Items in Caring Currents tagged with Home Care

The Junk Wars: 8 Ways to Get Rid of Aging Parents' "Stuff" (and Your Resentment Over Having to Deal With It)

Paula Spencer — Thu, 30 Apr 2009 07:00:00 -0000

"Christmas lights. Do not work." Three boxes, so labeled and tucked in the basement ceiling joists, were perhaps my favorite find while clearing out my parents' house. Well, those or the shelf of neat notebooks recording weekly bowling scores back to the 1960s. A dozen casserole lids, no casseroles. Spare stereo knobs, circa 1975. Enough yarn to knit a sweater that could encase the entire house and yard, Christo-style.

I tossed plenty of useless stuff while clearing out my parents' home of 40-odd years, recently. (100 pairs of elastic-waist pants, anyone?) But I had it relatively easy, because my parents weren't involved. (My mom had died and my dad, who was relocating, was sidelined by dementia.)

Most caregivers face the "junk wars" with still-living relatives. It can happen when you combine households because of the recession. Or help a parent downsize into assisted living. Or just try to make a crowded old house safer for an older adult in which to age-in-place.

Sorting through the accumulated years can be exasperating. Even a nightmare, if the person is a packrat, under stress, or hopelessly sentimental. (Which doesn't leave too many people, I know.)

This week I read some great tips on the topic in a thread in Caring.com Groups on whether people fantasized about getting rid of parents' stuff.

Here are some of the best, and a few others:

1. Start yesterday.

Just about everybody who's been through the ordeal – whether they have to "de-junk" in crisis mode or not – wishes they'd begun sooner.

Tip: Appeal to the person's sense of not wanting to be any "trouble": "Dad and Mom, it will be a heck of a lot more trouble for me to sort through all this after you're gone than to sit here and help you get a handle on it now."

2. Snap it, then dump it.

Great tip from Caring user Bobbi in Florida: Take pictures of beloved objects before disbursing them. "What is really important are the memories, not the stuff," she says she discovered. Your parent is apt to have more fun looking at albums (or downloaded images online) than dusting and digging. Likewise, you can scan old documents.

Tip: Perfect summer job for an unemployed teen.

3. Box it and "forget" it.

For stuff you're pretty sure you're not going to want to see again – but the resistant person insists is important – try some elegant boxing. Get official, sturdy moving boxes, carefully label contents, and relocate the clutter to a basement or storage unit. Nine times out of 10, it's never asked about or seen again. But the person feels reassured that it's safe.

Tip: For items worth leaving out, write the significance (where it came from, family meaning, etc.) on a piece of paper stuck to its bottom. Your own children may appreciate this tiny extra step.

4. Develop some questions to sort by.

The specific questions depend on the situation, but you can make a game of it. Samples: When was the last time you wore it? (More than two years and it's out.) Does it work? (If it doesn't function, forget it.) Is this a sentimental thing for you or a memory you want to pass on to somebody else? Is there anybody who could use this more than you right now (a young family starting out, a charity)?

Tip: Focus on potential gains (less to clean, safer floors, money, helping someone else) rather than losses.

5. Distinguish saving from collecting or hoarding.

It might all look like junk to you, but understanding the person's motivation can guide the psychology you use on them. People reared during the Depression tend to save stuff because they "might need it someday." (That would explain my Dad's broken Christmas lights.)

Collectors might be persuaded to cash in on their collection(s) in this economic climate. Or work with them to plan ahead to divide a collection among, say, grandchildren as Christmas gifts.

Hoarders are often ill. Often you can surreptitiously cart off some of their stuff with less much fuss. Learn how to spot a hoarder.

6. Cope with it as an alternative to "American Idol."

Try easing a willing parent into a downsizing spirit by suggesting you spend an evening a week, or an hour every evening, having "Sort Time."

Tip:Start nonthreatentingly small: a corner, a box of paper paraphernalia or photos, a bookcase.

I love how one Caring user put it: "I've learned stuff I would never otherwise have learned and for my Mom it is a trip down memory lane, on the one hand, and a chance to say goodbye and move on with the next life chapter, on the other."

7. Enlist professional help.

Especially if it's a crisis or you're out of town, consider finding a senior move manager. These experts know not only what to do with all that stuff but, more importantly, empathetic ways to get someone to willingly part with it.

8. Think twice about grabbing it for yourself.

Your own kids will thank you someday.

Your Parent's Pet: Friend or Foe?

Paula Spencer — Sat, 28 Mar 2009 07:00:00 -0000

Is your mom's Fido a faithful friend or complicating nuisance? What about Grandpa's Fluffy -- healing creature or potential deathtrap?

