Saturday, July 3, 2010
Thursday, April 22, 2010
What's YOUR Plan?
Yesterday I heard an interview on NPR's Talk of the Nation with Amy Dickinson a syndicated Columnist for the Chicago Tribune (Ask Amy). The topic was How to Talk to Your Parents About Assisted Living. In the course of the conversation she said that she and her sister had a plan. Their plan was that no one in their family would ever get old or frail. I had to laugh.
How many of us have had the same exact plan? And how many of you still do? It's a wonderful plan.....until the crisis hits and it all falls apart in a matter of nano-seconds right before your very eyes.
If we could all be healthy and strong and age gracefully and just go to sleep one night and not wake up. we would never be a burden, never have to lose our independence, never have to rely on someone else to help us with each and every one of our ADLs. But that happens once in a million.
The reality is that you can have this as your plan, but you've got to have a Plan B for when it all falls apart. It's kind of like dreading having the sex talk with your kids. It's something you MUST do and the sooner you get to it, the easier things will be for the next one. Because it doesn't end with just one talk. Neither does dealing with your aging parents.
Getting started talking is the hard part, from there it will get easier even if they are the most stubborn and resistant people on the face of the earth! Plan a family gathering and plot with your siblings, children and other significant helpers to make it about talking to Mom and Dad. And if you can do it long before it becomes a reality.... you'll have some ideas of what will work and what's going to be impossible. Heck, they might even surprise you....
Refer to Chapter 2 in my book, The Everything Guide to Caring for Aging Parents, for some hints about how to get started, and how to see things from their side first.
Don't put it off.... start making a plan today.
How many of us have had the same exact plan? And how many of you still do? It's a wonderful plan.....until the crisis hits and it all falls apart in a matter of nano-seconds right before your very eyes.
If we could all be healthy and strong and age gracefully and just go to sleep one night and not wake up. we would never be a burden, never have to lose our independence, never have to rely on someone else to help us with each and every one of our ADLs. But that happens once in a million.
The reality is that you can have this as your plan, but you've got to have a Plan B for when it all falls apart. It's kind of like dreading having the sex talk with your kids. It's something you MUST do and the sooner you get to it, the easier things will be for the next one. Because it doesn't end with just one talk. Neither does dealing with your aging parents.
Getting started talking is the hard part, from there it will get easier even if they are the most stubborn and resistant people on the face of the earth! Plan a family gathering and plot with your siblings, children and other significant helpers to make it about talking to Mom and Dad. And if you can do it long before it becomes a reality.... you'll have some ideas of what will work and what's going to be impossible. Heck, they might even surprise you....
Refer to Chapter 2 in my book, The Everything Guide to Caring for Aging Parents, for some hints about how to get started, and how to see things from their side first.
Don't put it off.... start making a plan today.
Thursday, April 15, 2010
Caregiving When You Just Want to Run...
It’s one thing when you have a loving relationship with your elder, or at least get along with them. But what happens when you’re faced with having to face the cruel reality of caring for an aging parent who was an alcoholic or substance abuser, or an absent or abusive parent?
There are legal systems in place to assist you with this process. You can make your parent a ward of the court and grant the court guardianship or conservatorship over your elder so they can take charge in matters necessitating decisions that your elder is no longer capable of making. However, be aware that there can be some issues such as decisions about end-of-life care (i.e. Advanced Directives and a DNR) that the court will not make and in some cases may not be able to honor. This will vary from state to state.
If your parent has developed dementia, you may find that they are a very different person; perhaps much more mellow and even kind. If placed in an environment where substances are no longer accessible, the substance abusers will become sober. This doesn’t change or wipe away the memories, but it can make the situation more workable and less stressful for you.
One thing to understand is that whoever your parent was before, the person that the facility will come to know, and perhaps love, is a very different person. This is true for those who have had loving relationships with their parents or elders as well.
The son or daughter who can stand back and let their parent have a happy last few months or years in a setting where their past doesn’t count deserve recognition for their efforts. In hospice, we see this far more often than one might think. In offering support and condolences at the passing of the loved one, we’re quick to say that memories will comfort you, but in these cases it just isn’t so. Yet acknowledging the fact that they were able to make this possible for their parent should be valued. It’s not easy for any of us.
