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Friday, January 28, 2011

Home Hospice Care – the Long Goodbye

My first exposure to Home Hospice Care was back in the mid 1980’s when a neighbor of mine abandoned his painful attempts to find a cure for his liver cancer and came home to die.  He was only 59 years old and had been more a father to me than my own had ever been.

He was a fighter in all things and many of us felt betrayed that he had given up his treatment at the cancer center at the University of Houston.  Hospice care was largely unknown back then – it was not allowed as a Medicare benefit until 1986.  It was also largely misunderstood.  I recall a particularly insensitive neighbor speculating that perhaps the family could not afford to allow my friend to die in a hospital.

What he taught us all was that home hospice care allowed people to die surrounded by family and friends instead of doctors and nurses.  A nurse came every day to offer support and monitor the painkillers that allowed him to be aware of what was going on around him without being in intense pain.

What he wanted for all of us was a chance to say goodbye in familiar and warm surroundings.  And so we did.  It was indeed a long goodbye, as hospice care sometimes is but somehow the setting and the community present made it less bitter and far more sweet.

I worked evenings at the time so I was able to visit him during the day.  I had the chance to thank him for all he had done for me and all the many things he taught me.  He thanked me and made me promise to pass it on and continue to do for those I met in my life what he had done for me.  And I have tried my best to fulfill that promise.

Relatives and old friends from around the country came to spend a little time with him.  He lasted for eight days before leaving us all behind.  I was working at the time but no matter as I had already said my goodbyes.

I think back to that long goodbye every time I hear of some friend passing on in a hospital or nursing home.  At first, I wondered why anyone would not choose home hospice care.  Later I learned it was not my place to judge.

Faced with the decision of where my own mother would spend her last days, I had second thoughts.  She was comatose and the hospital told us there was nothing more they could do and we had to look for hospice care for her.

The nursing home she had been in before her final trek to the hospital offered hospice care but it was not a home.  My brother wanted her at his home but for the first time I realized a potential disadvantage of home hospice care.  The room in which your loved one breathes their last remains after they are gone.  I wondered how long it would take my brother and his wife to view the room as what it once had been – a guest room.

We ended up taking her back to the condominium where she was still living by herself at the end. It was another long goodbye as she lasted 10 days.  There is no ideal way to say your last goodbye to a loved one.  But when my time comes, I hope I have the opportunity to be surrounded by those who have been a part of my life for one final long goodbye.

Original Post by ElderCare ABC Blog - December 28, 2010

Wednesday, January 26, 2011

How To Ease An Elderly Parent Into Assisted Living

Senior citizens need positive introduction to overcome resistance.

When confronted with situations we have little control over, we often focus on what we are losing rather than what we are gaining. Sometimes we have to be dragged kicking and screaming to make decisions.
This is especially true as we get older. So it's no surprise when we find our parents resistant to change, which makes it extremely difficult when a big change is needed, such as a move into an assisted living facility.
For many elderly seniors, assisted living offers the best option for a happy, high-quality life–if only they would be open to the possibilities. One of our planners had an 88-year-old grandfather who, like many healthy people his age, was fiercely independent.
"I am not giving up my independence and moving to a prison," he would say of assisted living. What seemed prison-like to him was the sense of loss of independence, the idea of having to eat dinner at a table with others and the thought that this would probably be his last move.
Finally, after falling twice, he moved and absolutely loved his new home. He talked politics every night with the three men who sat at his dinner table. He had his own living room, bedroom furniture, paintings and even his own dishes. He came and went as he pleased. He ended up happy until he passed away in his sleep at age 92.
When the time comes to look for alternative housing and care for your parents, look for an assisted living facility that cares for physical, social and intellectual needs. Ideally, it will offer the following:
--Highly functional, independently mobile residents
--Intellectually interesting activities--not just bingo and seated aerobics but classes like history and foreign language
--Internet capability in each room with tech support
--Restaurant-quality meals
--Comprehensive house cleaning
--Life alert safety systems
--Covered parking or garages
--Storage units on site
Once you find what you believe to be the right place, introduce it to your parent in a positive light. The first impression is vital.
Many adult children make the same mistake our planner did with her elderly father. She dropped by the facility unannounced in the middle of the day. The first thing her father saw was a man sitting by the door just staring out.
"I want nothing to do with this place," her father said. Telling him that the active residents were out doing things did no good.

Here are tips for introducing and elderly parent to an assisted living facility:
--Plan your visit.
--Consider attending a cheery event to present the prospective new home in a positive way.
--Try to find friends or colleagues who can introduce your parent to existing residents.
--Visit when the most active residents will be around.
--Take in a meal in order to participate in the biggest daily social event.
--Consider going for a day or half day to get a better feel for the residents and staff.
--Talk to the resident association president. Ask whether management is responsive, how much rent increases, about the personalities of the other residents and who might make good companions for your parent.
Early resistance aside, many seniors end up very satisfied with assisted living; it offers the best of both worlds in providing residents with the opportunity to spend time alone in their own apartments as well as to socialize daily.
Learn from others' mistakes so your parent never utters the word "prison" about the prospect of such a move but instead associates it with a concert or golf tournament. The right fit can make your parent's final years golden--for both you and your loved one.

Liz Davidson is CEO of Financial Finesse, the leading provider of unbiased financial education for employers nationwide, delivered by on-staff CERTIFIED FINANCIAL PLANNER™ professionals.

Monday, January 17, 2011

The Conversation: What Boomers Don’t Want to Say to Their Aging Parents

I'm worried about my mother. I'm also a little intimidated by her. Anyone out there with me?

