What Advanced Planning (Advance Directive) is Needed?

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What Advanced Planning is needed? What advanced planning should we do?

Advance directives are oral and written instructions about future medical care should you become unable to make decisions (for example, unconscious or too ill to communicate). Each State regulates the use of advance directives differently. A living will is one type of advance directive. It takes effect when the patient is terminally ill. Advance directives are not set in stone. A patient can revise and update the contents as often as he or she wishes. Patients and caregivers should discuss these decisions-and any changes in them-and keep the health care team informed. Everyone involved should be aware of your treatment preferences. Because State laws vary, check with your Area Agency on Aging, a lawyer, or financial planner. They may have information on wills, trusts, estates, inheritance taxes, insurance, Medicare, and Medicaid.

The person who has the authority to make medical decisions on another person’s behalf is called a healthcare proxy. The terms “healthcare proxy” and “healthcare agent” or “surrogate” are used interchangeably. These responsibilities are called “durable” (for example, you may hear the phrase “durable power of attorney”) because they remain in effect even if your parent is unable to make decisions. Most people appoint a close friend or family member. Some people turn to a trusted member of the clergy or a lawyer. The designated person should be able to understand the treatment choices. Know your values, and make sure others support your decisions.

The decision to name a healthcare proxy is extremely important. A written document, kept in the medical record and identifying the designated proxy, should always be up-to-date. Durable medical power of attorney forms do not give explicit guidance to the proxy about what decisions to make. Many States have developed forms that combine the intent of the durable power of attorney (to have an advocate) and the intent of the living will (to state choices for treatment at the end of life). These combination forms may be more effective than either of the two used individually. Each State regulates advance directives differently, so you will need to consult with the physician, nurse, social worker, or family lawyer to know what is required. It’s also a good idea to check to make sure that all financial matters, including wills and life insurance policies, are in order.

What important information should I keep track of?

The answer to this question is different for every family. You might want to help organize the following information and update it as needed. This list is just a starting point.

  • Full legal name and residence
  • Birth date and place
  • Social Security number
  • Employer(s) and dates of employment
  • Education and military records
  • Sources of income and assets; investment income (stocks, bonds, property)
  • Insurance policies, bank accounts, deeds, investments, and other valuables
  • Most recent income tax return
  • Money owed, to whom, and when payments are due
  • Credit card and charge account names and numbers

Source: National Institute on Aging, www.nia.nih.gov Long Distance Caregiver
Provided by: The Staff at www.RetirementConnection.com
Copyright © 2008 RetirementConnection.com. All rights reserved.

What if the Caregiver Passes Away? Who will provide the care?

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What if the Caregiver Passes On?

As caregivers, we cannot assume that we always will be able to provide care. Even if we are able to be active caregivers, it is important to establish both emergency and long-term alternative care plans for our older relative or friend, and to make sure that the necessary legal documents are in place.

Legal Documents and Care Plans That Should Be in Place

Every adult should have at least a power of attorney, a living will or medical directive and a will or trust in place so that his or her wishes can be followed. If your older family member does not have these legal directives, you both should consult an attorney and have the appropriate documents drawn up.

Making Alternative Long-term Care Arrangements

When making alternative long-term care arrangements, you will want to discuss the matter with your care receiver(s), if at all possible, and follow their wishes about the person(s) or facility that would care for them, if you were unable to do so. If your care receiver(s) want to live with another family member or friend, you will, of course, want to discuss this arrangement with the proposed caregiver to ensure that it is agreeable.

If your relative can make informed choices about an alternate caregiver, living arrangement, and other matters, it will be easier to make long-term plans, if you have a power of attorney . If your older relative or friend cannot make informed choices it may be necessary to seek appointment as a conservator and/or guardian. This requires an appointment from the court to act on your care receiver’s behalf regarding matters of care and financial dealings. Whenever possible, discuss your plans for alternative living arrangements or caregiver choice with your older family member or friend and with other close family members as well as the designated caregiver. This will help to avoid opposition in the future that could lead to serious problems.

If you are the only possible informal caregiver, you and/or your relative can appoint a trusted friend or perhaps a committee composed of several friends to oversee your relative’s care, or you may decide that it is best to have a lawyer act as your care receiver’s representative. These arrangements also should be legally established.

Once you have decided on an alternate caregiver(s), it will be necessary to ensure that they, too, have the legal power needed to make decisions, should your care receiver be unable to do so. This may involve a durable power of attorney, a special medical power of attorney, and, in some states, a special power of attorney, if property is to be bought or sold, or a guardianship and/or conservatorship. As stated before, you should ensure that both you and your care receiver have medical directives, living wills and estate wills and/or trusts established, if there are financial resources available for your care receiver.

