Four Generations, Four Days

Four Generations, Four Days

If there is a singular human being who is responsible for priming me to become a gerontologist, it is my maternal Gramma—Jewell Cochran. My Gramma comes from poor, scrappy folk. No one knew who her father was and she grew up without much stability. After her teenage mother abandoned her she was fostered by various family members until in her late teens she left her people in the Yakima Valley to move to Southern Oregon, where she found a job as a waitress. She met my grandfather, Preston Gustav Hotz, a much older man who frequented the café where she worked.

This grandpa is a pivotal character is my family history as he changed Jewell’s lot in life in many ways, and thus, two generations later, mine. At the time he met my Gramma, he was training to become a geologist, and she yearned to become his assistant, as well as his partner. In fact, they spent much of their life, along with my mother and her two siblings, exploring in a little Airstream trailer the Western United States, surveying and mapping the Great Salt Lake, Mt. Shasta, the Klamath Basin.

My small, strong, stubborn Gramma spent most of her life dreaming on behalf of others – sometimes even living vicariously through others. Her life was never quite big enough for her, so she tried her hardest to create bigger lives for the rest of us. I was the first person on either side of my family to pursue college besides my grandpa the geologist, and I owe this to my Gramma, as she planted the notion in me like a dormant seed for some new kind of plant, and she protected me the best she could from the harsh conditions of my immediate family so that strange seed in me might grow. (When I was in college and graduate school, I would send the materials for each of my courses to my Gramma—syllabi and reading lists, even books, and copies of the papers I was writing – so that she could follow my journey, think along with me, see how her work on my behalf was amounting to something.)

Recently I saw my Gramma Jewell—This past July, my 13-year-old daughter Isobel and I traveled to Spokane to fulfill a recently made promise to reunite, at least one time per year, with the women on my mom’s side of the family. It was a short, intense trip—there are four generations of us now, and many of us have fraught, complicated relationships, we carry difficult family history around with us in our bodies; we are all so much the same, and so very different in so many ways. Finally after all of these years, the adult women among us are more realistic about how much time we can live under the same roof together—four days is about right. Four generations; four days! Our four generations includes my 87-year-old Gramma Jewell, my 62-year-old mother Susan, 59-year-old aunt Martha, 42-year-old me, 32-year-old cousin Rachel, 13-year-old Isobel, 3-year-old second cousin Samantha (who sometimes demands to be called Sophie), and her 10-month-old sister Emily.

My Gramma has lived with my aunt and her family ever since my grandfather died of Alzheimer’s a few years back; soon after he died, she started having a series of small strokes. Whereas she used to divide her awake time as an old woman between taking long walks, writing letters, helping with chores, and reading, now she spends most of her time sitting in her recliner reading large print books and observing the activities unfolding around her; her lucidity is ever-shifting, so it is of benefit to sit quietly beside her for long stretches of time so you don’t miss one of her insightful questions or statements.

The first night of our visit, I crawled into bed beside her. She asked me a series of questions to confirm that what she was remembering about me was in fact accurate—which of “her girls” I am, where I live, what I do. She got all the details correct. She was a little confused by my daughter, whom she hadn’t seen for a year and who has undergone a teenage-transformation. While I snuggled-down in bed with my Gramma, she on her back, I on my right side with my arms and legs embracing her and my body curled around her, eventually she cast her mind into the remote past, when she was a girl picking apples on an orchard; when she was a young married woman and mother, raising small children and helping my grandpa with his work. She was luminous there beside me, in her flannel pajamas, her teeth and face freshly washed, her hair cut exactly like mine but completely silver. The smell and feel of her skin – like a soft, almost over-ripe peach – started to unwind tight little tangled balls of my own memories. I had temporal distortion—Isobel had changed so much in the past year; I certainly felt time working on me; but my Gramma seemed suspended in time.