Resources:
www.seniorlegalhotline.org/pdf/conserv.pdf
www.expertlaw.com/library/estate.../conservatorship.html
There are legal systems in place to assist you with this process. You can make your parent a ward of the court and grant the court guardianship or conservatorship over your elder so they can take charge in matters necessitating decisions that your elder is no longer capable of making. However, be aware that there can be some issues such as decisions about end-of-life care (i.e. Advanced Directives and a DNR) that the court will not make and in some cases may not be able to honor. This will vary from state to state.
If your parent has developed dementia, you may find that they are a very different person; perhaps much more mellow and even kind. If placed in an environment where substances are no longer accessible, the substance abusers will become sober. This doesn’t change or wipe away the memories, but it can make the situation more workable and less stressful for you.
One thing to understand is that whoever your parent was before, the person that the facility will come to know, and perhaps love, is a very different person. This is true for those who have had loving relationships with their parents or elders as well.
The son or daughter who can stand back and let their parent have a happy last few months or years in a setting where their past doesn’t count deserve recognition for their efforts. In hospice, we see this far more often than one might think. In offering support and condolences at the passing of the loved one, we’re quick to say that memories will comfort you, but in these cases it just isn’t so. Yet acknowledging the fact that they were able to make this possible for their parent should be valued. It’s not easy for any of us.
Resources:
www.seniorlegalhotline.org/pdf/conserv.pdf
www.expertlaw.com/library/estate.../conservatorship.html
Sunday, February 28, 2010
Why the Obsession with the Bowels?!
Does every conversation with your elders involve the state of their bowels? Listen in on the conversations with their friends and you'll find out more than you ever wanted to know about them as well.
Why oh why do they obsess? And then they eat too many prunes or take to many laxatives and end up with diarrhea! They need to understand that as they age and the body slows down, so will the everyday functions. They may not need to go every day and they can cause more problems than good with the laxatives. Fiber can turn to cement if they don't drink liquids. Read more...
I also have a discussion about this issue in my book.... The Everything Guide to Caring for Aging Parents.... click on the link in the sidebar to purchase a copy.
Saturday, February 13, 2010
Happy Valentines Day & Chinese New Year's
Wishing all of you a very Happy Valentine's Day! Feb. 14th this year also marks the beginning of the fifteen day Chinese New Year celebration. It's the Year of the Tiger now. Enjoy!
Thursday, February 4, 2010
Hospice Care for Alzheimer's and Dementia Patients
Did you know that your elder with Alzheimer's or other specific end-stage dementia could qualify for hospice care? Medicare has established hospice guidelines for end-of-life care for patients who have entered a terminal phase of dementia or any other terminal disease.
In the last and most challenging stages of dementia, caregivers can get support through hospice. It is paid through Medicare, as well as most private health insurances for those under 65 who qualify. Intermittent visits from nurses, hospice physicians, health aides, medical social workers, spiritual counselors and trained volunteers can help to reduce the burden of care giving. However, hospice is not meant to be a caregiver substitute.
If your elder has shown a decline in health status such as 10% weight loss in the last six months, is now dependent in at least 2-3 ADLs (the more the better), cannot converse effectively (speaks less than 6 words), is incontinent of urine and stool, and in the last 6 mos. has had a severe health issue such as an infection (urinary sepsis, aspiration pneumonia), stage III or IV bedsores, has lost greater than 10% of their normal body weight, or has had an exacerbation of a co-morbid illness, or recent hospitalization for Urinary Sepsis or Pneumonia, they may qualify for hospice care. Note that Alzheimer's can take 10 years to reach the terminal stage and hospice care is designed solely for the end stage.
The primary care physician has to certify that they have 6 months or less to live. (They can live past six months and as long as they don't show improvement, but rather continue to decline at a slow and steady rate, they will most likely qualify to continue hospice care until they pass away. Please note that some patients will improve substantially under hospice care and be discharged until they once again have a true terminal trajectory.)
Hospice care can help to palliatively control and help prevent issues such as hallucinations and behavior problems like "sundowners," calling out, or yelling at night, and infections from such sources such as the bladder, skin breakdown, incontinence, and aspiration. Any pain and respiratory distress can also be controlled to make for an improved quality of life and peaceful passing. The earlier the hospice can get involved during the end stages, the better the chances for controlling these issues.