One look at the pleasure my 87-year-old Dad gets cradling Coco, the miniature (and I do mean tiny) dachshund he lives with convinces me of all the research established on how pets do older people a world of good. They help a person relax and are a form of socialization. (Even if he has to look at her collar every few minutes: "And this is…what's your name? Coco!" )

But Coco's tininess is also a worry to me. She gets, well, underfoot.

And companion animals can be a very real health risk, it turns out. More than 21,000 elderly Americans are treated in emergency rooms each year due to falls associated with their pet dogs and cats, says a new report from the Centers for Disease Control and Prevention. That's not a huge number. But the really scary part: The highest rate of injuries from all pet-related falls occurs in people older than 75. And the most common diagnosis is the potentially life-altering one older people really want to avoid: Fracture.

The biggest dangers:

Tripping over pet toys
Untrained excited dogs who jump up
Pets who sleep on the bed or at one's feet
Tripping over a cat or dog lurking around one's ankles
Getting tangled in a leash

So what's a well-intentioned relative to do?

If someone insists on keeping a pet:

Warn them. For many elders "falls" is a very scary word. Just knowing the danger might help them move more carefully.
Really watch their interactions. Is it a frisky dog who jumps up on people? The CDC recommends obedience training, but many older people can't follow through with the rigors of training – and many old dogs won't learn new tricks.
Really watch the person. Being unable to care for a pet can be a red flag about the person's ability to live independently. When vision problems are severe, for example, even a well-behaved animal can be a hazard.
Consider hiring a dog walker –a.k.a. a local teen-- who can exercise the animal for the person.
Have someone walk with the person who can control the leash while going out together.
Routinely scour the house for chew toys, etc. just as you look out for throw rugs, papers on the floor, and other potential hazards. Just get rid of them.

If someone can't keep a pet:

See if a friend or relative will adopt the animal who's also willing to bring it for visits. Spending time with animals really can lift the spirits of the ill or housebound.
Look into pet-therapy programs in your area that bring pets to homebound people. Someone with mid-stage dementia may be comforted by any pet, not necessarily their own. Start by asking a program coordinator at a senior housing facility or your area agency on aging.
Know that some long-term care facilities do allow pets.
Don't feel overly guilty about removing an animal who can't be cared for. It's always sad when pet and owner must part ways. But in the big scheme of things, you have to prioritize. If you've done everything you can think of to help a pet-lover maintain the benefits of having one, and to find the pet a good home, that's huge on top of all of a caregivers' other demands, even if it doesn't work out perfectly.

Pets are neither all-bad nor all-good. Like most of us.

Possible Ban of Darvon is Good News for Seniors -- Even Those Who Take It!

Melanie Haiken — Wed, 11 Feb 2009 08:00:00 -0000

When you're in pain, it's natural to ask for something stronger. And of course doctors want to make patients in pain more comfortable. For many seniors, the result has been that they walk out of the doctor's office with a prescription for Darvon, Darvocet, or a generic equivalent.

In fact, these painkillers, which contain the active ingredient propoxyphene, are so popular they're the 12th most prescribed generic drug in the country, with 23 million prescriptions written a year. Having been around more than 50 years, they're very popular with older adults. Yet health experts and consumer groups have for years been warning of the dangers of Darvon/Darvocet, particularly for seniors.

In 2006, The Public Citizen petitioned the FDA to ban propoxyphene medications, and on January 30th, an FDA advisory panel narrowly voted to recommend a phase-out. (In 2005, health authorities in the UK initiated a phased removal and it's almost completely off the market throughout the UK.)

Why the alarm? Propoxyphene is a central nervous system depressant, so it can cause dizziness and disorientation, and many health advocates for the elderly are concerned that these drugs greatly increase the risk of falling. In fact, propoxyphene is specifically listed as a risk factor for hip fractures!

It can also cause mental confusion that can be mistaken for dementia. Another risk is severe depression, suicidal thoughts, and death. Data from the Federal Drug Abuse Warning Network attributed 5.6 percent of all drug-related deaths to propoxyphene-based painkillers. And many of these were suicides. (When combined with alcohol, it's even more dangerous.) Then there's the fact that propxyphene can build up in the system and increase or trigger heart problems. Need I say more?

The FDA is continuing to hear testimony from experts and is expected to decide the drug's fate in the next few weeks. At the very least, it's almost certain they will add new safety warnings and possibly tighten restrictions on use.

But for caregivers, there's no time to waste. Believe me, as many of us have found out the hard way, you really don't want your parent or other family member taking this drug. So check the medicine cabinet for Darvon, Darvocet, Wygesic, or a generic propoxyphene compound. If you find it, it's time for a talk.

Of course, those taking Darvon or Darvocet may be anxious about giving it up. But the truth is, repeated studies have shown that propoxyphene is no more effective than Tylenol (acetominophen) or aspirin, despite its risks. Here are some alternatives to ask about:

For mild pain, acetominophen -- up to 650 mg -- or aspirin is the best bet.
For moderate to severe pain, Vicodin (hydrocodone) is usually recommended.