So, why do I tell you these stories from my life? What relevance do they have for our work as gerontologists, for our own aging journies? These stories foreground relationships, specifically how who we become as we travel through the life course happens in the context of the web of relationships of which we are a part – together we dream, grow, fight, get stuck, care, misunderstand, and try again. These stories also speak to the tremendous capacity we humans have throughout the life course for transformation, for thinking new thoughts alongside old thoughts, for trying out new ways of being alongside old ways of being.

We all have our own version of these stories.

For the past couple of months, post-family reunion, I’ve been reflecting upon how I’ve had some movement in my ways of being in the world and relating to the women in my family – it feels like a miracle, especially as I wasn’t expecting it, worried I didn’t have the capacity, though I have hoped. Since the trip, I’ve been asking questions such as: From where do these glimmers of new patterns of thought come? Are they the inevitable fruits of being worked on by life for a few decades? My provisional answers are: Perhaps, probably, in part, but something else needs to happen – we know this from our own experiences and it is supported by scholarship on development and learning in adulthood, psychotherapeutic perspectives, as well as centuries of insights on spiritual practice – to experience deep development and change, we must in some way accept what life gives us and, like alchemists, take it through some sustained, ongoing process of intentional reflection that causes it to transform into the source of new thoughts and actions.

This is quite powerful, yes? You see — We have the capacity to take our own selves as the objects of our inquiry; we can ask questions, we can refine our questions about ourselves as we accumulate more experiences. If we are fortunate, we have people in our lives who love us, who figuratively or for real crawl into bed next to us or sit beside us waiting until we say something meaningful; they reflect our best selves back to us.

Article Provided by:
Jenny Sasser, Ph.D.
Chair, Department of Human Sciences, 
Marylhurst University
President, Oregon Gerontological Association (2008-2010)

Answers For Medicaid

Answers To Common Medicaid Questions

Q: Medicare paid for Dad’s hospital after his stroke. Won’t Medicare pay for nursing home, too? 

A:  No. Medicare and Medicaid are two different programs. Medicaid may pay for long term care if your dad qualifies. Medicaid rules are complicated and change over time.

Q: Mom can’t take care of Dad at home anymore. To qualify for Medicaid, will they have to sell their house and spend down all their investments?

A: Your parents residence is exempt, so they can keep the house. Depending on the value of their investments, your parents may have to “spend down” some assets. They can spend down “dumb” or they can spend down “smart.”  With help from an experienced elder lawyer, they can spend down “smart” or even avoid a spend down entirely.

Q: Will Medicaid take my parents’ house or put a lien on it?

A: No. Medicaid does not put a lien on the house. However, Medicaid may make a claim against your Dad’s estate for payback after he passes away.  An experienced elder lawyer may help your parents with legal ways to avoid a claim entirely or at least delay the claim until after your Mom passes away.

Q: Is it legal for Mom and Dad to retitle or transfer their property to me so they will qualify for Medicaid?

A: Actually, it is perfectly legal, but it must be done very carefully, because Medicaid recipients will face a “period of ineligibility” based on the timing and the amount of the gift.  There is a 5 year “look back” that applies in ways you may not expect. Don’t try this at home.

Q: Mom and Dad had their wills done years ago. Is there anything else they should do to plan ahead for long term care?

A: Yes. Here is their homework assignment:

  • Get a durable power of attorney from an experienced elder lawyer so Mom and Dad can legally sign documents for each other. For transactions to obtain Medicaid eligibility down the road, special provisions are required. A cheap power of attorney from the stationery store may be “legal,” but it may not work.
  • Get an advance directive so Mom and Dad can legally make end-of-life health care decisions for each other.
  • Consider long term care insurance.
  • Plan ahead with an experienced elder lawyer to preserve their assets for their care.

Article Provided by:
Tom Pixton, The Pixton Law Firm
(503) 968-2020
www.PixtonLaw.com

Costly Misconceptions

Costly Misconceptions: Most People Mistakenly Believe Long-Term Care is Covered

Have you failed to get insurance for long term care in a nursing home because you think you already have coverage? If so, you’re like a lot of other people, according to a Roper survey of Americans 45 years of age and over, recently released by the American Society on Aging (ASA).
That misconception can become costly when you consider long-term care in a nursing home currently averages $56,000i a year, according to the US Government, and is expected to quadruple by 2030ii. People could easily find their assets depleted, their choices limited and their independence gone if they need long-term care but have made no plans to pay for it.

