealtime chatter just like a friend who dropped by. Cady asks about the Fitzgeralds' family and neighbors, swaps jokes about the hot weather and chats with Colleen about the meal.
"Oooh, looks good," Cady says. "Are those fresh green beans?"
The scene may not seem so strange in the era of Skype, when many people use the computer to keep in touch with far-flung relatives. But Cady can see almost every move the Fitzgeralds make. Their house is wired with video cameras, like something out of a sci-fi movie, though, at first, you don’t notice it.
Seeing Everything
Edward points out a camera in the kitchen ceiling. It's enclosed in a dark-tinted bubble, but you can hear it swivel when it turns to scan the adjoining living room and dining room.
Another camera monitors who enters the front door. It can pan down a hall to show who goes into the bedroom and bathroom, though it can't see into those rooms. Colleen admits that the idea of video monitoring made her wary at first.
In addition to camera monitoring, companies offer other kinds of services to help keep track of an elderly person's daily activities.
Some use motion sensors to monitor someone's movement around the house, and daily tasks like preparing coffee. If a sensor detects that, say, Grandpa has been in the bathroom too long, a relative can be notified by cell phone or text. Companies that specialize in this kind of monitoring -- such as SimplyHomeQuietCare and BeClose -- provide detailed activity information for loved ones to see on a private website.
Medical alert services like LifeStation and ActiveCare offer emergency help at the push of a button. A similar service offered by Philips Lifeline can also detect falls, instead of relying on the user to push the button.
Still other services like MedMinder and Philips Lifeline's ManageMyPills offer reminders to take medication or, in the case of FineThanx, provide automated daily check-in calls and will alert others when there's no answer.
"I was thinking all sorts of things," she says with a laugh. "My dad sitting around in his underwear. My mother — I just thought these people are going to see everything, you know. And it bothered me."
But after her mom broke her ankle two years ago, Colleen became overwhelmed with the duties of caring for her aging parents. And she worried constantly when she wasn't with them. What if her dad had a heart attack? What if her mom had another stroke?
"The burden's on me if something happened," she says.
Desperate for help, Colleen discovered a new video monitoring service and signed them up. It has turned out to be a huge relief for her dad, as well.
As with many elderly spouses, his wife's condition had thrown Edward into the exhausting role of full-time caregiver. Now, with the cameras on, he gets out of the house for daily mass and a gab session with his buddies at McDonald's.
"We go down there and sit around and talk," he says. "That telephone will ring, and I'm home in five minutes."
Cady or another telecaregiver calls Edward's cell phone if they worry that Lavinia is staying in the bathroom a bit too long. They've called a couple of times when she had fallen and couldn't get back up. They also alert Colleen and even call in the middle of the night if something seems wrong.
"They're diligent," Edward says. "They're on the ball. And I like it."
Zooming In
But what about this hi-tech invasion of Edward's privacy? He says he has no problem with it. He worries more about strangers coming into the house. A home health aide does come to get his wife bathed and dressed every day, and Colleen is grateful the cameras can monitor the quality of that care.
The company that's monitoring the Fitzgerald house is called ResCare. At its offices in Lafayette, Ind., telecaregiver Cady sits before two large computer screens. On one, you can see the Fitzgeralds in Savannah, eating their dinner as Cady chats with them.
There are also thumbnail video images of two-dozen other homes, which Cady will check in with over the course of her shift. If one client signals for help, that image pops up larger. Children of her clients can log into the same video Cady watches and monitor their parents themselves.
This long-distance care isn't cheap. ResCare's services start at $600 a month and can run well over $1,000 depending on how much active monitoring is needed. But that's still a lot less than the average nursing home.
"Primarily the people using this at this time are in the beginning stages of Alzheimer's or dementia," says Nel Taylor of ResCare.
She says a telecaregiver can remind people to take their medication at a certain time. They can alert a relative if someone appears confused or in distress. They can help with the simple tasks of daily life, like the time a client was about to sit down to breakfast.
"The telecaregiver zoomed in on the frying pan and said, 'Maybe you ought to cook the sausage and the eggs a little longer. The eggs look kind of runny and the sausage is pink,' " Taylor says.
A New Paradigm
No doubt, starring in your own daily reality show won't appeal to everyone. But there are all kinds of remote monitoring systems popping up to keep tabs on a fast-aging population. Most use sensors placed around the house and alert children to every mundane detail of their parents' day: when they get in and out of bed, sit on the sofa, open the refrigerator door or turn on the air conditioning. ResCare's Taylor says all of the research and startup companies are driven by this simple equation.
"At the same time that we have this huge population of aging folks, we have a shrinking population of caregivers, of younger people able to provide the care that these older people are going to need," she says. "If we don't find other ways [to do that], then we are really going to be in big trouble in the future."
Back in Savannah, Colleen scoops out some extra banana pudding for her parents as she chats with Cady on the monitor.
"I was going to leave the whole dish, but I thought better of it," Colleen says.
Cady laughs. "It would be gone by tomorrow morning, I'm telling ya!"
Colleen says she assumed video monitoring would help keep her parents healthy and at home. But she had no idea it would also provide her parents with a new friend.
"You see how old people are just lonely," she says. "This makes Momma and Daddy happy."
And Colleen admits that it relieves her own guilt at not being around even more.
As her parents keep talking with Cady, Colleen packs up the dishes, shouts out a goodbye and heads for the door. She leaves her parents for the night, reassured that they're not really alone.
*                   *                   *                       *                    *                     *                       
The new technology helps Colleen's parents to age well in their home.  They retain independence and have another connection to someone.  It also helps Coleen feel less stress.  A win, win.  More Tuesday.