Discuss with the doctor whether it's necessary to gradually reduce your family member's dosage; because propoxyphene is an opiate, it's possible to become dependent on this drug, and many people who've been taking it for a long time are dependent, experts say.

No matter what the FDA does, the advisory panel's vote is good news for those trying to raise awareness about the dangers of Darvon/Darvocet. As one pharmacist commented in response to the FDA's news release: "As a pharmacist at a local hospital, I cringe every time I see an 80-something-year-old patient with Darvon/Darvocet listed among their home medications. In our hospital, we have a policy to limit the number of doses a patient can receive over 24 hours, for their own safety. Great job, FDA, on moving forward to remove a horrible drug from the market, when better alternatives exist."

What To Do When a Family Disagreement Makes Caregiving Way Harder Than It Needs To Be

Paula Spencer — Thu, 12 Feb 2009 08:00:00 -0000

There's little that's more frustrating than doing your best in a situation involving the welfare of an elder -- only to have your choices criticized or opposed by a sibling, parent, or other family member. Hello super stress.

Family disagreements are nothing new. But when you're all grown-ups, you can't slug it out in the backyard or send anybody to their room. At least, not if you plan to resolve anything. That leaves nitpicking, debating, raising voices -- or ceasing to talk to one another altogether. And when that's not productive, then what?

That's when you can try something relatively new: Elder mediation.

You might think of mediators in connection with the Middle East or high-profile corporate disputes. But many family mediators specialize in handling situations related to aging or ill relatives. They're a fast-growing subset of the mediation world.

If you're like me, the very word "mediator" may at first ring complicated – and expensive. But a closer look convinces me that elder mediators are actually one of the many unsung heroes of elder-care conundrums. They know how to get competing viewpoints aired in a constructive way and move past family dynamics (like, "once the baby, always the baby," even if you're 50-plus). Critically, they also understand the unique issues of aging.

So, 6 surprising reasons elder mediation might help:

* To slice your stress level in half.

If you're a hands-on caregiver, why waste your slim-to-nonexistent energy on bickering or defending yourself, when an independent figure with listening and problem-solving skills can become the magnet for high-running emotions? (Not to mention push family members past blame and toward a common goal.)

* To help everybody move on (whether you all end up sending birthday cards to one another or not).

Hard situations can gum up families for years. Mediators tackle toughies like charges of favoritism by a parent, step-family tangles, who should handle financial or legal affairs, or an abusive or uncaring parent who's come back in everyone's lives needing help. If everyone is willing to come to the table aiming for a solution, the odds increase that one can be found.

* To help an aging parent's wish for family harmony come true.

Parents hate knowing they're "causing anybody any trouble" and hate to be the cause of rifts. And they know when they are. Most elder mediation sessions helpfully involve the central figure, even in cases of dementia, unless they're too infirm to be able to contribute.

* To make a plan.

You don't need a Hatfield-McCoy-level feud to see a mediator. A calm, neutral forum is a great way to sort through confusing options on where an older relative should live or painful, emotionally-charged ones where nobody's sure what to do, like end of life care.

* To get far-flung families on the same page.

Ideally all the parties get together to hash out a conflict. But mediators will usually work with those who are long distance, after a starter group session or by conference call.

* To save money.

Especially these days, it can seem unreasonable to spend money solving an argument. Initial elder mediation consults are often free, then cost $150 and up per hour, varying by area. Some issues can be resolved in just a session or two, others longer. But mediating a conflict (especially over questions of guardianship or estates) avoids far more costly court battles in which a judge decides. Then there's the question of what peace of mind and moving on with your life are worth.

Ideally, families split the tab. "When parties share the cost, the investment in the process is usually greater," notes Debbie Reinberg, an elder mediator with ELDEResolutions in Denver.

You might have more luck than you think bringing sibs to the table. Mediators say that baby boomers are pretty comfortable "talking things out" and take to the idea better than their parents. But parents are more persuadable by benefits I just outlined, like financial savings.

To find a family mediator, ask a local geriatric care manager or lawyer. (Many mediators are themselves CGMs or attorneys, although the person you use should be an impartial third party to all involved.) Try for someone with a lot of experience working with elder concerns because they have training in dealing with situations that tend to be highly emotional; look for the moniker "elder mediator."

Federal Initiative Brings Nursing Home Patients Home

Nell Bernstein — Tue, 16 Dec 2008 08:00:00 -0000

It's that time of year, my husband and I joke nervously as winter and the holidays approach. Nursing home time.

The last two holiday seasons have found my 88-year-old father in skilled nursing facilities, following emergency-room stints for various age- and season-related ailments. He's got emphysema and arthritis, and winter means flus that can lead to pneunomia, and weather that ups the risk of falls or driving accidents.