In choosing a long-term care housing arrangement it is a good idea to select one that can provide varying levels of care so that your care receiver will not be forced to move, if his or her medical condition changes.

Short-term emergencies don’t require the same amount of legal planning, but they must be considered. If you are unable to look after your care receiver, you will need to make arrangements with:

  • a relative or friend
  • a facility that provides short-term respite care (many nursing homes and assisted living facilities offer such care)
  • a home care agency
  • a geriatric care manager.

Remember that home care agencies often cannot provide services on short notice, and that you may need to have more than one family member or friend as a backup person.

Source: www.aoa.gov
Provided by: The Staff at www.RetirementConnection.com
For more information: www.aoa.gov
Copyright © 2008 RetirementConnection.com. All rights reserved.

What is Alzheimer’s disease?

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Alzheimer disease is a degenerative disease of the brain that causes dementia, which is a gradual loss of memory, judgment, and ability to function. This disorder usually appears in people older than age 65, but less common forms of the disease appear earlier in adulthood.

Memory loss is the most common sign of Alzheimer disease. Forgetfulness may be subtle at first, but the loss of memory worsens over time until it interferes with most aspects of daily living. Even in familiar settings, a person with Alzheimer disease may get lost or become confused. Routine tasks such as preparing meals, doing laundry, and performing other household chores can be challenging. Additionally, it may become difficult to recognize people and name objects. Affected people may increasingly require help with dressing, eating, and personal care.

As the disorder progresses, some people with Alzheimer disease experience personality and behavioral changes and have trouble interacting in a socially appropriate manner. Other common symptoms include agitation, restlessness, withdrawal, and problems with speech. People with this disease usually require comprehensive care during the advanced stages of the disease. After the appearance of symptoms, affected individuals usually survive 8 to 10 years, but the course of the disease can range from 1 to 25 years. Death usually results from pneumonia, malnutrition, or general body wasting (inanition).

Four major types of familial Alzheimer disease have been identified. Types 1, 3, and 4 are classified as early-onset Alzheimer disease because their signs and symptoms appear before age 65. Type 2 is classified as late-onset Alzheimer disease because its signs and symptoms appear after age 65. Other cases of Alzheimer disease are classified as sporadic or nonfamilial, which means they do not appear to run in families.

How common is Alzheimer disease?

Alzheimer disease currently affects more than 5 million Americans. Because more people are living longer, the number of people with this disease is expected to more than triple by 2050.

What genes are related to Alzheimer disease?

  • Mutations in the APP, PSEN1 and PSEN2 genes cause Alzheimer disease.
  • Variations of the APOE gene increase the risk of developing Alzheimer disease.

About 75 percent of Alzheimer disease cases are classified as sporadic, which means they occur in people with no history of the disorder in their family. Although the cause of these cases is unknown, genetic changes are likely to play a role. Virtually all sporadic Alzheimer disease begins after age 65, and the risk of developing this condition increases as a person gets older.

The remaining cases of Alzheimer disease are familial, which means they are found in multiple members of a family. Familial Alzheimer disease can be divided into early-onset disease (symptoms begin before age 65) and late-onset disease (symptoms begin after age 65).

The early-onset forms of Alzheimer disease are caused by gene mutations that can be passed from parent to child. Researchers have identified three genes that cause these forms of the disorder. Mutations in the APP gene cause Alzheimer disease type 1. Changes in the PSEN1 gene are responsible for Alzheimer disease type 3, while PSEN2 mutations lead to Alzheimer disease type 4. As a result of mutations in any of these genes, large amounts of a toxic protein fragment called amyloid beta peptide are produced in the brain. This toxic peptide can build up in the brain to form clumps called amyloid plaques, which are characteristic of Alzheimer disease. Amyloid plaques may lead to the death of nerve cells and the progressive signs and symptoms of this disorder.

Some evidence indicates that people with Down syndrome have an increased risk of developing type 1 Alzheimer disease. Down syndrome, a condition characterized by mental retardation and other health problems, occurs when a person is born with an extra copy of chromosome 21 in each cell. As a result, people with Down syndrome have three copies of many genes in each cell, including the APP gene, instead of the usual two copies. Although the connection between Down syndrome and Alzheimer disease is unclear, the production of more amyloid beta peptide in cells may account for the increased risk. People with Down syndrome account for fewer than 1 percent of all cases of Alzheimer disease.

