Starting a Care Conversation With Aging Parents


In the United States, nearly 70 percent of individuals age 65 and older will require long-term or post-acute care at some point in their lives. And with the population of older Americans expected to more than double to 92 million by 2060, the growing need for skilled nursing care will be experienced by families from coast to coast.

However, for many families, starting a conversation about aging care and options with a loved one is very difficult and emotional. By beginning a care conversation early, families can talk openly and honestly about aging, senior care, medical needs and their loved ones’ desires. Using simple steps to start a conversation, you and your loved ones can plan for the future and ensure care needs are met every step of the way.


DO

Do start the care conversation early

Despite the growth in the number of older Americans, long-term and aging care is still a very sensitive subject. For many families, discussions about aging and mortality are swept under the rug, tucked away as a conversation for a later date.

Starting the conversation is often the hardest part. According to 2011 market research commissioned by the American Health Care Association (AHCA), the nation’s largest association representing long-term and post-acute care providers, nearly 60 percent of adults were not having conversations with families and loved ones about plans for aging or long term care needs.

Many of us avoid care conversations because we assume loved ones don’t want to discuss sensitive matters. These perceptions may not be reality. Loved ones may want to talk and the process may be easier than we think. We simply won’t know until we try, so it is vital to push past initial reservations and commit to taking action. When embarking on a care conversation, remember to address the who, where and when; be flexible; take the right approach; ask specific questions; and remember, it is not about you.


Do know your loved one’s care needs

There are several important steps to take when planning care for a loved one. It is crucial to recognize the signs--including the mental, emotional, social, physical and medical signs--that a loved one may need additional assistance, or that your loved one may require a more customized care solution.

Having care conversations with a doctor and other care providers before a crisis situation occurs will allow an individual to determine his or her own wants. But it also aids in determining which type of facility is best, based on a loved one’s medical condition.

One of the biggest challenges is understanding the medical needs of a loved one. This will largely influence the type of care facility that will best suit a person in times of need. Care needs can change, so it is helpful to familiarize yourself with various short-, mid- and long-term options.


Do plan and prepare for care

It is essential to make decisions based on medical needs and evaluate the types of care providers--such as in-home care, adult day care, assisted living care and skilled nursing care--that can best meet those needs.

Families should ask questions of various facilities and observe different types of care, as well as discuss costs and finances associated with each center. Learning about payment methods and government assistance programs, such as Medicare and Medicaid, also can guide a decision about the type of facility that is best for an individual.

It is critical to consider various ways of evaluating care, not just online surveys and ratings. While many resources are available to check a facility’s ratings, oftentimes these reports do not paint the full picture of a facility. It may be helpful to talk with other family members of residents at a facility to understand the quality of care provided.


Do visit care centers and know what to ask

Visiting a facility is the best way to compare facilities. If you are able, take time to tour facilities in the area where your loved one will reside. Many individuals have misconceptions about what long-term care facilities are like, how they function and the services offered.

It is also important to know the right types of questions to ask when an individual is exploring choices and options. Questions about the facility’s history, special care programs, how complaints are handled and what emergency plans are in place can help shape a family’s thoughts on a particular facility.


Do prepare for the transition

Transitions are usually easier to manage when you know what to expect and how to help a loved one feel more at home. As you and your loved one prepare for a move from the home, take some time to plan out the hours after you leave the center on moving day. Maybe your loved one will want company or maybe he/she will want to be alone. Be prepared for different options. Understand what you can expect during the first day, week and month after a transition.


DON'T

Do not leave your loved one out of the conversation

The right mix of people, place and timing will help set the right tone for a pleasant, productive care conversation. Because care conversations are likely to affect everyone, it is worth trying to involve everyone. While it may seem tough to find a quiet moment amidst the hustle and bustle of busy lives, try to find a place and time when people are likely to be relaxed and receptive.

If a family sits down together prior to a crisis, many of the difficult decisions will have been made, ensuring that the family knows the desires of their loved one and can be prepared when a crisis situation does develop.


Do not ignore your emotions

According to research conducted by AHCA, adult children often experience strong emotions of guilt when it comes to caring for their parents. Additionally, aging Baby Boomers do not want to place a burden on their families. This can develop into a difficult choice for families to decide what type of care is best. For many families, there is a challenging balance between emotions and action.

Experiencing a health crisis is a stressful situation, and attempting to develop a care plan for your loved one can be an overwhelming situation for many individuals. Choose a time when your family can focus on the conversation. Some may be upset about the news and that is okay. Allow them to have their reactions and don’t take their reactions personally.


