GrampsCare (TM) - Caring for the Elderly

HAPPY NEW YEAR 2010!!!

2009-12-31T16:38:00.001-05:00

Merry Christmas to all!

2009-12-25T16:18:00.002-05:00

Here are links to some nice Christmas music by Mannheim Steamroller, YouTube videos: http://www.youtube.com/watch?v=DEXQOtaPdg8&sns=em

http://www.youtube.com/watch?v=EY-EL56ArUc

Happy Thanksgiving!

2009-11-25T23:54:00.002-05:00

Gift-giving for Gramps - holidays coming up, and birthdays year-round: some great ideas for all budgets

2009-11-08T13:17:00.001-05:00

It's that time of year again as holidays approach, plus there are birthdays year-round, and budgets of all sizes are as challenged as our imaginations by that question: what might Mom / Dad / Grandma / Grandpops / Aunt Audry / Uncle Malcolm / hubby Will / wife Doris / GRAMPS of all relationships and friendships, like to receive?

Well here are some new ideas in addition to those we reviewed last year (use the "Holiday" label to find). These include ideas you can do for free, almost free, and range from low-cost gadgets through more expensive items:

Holiday Gifts for Seniors | Article and Information | Caring.com, at http://www.caring.com/articles/holiday-gifts-for-seniors
Bionic gloves for gardening, etc., and more! There are plenty of neat ideas in this article along with website link where you can buy the productes described. Here's one among many:

Using the Presto Printing Mailbox, seniors can receive and print e-mail and digital photos without a computer.
Automatically converting and printing digital content, the Presto doesn't require a dedicated line, and it doesn't interfere with using the house phone.
Ideal for receiving and printing photos, personalized newsletters, and e-mail, the Presto functions as a kind of indoor mailbox.
To order: Presto (link is in the article so click the article link above to locate)
Cost: $149 for the printer; $13 monthly for the delivery service

Here's another that's focused especially for those in hospice or otherwise getting close to the end of life -

Best Gift for Dying Parent | Best Gift for Someone Dying | Caring.com, at http://www.caring.com/questions/best-gift-for-dying-parent

There are many great answers contributed. Here's a quote from just one of them:

You can get her a FotoDialer. It is like a combination photo album and speed dial that connects to her phone. It is full of 24 wallet sized photos you put in of family friends, places etc. When she wants to call someone, she finds their photograph and pushes a button next to it and FotoDialer calls them through her existing phone. http://www.PhotoDialing.com or http://www.FotoDialer.com.

Here's a good article for all families (written in terms of Christmas but the ideas are useful for those of any faith, as well as birthdays): Creative Christmas Gift Ideas from Dave Ramsey, at http://www.daveramsey.com/etc/cms/creative_giving_5811.htmlc. These are budget-friendly ideas, and many will be suitable for the seniors ("Gramps") in your family.

Article: Five Debt Triggers -- One Simple Solution | Caring.com

2009-08-27T05:40:00.003-04:00

Here's some great information for families sinking into debt, for any reason which can include caring for or helping with Gramps' situation. You are NOT ALONE - and there are good companies that are helping others like you every day.

This article at Caring.com gives info and a link to find one of these good companies:
Is Debt Becoming Contagious in Your Family? Five Debt Triggers -- One Simple Solution at Caring.com.

Here are some of the common problems entangling families nowadays:

1. Medical bills. Who wouldn't help a family member out in a health crisis? But the need can be so great that it sinks everyone.

2. Mortgage payments. When one family member is about to lose a house, it's natural for another to step in. But co-signing loans or loaning money to make payments can make one disaster into two.

3. Property taxes. In my family this was what tipped the scales; my sister had to borrow $20,000 to cover my mother's unpaid property taxes and keep her house off the county auction block. Luckily, this was before the downturn, and my mother was eventually able to pay her back by refinancing her house.

4. Credit card debt. While this type of debt is individual, we've heard from manyCaring.com members about parents deeply in debt and adult children wondering how to help them.

5. Gambling debts. Lonely older people are vulnerable to casino policies that can rapidly turn small debts into big ones.

If you're in this situation, I'm hoping that reading this list is making you feel better. You're not alone, and it's important not to let shame keep you from getting help.

I echo that sentiment. So I urge you to click and read the article and follow the link to find help. Do it now!

Swine Flu vaccine coming soon and 9 more senior health items

2009-08-23T20:35:00.000-04:00

Caring.com circulated another good batch of info and Q&A topics in one of the emails I received from them, so I want to share this set: Swine Flu vaccine coming soon and 9 more senior health items:

From: "Caring.com Suggests" <caringsuggests@m.caring.com
Subject: Swine Flu vaccine coming soon and 9 more senior health items

10 New Senior Health Items
Forward to a friend
View online

Swine Flu Vaccine Coming in the Fall: What You Need to Know Caring Currents
Swine Flu was back in the news last week with reports of so many cases spreading around the globe that the World Health Organization announced it's no longer going to keep count...

Incontinence: Did Your Loved One Request Adult Diapers Or Did You Insist? DISCUSSION Active 1 Post | Last Updated: July 20, 2009
Incontinence is such a tough topic to talk about. If your loved one has issues with it, how did the conversation about adult diapers come up? Did your loved one request to use them or did you...

Elder Boom Will Be Felt Worldwide NEWS
MONDAY, July 20 (HealthDay News) -- The proportion of people who are age 65 and older will double from 7 to 14 percent of the world's total population by 2040, says a new U.S. Census Bureau study.

Dementia Increasing Among the 'Oldest Old' NEWS
MONDAY, July 13 (HealthDay News) -- Scientists tend to think that dementia and Alzheimer's disease taper off in the oldest, but a new study finds that people over 90 have the highest rates. According...

