Items in Caring Currents tagged with parents

Should Family Members Who Provide Alzheimer's Care Be Paid?

Paula Spencer — Tue, 24 Jun 2008 07:00:00 -0000

Should the family member who's handling the lionshare of caregiving for a parent with Alzheimer's be paid for his or her (usually her) services? That "increasingly popular option" came up in a Wall Street Journal column on blunting the costs.

The problem:

Alzheimer's care carries the twin burden of usually being available both 24/7 and long-term. We hear so many stories at Caring.com of members who give up their jobs or downshift to part-time in order to look after parents. They save on the cost of professional care. But they lose income, retirement savings, Social Security -- and, potentially, medical insurance.

The pitfalls:

Federal bills that would compensate family caregivers have tended to die in committee. Should taxpayers pay for this growing need? Families may not have funds to pay one of their members, especially in this economy. And If funds come from family, there may be sibling disagreements over how much -- or whether -- to pay. How will care be monitored? Is it a wise financial move for everyone? If your parent ends up applying for Medicaid some day, the payments can be viewed as a transfer of assets, the WSJ warns, delaying eligibility.

The advice:

Be sure to draw up a personal-care agreement if you go this route.
Use an elder-law attorney who knows both state law and federal Medicare rules.
Talk about the possibilities early in the disease, if you can. What are your parent's preferences? Should a live-in caregiver inherit the house or a larger share of the estate, instead of taking a salary?
Turn over all the money rocks. Some long-term care insurance policies pay for a family caregiver to become a licensed home-health aide. Don't overlook paid family leave. Medicaid offers a Cash and Counseling program, which Caring.com blogger Nell Bernstein highlighted last week. More on options for getting paid here.

The questions:

Do you know anybody for whom paying a family Alzheimer's caregiver works?

Should family caregiving be paid at all, or does it fall under "what families just do"?

Image by Flickr user mushroom and rooster, used under the Creative Commons attribution license.

Say What? Hearing Loss Common Among Adults with Diabetes

Sarah Henry — Thu, 26 Jun 2008 07:00:00 -0000

Listen up: There's yet another test to add to the list of health checks and screens for your parent with type 2 diabetes. Turns out that hearing loss may be an under-recognized complication of diabetes.

A recent NIH study found that hearing impairment is almost twice as common in adults with diabetes compared with the general population -- and diabetes appears to be a risk factor for the condition, independent of exposure to noise, certain medications, or other known potential hearing loss triggers.

Of course, hearing impairment and old age tend to go together, but a strong connection between diabetes and trouble hearing has only been hinted at until now. Researchers speculate that diabetes may lead to hearing loss by damaging the nerves and blood vessels of the inner ear.

So, when your parent goes for a doctor's visit and gets screened for the usual suspects -- foot problems, high blood pressure, and blood sugar -- make sure she gets checked for some of the lesser known diabetes-linked ailments, such as depression, sleep apnea, gum disease -- and get those ears checked too.

Do you hear me loud and clear?

Image by Flickr user altemark used under the Creative Commons attribution license.

Falling Down and Feeling Down: What's the Connection?

Sarah Henry — Thu, 26 Jun 2008 07:00:00 -0000

Researchers from Down Under have discovered that older folks who are depressed are more likely to take a topple than those who feel relatively chipper -- and seniors who take meds to deal with their depression are at even greater risk for falling down and getting injured that those who don't.

If your parents are prone to blue moods, these stats will make you want to watch their steps:

People with depression taking antidepressants -- especially the commonly-prescribed kind known as SSRIs -- are 50 percent more likely to take a spill than other old folks.
In women over 80 with depression on an SSRI, the numbers jump to 60 percent.
Those with any degree of depression were up to 70 percent more likely to have multiple falls and injury than those who weren't feeling low.

Yikes! What to do if your parents are in the doldrums? First, find out if they're taking any drugs to deal with their depression; if so, you'll want to be extra vigilant to ensure they don't have a fall.