She's 81, fit as a fiddle, could run a marathon tomorrow if she had to, routinely beats my 6'3" son at badminton, and takes her daily constitutional at a pace that my 47-year-old husband struggles to match. She hangs her own wallpaper, cleans her own house, and turns her large vegetable garden by herself with a grub hoe. We don't call her every day because she doesn't need to be checked in on -- and she doesn't really appreciate the hovering, thank you very much.

So what's the problem? How about that she weighs 95 pounds, has mild osteoporosis, and is alone for the first time in her life? The next time she gets on a chair to change a lightbulb, if she loses her balance, she could break a hip and be on the floor for days -- which happened to a friend of hers. And then what? Crisis management for all of us who already have lives filled to capacity with obligations -- especially given that she lives in Massachusetts, and I'm in Washington, D.C.

But still I tap dance as long as I can to avoid having what I think of these days as "The Conversation": "Mom, I'm worried about you. We have to come up with a plan."
It's been a challenging couple of years for our family. My father went into decline two years ago and my mother had to become a caregiver in a way she'd never really contemplated. Six months later I was diagnosed with thyroid cancer. A few months after my recovery, my father had a fall that left him unaware that it was Thanksgiving, much less the year 2009. He died six weeks later, two days before Christmas.

On the day of my father's burial, my mother-in-law was diagnosed with stage four ovarian cancer, and my sister-in-law with the same thyroid cancer I'd had a year earlier. My sister-in-law is out of the woods; my mother-in-law is still fighting, and will till the end.

And did I mention that I sold one company, started another, and attempted to do a respectable job of raising three pre-teen kids at the same time?
And we're the lucky ones: in our lives, the young sick people have gotten better and the old people haven't suffered much. But most Americans aren't so lucky.

The process of caring for aging parents who live far away threatens to cripple an already over-tasked boomer population. There are currently 40 million Americans over the age of 65 -- that's roughly 20 percent of our population. Of those, close to 10 million live alone in single family homes, and more than a third report physical limitations preventing them from performing basic activities.

At the same time boomers are stretched thinner than ever before. According to a recent study by Compsych, 34 million Americans provide unpaid care to an elderly relative; 20 percent of American families provide more than 18 hours per week. 80 percent of boomers report high levels of stress in their lives due to caregiving, and half worry that it is affecting their job adversely. Nearly 70 percent missed work in the past year because of caregiving needs.

Aging Americans are running out of options; increasing numbers of them will have to age at home -- with assisted living facilities averaging $200 per day, and home care aids running at $30 per hour, few can afford to do otherwise., The risks and responsibilities associated with the innocuous-sounding "aging in place" are actually enormous. And we, their children, must figure out how to keep them safe.

Meanwhile, the 65-plus population will balloon to 55 million by 2020, while the population of caregivers will stay flat and the cost of assisted living will double. What's our plan, exactly? Just hope our parents stay healthy, independent and clear-headed until they die by painless lightning strike?

The greatest risk to my mother and others in her age group living alone isn't that they'll die; it's that they'll survive with a crippling disability that robs them of the independence they're trying to maintain. A simple fall could cost them everything -- if they're too injured to return home, someone else will pack up their belongings, and find them a new place to live. A place they probably won't like very much. And if it's halfway decent, it's likely a place most of us can't afford.

So we're left with the choice of helping our parents stay at home as they age. It's what they want; it's what we want, and can afford. But first we have to figure out, with them, how they can do so safely. Here's where we get squeamish. "Actually talk to my dad about the fact that his body is weak, he's sort of forgetful? No way," a friend recently said.

To him, I say: Ours is the generation that acquiesced to wearing seatbelts, quitting smoking, and watching our cholesterol intake. Our kids climb into car seats and wear helmets to bike, ski and scooter. So why are we so wimpy about having a conversation with our parents about aging safely? Maybe it's because our parents are so tough, so flinty; after all, they're the same ones who mock strapping our kids into car seats, and turn up their noses at bike helmets.

But it's time to get over it. No one is immune from the effects of aging, whether it's in body or in mind. Not even (gulp) our parents.

In the spirit of new year's resolutions (and sanity preservation) I encourage all boomers with aging parents to have "The Conversation." It doesn't need to be gloom and doom, but it does need to be pragmatic. "Mom, I want you to have everything you want.... and I want you to be safe."

There. That wasn't so hard, was it?

By Liddy Manson, President of Posted: January 10, 2011

Sunday, January 16, 2011

The Complete Eldercare Planner: Free forms to download – Effective Planning

I work full time. How am I supposed to take on family caregiving responsibilities and keep my job, too? Where will the money come from to pay for in-home care? I’m an only child and I can’t possibly do this alone. I live miles away from my aging parents so who can I turn to for help? Why do I feel guilty so much of the time? How do I know if I’m doing the right thing? Most of us are inadequately prepared to face and accept the complex challenges associated with caring for aging parents and other elderly loved ones.

There’s nothing new about the aging process. People in our families are getting older, and so are we. Aging is real, and as long as we start making plans to sustain a quality of life as we age, the better off we’ll be.

Planning, however, takes on a whole new meaning when it comes to caring for aging parents and other family members. Historical family decision-making patterns will no longer apply; the question of “Who’s in charge?” is up for grabs. What was once written in stone regarding family rules and roles will no longer apply. What we can plan on when care issues crop up is the never-ending challenge of responding to changes of all kinds. When it comes to eldercare, family life as we once knew it will never be the same.

My book, The Complete Eldercare Planner (Random House, 2009, Revised and Updated) is your roadmap through this unfamiliar and often unsettling territory and is an invaluable tool as you begin to create your customized family caregiving strategies.

Start the process of eldercare planning by downloading the following documents from Chapter One in The Complete Eldercare Planner:
-Emergency Information Chart
-Decision-making Worksheet
-Eldercare Goals Chart
-Effective Planning Action Checklist

by Joy Loverde
January 13, 2011
Original article