(I'm postponing the intended Aging, Appearance and Fall Fashion until Saturday.)  

Tuesday, September 21, 2010

Help Aging Parents: Veterans Aid and Attendance Pension Benefits Program Revisited

Having money helps when we're trying to help parents age well. "Aging Veterans and their Spouses" (June 1, 2010), focusing on a friend's 90+ year-old mother (a WWI veteran's widow) and the Aid and Attendance Pension benefit, attracted many viewers. 
Next The Wall Street Journal (August 2010) wrote about the Aid and Attendance Pension (called "the pension").

To help aging parents who may qualify, I've selected websites and blogs that can untangle and clarify needed information and help families with aging parents gain new insights into how this program may work for them. Start with my June post (if you haven't read it).  I include links and my annotations from that site as well as other sites and blogs.

Department of Veteran's Affairs Information provides concrete information about the pension:  http://www.vba.va.gov/bln/21/pension/vetpen.htm
In an excellent, comprehensive article, the Wall Street Journal, reports on this being an underused program, with available funds; and provides specific financial information with helpful examples.
http://www.rightathome.net/blog/government-program-pays-family-members/ --an informative, detailed 2009 post about the the pension, spells out everything. But you might skip everything following the recommendation for the "How to Apply for the Veterans Aid and Attendance Pension Benefit" book, either because it's repeated on the following book site or it discusses "Veteran's Benefits Advisors," which carries a cautionary note on the blog and in the Wall Street Journal article.
http://www.longtermcarelink.net/a16Veterans_standard_book.htm --site with the excellent, instructive How to Apply book. Includes testimonial letter from a book purchaser who followed the directions and received the pension benefits within a month.
http://www.underhilllaw.com/veterans-benefits: my friend found this firm helpful with the paperwork. (I don't know if she knew about the How to Apply book.)
For further advice about applying on your own, check out: www.veteransaidbenefit.org, which is illegal to reproduce without permission. So paste the website into your browser, then go to #11 "When the Family Can Submit a Claim Without Help."
Love, sensitivity, caring and a lot of information go into helping parents age well. Obviously extra money, if available, helps too.

Let me know how this works for you and your comments can help others (if comments don't work, e-mail my gmail: helpagingparents@gmail.com).  And/or go to my new site: http://helpparentsagewell.com where posts are more professionally published without problems. 

Saturday, September 18, 2010

Help Aging Parents: Shorter Days=Depression and Doldrums

Six Suggestions to Help Aging Parents Through the Shorter Days of Autumn and the Short, Dark Days of Winter 
Why?  Just as sunshine usually raises our spirits, the arrival of autumn (on Wednesday) with less sun, cooler weather, falling leaves, and ultimately barren trees and dark days has the opposite effect on many.  To help parents age well with a positive attitude, six suggestions follow.

1.  Structure things so aging parents--especially those who are homebound--have daily connections with family and friends (old friends, new friends, your childhood friends who are still in contact with your parents, clergy).  It can help avoid the doldrums or get them out of a "funk."