And chances are good they will need long-term care. Statistics released by the Health Insurance Association of America say that after age 65, Americans have more than a 70 percent chance of needing some form of long-term care, whether it’s an aide coming to their home, a stay in an assisted care facility or an extended stay in a nursing home.iii Younger people may also need long-term care if they’ve had a stroke, for example, or been in an accident.
“This survey confirms that Americans need to wake-up to the realities of long-term care,” said Jim Emerman, senior vice president of the ASA. “All it takes is a phone call to a financial services professional to find out the truth behind the misconceptions so many have about long-term care.”

Some of the common misconceptions uncovered in the Roper study are below:

  • Forty-two percent were not aware
  • Medicare only covers long-term care expenses for a short time, and only after someone is released from the hospital.
  • Thirty percent were not aware Medicaid coverage for long-term care is only available after someone’s financial resources are exhausted.
  • Almost half (46 percent) are under the impression their health insurance will automatically cover long-term care.

It’s dangerous to assume you’re covered for long-term care. When the need for a nursing home stay or other long-term care arises, you may discover you’re not covered and have waited too long to buy insurance. Long-term care insurance is an important part of a financial plan.I urge people to speak with a financial services professional about their need for long-term care insurance now, before it’s too late to get coverage

Article Provided by:
Kareen Mills, State Farm® agent
(360) 944-6677
kareenmills.com

Oral Hygiene: A Simple Step to Better Health

Oral Hygiene: A Simple Step to Better Health

As our bodies age they become more prone to systemic disease such as pneumonia, diabetes, and heart disease. One simple way to help reduce the risk of these diseases is to keep our mouths clean and healthy. Our mouths are the perfect location for germs and infections to dwell. In fact, studies show that germs and infections that start in our mouths can quickly lead to systemic diseases.  Quite simply, a healthy mouth leads to a healthy lifestyle.

One way to make sure your mouth is clean and healthy is regular visits to your dentist for checkups and cleanings.  Regular dental hygiene services may:

  • Enhance oral health and prevent tooth loss
  • Minimize the effects of gum disease
  • Provide routine checks for early stages of oral cancer
  • Protect physical health and increase quality of life

For some seniors, though, a trip to the dentist can be a difficult task. Arranging transportation, long waiting times, and anxiety over the dental work itself all lead to many seniors living below their lifestyle potential.  This is especially true for those who either have difficulty leaving their homes or need assistance to make it to an appointment.

To overcome these obstacles, the Oregon Board of Dentistry had made available an advanced dental hygiene license called a Limited Access Permit (LAP).  The Limited Access Permit opens up doors for patients to receive the oral care they need without leaving their home.  If you or your loved ones require assistance to visit a dentist, you qualify for this in-home dental hygiene service.

Using the tools found in a typical dental office, a fully licensed LAP can provide the following services in your home:

  • Oral exam, including oral cancer screening
  • Basic and deeper cleaning
  • Fluoride treatment
  • Denture / Partial cleaning
  • Soft Reline (temporary adjustment) of dentures

It’s never too late for a healthy mouth and a healthy lifestyle! Contact your health provider or home care service today to find out if they offer in-home dental hygiene services.

Article Provided by:
Laura Jaussi, RDH, LAP
Adeo In Home Care
www.AdeoHomeCare.com

Laura Jaussi, RDH, LAP. is the Director of Dental Services for Adeo In Home Care.  She has over 13 years dental hygiene experience and has developed programs to bridge dental care services with in-home care.