Do not believe that in-home care is always the best care

For many families, in-home care is often the first type of care considered. However, in-home care is not necessarily the right type of care needed for an individual. Considering the medical needs of your loved one should be the main driver of the selection of a care center. If a current care solution is not meeting your loved one’s needs, it is time to explore different options. Oftentimes, different relationships or circumstances require a different approach.


Do not forget to consult a doctor

Consulting with primary care doctors prior to a medical crisis can provide insight as to the types of skilled nursing and post-acute care centers most appropriate for a family member or loved one.
Do not think that today’s care centers resemble nursing homes of the past

Over time, skilled nursing care centers, like all areas of health care, have advanced in terms of clinical practices, resident rights, quality improvement, and the overall approach to the needs and wants of residents and patients. Yet, even today, many misconceptions about nursing homes (called skilled nursing care centers) do exist.

Separating fact from fiction will help you stay open to all of your care options. It is essential to experience a care center firsthand to understand that nursing homes are not what they used to be in the 1940s and 1950s. This is a new era of healthcare and senior living.


SUMMARY

After conversing with a loved one’s doctor or care provider and determining what type of care center is most appropriate, a family can explore options within their community that fits their budget and care needs.

Speaking with an elder care advocate, such as Elder At Home, can help families navigate through the process of selecting a facility for their loved one. It is important for families to grasp what to look for in a facility, to understand the elements of care that are important to them and their loved one, to know the key questions to ask when visiting a facility and to appreciate the rights of all patients.



Navigating The Challenges of Becoming a Caregiver to Aging Parents


With each new decade, the expected age of longevity increases. And elderly parents tend to require care from their adult children who are also aging.

It is a fact that most adult children expect to offer financial assistance and/or personal support to their parents at some time. Recognizing the steps that adult children can take to assist their parents in the role of caregiver will make the task easier for both caregiver and care receiver.


DO


Do prepare legally

To prepare you for your role as caregiver, make sure your parents’ necessary legal documents are current and in order. Know how to access them. These documents will help you make decisions on your parents’ behalf, should it become necessary. A durable power of attorney allows a person of their choice to handle their finances and housing decisions. An advance healthcare directive provides for an individual to make healthcare decisions in their place. A living will states their wishes concerning end-of-life wishes and medical care. A will or trust stipulates how to distribute the estate upon death.


Do research all of the logistics

Research senior services in the community where your parents live. Visit various levels of senior housing facilities and put their names on waiting lists before it becomes necessary. If you receive a call that space is available and the time is not right, state this fact and ask to remain on the list. Keep a list of names and telephone numbers of one or two of your parents’ neighbors, doctors and lawyer. Let each of these individuals know how to contact you.


Do define your role

How much you are willing and able to do for your aging parents depends on how close you live to them and on the current relationship you have. There is no way you can take care of yourself, any children still living at home, a job and relate to your significant other, while also caring for someone else. Make a commitment to yourself about how much you are willing and capable of doing and stick to it. Share that commitment with someone you trust and ask them to help you honor it.


Do provide intergenerational time

If your parents are able, give them the opportunity to interact with their grandchildren and great grandchildren. Family contact does wonders for their feelings of belonging. Parents often underestimate the memory-building that takes place when younger generations interact with their grandparents and great grandparents. If you live in the same community and still have children living in your household, visit your parents with the children on a regular basis. If your parents are capable, you might read together, play board games or take a walk. If you have adult children, encourage them to email or Skype their grandparents. Sometimes it is only after the older generation is gone that grandchildren and great grandchilden recognize how important the interactions have enriched their own lives.


Do take care of yourself

When caring for parents, self-care becomes a necessary priority. Just like when flying, in an emergency you are advised to put on your own oxygen mask before assisting another. And the same dictum holds true in caring for aging parents. One cannot successfully give when trying to do so from a state of depletion. When you don’t take care of yourself, you become exhausted, resentful and depressed. Take advantage of available respite programs. Spend time with significant others and friends. Find humor in the situation whenever possible. Take walks, breathe, read a good book, soak in a bubble bath. Whatever feels nurturing to you, do it on a regular basis. Unless you do, you will be unable to care in the way you would like.



DON'T


Do not do for your parents what they can do for themselves

Some families take on more responsibility for their parents earlier than is necessary and do more than their parents need when caretaking must begin. Be clear about what the needs are before stepping in to assist. Doing for others what they can still do for themselves can cause friction or result in unnecessary dependency. Elderly people need to be respected for the skills they possess.


Do not treat your aging parents like children

Caregivers tend to talk with the elderly as if they were talking to children. Choose words that your parents will understand combined with an adult tone of voice. Do not call them pet names, such as honey. While your parents may sometimes act like children, they are not. At some level, they recognize the difference between respect and condescension. Condescension demeans. Adjust your tone to the situation. Always remember that you are speaking with an adult.