Although end-stage dementia patients will most likely not benefit from most of the emotional and spiritual support that hospice can provide, the caregivers and family members should be able to enjoy this benefit at the time when they can be in the most need of this support.
The hospice agency can assess and help determine if your loved one is eligible for hospice care. An order for a hospice evaluation is needed from the primary care physician. If your loved one is not quite yet eligible for hospice care, the hospice may be able refer to home health or to palliative care until they do meet criteria.
If your loved one is on a managed Medicare aka Medicare Advantage program, they will revert to regular Medicare for the hospice care. If they need medical care for a non-hospice related issue, the managed care remains in effect for this treatment. The hospice agency can explain this.
Don't overlook this valuable resource option. Talk to the physician and arrange for a hospice evaluation. Find an accredited hospice through the National Association for Home Care and Hospice (NAHC) or the National Hospice and Palliative Care Organization (NHPCO).
In the last and most challenging stages of dementia, caregivers can get support through hospice. It is paid through Medicare, as well as most private health insurances for those under 65 who qualify. Intermittent visits from nurses, hospice physicians, health aides, medical social workers, spiritual counselors and trained volunteers can help to reduce the burden of care giving. However, hospice is not meant to be a caregiver substitute.
If your elder has shown a decline in health status such as 10% weight loss in the last six months, is now dependent in at least 2-3 ADLs (the more the better), cannot converse effectively (speaks less than 6 words), is incontinent of urine and stool, and in the last 6 mos. has had a severe health issue such as an infection (urinary sepsis, aspiration pneumonia), stage III or IV bedsores, has lost greater than 10% of their normal body weight, or has had an exacerbation of a co-morbid illness, or recent hospitalization for Urinary Sepsis or Pneumonia, they may qualify for hospice care. Note that Alzheimer's can take 10 years to reach the terminal stage and hospice care is designed solely for the end stage.
The primary care physician has to certify that they have 6 months or less to live. (They can live past six months and as long as they don't show improvement, but rather continue to decline at a slow and steady rate, they will most likely qualify to continue hospice care until they pass away. Please note that some patients will improve substantially under hospice care and be discharged until they once again have a true terminal trajectory.)
Hospice care can help to palliatively control and help prevent issues such as hallucinations and behavior problems like "sundowners," calling out, or yelling at night, and infections from such sources such as the bladder, skin breakdown, incontinence, and aspiration. Any pain and respiratory distress can also be controlled to make for an improved quality of life and peaceful passing. The earlier the hospice can get involved during the end stages, the better the chances for controlling these issues.
Although end-stage dementia patients will most likely not benefit from most of the emotional and spiritual support that hospice can provide, the caregivers and family members should be able to enjoy this benefit at the time when they can be in the most need of this support.
The hospice agency can assess and help determine if your loved one is eligible for hospice care. An order for a hospice evaluation is needed from the primary care physician. If your loved one is not quite yet eligible for hospice care, the hospice may be able refer to home health or to palliative care until they do meet criteria.
If your loved one is on a managed Medicare aka Medicare Advantage program, they will revert to regular Medicare for the hospice care. If they need medical care for a non-hospice related issue, the managed care remains in effect for this treatment. The hospice agency can explain this.
Don't overlook this valuable resource option. Talk to the physician and arrange for a hospice evaluation. Find an accredited hospice through the National Association for Home Care and Hospice (NAHC) or the National Hospice and Palliative Care Organization (NHPCO).
Friday, January 29, 2010
Is it Time to Consider Hospice?
When your aging parent reaches a point at which he/she seems to be declining and not able to bounce back, it may be time to consider palliative care. Perhaps hospice is an option. Talk with the primary care practitioner and see if a hospice eval can be arranged. Hospice care can help all of you ease into the next phase and maintain a good quality of life and eventually achieve a peaceful passing for your loved one, with dignity and without pain or discomfort.
If your elder doesn't yet meet hospice criteria, the hospice nurse may be able to recommend other options such as home health care. Perhaps some PT to strengthen muscles and increase safety would be advised, or an OT eval for some assistance with energy conservation techniques.
If your elder doesn't yet meet hospice criteria, the hospice nurse may be able to recommend other options such as home health care. Perhaps some PT to strengthen muscles and increase safety would be advised, or an OT eval for some assistance with energy conservation techniques.
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