How can we get Mom to agree to move into an assisted living facility? DISCUSSION Active 11 Posts | Last Updated: July 20, 2009
My Mother - in-law has always been disabled, she suffers from TIA's, has seizures, has a trake tube and hip displacia. I've tried convincing her that she would have better care is she lived in an...
What could cause frequent dry heaving? QUESTION Active 1 Expert Answer, 1 Community Answer Add Your Answer
I have bouts of dry heaving at times and it hits me all of a sudden with frequent stomach indigestion or acid reflux. I sometimes get bile, but typically I don't throw anything up...

Dental Care for Seniors ARTICLE Active 3 Comments
Dental hygiene may easily be overlooked, but it's an important part of keeping an aging loved one comfortable and healthy. As we age, adults in general tend to have dental problems that can cause pain...

Do You Feel Like Your Parent Has A Doctor Who Looks At The "Big Picture"? DISCUSSION Active 3 Posts | Last Updated: July 16, 2009
One of my biggest frustrations in helping my parents with their medical care is how quickly a generalist will toss you to a specialist who, in turn, only looks at that one small area, completely neglecting the rest...

10 Signs That Your Parent Might Have Parkinson's Disease CHECKLIST 1 Comment
Parkinson's disease creeps up slowly, starting with mild symptoms that are easy to ignore at first. What follow are three cardinal features of the disorder (signs 1, 2, and 3 below) that doctors look for...

Checklist: Travel for Someone With a Chronic Condition ARTICLE
Let the person's primary care doctor know of your travel plans. Take more of the person's medications than needed, along with a list of names and dosages. Check with the doctor to see if an immunization...

Visit Caring.com Suggests--and choose the topics you're interested in. Then let us sift through the clutter, so you always have the right information at your fingertips.

All content © 2007-2009 Caring, Inc., 2600 S. El Camino Real, Suite 220, San Mateo, CA 94403. All rights reserved.

Caring.com is here to help you care for your aging parents and other loved ones. We provide information and other resources you need to make better decisions, save time, and feel more supported.

Caring.com is an informational site only. Neither Caring.com nor its partners provide medical advice, diagnosis or treatment, or legal, financial, or other professional services advice or advice about what service providers to use. By using our Website, you agree to the Terms of Use and Privacy Policy.

Can you take care of your Gramps at home? "Yes You Can" and here are some tips and resources

2009-08-23T20:07:00.003-04:00

There's a good article about how you can set up to care for a loved one at home, so I'll quote from it below. Here's the link to read the whole thing: Providing Care at Home: Can I Do It?, at the American Hospice Foundation.

This article gives answers for a wide variety of questions asked by people about caring for family members in the home. So I recommend reading it, including for particular questions about special medical situations, Alzheimers, etc. It also includes a list of links to other resources for family and home-based caregivers.

One set of info is simple, practical, and universal for everyone. So I'll copy it in below. But you'll still want to read the whole article:

Much as you would if a toddler were coming for a visit, do a safety inventory of your home, but tailored to the needs of your loved one:

Remove scatter rugs to prevent trips and slips.
Remove obstacles from areas where your loved one might walk to prevent falls.
Place grab bars in the tub and next to the commode.
Use raised toilet seats and non-skid shower seats.
Be sure that your loved one has well-fitting shoes with non-skid soles.
Floors should have a slip-resistant finish.
Electric cords should be properly secured well away from areas where your loved one might walk.
Be sure emergency contact telephone numbers are posted prominently.
Observe good hand-washing routines before and after providing hands-on care.

Helping Gramps with toothbrushing and dental care is simple and important

2009-07-22T08:00:00.001-04:00

Dental care is an item that isn't often discussed but is surprisingly important. There are studies for example that have linked poor dental hygiene with increased incidence of various illnesses. And obviously, it's a bad thing for Gramps to have gum disease, cavities, or even losing teeth and having to have dentures. Even Gramps with dentures needs to brush, use mouthwash, etc., in order to keep the gums and mouth healthy, and keep any teeth that are still there. (Even having a few teeth helps to "anchor" dentures.)

What about costs of dentures? It does make a difference to pay for the extra costs of having dentures that fit to Gramps' mouth. If they are customized in this way, then they stay in better with much less denture adhesive (maybe even no adhesive, as we found for a while).

Here are a few simple tricks we learned for helping Gramps do a good job brushing teeth:

* Use a very soft brush. The soft bristles can bend to get where they need to go to clean in between teeth, and brush/massage the gums to keep them healthy too. And they don't hurt Gramps' mouth the way hard bristles can.

* Allow Gramps to use tepid water, meaning water that isn't too cold. Not hot water either, of course (don't risk burns)! But room-temperature water, or water running with some cold and a little of the hot to make it comfortable to the touch (you can check with your wrist), can help make the experience more comfortable for Gramps. (And therefore encouraging full brushing.)

* By all means, use a toothpaste flavor Gramps likes!

* Ask the dentist what kind of toothpaste is recommended. It may be that you should avoid the "whitening" types if they may contain substances that are too harsh for the enamel, for example.

* If Gramps has difficulty being at the sink for tooth-brushing, then simply bring two cups - 1 empty, 1 with room-temperature water, along with the toothbrush already cleaned and with the toothpaste, to Gramps where s/he is sitting. It's simple for Gramps this way. Having 2 cups helps Gramps to rinse with the water from one and spit out into the empty cup.