The genetic causes of late-onset (type 2) familial Alzheimer disease are less clear. This disorder is probably related to mutations in one or more risk factor genes in combination with lifestyle and environmental factors. A gene called APOE has been studied extensively as a risk factor for the disease. In particular, a variant of this gene called the epsilon 4 (e4) allele seems to increase an individual’s risk for developing type 2 Alzheimer disease.

How do people inherit Alzheimer disease?

The early-onset familial forms of Alzheimer disease (types 1, 3, and 4) are inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to cause the disorder. In most cases, an affected person inherits the altered gene from one affected parent.

The inheritance pattern of late-onset (type 2) familial Alzheimer disease is uncertain. People who inherit one copy of the APOE e4 allele have an increased chance of developing the disease; those who inherit two copies of the allele are at even greater risk. It is important to note that people with the APOE e4 allele inherit an increased risk of developing Alzheimer disease, not the disease itself. Not all people with Alzheimer disease have the e4 allele, and not all people who have the e4 allele will develop the disease.

What other names do people use for Alzheimer disease?

  • AD
  • Alzheimer dementia (AD)
  • Alzheimer sclerosis
  • Alzheimer’s Disease
  • Alzheimer syndrome
  • Alzheimer-type dementia (ATD)

Source: Genetics Home Reference, A Service of the U.S. National Library of Medicine, Reviewed: October 2006, Published: February 2, 2008
Provided by: The Staff at www.RetirementConnection.com
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Copyright © 2008 RetirementConnection.com. All rights reserved.

Care for Terminally Ill Individuals – What is Hospice?

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Hospice programs are available to help terminally ill individuals live their remaining days with dignity. These programs can assist the family (or other designated caregiver) in making the patient as comfortable as possible, and assistance is available around the clock, seven days a week.

Hospice is primarily a concept of care, not a specific place of care. Hospice care usually is provided in the patient’s home. It also can be made available at a special hospice residence. Hospice is a combination of services designed to address not only the physical needs of patients, but also the psychosocial needs of patients, their loved ones.

Hospice combines pain control, symptom management and emotional and spiritual support. Seniors and their families participate fully in the health care provided. The hospice team develops a care plan to address each patient’s individual needs. The hospice care team usually includes:

  • The terminally ill patient and his or her family caregiver(s)
  • Doctor
  • Nurses
  • Home health aides
  • Clergy or other spiritual counselors (e.g., minister, priest, rabbi)
  • Social workers
  • Volunteers (if needed, and trained to perform specific tasks)
  • Occupational, physical, and/or speech therapists (if needed)

When is Hospice Care Appropriate?

As with many end-of-life decisions, the choice to enroll in a hospice care program is a deeply personal thing. It depends almost as much on the patient’s philosophy of living and spiritual beliefs as it does on his or her physical condition and the concerns of family members. The following case study shows how one patient decided that hospice care was what she wanted and why it was right for her:

A Case Study of Hospice Care

Lynda was 57 years old when she was diagnosed with liver cancer. In spite of the best medical treatment her doctors could provide, her cancer proved incurable. Although the prospect of dying frightened her, Lynda wanted to receive professional assistance to prepare herself and her family for her death.

She realized that she wanted to be cared for at home by her sister, Sara. The local hospice service made the arrangements so that this would be possible. Hospice staff made sure that Lynda’s family would have the equipment they needed, and trained Sara in how to administer medications to relieve Lynda’s pain.

The hospice program also sent a registered nurse to the house to oversee Lynda’s care, and the nurse consulted with a doctor to make sure Lynda was as comfortable as she could be during her final weeks. In addition, the hospice service sent a personal care attendant to bathe Lynda twice a week, and a social worker and a clergyman to provide spiritual and grief counseling for Lynda and Sara.

Lynda lived the last six weeks of her life at home before she passed away surrounded by Sara and the rest of her family.

  • Empowering adults as they age with reliable information and access to the care they need
  • Enabling individuals who are at high risk of nursing home placement to remain at home
  • Building disease prevention into community living through the use of low-cost, evidence based programs

How Can I Pay for Hospice Care?

Medicare, private health insurance, and Medicaid (in 43 states) cover hospice care for patients who meet eligibility criteria. Private insurance and veterans’ benefits also may cover hospice care under certain conditions. In addition, some hospice programs offer health care services on a sliding fee scale basis for patients with limited income and resources. To get help with your Medicare questions, call 1-800-MEDICARE (1-800-633-4227, TTY/TDD: 1-877-486-2048 for the speech and hearing impaired) or look on the Internet at www.medicare.gov. Additional information about how to pay for hospice care can be found at the Public Policy Institute of the AARP.