Do not forget to ask for help

You are not in this alone. Caring for aging or sick parents challenges even the most loving of adult children. It means adding one more role to your busy life. Use available community services. Ask friends and neighbors for a helping hand. Accept help when others offer to assist. Usually people are generous with their time when they know you need some short-term assistance.


Do not fail to take breaks

Everyone needs a break from caregiving if they are to give from a full heart. Breaks help in maintaining enthusiasm for life. Spend time with friends. Continue your hobbies. Take regular date nights with your significant other. Discipline yourself to think of things other than your parents and their care.


Do not ignore your emotions

While you have known that caring for your aging parents might become a possibility, when the day arrives, it comes as a shock to many. Although you may want to provide care, there is also an emotional cost. You will probably experience a range of emotions during the months or years of caregiving--sometimes in roller coaster fashion. Remember that this is normal. Just when you think you have a handle on life, something may happen to disturb the equilibrium. Seek counseling or medical help if necessary. Ignoring your feelings will not help you move through them.


SUMMARY


Caring for aging or sick parents can bring rewards, but it also comes with challenges. Take the steps to assist your parents in getting their legal documents in order before caregiving becomes required. This saves time, money and possible family disruption upon their death. Learn the community resources available for elder care and get your parents names on waiting lists. This provides options.

Even in their most difficult times, your parents are adults and need to be respected as such. They can perceive how you approach them and what you say at a deep and subtle level. Above all, take care of yourself. You can only give when your needs are met. Take time for yourself, nurture yourself and allow others to nurture you. Always remember that you are not alone.




How Alzheimer's Disease And Lewy Body Dementia Are Different


Alzheimer's disease is one of the more serious chronic health conditions that seniors can face. In fact, the impact the ailment can have not just on older adults, but on family members, caregivers and health care providers as well, has elevated Alzheimer's to a catch-all term that encompasses any and all type of cognitive decline, at least when people speak about it casually.

The truth, however, is that while Alzheimer's is a serious cognitive condition, and while the Alzheimer's Association indicates that it currently affects around 5 million Americans, associating any type of cognitive illness or dementia with Alzheimer's is a mistake. One condition in particular, known as Lewy body dementia, has been confused with Alzheimer's so often that it's actually been underdiagnosed in years past. Understanding what LBD is, and how it differs from Alzheimer's and other forms of dementia, is important for providing seniors with proper care.


What is LBD?

According to the Lewy Body Dementia Association, LBD is actually a term that refers to two separate but similar conditions. The source noted that the reason the diagnosis is shared is because both presentations - Parkinson's disease dementia and dementia with Lewy bodies - effect the same type of change in the brain, despite having different symptoms at their onset. The disease currently affects around 1.4 million Americans, though the source estimates that there are likely more individuals who have the condition and have not received a proper diagnosis. In fact, LBD is the second-leading cause of dementia. Unfortunately, its symptoms, diagnosis and treatment are still misunderstood by many, including health care providers.

How is it different?

Like Alzheimer's, LBD is a form of dementia that affects the cognitive ability of the person living with it. Due to this similarity, as well as the prevalence of Alzheimer's - a disease which affects nearly five times as many people - it's not uncommon for doctors to misdiagnose LBD as Alzheimer's. However, the two different conditions not only affect the brain in different ways, but also display somewhat different symptoms.

As the LBDA pointed out, Alzheimer's affects the brain's ability to store new information in the form of memories, which accounts for the condition's characteristic memory loss. Lewy body dementia, on the other hand, targets a different set of cognitive functions - specifically problem-solving and reasoning. While there are tests that can more conclusively determine the presence of these conditions, in general, both Alzheimer's and LBD are diagnosed through observation and tracking how symptoms progress.

The Alzheimer's Association indicated the 10 warning signs that may indicate the onset of Alzheimer's, which include things like memory loss that is disruptive to daily life, as well as confusion relating to perception of time and place. As the LBDA noted, progressive dementia is also the central feature and most prominent symptom of Lewy body dementia, though the organization did say that cognitive symptoms may not be present in the condition's early stages.

The differences between Alzheimer's and LBD are subtle but significant. For example, in addition to cognitive impairment, LBD can also manifest through frequent disruption to REM sleep cycles. Depending on the type of LBD, features similar to Parkinson's disease can also appear, which is another factor contributing to misdiagnosis.