Also check out this article at Caring.com for more good information and tips for helping with tooth care and dental visits: Dental Care for Seniors - Article and Information at Caring.com

Caring.com: 9 New Stress and Burnout Items

2009-07-10T11:54:00.005-04:00

Here are links to some good articles, within an example of little email newsletters you can get from this online resource (Caring.com):

From: "Caring.com Suggests" caringsuggests@m.caring.com>
Date: July 10, 2009 9:01:57 AM EDT
Subject: 9 New Stress and Burnout Items
Reply-To: caringsuggests@m.caring.com

9 New Stress and Burnout Items
Forward to a friend
View online
I'm Getting Roped into Caring for an Elderly Neighbor! How Can I Get Out Without Hurting Anyone? Family Advisor
I am a neighbor to a dear elderly woman. We've become close over the years (I'm about 20 years her junior), and I haven't minded doing little things for her. About six months ago, she broke her hip and...
Caregiver stress is making my brother hostile. What can I do? QUESTION Active 1 Expert Answer Add Your Answer
My brother has been living with my mom since my dad died five years ago. She is legally blind, with advanced Parkinson's and back pain . He has done a wonderful job of taking care of her...
How can I be active in my parents' care from a distance? DISCUSSION Active 5 Posts Last Updated: July 06, 2009
Hi, I stumbled onto this web site while looking for senior resources. I've been trying to help my parents for the past couple of years after my Dad broke his hip and Mom had her heart attack with stent install...
I'm caring for a difficult husband and want to leave but he has no one else. DISCUSSION Active 90 Posts Last Updated: July 07, 2009
I would be interested in exchanging problems and thoughts with others that are caring for spouses. There are a lot of discussions for caring for parents. This situation is totally different as far as I am concerned...
How can I stop feeling so anxious and relieve caregiver stress? QUESTION Active 1 Expert Answer, 23 Community Answers Add Your Answer
I have been a caregiver for my parents for the last four years. They live in an assisted living facility and have a 24/7 aide, and I visit them at least once a week and talk to them on the phone quite often as well...
How can we reconnect our marriage now that MIL is in a nursing home QUESTION Active 1 Expert Answer, 3 Community Answers Add Your Answer
I have been caring for my mother-in-law for a couple of years and quit my job last September to take care of her full time. The stress and burnout of taking care of her has caused our marriage great stress...
Does Anyone Have A Parent With C O P D? DISCUSSION Active 40 Posts Last Updated: July 02, 2009
My mother was diagnosed with COPD ( Chronic Obstructive Pulmanary Disease) about 12+ years ago. She also has bouts of bronchitus with this. Emphazema is always on the horizion...
How can I stop my mother with dementia from handling her feces and to wash her hands? QUESTION 1 Expert Answer Add Your Answer
My parent was diagnosed with dementia about four years ago. The problem I need advice on I found about a year ago. When going to the bathroom, she uses her index and next finger and thumb to pull out her feces...
5 Ways to Connect With Other Heart Disease Caregivers ARTICLE
Connecting with other heart disease caregivers 1. Join a support group for heart disease caregivers near you. A support group is a great way to connect with other heart disease caregivers...

Need to add or change your selection?
To update your profile, including your e-mail subscriptions, visit the Caring.com Member Center at http://www.caring.com/account/
Visit Caring.com Suggests--and choose the topics you're interested in. Then let us sift through the clutter, so you always have the right information at your fingertips.
To unsubscribe from this newsletter, click Here.
All content © 2007-2009 Caring, Inc., 2600 S. El Camino Real, Suite 220, San Mateo, CA 94403. All rights reserved.
Caring.com is here to help you care for your aging parents and other loved ones. We provide information and other resources you need to make better decisions, save time, and feel more supported.
Caring.com is an informational site only. Neither Caring.com nor its partners provide medical advice, diagnosis or treatment, or legal, financial, or other professional services advice or advice about what service providers to use. By using our Website, you agree to the Terms of Use and Privacy Policy.

Hospital do's and don'ts for Alzheimer's caregivers and 8 More Alzheimer's Items

2009-07-07T09:37:00.004-04:00

Here are some items of information available via Caring.com that may be very useful for a lot of people:

9 New Alzheimer's Items
Forward to a friend
View online
Why Hospitals and Alzheimer's Are a Tough Mix Caring Currents
The hospital is a stressful place for everyone –- and when the sick also have Alzheimer's or another form of dementia, both patient and loved ones face some extra hurdles, like these: Hospitalilized...
Do You Worry About Developing Alzheimer's Yourself? DISCUSSION Active 6 Posts Last Updated: July 06, 2009
If you've got a parent or family member with Alzheimer's , how much do you worry about getting it, yourself?
Tips For Keeping A Wandering Parent Safe DISCUSSION Active 1 Post Last Updated: July 06, 2009
It would be a nightmare to find a parent with Alzheimer's in an unsafe situation because of wandering. Yet...it's so common. Has your parent wandered? How did you find him or her...
Alzheimer's And Spending Money For "Contests" DISCUSSION 1 Post Last Updated: June 23, 2009
My father has never been a smart money manager, but his recent diagnosis of Alzheimer's may have made the situation worse. I live across the country from my dad, and have been helping him more and more for the past several years...
Dementia Alert: The Scary Complication Nobody Tells You About Caring Currents Active 8 Comments
You have plenty on your mind when an older relative has a health crisis. Allaying his or her fear. Figuring out next steps. In case of hospitalization, trying to catch the doctor in order to get firsthand...
Mother Angry At Being In Assisted Living DISCUSSION Active 33 Posts Last Updated: July 01, 2009
The NC court declared mom incompetent and me as her guardian last Aug. She is very angry that "I put her there", "would never have expected it of me", "there is nothing wrong...
I'm caring for a difficult husband and want to leave but he has no one else. DISCUSSION Active 87 Posts Last Updated: July 06, 2009
I would be interested in exchanging problems and thoughts with others that are caring for spouses. There are a lot of discussions for caring for parents. This situation is totally different as far as I am concerned...
My mother has Alzheimer's. Does that affect her legal obligation to pay donation pledges she has given over the phone? QUESTION 1 Expert Answer Add Your Answer
Obscure and, in my mind, dubious charities are constantly calling my mother getting her to donate ten or fifteen dollars and then pester her for the payments. Because she has Alzheimer's she doesn't remember the details of her pledges...
How can I convince my father to go to an Alzheimer's adult day care? QUESTION 1 Expert Answer Add Your Answer
How can I convince my father to go to an Alzheimer's adult day care center? We all need a break and he needs more socialization, but refuses to go.
Need to add or change your selection?
To update your profile, including your e-mail subscriptions, visit the Caring.com Member Center at http://www.caring.com/account/
Visit Caring.com Suggests--and choose the topics you're interested in. Then let us sift through the clutter, so you always have the right information at your fingertips.
To unsubscribe from this newsletter, click Here.
All content © 2007-2009 Caring, Inc., 2600 S. El Camino Real, Suite 220, San Mateo, CA 94403. All rights reserved.
Caring.com is here to help you care for your aging parents and other loved ones. We provide information and other resources you need to make better decisions, save time, and feel more supported.
Caring.com is an informational site only. Neither Caring.com nor its partners provide medical advice, diagnosis or treatment, or legal, financial, or other professional services advice or advice about what service providers to use. By using our Website, you agree to the Terms of Use and Privacy Policy.