Eating Well, Aging Well

Eating Well, Aging Well

Did you know that your biological age may be older than your chronological age?  Someone of 68 may have a health age of 80 if the diet lacks key nutrients.   Add foods that replace missing vitamins and minerals to slow down the aging process.  Here are five nutrients and their sources that help increase vitality, plus a recommendation to reduce salt.

  1. Water – sometimes called the “Forgotten Nutrient,” water helps to move oxygen and minerals throughout your body and eliminate waste products. Drinking water is like taking a shower under your skin. Add just two 8-ounce glasses more than you normally do.
  2. Vitamin D – the true “Sunshine Vitamin” comes from the sun’s effect on our skin!  Non-burning sun exposure is valuable, but without sunshine you may need supplemental Vitamin D.  Vitamin D keeps bones strong, with calcium and magnesium, and can reduce inflammation in the heart and joints.  Milk is usually fortified with vitamin D.
  3. Magnesium – helps bone health, improves immunity, and regulates muscle and heart function.  Its main dietary sources include beans, peas, pumpkin seeds, almonds, and leafy green vegetables.
  4. Vitamin C – assists the immune system, builds connective tissue to support bones, skin, and muscles, and also increases iron absorption. Good sources include red peppers, oranges, strawberries, and broccoli.  Vitamin C is easily lost after picking, so the fresher, the better!
  5. Fiber – which comes from plants, holds water, improves bowel function, and decreases the risk of heart disease and Type 2 diabetes.  The best sources are legumes, whole grains, berries, apples, and flax seed meal. Ten grams a day is average, 25-30 grams a day are recommended.

What about sodium?  Some salt, or sodium, is essential, but too much is hard on your heart and kidneys.  An average salt intake is 5,000mg, mostly from processed foods.   The American Heart Association recommends 2,500mg of sodium, about one teaspoon per day, or 500-600mg per meal.

Scientists continue to discover benefits of important nutrients, especially for older people.  Take advantage of your nutrition powerhouses by eating simple, locally produced foods, which typically contain more vitamins and minerals, and taste good too!

Article Provided by:
Julia Hanfling, Registered Dietitian, Certified Diabetes Educator, Certified Specialist in Gerontology Nutrition
Stay at Home America
(503) 641-4663
www.stayathomeamerica.com

Elder Wisdom

Elder Wisdom

When I was a kid in Great Falls, Montana, my parents taught me to respect my elders.  To me, that respect was a given.  However, over time I have learned that our society often casts elders to the side and does not revere them in the way one would hope.  I have no grand answer as to what has created this belief that elders have less to contribute than others except that our society looks more to tangible results rather than supportive and coaching positions.  Elders have their own purpose in later life and while not all embrace it, many continue to help pass on experience and traditions to those interested in learning.

It is a great feeling when you can see that the respect is still there.  There may come a time in his life when grandpa passes on the torch of residing over Thanksgiving to dad, but grandpa is still there for support and for stories.  And who would dare to show disrespect to their own grandmother?  Our elders have experienced drastic societal changes throughout their lives, and this creates an astute vantage point from which to offer perspective on our lives today.

An elder’s wisdom comes from a lifetime of experience.  This is not to say that all elders reflect on their lives and cultivate wisdom, but the ones who do, have the opportunity to learn and grow.  I have noticed in my thirties that I know a lot less now than I thought I knew about the world when I was in my twenties; we learn from our experiences.  Elders can help to mentor and coach us, to illustrate stories and parables that allow us to learn from their experiences and apply this learning to our own lives.  While a young sapling may help build a fire, a mature tree can help build a house.

I have always liked the word elder, the idea of a sage wisdom keeper.  I find senior citizen to be a bit demeaning, and while it is not insulting, it connotes infirmity and perhaps even illness.  On the other hand, “senior”, by itself, simply illustrates a senior person, one that is more advanced…  I am okay with that, but elder…that is the term that grabs at me.