Want to Learn More About Hospice Care? Visit these websites:

Hospice Foundation of America

Hospice Foundation

The Hospice Association of America

Hospice Net

The Eldercare Locator

To find out more about hospice programs where you live, you can contact your local aging information and assistance provider or area agency on aging (AAA). The Eldercare Locator, a public service of the Administration on Aging at 1-800-677-1116 can help connect you to these agencies.

Other Family Counseling and Support Services

Seniors and family caregivers facing end-of-life decisions often must deal with very difficult issues of grief and loss-both before and after their loved one dies. In addition, they may have practical concerns about their legal rights and how to pay the bills now that an important member of the household is gone.

Americans for Better Care of the Dying

Family Caregiver Alliance

Source: Administration on Aging, Build the Future of Long Term Care, www.AoA.gov
Provided by: The Staff at www.RetirementConnection.com
Copyright © 2008 RetirementConnection.com. All rights reserved.

Personal Emergency Response Systems (PERS) – What You Need to Know

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Could you or a loved one benefit from a Personal Emergency Response System (PERS). A PERS is an electronic device designed to allow people with disabilities or older people living alone to summon help in an emergency.

People use Personal Emergency Response System (PERS) for various reasons, such as general concerns about falling, needing reminders about when to take medications, or to allow loved ones or caregivers to run errands or go out for a while without worry. Others, like John, may have medical conditions that affect their ability to be alone and still be able to call for assistance.

John had in-home care nearly all the time, but his caregiver had taken a quick trip to the pharmacy to pick up his medications. Suddenly, he needed help, but found himself all alone. He hadn’t been in this position for as long as he could remember and he was frightened by his feelings of fear and helplessness.

Thanks to a Personal Emergency Response System (PERS), John was able to call for help that responded in just seconds. Once he pressed the button he wore around his neck, remote call answering began communicating with John without him ever having to get to the phone.

The call for help was received at a centrally monitored response center, where trained response associates have complete access to John’s personal profile and critical information. They quickly found out why John needed help and took action.

The response center can assess the situation and get help from a close neighbor or family member, or an ambulance, fire, or police department, when needed. If John had been unable to indicate his needs, emergency help would have been dispatched immediately.

Not only do Personal Emergency Response System (PERS) provide peace of mind to the person with limited physical abilities, but caregivers can also feel secure in knowing that their friend or family member is well cared for. Continuous caregiving can lead to exhaustion, putting the friend or family member at risk. Having reliable help just seconds away is a comfort to everyone.

Aside from the two-way voice communicator, a selection of specially designed assistive devices can be used with a Personal Emergency Response System (PERS) to give individuals with neuromuscular disabilities the ability to call for help. An assessment by an occupational or physical therapist may be needed to determine which assistive device would be most appropriate.

Examples of Assistive Devices Include:

  • Pillow Switch that can be pinned to a pillow and activated by a controlled head movement.
  • Wobble Switch that can be activated by gross body or head movements coming from any direction.
  • Rocker Lever Switch that is activated by gross hand, arm or body movements or by a mouth or head stick.
  • Sip or Puff Switch that is activated by sipping or puffing on a tube depending on availability of breath control or respiratory control.
  • P-Switch, which is activated by minimal movement, detected by small sensors (set by the user) and can be placed on any part of the body capable of minimal motion.

There are a variety of Personal Emergency Response System (PERS) available. Many charge a monthly fee and a one-time set-up fee. Others require you to sign a three-month, six-month or year-long-lease, while others offer rental opportunities. To navigate the maze of PERS, the Federal Trade Commission (FTC) offers the following suggestions:

  • Check out several systems before making a decision.
  • Find out if you can use the system with other response centers. For example, can you use the same system if you move?
  • Ask about the pricing, features, and servicing of each system and compare costs.
  • Make sure the system is easy to use.
  • Test the system to make sure it works from every point in and around your home. Make sure nothing interferes with transmissions.
  • Read your purchase, rental, or lease agreement carefully before signing.

Questions to Ask the Response Center

  • Is the monitoring center available 24 hours a day, 7 days a week?
  • What is the average response time?
  • What kind of training does the center staff receive?
  • What procedures does the center use to test systems in your home? How often are tests conducted?

The FTC works for the consumer to prevent fraudulent, deceptive and unfair business practices in the marketplace and to provide information to help consumers spot, stop and avoid them. Visit www.ftc.gov/ftc/consumer.htm for free information on consumer issues. Also visit www.ftc.gov or call toll-free, 1-877-FTC-HELP (1-877-382-4357); TTY: 1-866-653-4261.