Remaining aware of food safety alerts like the recall today, helps you, your family, and Gramps

2009-06-19T11:22:00.004-04:00

When you're responsible for the food eaten by any member of your family, and especially Gramps who's likely to be frail or have a weakened immune system due to advanced age (not unlike very young children whose immune systems often aren't strong) - you should keep up with food product alerts and recalls. The food may be recalled as a precaution, or for a minor reason. But there can be serious health problems if food becomes tainted for any reason.

One way to remain informed is to check the FDA's news site at http://www.fda.gov/NewsEvents/default.htm. You can even sign up to get email updates on these and similar alerts from the federal government, at http://www.fda.gov/AboutFDA/ContactFDA/StayInformed/GetEmailUpdates/default.htm.

Today's an example, here's an alert circulated today by the U.S. FDA (yes, this is real):

FDA Warns Consumers Not to Eat Nestle Toll House Prepackaged, Refrigerated Cookie Dough

Nestle Voluntarily Recalls all Varieties of Prepackaged, Refrigerated Toll House Cookie Dough

The Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) are warning consumers not to eat any varieties of prepackaged Nestle Toll House refrigerated cookie dough due to the risk of contamination with E. coli O157:H7 (a bacterium that causes food borne illness).

The FDA advises that if consumers have any prepackaged, refrigerated Nestle Toll House cookie dough products in their home that they throw them away. Cooking the dough is not recommended because consumers might get the bacteria on their hands and on other cooking surfaces. Note that you should be able to return the product for a refund to the store where you bought it (but don't open the package, you don't want to get the bacteria on your hands) - so if you return it for a refund, return it unopened for your safety.

Retailers, restaurateurs, and personnel at other food-service operations should not sell or serve any Nestle Toll House prepackaged, refrigerated cookie dough products subject to the recall.

Nestle USA, which manufactures and markets the Toll House cookie dough, is fully cooperating with the ongoing investigation by the FDA and CDC. The warning is based on an ongoing epidemiological study conducted by the CDC and several state and local health departments. Since March 2009 there have been 66 reports of illness across 28 states. Twenty-five persons were hospitalized; 7 with A form of kidney failure called Hemolytic Uremic Syndrome (HUS). No one has died.

E. coli O157:H7 causes a diarrheal illness often with bloody stools. Most healthy adults can recover completely within a week. Young children and the elderly are at highest risk for developing HUS, which can lead to serious kidney damage and even death.
Individuals who have recently eaten prepackaged, refrigerated Toll House cookie dough and have experienced any of these symptoms should contact their doctor or health care provider immediately. Any such illnesses should be reported to state or local health authorities.
FDA reminds consumers they should not eat raw food products that are intended for cooking or baking before consumption. Consumers should use safe food-handling practices when preparing such products, including following package directions for cooking at proper temperatures; washing hands, surfaces, and utensils after contact with these types of products; avoiding cross contamination; and refrigerating products properly.

For more information on safe food handling practices, go to http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm109899.htm.

Consumers who have additional questions about these products should contact Nestle consumer services at 1-800-559-5025 and/or visit their website at http://www.verybestbaking.com/ .

For a complete listing of the recalled products go to: http://www.nestleusa.com/PubNews/PressReleaseLibraryDetails.aspx?id=133CC131-A79F-4E84-9C43-C9F99FE5BC99.

This recall today is important because often people do eat raw cookie dough; and often, it's younger children or busy mothers with families who use the refrigerated cookie dough product that Nestle is recalling today.

But consider getting onto the recalls and alerts mailing lists, so you can remain informed about these important actions!

Help your Gramps travel - government's new airline travel ID requirements, and disability/special needs accommodations

2009-06-07T19:39:00.003-04:00

Gramps won't be able to travel on an airplane unless his/her name on the airline ticket exactly matches his/her government-issued photo ID. And neither will you! Since May 15, people purchasing airline tickets have been required to provide their name as it appears on the government-issued ID they will use when traveling. This is the first phase of a new federal Transportation Security Administration (TSA) program called “Secure Flight.”

Some examples:

If you plan to present a driver’s license at the airport, purchase your ticket using your name as it appears on your driver’s license.

If your Gramps plans airline travel and will present a passport, purchase Gramps' ticket using the name that appears on your passport.

The passenger must have a U.S. federal or state-issued photo ID that contains the following: name, date of birth, gender, expiration date, and a tamper-resistant feature. You can look up the TSA's complete list of acceptable forms of identification at their ID Requirements for Airport Checkpoints website.

Note: the image at left is just a screen shot of the TSA's depiction of acceptable ID documents. Be sure to check the TSA's site yourself if you are not sure, or to verify the requirements. Especially since they may refine the rules or issue more explanation at any time.

Right now, the airline officials may be allowing small differences between ID and reservation information, such as the use of a middle initial instead of a full middle name or no middle name/initial at all. But you run the risk that very soon, they will apply the rules strictly, so don't waste time making sure you comply.