Article Provided by:
Paul Burnstein, Executive Director
Sinai Family Home Services
(503) 542-0088
www.SinaiFamily.org

Not Always A Hallmark Holiday

Not Always A Hallmark Holiday

When families gather for the holidays there is great anticipation of joyful reunions and the creation of happy memories. Unfortunately all too often these hopes are disappointed and concerns are raised when families experience noticeable changes in their elder family members.
Did this holiday season raise concerns about physical and cognitive changes in your elderly family members?

Here are some frequently observed changes that should cause family members concern:

  • Memory lapses—forgetting important names or events—loss of ability to follow and track in conversation. Repeating things said without remembering that the question or story has already been asked or told.
  • Withdrawing from social interaction, in particular large family gatherings as these are felt to be overwhelming or over stimulating for the senior
  • Mood changes—increased depression or moodiness
  • Unkempt appearance-notable deterioration in hygiene (frequency of bathing) or wearing of unsuitable or unwashed clothing.
  • Noticeable change in housekeeping—house not kept up to the standard of customary cleanliness—dishes unwashed, floors not vacuumed, accumulation of dirty laundry and linens unclean.
  • Medications not being taken correctly and on time. The importance of taking medications as prescribed cannot be emphasized enough; 68% of hospital admissions for the elderly are the result of medication mismanagement.
  • Unexplained bruises or injuries
  • Hoarding of food or other items such as toiletries, newspapers and household items
  • Purchases from television vendors
  • Dents and scrapes on a senior’s car which cannot be explained
  • Spouses “covering” for each other—one spouse compensating for the diminished capacity of the other—finishing sentences, answering questions asked of the other.
  • Significant weight loss or gain, signifying the elder individual is not able to feed themselves in a manner that is nutritionally sound.
  • Excessive television viewing to the exclusion of human interaction

If you or other family members have observed such changes in elder relatives during recent holiday family functions and are concerned for the well being of your parents or senior loved ones do not discount these changes or wait until your relatives come to serious harm. In the field of senior care we see far too many elderly individuals who have been significantly harmed or hospitalized because they were neglected by relatives who meant well and did not want to interfere—at significant risk to their loved ones.

If you are concerned and wish to speak to a professional about the safety & health of your elder loved one, see contact information below.

Article Provided by:
Nancy Raske, Consultant
NW Senior Resources,Inc. – Placements and Referrals
(503) 680-9407
www.nwSeniorResources.com

Your Golf Swing

Your Golf Swing

The golf swing is a complex series of physically explosive movements.  You can improve your game while avoiding injuries by incorporating a focused, physical conditioning program that addresses joint flexibility, muscular strength, balance and coordination.

The winter months are the best time to prepare for that first warm spring day, when you will be ready to tee up with a stronger, more energetic body.  Once you are on your way, it’s easy to stay “tuned-up” with a short 15-minute golf-specific workout twice per week.

As we get older our muscles lose tone, shortening our golf swing and causing the wrong muscles to compensate for the weakened muscles. For example, senior men can be observed walking with their rear down and their legs forward. This is because their gluteus muscles are weak, and without a focused physical conditioning program, are incapable of maintaining healthy posture.

To execute a superb golf swing we need to maintain the condition and flexibility of all our muscles.  As flexibility decreases, golfers may try to make their swings bigger.  However, when watching a senior professional golf tour, the participants preserve a short swing.  When one forces a swing to be something it isn’t, proper position is compromised, hindering performance and inviting injury.  Expect that your swing is going to be shorter and get your gluteus and hamstring muscles in tone.

There are no shortage of workout routines designed to improve strength and flexibility of specific muscle groups. The important thing is to find one that is specially designed for seniors and the explosive movements and necessary flexibility specific to swinging a golf club. It is also just as important to choose a routine that is mentally and physically engaging, so that you do not give up a healthy habit. Make it fun so that a vigorous, healthy habit becomes a lifetime habit.

A New You

A New You: How to Make it Happen

Throughout the year, we receive multiple messages about improving our health: lose weight, start a regular routine, go to the gym more often, eat better and smarter, etc. Fitness clubs are jammed each New Year with resolution-inspired workout novices trying to “reboot” their fitness program. By mid-February, the aerobics machines do not have long lines; the classes return to a manageable size and the “want-to-be-fit” novices are nowhere to be seen.