Either way, you can plan to minimize their risks. Think leg strengthening and balance training exercises for your parent, as well as completing a home assessment plan to reduce hazards, such as ensuring adequate lighting, removing potentially dangerous obstacles like throw rugs, and installing grab rails in the bathroom.

I'm curious: Would you have suspected a connection between stumbles and sadness?

Image by Flickr user D'arcy Norman used under the Creative Commons attribution license.

New Legislation (and You) Can Help Prevent Seniors From Falling

Nell Bernstein — Tue, 24 Jun 2008 07:00:00 -0000

The Safety of Seniors Act, a bipartisan bill recently signed into federal law, tackles a problem that keeps many care givers up at night but has previously received little in the way of national attention: senior falls.

Falls are the leading cause of injury deaths among those over 65, accounting for about 13,000 deaths and 1.8 million emergency room visits annually. With one in three seniors experiencing a fall each year, fall-related medical costs total a staggering 19 billion annually.

If your parents have decided to grow old in their own home, there are a few simple steps you can encourage them to take right now to lower the odds of a fall (lots more information is available at stopfalls.org):

Get rid of any throw rugs.
Install a banister on both sides of the stairs for extra stability.
Make sure all areas of the home are brightly lit.
Install grab bars in the shower or bathtub and beside the toilet.
Go over all your parents' medications with their doctor and/or pharmacist to be aware of interactions that might cause grogginess or disorientation, and ask the doctor to help figure out the best times to take drugs to minimize interactions and side effects.
Ask the doctor or a physical therapist to suggest exercises to improve balance.

The Safety of Seniors Act focuses on increasing public awareness, supporting research and demonstration projects that foster new approaches, and studying the effects of falls on health care costs. While President Bush has signed it into law, there is no funding attached yet to implement it.

What do you think? Have your parents experienced a fall -- or do you worry that they're at risk for one?

Next week: Can New Technology Offer Seniors a Fall-Free Future?

Image by Flickr user SuziJane, used under the Creative Commons licencing agreement.

Do Parents With Dementia Need a "Sexual Power of Attorney"?

Paula Spencer — Thu, 12 Jun 2008 07:00:00 -0000

Nobody likes to think about their parents', um, sex lives. Once dementia enters the picture -- bringing so many other concerns to deal with -- you might think sex, at least, is a moot issue. Not so fast, suggests an illuminating article in Slate. "Dorothy," 82, and "Bob," 95, were residents of a long-term care facility who fell in love and became sexually active. Both have dementia.

On their side: Relatives and staff who saw the pair as happy, healthy, and (critical to old age) socially reinvigorated -- and who perhaps wondered about their own rights to sexual pleasure and autonomy in their later years.

On the other side: Those who were horrified by the affair and variously worried about heart attack, socially and morally inappropriate behavior, and gold-digging.

In the grey middle: Concerns about informed consent, given the dementia, and about the role of the nursing home to balance the needs of sociability, safety, and privacy.

"Who controls the intimate lives of people with dementia?" the article asks. "Unless specific provision has been made, their families do."

Bob's dispproving son moved his dad elsewhere without warning him. Dorothy drooped and, in a lucid moment, asked her daughter to publicize her plight.

Most families find it hard enough to talk about financial and medical powers of attorney. Can you imagining hammering out with your parent his or her sexual rights in the event of mental decline?

Forget me not image by Flickr user Umme Salma Hamdani, used under the Creative Commons attribution license.

Aggression, Fighting Common Among Nursing Home Residents

Nell Bernstein — Tue, 10 Jun 2008 07:00:00 -0000

I will never forget the image of my grandfather lying in his bed in a skilled nursing facility in Wyoming, clutching his wooden cane. Another resident had taken an unfriendly interest in him and would steal the shoes right off his feet, and my grandfather felt the need to defend himself even in his sleep.

New research from Cornell University helps explain my grandfather's hyper-vigilance. Aggression and violence among nursing home residents, the researchers found, is much more common than is generally recognized, with "serious consequences for both aggressors and victims."