If you or Gramps has a "profile" with a travel agency or frequent-flier membership with one or more airlines, you should check with them and make sure the profile is updated so the name matches exactly. That way, if your tickets are issued automatically, they should still match.

What if Gramps is disabled or has special needs because of a medical condition? The TSA has a webpage for that also, at Travelers with Disabilities and Medical Conditions. Disability-related items permitted through the security checkpoint include:

Wheelchairs
Scooters
Crutches
Canes
Walkers
Prosthetic devices
Casts
Support braces
Support appliances
Service animals
Baby apnea monitors
Orthopedic shoes
Exterior medical devices
Assistive/adaptive equipment
Augmentation devices
Ostomy supplies
CPAP machines & respirators
Hearing aids
Cochlear implants
Tools for wheelchair disassembly/reassembly
Personal supplemental oxygen
CO2 personal oxygen concentrators
Tools for prosthetic devices
Medications and associated supplies
Braille note takers
Slate and stylus
All diabetes related medication, equipment, and supplies
Any other disability-related equipment and associated supplies

What about liquids needed with carry-on luggage? As of the date of this post (June 7, 2009), TSA's current information is that they allow prescription liquid medications and other liquids needed by persons with disabilities and medical conditions. These include:

All prescription and over-the-counter medications (liquids, gels, and aerosols) including KY jelly, eye drops, and saline solution for medical purposes;
Liquids including water, juice, or liquid nutrition or gels for passengers with a disability or medical condition;
Life-support and life-sustaining liquids such as bone marrow, blood products, and transplant organs;
Items used to augment the body for medical or cosmetic reasons such as mastectomy products, prosthetic breasts, bras or shells containing gels, saline solution, or other liquids; and,
Gels or frozen liquids needed to cool disability or medically related items used by persons with disabilities or medical conditions.
However, if the liquid medications are in volumes larger than 3 ozs each, they may not be placed in the quart-size bag and must be declared to the Transportation Security Officer. A declaration can be made verbally, in writing, or by a person's companion, caregiver, interpreter, or family member.
Declared liquid medications and other liquids for disabilities and medical conditions must be kept separate from all other property submitted for x-ray screening.
For more information on these measures, the TSA posts a letter outlining this policy, at Changes in Allowances for Persons with Disabilities at Airport Security Checkpoints (pdf, 101Kb).

TSA's webpage at Travelers with Disabilities and Medical Conditions includes the following list of their more detailed webpages on the following items:

Introduction
Before You Go
Tips For The Screening Process
Mobility Disabilities
Hearing Disabilities
Visual Disabilities
Hidden Disabilities
Pacemakers, Defibrillators, Other Implanted Medical Devices, & Metal Implants
Continuous Positive Airway Pressure (CPAP) Machine
Medical Oxygen and Respiratory-Related Equipment
Diabetes
Medications
Assistive Devices and Mobility Aids
Prosthetic Devices, Casts, and Body Braces
Walkers, Crutches, and Canes
Augmentation Devices
Orthopedic Shoes, Support Appliances, and Exterior Medical Devices
Dressings
Service Animals
Children with Disabilities
Medical Conditions and Special Situations
Military Severely Injured Program

If you have additional concerns or questions you can also contact TSA's Call Center, or email - tsa-contactcenter@dhs.gov

=============
The government's Secure Flight is a multi-phase program developed by the U.S. Department of Homeland Security (DHS) to match passenger information against federal government watch lists for domestic and international flights. Before Secure Flight, airlines themselves were responsible for matching passenger information to the federal watch list. As Secure Flight is implemented, TSA will begin to assume responsibility for the security program. When you buy an airline ticket your name will be compared to the “No Fly” and “Selectee” lists, which are distilled from the FBI’s terrorist watch list. Individuals confirmed to be on the Selectee list, will automatically be subject to secondary screening, but could still be allowed to fly. If an individual is confirmed to be on the “No Fly” list, he or she won’t be able to fly within, into, or over the United States.

After August 15, domestic airlines will be required to collect (and passengers will be required to provide) date of birth and gender in addition to name as it appears on the government ID.

Information about the photo ID requirements for this post, was obtained from this post at the TSA's official www.tsa.gov/blog blogsite.

One Week Left (to June 12) before Digital Transition is Complete... Are You Ready?

2009-06-05T15:24:00.005-04:00

Did you realize that on June 12, the "digital transition" for TV reception will be final? I received an update about it from, of all sources, FEMA (the Federal Emergency Management Agency)! This is because I've signed up to receive alerts about things like hurricanes and similar emergency situations. Obviously they want people to ready to receive digital TV signals because so many rely on TV for information on emergencies. If you are receiving TV via a paid cable or satellite TV service, you are theoretically okay ... But, what if your cable (or satellite) service goes out in an emergency? Don't you want you - AND your Gramps - to have a backup digital converter box, so you can get local TV news in an emergency?

That's right, you want local news in an emergency, and you'll need a digital converter box (unless your TV is already digitally equipped) if your cable (or satellite) service goes out. The worst time for you to be stuck without cable/satellite TV service, and then not even able to use "rabbit ears" for over-the-air digital TV from your local TV news stations, could be right in the middle of an emergency. Once transition is complete, all local TV stations will broadcast ONLY IN DIGITAL. The FCC (Federal Communications Commission, the U.S. agency that's been working on this for a very long time) set up a website just to help with any questions: http://www.dtv.gov/ (farther below is an image showing what you see when you click to visit it).