By the second time around, the hospital-to-nursing-home trajectory seemed crushingly familiar: the meetings with the hospital discharge planner, the visits to tinsel-draped nursing facilities, and then the long, slow car ride with my father dozing in the passenger seat as we took him to the last place on earth he wanted to be.

As soon as we got him settled in to the half-a-room he was to call home for the holidays, he'd start complaining loudly and lobbying for his car keys. And really, who could blame him? Researchers who've surveyed the over-sixty set have found that they fear winding up in a nursing home more than they do death itself.

Despite that, the way current funding streams are structured, if you need extra care after a hospital stay, a nursing home is usually your only option -- even if it might be cheaper, and a lot more pleasant, to receive similar supports at home.

But this holiday season brings some glad tidings. On the home front, my dad is doing just fine -- no ER visit or nursing home stint on the horizon (fingers crossed). And on the policy front, Connecticut has just joined several other states in a federal initiative with the evocative title "Money Follows the Person" (MFP) that, should it become the norm nationwide, could save my dad and lots of other frail elders from unwanted nursing home stays -- and save taxpayers money.

The MFP initiative is designed to support seniors at home, paying for things like in-home caregivers and wheelchair ramps. In Connecticut, it costs the government just over $1,000 per month to support an elderly person at home, compared to about $5,500 in a nursing home. The state estimates that 700 seniors and others with disabilities who are currently living in nursing homes will actually move home (their own, a family member's, a new apartment or assisted living) as the initiative is implemented.

The program got its impetus in 2005, when a Southbury, Connecticut, resident named Joseph Stango, who wanted to bring his nursing home-bound mother home to live with him, became discouraged (just as I was) by the fact that the government would spend thousands of dollars for care she didn't want in a nursing home, but wouldn't help him give her the care she did want at home. He took her cause to state legislators, and over a three-day campaign, collected 700 letters of support from elders and their children.

The upshot? Connecticut was awarded a $24.2 million federal grant to broaden the use of government funding in the home setting. This month, the first nursing home patients will start enrolling in the program, and packing their bags for home.

The first time my own father was in a nursing home, he was so rattled that -- still recovering from pneumonia and heart problems complicated by emphysema -- he checked himself out against doctor's orders, leaving me to scramble to meet his needs at home.

The second time around, I saw what was coming. As soon as the words "get me out of here" left his lips, I started making arrangements for home care -- knowing, again, that we were entirely on our own.

Being old and sick is scary enough as it is. Forcing ailing elders to stay in nursing homes when they've told us they'd rather be dead, and there are other, cheaper options….well, most of the rest of what my dad had to say about it isn't fit for print.

During the Connecticut campaign for MFP, the local Catholic bishop went on record describing home care as a "basic human right." I'm with him -- and I'll be watching that state's MFP roll-out with one eye as I keep the other on my dad during this risk- and thanks-filled holiday season.

Image by Flickr user Michael (mx5tx) under a Creative Commons attribution license.

Cash and Counseling Program Offers a Paycheck for Care Giving

Nell Bernstein — Tue, 17 Jun 2008 07:00:00 -0000

Providing care to an elderly relative can be costly not only emotionally but also financially. One study of 30 families providing care determined that collectively, they would sacrifice more than half a million dollars over their care giving years in lost wages alone.

Of course, none of us are in it for the money, but it certainly is nice when a government program comes along that recognizes the financial strain care giving can place on a family.

The Cash and Counseling Program -- which allows Medicaid recipients who would otherwise be eligible for in-home care benefits to receive the money themselves, and spend it on their own care as they see fit, including paying family members to look after them -- does just that.

Pioneered in the late 1990s, Cash and Counseling is now available in 15 states. The good news is that the federal government recently eliminated the requirement that states get a Medicaid waiver in order to offer the program. Now that the process has been simplified, at least 18 more states are planning to adopt Cash and Counseling over the next several years.

These are the years during which more and more of us will be taking on greater responsibility for our parents -- cooking for them, taking them to doctor's appointments, perhaps even moving them into our homes. What I wonder is how getting paid to do these things might change the parent-child dynamic.

On the one hand, getting compensated could certainly take the pressure off -- especially if you've had to cut back on paid work -- and this might decrease the odds of resentment creeping into the relationship. But could a paycheck also create unexpected strains? Could a parent -- perhaps one whose perceptions are beginning to be altered by dementia -- start thinking that you're "in it for the money," or begin treating you like paid help and making unreasonable demands?

As Cash and Counseling catches on, these may be questions for the next round of researchers. Meanwhile, to learn more, check out Caring.Com's article on how Cash and Counseling works, and a related guide to putting a personal care agreement in writing.

Photo by Flickr user materials boy, used under the Creative Commons licensing agreement.