What happened?

In my opinion, what is missing is the relationship that a wellness coach, personal trainer or even a committed friend with a fitness lifestyle can bring to the novice—no matter what age. It really is helpful to work with someone who can help develop meaningful goals and appropriate rewards based on motivation and commitment. Reasonable goals and achievable objectives require teamwork and a major dose of reality therapy. In spite of the claims of some ads—lose 30 pounds in 30 days—it isn’t going to happen that way. If it did, it wouldn’t be a healthy way to become more fit.

No one wants to feel guilty or defeated due to repeated unsuccessful efforts to become healthier and more fit. So how can people be successful and “make it happen?”

The components for success include:

  • Adequate and appropriate baseline testing and assessment by a qualified health professional.
  • A visit to your personal physician if any of the questions in the EASY (Exercise and Screening for You) toolhttp://www.easyforyou.info/ generate additional questions based on your answers.
  • A long-range plan with short-term achievable objectives determined by you and your fitness coach.
  • A program that includes activities and food choices that you enjoy and will continue to practice consistently as you begin to change unhealthy habits or poor choices.
  • A simple but complete system to measure progress.
  • Intrinsic or even extrinsic rewards that you deserve as you develop and maintain new healthy habits. These rewards could be buying new fitness outfit, going out to dinner with a friend or maintaining a personal journal of discovery and encouragement. What’s important is that the reward is meaningful.
  • Support from family, friends and your significant other.
  • Fun!

No matter what age you are or what time of year it is, following the guidelines above will lead to a sustained fitness program—and a new you.

Article Provided by:
Marge Coalman, EdD, 
Vice President of Wellness & Program, Touchmark
Coalman’s many responsibilities include overseeing the Waterford Health & Fitness Club in Vancouver
waterfordvancouver.com/health-and-fitness-club

Homecare: When and Where

Homecare:  Making the Decision About When and Where

Most of us want to remain as independent as possible. Sometimes, all that may be required is a simple medication reminder.  However, if getting ready for your day has become more difficult and you require some assistance with activities of daily living (ADLs) such as bathing, grooming and getting dressed, there are caregivers that can assist with these tasks.  The first step is realizing that you need additional support and then asking for it.

Asking for help and the fear of losing independence and control can be challenging.  There are community resources available to discuss these very topics, including: Registered Nurses and social workers.  These professionals are well versed on what resources are available in your area.

Next, take some time to consider whether or not you’ll stay in your home or move to community.  Monthly charges range from $2,000 to $8,000 per month (depending on the level of care). Your financial situation and family support system will likely influence your decision to stay at home with extra help; or move to a community.  This is a tough decision and may require downsizing and selling your home. Take your time and do this in steps.

How will I pay for this in home services?

  • Medicaid:  funding for those with limited financial resources may receive assistance with some or all of their home care expenses from Medicaid.
  • Medicare:   is available to all adults 65 and older. However, Medicare is meant for acute health episodes, and not long-term care. Those that are homebound, need skilled services, and require intermittent help may be able to receive some home health care services under Medicare funding.
  • Long Term Care Insurance:  Each policy is different, with some covering only nursing home costs- but many current policies allow for homecare services.
  • State Programs:  older adults that do not qualify for larger government programs like Medicaid may qualify for more local state programs, because states have greater freedom in establishing requirements for their programs
  • Private Pay: Many families choose to perform many of the home care services for a loved one, themselves. Yet, some seniors require skilled services. For families that do not meet eligibility requirements of certain programs, out of pocket funding may be unavoidable.
  • Non profit support: there are many other non-profit organizations, volunteer groups, or faith based organizations that may also help. Check your local area agency on aging for more information.

Although paying for home care is expensive, there are many options for seniors and their families. Learning more about Medicaid, Medicare, long-term care insurance, and various state programs can help older adults as they navigate the financial aspect of long-term care.