So it's worth asking: One Week Left before the Digital Transition is Complete on June 12 ... Are You (AND GRAMPS) Ready?
Here's the information from FEMA:

One week from today, on June 12, 2009, all full-power broadcast TV stations in the United States will stop broadcasting on analog airwaves and begin broadcasting only in digital. Millions of Americans depend on TV as a source of information, to include emergency alerts and warnings. However, following the transition, the FCC estimates up to 20 million individuals could be left without TV communications because they haven't taken the appropriate steps to transition. We encourage everyone to ensure they are ready for the transition and to take steps to help their families and neighbors -- especially older adults and homebound individuals.
The switch to digital will reward most viewers with better sound, a better picture, more channels, and more programs. The transition will also help save lives by clearing airwaves for better first-responder radio service and making room for the future by clearing airwaves for advanced mobile Internet services.
Visit www.DTV.gov to find information on how to transition to digital TV, including:
Details about how to get help locally, the local channels predicted to be available after the transition, contact information for local support centers, TV reception maps for your area, local DTV events, a list of local retailers who sell converter boxes
An interactive troubleshooting guide that helps you solve your specific problems related to the DTV Transition as well as DTV Transition Call Centers
Fact sheets that cover what the transition is, the supplies needed to transition, and various guides to transitioning effectively
DTV information in multiple languages, a Media Toolkit, and much more
For ideas on how to get involved in your community's DTV transition efforts, view the Citizen Corps DTV Transition Fact Sheet at http://www.citizencorps.gov/news/press/2009/DTV_Transition.shtm.
This news story and other Community Preparedness news, including Citizen Corps Bulletins, can be found on our website at http://www.citizencorps.gov/.
Sincerely,
The National Office of Citizen Corps
FEMA Community Preparedness Division

Subscribe to receive alerts during disasters in your state.
FEMA · U.S. Department of Homeland Security · Washington, DC 20472
· 1 (800) 621-FEMA (3362)

www.Caring.com may be just the ticket for family helping Gramps

2009-05-25T13:42:00.005-04:00

Finally, I've come across a website that looks so promising, I might encourage all my readers to just go there! This does not mean that I won't continue GrampsCare. But it looks like some other folks have done a lot of work to create the type of website that I envisioned when I first started this blog. It's called Caring and is at http://www.caring.com/. A picture of what you see when you go there, is below. I heartily recommend visiting and browsing around!

I don't know if they have my ideas that have helped us and others - such as the wireless doorbell that Gramps can easily press to call for help. (Still my favorite.) Or the laptop beanbag "writing table" that Gramps uses for breakfast, lunch and dinner plates to eat easily (instead of those cumbersome swingaway or rolling tables.) But the site is full of all sorts of the information that I've been trying to make available to others like me.

So you'll be doing yourself a favor if you check it out - Caring at http://www.caring.com/:

Many options in durable medical equipment (DME) help you care for Gramps in-home

2009-05-25T13:09:00.005-04:00

Assisting devices, sometimes called durable medical equipment (DME) or medical devices, can make a huge difference in taking care of Gramps at home. Even when they are very simple!

Here are two examples of DME that we recently added for our Gramps. One is a mattress pad to help prevent bed sores. Bed sores are a real danger for Gramps because s/he has very thin skin and the pressure of lying or sitting for any amount of time can start these pressure sores, which can get worse, open up, get infected, etc. The mattress pad we got happens to be made by Invacare (with their cute new logo, "Yes You Can"!) with a simple air pump that circulates air through pockets sewn into the pad. You simply place the pad on top of Gramps' existing bed. Then the pressure on Gramps' skin is constantly changed, to prevent sores from starting in the first place. It's relatively inexpensive and easy to install.

Obviously "a stitch in time saves nine" so the modest amount of money it costs now can save very large amounts later. That's probably true for a lot of DME items which help you continue caring for Gramps at home and save on outside help or other, more expensive living arrangements. You can also save some by shopping and comparing prices online. For example, www.Invacare.com shows the retailers' suggested price, so you can compare against pricing offered at your local DME stores. Of course you can also use Craig's List, other shopping sites that help you save, and even just Google to look for DME items and providers to compare and save. These sources can also help you to locate information on other options. Importantly, you can also locate information on how to use DME items properly.

Here's the other item we got recently, an inexpensive "gait belt". There are different styles of gait belts. The basic idea is to place a special style of belt around Gramps and use it to help Gramps stand up, to transfer to and from a wheelchair, and even just walking if Gramps is unsteady. This is far better than just pulling on Gramps' arms or shoulders to lift - you can risk hurting Gramps' arm or even pulling their shoulder out of socket! Remember that Gramps is very frail. These belts help by supporting Gramps around the body, so reduce injuries. And they also help provide better leverage for the caregiver, too. Some examples of these gait belts and photos showing how they can be used are in the image below:

So, I very much recommend going to your local stores that sell durable medical equipment (DME) and other medical devices. These include shower chairs, special toilet seats, wheelchairs of various types, walkers, grab bars, and all sorts of items you might not known about. The ones that will be helpful for you and your Gramps, depend on your unique situation. So spent a bit of time, browse and see what's there. You should expect the people who work there to be knowledgeable and answer your questions. They should also be able to help you fill prescriptions, if your Gramps' doctor writes a prescription for a particular item of DME (often Medicare will pay for DME items prescribed by a doctor).

Your neighborhood DME store will probably look something like this:

National Institutes of Health (NIH) new "Medicare Basics for Caregivers" webpage

2009-05-25T12:41:00.004-04:00

National Institutes of Health Website that targets senior citizens with health information has announced the addition of “Medicare Basics for Caregivers” at http://nihseniorhealth.gov/medicare/toc.html to their existing website – http://www.nihseniorhealth.gov/. When you visit the new webpage, you'll see a list of topics including:

What Is Medicare?

Managing Medical Conditions

Prescription Drug Coverage

Continuing Care Options

Frequently Asked Questions

MedlinePlus - more information on Medicare Basics for Caregivers

The NIH issued a news release covered in this article, Basic Medicare Information Targeting Caregivers Added to NHSeniorHealth.com (Senior Journal News, 5/13/09). It explains that the NIH's new webpage was developed with the Centers for Medicare and Medicaid Services based on its booklet, Medicare Basics: A Guide for Families and Friends of People with Medicare. It goes on to explain:

“If you’re caring for an older friend or family member, you’ve probably had questions about Medicare, the federal health insurance program for adults 65 and older and people under age 65 with disabilities,” according to the announcement. “While you may know that Medicare helps pay for medical and prescription drug costs, you may want to become more familiar with the Medicare benefits and resources available to your friend or loved one.”