The importance of getting it right

Any chronic condition requires accurate and expedient care, however this is especially true of LBD. According to the LBDA, individuals with this ailment can be more sensitive to certain medications than those with other types of dementia, leading to fewer drug treatments that are actually effective. Identifying the presence of Lewy body dementia early and, importantly, correctly is essential to stopping the progression of symptoms.


Little-Known Winter Dangers For Elders


Falls, and hypothermia are likely to top the list of caregiver concerns during the icy winter months. But, elderly loved ones are also at risk for some lesser known, but still impactful, hazards brought on by frigid weather.

Seasonal affective disorder and vitamin D deficiency can be hazardous to a senior's health. The good new is, they are both easily treatable if identified and dealt with properly


Winter SADness

Feeling a bit glum may seem like an ordinary reaction to the fading glow of the holidays. But, when that feeling of sadness persists for more than a week or two, it might not be just the lack of festive lights and carols getting your elderly loved one down.

Seasonal Affective Disorder, also known by the acronym, SAD, is a form of depression that cycles with the seasons. It can occur during any time of the year, but it typically hits most people in the winter.

As the weather gradually gets colder and the days shorter, people affected by the winter-induced form of SAD will generally begin to feel the symptoms of depression, including; a loss of energy, an increased appetite and an enhanced feeling of lethargy and tiredness.

According to the National Institutes of Health, SAD is more likely to strike women and people who live in northern areas where the sun is not as strong or constant.

The main difference between SAD and general depression is that SAD only strikes during certain times of the year. The hormonal changes that lead to depressive symptoms in people with SAD are usually caused by a decline in the amount of daylight during the winter and fall.

These effects can be compounded if a person primarily stays indoors and doesn't have the opportunity to venture out into the sun often.


Turning their Frown Upside Down

Like other forms of depression, SAD can be treated with antidepressant medications, which are most effective if started prior to the onset of symptoms each year.

Another form of treatment designed to alleviate the symptoms of SAD is light therapy.

Light therapy utilizes a piece of equipment called a ‘light box'—essentially a fluorescent lamp that gives off light similar to natural sunlight.

A good quality light box generally costs about $200 and most come with a filter that blocks UV rays so that the light does not to damage a person's eyes or skin.

Research has shown that, when used properly, a light box can help decrease the amount of melatonin (a hormone that causes drowsiness and lethargy) circulating in a person's body, and regulate the neurotransmitters serotonin and epinephrine. Having an imbalance of these chemicals can heighten the symptoms of depression.

If your loved one is diagnosed with SAD, their doctor may instruct them to sit in front of the box for 30 to 45 minutes a day, usually in the morning, in order to make up for the lack of sunlight most people experience during the winter.

Though it is not always the go-to treatment for SAD, some studies have shown that light therapy has the potential to be as effective as antidepressant medication when it comes to treating the disorder.

Of course, a more natural alternative to light therapy is daily exposure to sunlight. If time and weather conditions permit, it would be helpful for a person with SAD to go outside for a few minutes during daylight hours.


Vitamin D Deficiency

Vitamin D is a vital nutrient that has been linked to bone health, cancer prevention, incontinence prevention, and diabetes prevention. A person can obtain vitamin D by eating certain foods (Salmon, beef, egg yolks, fortified cereals and juices), brief sun exposure, and by taking dietary supplements.

While frigid weather is likely to have little effect on that availability of the right foods and supplements, the sun is weaker and out for shorter periods of time in the winter, making it difficult for people to get enough exposure to produce vitamin D.

Lacking vitamin D is bad for a person's health at any age, but can be particularly dangerous for the elderly. Older people who don't get enough vitamin D have an increased risk for developing osteoporosis—a dangerous decrease in bone density that can contribute to broken bones.

Unfortunately for seniors, the National Institutes for Health has identified elderly people as an at-risk group for vitamin D deficiency.

Older people are less efficient at using sunlight to produce vitamin D, and are more likely to be housebound and unable to be exposed to enough sunlight to be beneficial. Also, certain medications taken by older people, such as the anti-inflammatory, prednisone, can inhibit their natural ability to produce and metabolize vitamin D.


Fortify Your Senior Against a D Deficit

Combating vitamin D deficiency in the elderly can be tricky.

Experts are loath to prescribe extra time in the sun to a group of people more prone to developing skin cancer and it can be tricky to determine how much supplementation to suggest.

Making sure a senior is eating foods fortified with vitamin D is the safest way to help reduce or prevent a deficit. Certain varieties of milk, yogurt and juice all contain extra doses of the vitamin, but not so much as to pose a hazard to an elderly person's health.

If you are considering supplementation or extra time in the sun for your elderly loved one, consult with their doctor to come up with a proper plan of attack.