2.  Arrange for letters, notes, faxes, e-mails (hard copies can be shared with friends and reread), phone calls, Skype to arrive daily.  Fax and e-mail take little time, require no conversation, yet bring stimulation to aging parents along with the knowledge that someone is thinking about them.  (Great for adult children.)

3.  Remember that "carrots," plans to do something at a future date, give aging parents something to think about and look forward to.

4.  Asking advice in a phone call, e-mail etc. doesn't happen so much any more with older people.  To be asked reinforces self-esteem--feelings of being able to contribute, of being needed.

5.  Sharing appropriate personal thoughts and feelings--with or without asking for input--is flattering (enhances self-esteem) and inclusive.

6.   Discussing news and exchanging ideas is stimulating.  And who doesn't like gossip?

The highly regarded 1987 MacArthur Foundation Study of Aging in America (along with other studies) identifies social connectedness as one of the three most important factors in successful aging.  The more people in an aging person's life, the better.

So for older people--especially if they live in the north--there are dreary months ahead and connections with others become even more important.  They provide stimulation.  They help older people combat feelings of isolation, loneliness, and depression.  And that makes our life easier too.  

In addition, an elderly person's feeling that he or she matters--that someone cares--is priceless.  And isn't that a big part of what helping parents age well is all about.
Please visit my .com:  http://helpparentsagewell.com

Tuesday, September 14, 2010

Best Hospital Geriatric Department Visit

Unless it's an emergency, simply deciding to take a major step to help parents age well often takes time.  And once the decision is made, additional time may be necessary before an aging parent receives help.

My July 17th post, "Aging Parents, Best Hospitals, 16 Specialties, 5 Reasons to Consider Them," encouraged at least one adult child to make an appointment at Mt. Sinai, ranked #1 in geriatrics. Her email:

Hi Susan,
Just wanted to let you know that it took a while to get my mother (age 90) an appointment at the Martha Stewart Living Center at Mt. Sinai Hospital but it was well worth the wait.  Her evaluation was quite thorough.  It took over two hours.  Some of her medications were changed; the geriatrician recommended that she start physical therapy again; and consulted with her primary physician.

Today I visited her and asked her how she was feeling
with her new medications.  She said she no longer felt “foggy” and “sleepy” and that this new drug helped the chronic pain she was feeling. What was this drug?  Tylenol! It replaced the potent pain killer she had been taking.  Thank you for bringing this geriatric clinic to my attention.  We go back for a follow-up in a few months.  Karen

PS. She loved the geriatrician who treated her with such respect and interest.  He paid attention to everything she said, did not rush and really treated her like a person. It was so wonderful for me to see her treated so well.

Dear Karen,
Thank you for sharing your--and your mother's--experience.  It sounds like it may often be necessary to wait for an appointment. That's helpful to know. And it's wonderful to know that your elderly mother is feeling alert, has less pain and "loved" the geriatrician.  Susan
*                 *                   *                    *                      *
Because many caring children with aging parents are on fast forward and overload, it's understandable that we put off initiating certain things that may help our parents--until it's a crisis.  It sounds like Karen didn't wait for a crisis.  So like Karen, we may save our parents discomfort and ourselves precious time if we just "do it."

Visit my .com site at: http://helpparentsagewell.com

Saturday, September 11, 2010

Help Aging Parents With More Checklists

Last Saturday's post provided a checklist list to answer Pat's question about where to find aging parents' important information. Her parents were very elderly, still took trips, so I assume she was thinking about one of the "what ifs" we all think about when we try to help parents age well: "What If Something Happens While They're Away?"....a list equally appropriate for far-away-living children who feel/have major responsibility for helping their aging parents.
That said, there are many checklists you can Google, focusing on elderly care, end-of-life planning, financial planning, home safety, legal, problems to look for, questions to ask doctors, what to look for in assisted living arrangements... to name some.
The checklist from last Saturday plus the ones below provide comprehensive information for us as we try to do our best to help relatively healthy, independent-living, aging parents age well. (FYI--Interestingly, my last Saturday's checklist is the only one I've found that mentions "computer passwords" and "PINS.")
I particularly like the two sites below.  Upon clicking the 2nd site, you will be asked to click "plain html," after which the document will appear-- initially the documents on both sites begin somewhat far down on the screen.
Caring for an Aging Parent Checklist (Henderson Group) is on the first Google page for "help aging parents checklist."