Provided by: Phillips Lifeline
For more information: www.usa.philips.com
Copyright © 2008 RetirementConnection.com. All rights reserved.

Telecommunication Relay Service (TRS) for the the Deaf and Hard of Hearing

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Provided by State Agency of Office of the Deaf and Hard of Hearing – Department of Social and Health Services (DSHS). They can be reached 800-422-7930 (Voice/TTY), 360-902-8000 (Voice/TTY) or visit their websites for more information: http://odhh.dshs.wa.gov, www.washingtonrelay.com or www.dshs.wa.gov. Also available through: Videophone: (VP): VP: (360) 339-7382; VP: 65/113/246/110.

Telecommunication Relay Service (TRS) Relay operator services allows people with hearing loss to communicate effectively with others who do not have specialized telephone equipment, in a way similar to what a person with normal hearing and clear speech communicates with the telephone.

Telecommunication Equipment Distribution (TED) Specialized telephone equipment is available to eligible clients. Contracted trainers provide client training on how to use the equipment.

Sign Language Interpreter Management (SLIM) A statewide contract for interpreter services is available so that individuals using sign language can communicate with staff of government and service providers.

Assistive Communication Technology (ACT) A referral/loan system to provide assistive listening device systems, real-time captioning and other assistive technology.

Communication Access Network (CAN) Videoconferencing sites throughout Washington provide access to video relay services (VRS), video remote interpreting (VRI), video remote captioning (VRC) and face-to-face interpersonal communication (P2P).

Social & Human Services (SHS) Non-profit Regional Service Centers for the Deaf and Hard of Hearing are contracted to provide an array of social and human services throughout Washington, including case management and advocacy services.

Information, Referral & Advocacy (IRA) Provides information, resources and referrals to the general public and communities. Advocates on behalf of individuals needing accessible communication to state government.

Outreach & Training (OT) Outreach activities increase awareness about diversity and culture. Training activities provide knowledge and skills to effectively serve people with hearing loss through the provision of reasonable accommodations.

The State Agency of Office of the Deaf and Hard of Hearing – Department of Social and Health Services (DSHS). can be reached at:
Mailing Address: 1115 SE Washington Street, PO Box 45300, Olympia WA 98504-5300
Voice: 800-422-7930 (Voice/TTY), 360-902-8000 (Voice/TTY), 360-902-0855 FAX
Websites: www.odhh.dshs.wa.gov, www.washingtonrelay.com, www.dshs.wa.gov
Videophone: (VP): VP: (360) 339-7382, VP: 65/113/246/110
Copyright © 2008 RetirementConnection.com. All rights reserved.

What Services Can Help Caregivers?

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If you are a caregiver and need help, chances are that assistance is available in your community. There are many different government and privately funded services that may be available. Most of the programs and services mentioned in this guide are federally funded through the Older Americans Act. You can get information about these services and programs in communities throughout the nation by calling the Eldercare Locator at 1-800-677-1116. Staff is available from 9:00 A.M. to 8:00 P.M. EST, Monday-Friday.

While some services are free, others are fee-based. In-home and community-based services that you might find helpful include:

  • Personal and in-home services
  • Home health care
  • Transportation
  • Meals programs
  • Cleaning and yard work services
  • Home modification
  • Senior centers
  • Respite services including adult day care

Personal and In-Home Care Services

Personal and in-home care assistants help with bathing, dressing, preparing meals, house cleaning, laundry, toileting, and other personal “activities of daily living.”

Home Health Care

Home health care includes such care activities as changing wound dressings, checking vital signs, cleaning catheters and providing tube feedings. Home health care staff also may provide some personal care services and light housekeeping.
If the older person for whom you are caring is recuperating from an accident, operation, or illness, he or she may be able to receive home health care assistance through a Medicare certified home care agency. If older persons cannot care for themselves because of physical functioning, health problems, or because they no longer are able to mentally process things, they may be eligible for skilled nursing care or physical, speech, or occupational therapy. In these cases, home health care also may be available. Ask your older relative’s doctor if your family member is eligible for these services.

To find out more about home health care, check “Home Health,” a publication by the Centers for Medicare and Medicaid Services (CMS)-formerly the Health Care Financing Administration (HCFA)–the federal agency that administers the Medicare program, or talk to the doctor who is caring for your family member.Medicare usually pays for home health care services for two or three hours a day, several days a week, and for the medical care provided by a doctor, nurse, or other health professional. Such care tends to be for a limited time.