Researchers at a large urban nursing home documented 35 types of physical and verbal abuse, including screaming, pushing, punching, and fighting. In a related study, nurse-observers reported 30 episodes of resident-to-resident aggression during a single 8-hour shift.

Unfortunately, the study's authors were short on solutions. So I asked two Caring.com senior housing specialists what they recommend you do if your parent has a run-in with an aging bully.

Here's what they had to say:

Nan Hayes, President, RIghtSized Living: First, involve staff to help check facts and determine the cause of abuse. With new residents, staff and family should also take time to evaluate the behavior of the victim, who may unknowingly be contributing to the situation. For example, a new resident who is disoriented may wander into another resident’s “space," creating fear and resulting in an incident of verbal abuse. Family and staff can support parents in a new social setting by making sure they're comfortable with basic logistics and daily routines. New residents should understand procedures for reporting abuse within the community and feel comfortable sharing fears or concerns.

Donna Quinn Robbins, CEO, Ultimate Moves: In my experience the family doesn't have much control in a situation like this. My advice would be to go directly to the administrator rather than a nurse or nurse's aide, who are often overwhelmed. Request a room change if the aggressor is a roommate, and keep up the pressure. The administrator is the key.

Have you been there--trying to help your parent deal with conflict or aggression in a nursing home or other retirement setting? What worked for you?

Image by Flickr user Eddie~S, used under the Creative Commons licencing agreement.

To Protect Seniors in Natural Disasters, Talk About It Beforehand

Kate Rauch — Mon, 09 Jun 2008 07:00:00 -0000

Worried about how your parents will manage in a hurricane, cyclone, earthquake, flood, or other disaster? Get them gabbing. Talking is one of the most important ways to protect seniors in a natural disaster, according to a recent report from the Hartford Financial Services Group, an insurance company that funds research on aging, among other things.

A recent survey of older Americans commissioned by Hartford found that a huge majority expect to rely on others in a disaster. But most of these same folks haven’t talked about disaster planning with their family, friends, or neighbors. So the people most likely to help them don’t know what they need or expect.

The solution: Sit down for a chit-chat with your parents or other elderly loved ones and hatch out a plan for handling disasters. Covers such basics as:

Establishing a network of people to check on them and then to pass information to others
Making sure they have an emergency supply kit. Check out these tips on kits from the Red Cross and the U.S. Department of Homeland Security
Back-up medications, prescriptions, hearing aids, glasses
Extra food and medications for pets

This information plus much more is covered in detail in a great booklet published by the Hartford with the MIT AgeLab. The Red Cross also has helpful disaster planning information for seniors.

It’s so easy to put this stuff off until it’s too late. I’m guilty of this, and I live in earth-shaky California, where the next “Big One” is expected any second. What I like about this recent advice is that it's straightforward: “Mom, dad, let’s chat. Do you own a flashlight? Got any bottled water on hand?”

Image by Flickr user pink moose under the Creative Commons Attribution License.

Parents' Driving Worries Baby Boomers, But No One Wants to Talk About It

Connie Matthiessen — Wed, 11 Jun 2008 07:00:00 -0000

It turns out that Baby Boomers would rather talk to their parents about almost anything except their driving. In fact, in a recent survey by Caring.com and the National Safety Council, adult children agreed that given the choice, they'd even prefer to talk to their parents about death over driving.

A Charged Issue The "Mature Drivers Survey" underscores the fact that seniors and driving safety is a deeply charged issue for contemporary families. More than a third of the adult children surveyed said they'd prefer to talk to their parents about selling their home, or even about their funeral wishes, than about giving up the car keys.

Safety Concerns Their reluctance to broach the subject doesn't mean adult children aren't concerned about their parents' driving. A quarter of survey respondents believed their parents should limit their driving, and one in ten felt their parents should be required to restrict their driving, or shouldn't be driving at all. Seven in ten adult children believed there should be some form of mandatory testing for older drivers.

Few Alternatives A shortage of transportation alternatives may be the biggest challenge facing seniors and driving safety, according to survey findings. Over half of respondents reported that public transportation was not available where their parent lived, and only one in seven said that public transportation was available that would meet their parents needs. This means that for many seniors, giving up the car keys means increasing isolation and dependence. It's no wonder, then, that this is a subject both parents and adult children want to ignore as long as they can.