Tuesday, September 7, 2010

Aging Parents, Adult Children: Control and End-of-Life Issues (scroll down, you'll find the post)

The "12 Things Children of Aging Parents Should Know" post, assumes parents feel able to give up some control. It also assumes discussing wills and things pertaining to end of life will help aging parents and their adult children because of the practicality, even if it's not pleasant.
Part of the aging process involves a lessening of control that's out of an older person's control.  But older people can keep a significant amount of control if they make the effort. Thus, not divulging PINs and where bank accounts, valuables etc. are kept may be a matter of not wanting to relinquish control.
For some, discussing anything pertaining to their mortality is off-limits. Period.  (No problem. We give a solution at the end of this post.)  But isn't it interesting that, in an era when so many subjects are freely discussed, end-of-life issues remain awkward--even taboo--for many in both generations.
Our senior advisor, psychiatrist Dr. Bud, explains: "It can be superstition--fear that talking about end-of-life issues can put a hex, cast a spell, or cause something to happen.  Some shun this kind of conversation also because it stirs up fear of death."
Adult children, not their aging parents, may stonewall attempts to talk about planning for the last stage of life. They don't want to think about their parents dying. They can be in denial about the predictability of death, resist anything that hints at parents' death--even to the point that they don't want to accept a special heirloom-type gift or piece of art that elderly parents want to give their children to enjoy during their lifetime.
To help parents age well throughout the lifespan using the information listed in the "12 Things" post will save caring children time and stress.  If the information is not forthcoming during a parent's lifetime, however, our senior advisor attorney suggests that parents write a letter, explaining the location of those 12 important things.
The letter's envelope stating "Not to be opened until my death" should be kept with other important documents. There's the solution.
Although not as helpful as having the information while parents are living, such a letter will help aging parents ultimately make their children's lives easier; and will help adult children to better carry out their parents' wishes.

Please go to my new site: http://helpparentsagewell.com. Same blog, more information
and the spacing works.  The spacing here is not fixable.  I will soon be moving to the .com blog for good.

Saturday, September 4, 2010

12 Important Pieces of Information Children of Aging Parents Should Have

Pat writes: Is there a list somewhere of all the important information you should have as your parents age?  Like where they keep their will, where the household papers are, etc. Thanks.
Dear Pat,
The list below highlights 12 important pieces of information children of aging parents should have when trying to help parents age well. Some may be immediately useful; some helps in emergencies, and some enables an easier transition at the end of life.

This list was compiled with the help of my senior advisors including an attorney and 86-year-old Arline, since I know of no existing list. It should save a great deal of stress at critical times when trying to help aging parents.

Specifically children should know:
 1.  Where legal documents: power of attorney, health care proxy, living will, and will are kept.  Our senior advisor attorney points out the lawyer--as well as parents-- should have these documents. He explains that if parents have used a lawyer who's in a law firm, that firm should have copies of the documents whether or not the lawyer who drew them up is still there. An individual practicing lawyer may have moved around and could be harder to locate. Then ditto for the documents.
 2.  Location of bank account(s)
 3.  Location of safety deposit box(es) and key(s)
 4. Location of other keys
 5.  Hiding place of any valuables
 6.  Names/phone #'s,/ fax #'s of significant professionals: attorney, physician(s), financial advisor, parents' close friends as well as people who help in a variety of ways (ie. cleaning person, companion). Our attorney points out that hospitals, for example, accept faxes of powers of attorney, health care proxies etc., if a scanner is not practical and you don't bring the document in on your own.
 7.  PIN and Passwords in order to communicate with any company that requires them in order to communicate with you (think bills, Medicare).
 8.  Where computer passwords are kept
 9.  Where checkbook and bills are kept
10. Medication list--up-to-date (Tuesday's post). Note: a reader e-mailed "A very good idea about laminating your meds.  Every time I go to a doctor's office, they always ask me for my meds and dosages and I'll be damned if I can remember…."
11.  Veterinarian (should pet need care or boarding).
12.  Parents' wishes regarding end of life (funeral, final resting place)
*                            *                           *                         *                          *
We can help aging parents and make it easier for ourselves when we have these 12 key pieces of information.

And thank you, Pat, for asking for a list!
Go to my new site: http://helpparentsagewell.com.  Same post, additional information and resources.