If the person for whom you are caring has a limited income and assets, he or she may be able to receive home health care, personal care, or hospice services as well as occupational, physical, or speech therapy through Medicaid (a federal-state program, administered by CMS at the federal level). Some older persons with limited assets and income are eligible for help through both the Medicare and the Medicaid programs. If this is the case, your care receiver may be able to obtain personal and/or home health care services on a long-term basis instead of being cared for in an extended care facility. Otherwise, in-home and community-based services may be available through an Area Agency on Aging.

Middle and higher-income persons often pay out-of-pocket for personal and home health care services. If you hire staff through a home care agency, ask the agency how they screen their staff and if staff is bonded. Agencies charge you for the costs of doing business; i.e., for management, administration, and recruiting workers. This can be quite expensive, but there are ways to make help more affordable. For example, you can explore the possibility of directly hiring a personal or home health care assistant. If you choose to hire help, be sure to check their qualifications and references carefully. Remember, you will then be an employer, and you may need to cover Social Security and other benefits. (See the Section on How Do I Hire a Home Care Employee?)

Respite Care

Respite care can be a voluntary or paid service. It can be provided in your relative’s home, in an extended care facility, such as a nursing home, or at a senior center or adult day care center. Respite care can extend for a few hours or for several weeks. It provides the caregiver with opportunities to take care of personal affairs, to get some rest, or to take a vacation.

Transportation

Transportation services are vitally important to older persons with limited mobility. Transportation enables them to go to their doctors, to the pharmacy, and to attend to day-to-day activities.

Many public mass transit systems are fitting buses and other vehicles with hydraulic lifts and other aids to assist older persons and others that have physical disabilities. Sometimes several transit systems operate independently of each other. Transportation options may be available through private companies and private non-profit organizations. These include public fixed-route, demand-response, ride sharing, volunteer drivers, limousines, buses, vans, and regular and special purpose taxis. Some services provide an escort to assist older people.

To arrange transportation for an older person in your community, contact your local Area Agency on Aging (it is listed under “aging,” “elderly,” or “senior services” in the government section of your telephone directory). Area Agencies on Aging provide older persons and their caregivers with specific information and assistance in getting transportation and other supportive services in the community.

If you want information about safe driving and older drivers you may want to contact the National Highway Traffic Safety Administration.

Meals

Good nutrition can help to improve health and control a range of conditions and diseases. The National Elderly Nutrition Program, funded by the Administration on Aging, provides meals to older persons in need and their spouses. Older persons who participate in the group meal program have an opportunity to socialize, receive nutrition education, and take part in other activities, including health screenings.

Elderly persons who are ill or frail may be able to receive a government-subsidized home-delivered meal. To find out about home-delivered meals programs and other meals programs, please contact the National Eldercare Locator or your State or Area Agency on Aging.

If these meals are not available, see if your grocery store prepares food orders for pick-up or if it provides home-delivery service. A growing number of grocery and meal services are available via the Internet including some that offer organic, ethnic and kosher foods. Many local restaurants deliver meals without additional charge and some even offer senior discounts on meals. A growing number of restaurants offer special low-fat and low-salt meals.

There also are local and national franchised meals delivery services. These are listed in the yellow pages of the telephone directory under “foods-take out”; some can be found on the Internet.

Cleaning and Yard Work Services

An Area Agency on Aging may be able arrange for chore and yard maintenance services or put you in touch with religious, scout or other volunteer groups that provide one-time or occasional services to older persons who need help. Of course, you can hire a cleaning service or yard maintenance firm, but this may be more expensive than hiring someone that works as an independent contractor.

Home Modification, Improvement, and Weatherization Programs

Home modification and repair programs can make homes safer and more energy efficient. They can result in greater independence for an older person with disabilities. The Home Modification Action Project at the University of Southern California’s Andrus Gerontology Center has online consumer oriented information and publications on accommodations and modifications and how to pay for these. There is information on how to make dwelling units safe for persons with Alzheimer’s Disease. There also is information for builders, a library of useful publications on housing adaptation, and links to other useful web sites.

Senior Centers

Seniors Centers offer older people a safe environment where they can take part in a range of activities led by trained personnel that promote healthy lifestyles and where they can develop a network of friends.

Meal and nutrition programs, information and assistance, health and wellness programs, recreational and arts programs, transportation services, volunteer opportunities, educational opportunities, employee assistance, intergenerational programs, social and community action opportunities and other special services are often available through a senior center.