The news release describes “Medicare Basics For Caregivers” as an “easy-to-read overview.” But, adds, “This brief, yet comprehensive introduction to Medicare gives caregivers the basics and helps them find answers to their questions.”

Caregivers and others needing a general introduction to Medicare can visit http://nihseniorhealth.gov/medicare/toc.html to find out about medical and hospital benefits, enrollment, billing, prescription drug costs, home health care and much more.
Older Americans are increasingly turning to the Internet for health information - over 70 percent of online seniors look for health and medical information when they go on the Web.
NIHSeniorHealth (http://www.nihseniorhealth.gov/), which is based on the latest research on cognition and aging, is a joint effort of the National Institute on Aging (NIA) and the National Library of Medicine (NLM). The site features short, easy-to-read segments of information that can be accessed in a number of formats, including various large-print type sizes, open-captioned videos and an audio version. Additional topics coming soon to the site include dry eye, periodontal disease and long-term care.

Benefits Checkup services offered by National Council on Aging

2009-05-25T12:00:00.006-04:00

Check out BenefitsCheckup at https://www.benefitscheckup.org/ provided by the National Council on Aging (NCOA). This is a great service to seniors across the country, all Gramps and caregivers too. Going to the site this morning, here is what I saw on their website (see picture below). Notice that there are specific items about families caring for their elderly Gramps and also about eldercare, so I encircled those in green to help you spot them on the picture. I recommend spending a bit of time browsing their site. Even if you don't have questions now about benefits, you might learn about benefits issues that you didn't realize before.

I came across this information following up on a news article about CVS partnering with NCOA so CVS customers can get this BenefitsCheckup easily. Now, my site does not promote any particular companies, so I'm just passing along how I learned about this information. If you are a customer with a different pharmacy than CVS which is featured in this story, then just ask your pharmacy if they provide a similar service. Chances are they can. Having said that, here's the piece of news I'm passing along today:

CVS/pharmacy, NCOA promote BenefitsCheckUp for seniors (Drug Store News, 5/18/09)
CVS/pharmacy and the National Council on Aging are looking to help seniors manage their monthly expenses and encourage medication adherence by promoting the online service, "BenefitsCheckUp".

The pharmacy retailer and NCOA are promoting the online service, which allows seniors aged 55 and over to determine if they qualify for more than 2,000 benefit programs across 50 states. To date, BenefitsCheckUp, located at www.BenefitsCheckUp.org/cvs, has helped more than two million seniors find more than $7 billion worth of annual benefits.
“Not taking your medication as prescribed can put your health at risk and can cost more in the long run,” stated Papatya Tankut, VP pharmacy services at CVS/pharmacy. “There are simple yet significant ways to lower the cost of your medication, like switching to a generic alternative.”
CVS pharmacists are also working to educate patients on ways to lower their health care costs, the retailer stated.

Now, I will be the first to admit that I find the maze of insurance and governmental programs, rules and regulations very confusing. So any trusted source that can help sort through and give you guidance and pointers, can be a very good thing!

That news article led me to look up https://www.benefitscheckup.org/ which turns out to be a service of the National Council on Aging (NCOA). So you don't have to go through CVS, although you can if you're a customer there and it would be convenient for you.

By the way, I've added the BenefitsCheckup.org website in the list of "other sites of interest" at the right side of the page here, so you can reference it at any time. Looks like it's got plenty of information to help you help Gramps!

WellCare terminating PFFS Medicare Advantage plans at the end of this year (this does not apply to Connecticut, Florida or Texas)

2009-05-20T12:56:00.004-04:00

WellCare announced on May 4 that: WellCare Intends to Withdraw in 2010 from Medicare Advantage private fee-for-service (“PFFS”) plans in 2010. Here is some information from the news article:

WellCare Health Plans, Inc. WCG
has notified the Centers for Medicare & Medicaid Services (“CMS”) that it
does not intend to renew its contracts to offer Medicare Advantage private
fee-for-service (“PFFS”) plans in 2010. As of March 31, 2009, about 110,000 of
the approximately 2.5 million members served by WellCare are Medicare Advantage
PFFS members.
WellCare Medicare Advantage plan members whose identification card includes
the letters “PFFS” will be affected by this action. Current WellCare Medicare
Advantage PFFS members do not need to take action now. They will continue to
have access to their WellCare benefits until January 1, 2010. WellCare members
enrolled in a WellCare HMO (coordinated care) plan or a prescription drug plan
(“PDP”), or a WellCare Medicaid plan, will not be affected. WellCare does not
offer Medicare Advantage PFFS plans in Connecticut, Florida, or Texas.

If this change affects you or your Gramps, then you should start thinking about what replacement covering you will want to sign up for. Because these plans vary, it's a good idea to start early, getting information from other providers and thinking about which plans will be best for you. Use the "Medicare" label (in the labels list at right) to look at more information about ways that some plans can be better or worse for you, depending on your needs.

Happy Mothers Day! and - Learn About Eldercare Issues

2009-05-10T21:12:00.009-04:00

"Learn About Eldercare Issues" - I fully agree with this statement emblazoned across this website, Aging Avenues (www.AgingAvenues.com). Its founder and president, Carlotta Katra, even has neat videos at this site in which she explains about it and some of the resources you can find there to assist you in locating resources for taking care of your Gramps. Her Aging Avenues company is based in Indianapolis, Indiana, so it may focus most on that part of the country. But it's a great idea as a site featuring information exchange that may be spreading more broadly, so check it out.