If you're worried about your parents' driving but have been avoiding the issue, Caring.com can help you get started with a variety of driving resources, including a tool that will help you determine the regulations for senior drivers in your parents' state, ideas for how to talk to your parents about driving safety, and tips on alternative forms of transportation.

Check it out and let me know what you think.

Image by Flickr user Calamity Meg, used under the Creative Commons licencing agreement.

What Do You Give an Old Dad for Father's Day?

Paula Spencer — Sun, 08 Jun 2008 07:00:00 -0000

My dad's had a rough year. His wife of 57 years died unexpectedly of cancer, and he moved from his home of more than 40 years in Michigan to my brother's home not far from me in North Carolina. He has dementia. He also has a renal mass, found last spring, that couldn't be biopsied.

But he complains of no pain and joined a new bowling league in N.C., the Swinging Seniors. He helps my brother and his wife move mulch and fold laundry. He plays Wii with their six kids.

He's like a lot of dads: failing, but resilient. He always was like a lot of dads of his era: A lifetime employee who left in the tract-house morning with tie and briefcase and came home in time for meat and potatoes. Let Mom play the heavy. Watched a lot of sports.

On Father's Day, I used to make him a paper crown and give him Old Spice, a tie, and chocolate covered cherries. Father's Day seemed like a bonus birthday.

It's only as an adult that I've come to think of the day not just as a way to celebrate a parent, but to reflect on him in relation to the person I've become. It's impossible to idealize your dad when you're the one filling out the forms at his doctor's office or working the ATM for him.

He doesn't seem to care about gifts. (Who needs more stuff at 86?) Flowers were always welcome on Mother's Day, but Dad would just give them to my sister-in-law (who deserves them, but that's another point).

I'm not wracking my brains beyond hugs and cards, though. Already this year, I've steered him through medical crises and helped him plan Mom's funeral. I packed him for a move South and then went back up north and packed up his whole house.

And I'm not even the primary caregiver. My brother and his wife have changed their whole lives adding him to their household. Another brother takes him to Mass every weekend. A sister manages Dad's finances. We're trying to sell his house.

Father's Day? These days it's like Father's Year.

Which is true for so many of us. Because what aging dads need most can't be wrapped.

Going For Broke? Seniors Turn to Newer Loans To Avoid Cash Crunch

Stephanie Miles — Fri, 06 Jun 2008 07:00:00 -0000

As the economy continues to falter, senior citizens are turning to more aggressive -- and in some cases riskier -- ways to generate cash to pay bills and buy groceries and gas, according to a front page story in the Wall Street Journal (online subscription required.)

In record numbers, seniors are raising money by turning to products like:

Reverse mortgages
REX loans, which pay out lump settlements in exchange for a chunk of future equity gains
Life insurance settlements
401k loans and hardship withdrawls

Though these loans and products may seem like a convenient way for income-strapped seniors to get quick money, some carry tax consequences and higher fees than traditional loans and home equity financing. The article blames the trend on the usual culprits: falling home prices, dwindling jobs, and a sharp increase in food and energy prices.

Seniors who buy into these types of products won't necessarily lose their money or assets, but there is the risk of jeopardizing future investment returns (say, by cashing out a 401k early) or reducing the size of an estate that your parent may want to leave to future generations (like with a life insurance settlement.)

If your parent is considering any type of loan or other product that offers up-front cash in return for high-fee or high-interest payments down the line, it's important that they talk over all their options with a financial advisor experienced in elder finance issues. Other resources to help you help your parents make smart financial decisions include:

Seniors who opt for one of these "riskier" options may wipe out whatever financial safety net they've worked to create over long years of saving and planning. On the other hand, in the words of one man in the story who emptied his retirement accounts at the age of 51: "Why plan for retirement if you can't make it today?"

Image by Flickr user Kevin Dooley, used under the Creative Commons License.