Adult Day Care Services

For older persons with serious limitations in their mobility, those who are frail, and those who have medical and cognitive problems, adult day care centers can provide care in a safe, structured environment. Adult day care can provide relief to working caregivers and respite for full-time caregivers. Adult day care services include personal and nursing care, congregate meals, therapeutic exercises, and social and recreational activities.

Most adult day care centers, like senior centers, are supported through public and non-profit organizations. Fees may range from a few dollars a day to close to $200, depending on the services needed. The National Council on the Aging maintains a directory of adult day care centers and links to other related sites.

Additional Resources and Reading Lists

The Administration on Aging-operated National Aging Information Center Internet Notes home design web page is full of web sites that provide useful information on home modifications, home design, and home safety for the elderly.

To find out about eligibility requirements for benefits under both the Medicare and Medicaid programs, go to the Health Care Financing Administration’s dual eligible web site.

Source: The Administration on Aging. www.aoa.gov
Copyright © 2008 RetirementConnection.com. All rights reserved.

What to Look For in a Continuing Care Retirement Community

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As providers of senior housing in a CCRC (Continuing Care Retirement Community), we are often in the position of helping people choose where they are going to live. It might be helpful for you to review some of the reasons we feel are very important in helping all seniors make this decision.

The Residents – Look for a community where the residents are interested in their lifestyle, health, learning, leisure activities and volunteerism. A community where the residents are striving to be engaged to the fullest extent possible in activities that are satisfying, challenging and fulfilling.

The Staff – Look for staff that recognizes that the community is the home of the residents. Staff should be respectful, courteous, and competent, and willing to go the extra mile to provide the quality of life you expect and deserve.

Service and Trust – Look for a marketing department that provides accurate and honest information. Review the longevity of the organization and review any financial information that is provided. Get to know the people who live there and ask questions. Look for flexibility in services, such as dining and other programs.

The Site – Look for your preferred location. Is it close to those things you enjoy doing? Activities such as shopping, cultural events, medical services, and church are all things that should be within a short distance. Think ahead to a future need to utilize public transportation and recognize its availability.

The Building – Explore spaces and uses for those spaces in the physical plant. Ask yourself if those spaces meet your needs. Are there opportunities to enjoy nature, to engage in gardening, and to enjoy walking paths, quiet spaces, and fitness opportunities? Are there spaces for group activities and social interactions? How is the maintenance? Are the grounds well maintained? Do you like the way it looks? Remember this will be your home and a place where you will invite friends and family.

Focus – Does the community focus on meeting the challenges and expectations of the residents? Is the theme to merely survive or is it to consistently try to recognize the changing environment and how to best address those obligations. Is the community focused on providing quality services and quality health? Does it provide a continuum of health services that will provide for you throughout your remaining years? Does it promote aging in place.

Accreditation – Finally, it is very important that a CCRC be accredited. Accreditation means that the organization and community have met standards concerning governance, resident health care and services, and financial matters. Look for the seal that designates Accreditation and you can be assured the organization has addressed these areas.

Obviously, these are difficult questions, but finding the answers will help make your life enjoyable in your new home.

Source: Marketing Department at Terwilliger Plaza, 503-299-4242

Copyright © 2008 RetirementConnection.com. All rights reserved.

How to Tell When a Senior Needs Care and Assistance

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Sometimes it’s easy to know when your senior family member needs care and assistance. For instance, maybe he or she has a major disability or requires additional help following a hospital stay. In other cases, however, it isn’t immediately obvious that your senior is in need of care.

Families need guidance, and should follow a careful assessment of their senior’s needs in making a decision about whether to provide extra care and assistance.

Below is a list of questions to consider when determining if your loved ones are in need of additional care or assistance:

Pay Attention to How They Look – Looking at the senior’s appearance can be a sign that they are being limited either physically or mentally from completing otherwise normal daily tasks.

  • Are they wearing dirty or stained clothing?
  • Have they brushed their teeth?
  • Is their hair combed?
  • Do they appear to have lost weight?
  • Listen to the Senior – Listening to what and how seniors speak can tell you a lot about their current mental status.

Don’t assume that “old age” is causing these problems; doing so can sometimes lead to further deterioration in their mental state.

  • Are they up on current events?
  • Do talk about future plans or goals?
  • Have they forgotten to refill prescriptions or take their medicine?
  • Have they missed doctor’s appointments?

View the Senior’s Surroundings – Looking at their food and sorting through their medications can help you determine if they are eating healthy or even worse, taking expired medicine.

  • Is there an unusual amount of garbage, clutter, dust, or dirt?
  • Do they have fresh and stocked pantry items?
  • Are there piles of unopened bills?
  • Has their housekeeping declined, i.e. dirty floors, windows or bathtubs

Use Your Nose – Using your nose as an indicator can help you determine if your family member is bathing properly, participating in otherwise normal activities or whether or not they are eating regularly.

  • Does their living environment possess any unpleasant odors?
  • Does the refrigerator or cupboard smell?
  • Are they bathing regularly?
  • Do they have expired or rotten food in the refrigerator?

If you sense a problem based on the above indicators, you and other family members should waste no time in taking the appropriate next steps. As difficult as the process might be, keep reminding yourself that by being proactive you will not only provide safety for your family member, but will also keep them happy and healthy for years to come.

Provided by:  Right at Home, www.RAHcares.com, 503-574-3674
Copyright © 2008 RetirementConnection.com. All rights reserved.

When The Care Receiver Lives With you

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American society is often a muddle of contradictions, and this is certainly true when it comes to families. On the one hand, we cherish the concept of the extended family and laud the ideal of multiple generation households. On the other we cherish our privacy and fiercely defend our independence. It is thus important for you, your relative or friend, and other family members to weigh the pro’s and con’s of living together. This is especially true if you are working or have other family responsibilities. You will need to consider these before you enter into an arrangement that may or may not be the best option for you and your care receiver.

Pro’s and Con’s

It is probably best for everyone involved to discuss what you imagine the pro’s and con’s of living together to be. Every family’s situation is unique. Listed below are some of the benefits and drawbacks that may result. It is important for your relative or friend to take part in the decision, and to be a valued and contributing member of the family with meaningful roles, whenever possible.

On the plus side:

1. If your care receiver needs considerable care, you will save the expense of a long-term care facility or, at least, some in-home services.
2. You know that your care receiver is getting the best possible care because you are either providing it yourself or directly overseeing the care.
3. You will be able to make major decisions that can give you a sense of empowerment.
4. You will have more time to spend with your family member or friend.
5. Your children will have an opportunity to spend more time with their grandparent(s) or other older relative, have an important lesson in compassion and responsibility, learn about their roots, and develop a sense of family continuity.
6. If your care receiver is fairly healthy, he or she may help with household tasks, and/or with the children.

On the other side:

  1. You may have less time for yourself and/or other family members and if you work you may find conflicts between your job and caregiving responsibilities. Some employment versus care giving responsibility may be relieved, especially in light of the technology revolution that is taking place, where telecommuting may now be an option.
  2. Depending on your lifelong relationship, you may find that you and/or your relative resent changes in your relationship that may take place.
  3. You will lose at least some of your privacy.
  4. Other family members may resent the new arrangement.
  5. There may be less space for everyone in the family.
  6. You may find that hands-on caregiving is too physically and/or emotionally demanding.

If you decide that you do want to live together, you might want to try it on a trial basis, if possible. You might consider renting or subletting your care receiver’s home on a short-term basis so that he or she has the option of returning home if the new arrangement does not work out to everyone’s satisfaction.

You will want to consider what, if any, physical changes need to be made to your residence and how much they will cost.

Will Intergenerational Living Work in Your Home?

As a guide, you may want to ask the following questions:

  1. Is your home large enough so that everyone can have privacy when they want it?
  2. Is there a separate bedroom and bath for your family member, or can you create an accessory apartment?
  3. Are these rooms on the first floor? If not, can your relative climb stairs safely?
  4. Can you add to or remodel your home to provide a first-floor bedroom and bath?
  5. Do you need to add safety features such as ramps and better lighting?
  6. Does the bathroom have a shower, is it large enough to accommodate a wheelchair, if needed, and can safety features, such as grab bars, be installed to prevent falls?
  7. Are door openings wide enough for a wheel chair?

You also may want to set some ground rules for privacy.

Sharing Time Together

Obviously, if you want your care receiver to live with you, you will want to share times together.

  • Set aside times to talk.
  • Involve your care receiver, if possible, in family outings and social events.
  • Invite other family and friends to your home, and let them know that you are available to come to their house as well. Not all of them will respond, but some will.
  • Even errands, such as shopping, can be something of a social event, and give your relative a chance to participate in decision-making.

At the same time, you want to ensure that other family members do not feel that they have been “displaced” and that they are as important to you as ever.

Source: www.aoa.gov
Provided by: The Staff at www.RetirementConnection.com
For more information: www.LongTermCare.gov
Copyright © 2008 RetirementConnection.com. All rights reserved.