Here's a news item that caught my eye today: "Laughter - One Phone Call Away (Santa Rosa Press Democrat, USA - May 10, 2009). A stress-relieving approach to having fun with yoga! Apparently these folks are doing "customized Laughter Yoga for workplace, residential eldercare and dementia-care communities." Now this sounds like a wonderful idea. Even if it isn't feasible for you to sign up for something like that - please remember to smile and laugh every day! Both have been scientifically proven to improve your health - I kid you not. Probably improves the health and well-being of everyone around you, too. So find a way to smile and laugh each day!

Today I spent more time with my own mother, my own Gramps, just talking and sharing some memories and comments about current events and so forth - it was very rewarding. Time being together simply as family and friends, not just in a caregiving role. We placed some phone calls to other family who live in other locations too. Simple, easy, relaxed ..... nice! Here's wishing you similar enjoyable times with your moms and your Gramps too!

Concerned about Gramps with the H1N1 Flu "A" ("swine flu") circulating? Helpful suggestions

2009-05-03T12:38:00.004-04:00

You're right to be concerned about yourself, and your Gramps, with virus and other illness-spreading germs about. The latest H1N1 Flu "A" (formerly called "swine flu") seems like it won't get too bad yet, but it's a very good reminder that there are many virus and other organisms that can cause serious problems. There are plenty of others to be concerned about, ranging from hepatitis to staphococcus. Many can endanger not only health but life. What can you do for yourself and your family, including Gramps? Here are some suggestions:

* Handwashing is the mantra - use plenty of soap and hot running water (as hot as you can stand - it should be 120 F or so, but don't burn yourself). Use the "20-second rule" - wash your hands for the time it takes to sing the "Happy Birthday" song, or to sing your "ABC's" twice.

* Wash well any other parts of your body that you think may have been exposed, including your face.

* Don't place your fingers into your eyes, nose, or mouth - or into anyone else's eyes, nose or mouth, including Gramps. If caregiving duties require you to do that (e.g., helping Gramps with false teeth), wear protective gloves. These gloves come in both latex versions, and vinyl gloves without latex (for people who are allergic to latex).

* Children spread viruses and other germs very quickly, as any parents of young children can attest. Encourage grandchildren to visit with Gramps, but do your best to make sure the children wash up well before and during the visit (teaching and reinforcing good habits!). And help Gramps to wash up after the visit too.

* Keep clean! This means kitchen surfaces and utensils, bathroom surfaces and fixtures, refrigerator door and other door handles, and the frequently-touched areas of often-used items such telephones, cell phones, microwave touchpads and doors, doorbells, computer keypads and game devices, lotion and other bottles, candy dishes, vacuum cleaner handles ... you'll be amazed when you start paying attention to what you touch, how many there are! Products that contain antibacterial properties, including sprays and wipes, normally have enough germ-fighting power to get the job done.

* Don't overlook "spring cleaning" type tasks such as cleaning doors, walls, and other surfaces in your home that are overlooked in normal daily and weekly cleaning. You might want to address these at least once every few months.

* Additional information is listed in 7 Things Caregivers Should Know About Swine Flu, at the "New Old Age Blog" at New York Times

* Environmentally friendly cleaners are more available nowadays. Check the labels to be sure whether they have the antibacterial power you need to reduce illness-causing germs in your and Gramps' environmenta.

Naturally, you'll never be able to turn the home into a "clean room" environment that's totally antiseptic! We as human beings will always have to rely on our immune systems to prevent viruses, bacteria and other organisms from setting in and making us ill. But at least we can improve the odds in our favor, especially in our homes where these organisms can be fostered and grow unless good cleaning measures are used. Just think how sad it is, that many hospital personnel fail to use proper cleaning and handwashing and therefore allow too many patients to fall prey to unwarranted illnesses! We can certainly try to do better in our own homes, and in Gramps' home too.

News on Medicare Advantage plans; and interesting financial planning ideas for seniors on Social Security

2009-04-03T08:52:00.000-04:00

First, here's a news item about Medicare Advantage plans:

CMS sets new rules for Medicare Advantage plans
CMS has implemented new pricing rules for Medicare Advantage health plans and will reduce the number of plans offered by 27% to make it less confusing for seniors. CMS has promised additional government scrutiny of insurers if annual out-of-pocket patient costs are more than $3,400 or if patients are charged more than traditional Medicare pays for dialysis, home health care and other services. You can find articles about this at The Wall Street Journal (3/31) , and Google/The Associated Press (3/30).

Also, here is an article explaining a way that older seniors can supposedly "game the system" to obtain higher benefit payments from Social Security. Please be aware that I do not have any personal knowledge about this, and so I would recommend being VERY careful about trying this out. This article was written over a year ago, and I only recently came across this. So you can read it - but please, be careful before making any drastic changes - make sure that there isn't some "catch" that can hurt you later on:

Older Senior Citizens Consider Withdrawing from Social Security and Reapplying for Higher Benefit
By Tucker Sutherland, editor & publisher, SeniorJournal.

Feb. 26, 2008 – A seldom noticed provision in Social Security allows senior citizens, who began taking their benefits early, to pay the money back and reapply at their current age and get a much higher income for life. .... We first noticed it in a column by Scott Burns, the syndicated business writer at the Dallas Morning News. The headline on the Burns column was “Reapplying for Social Security may be a good idea.”

Burns, who often addresses topics of importance to senior citizens, wrote -
“If you're retired and are interested in having a higher income for as long as you live, you have two main options.
One he says is to buy a life annuity which does provide life-long income but nothing for heirs. Or, the second option offered by Burns, is buy “a variable annuity with a variety of living-benefit provisions.” The income is less but there may be something for the heirs.
“Fortunately,” writes Burns, “there is a simple alternative. It will work nicely for retirees in their late 60s or early 70s who opted, years ago, to take Social Security benefits at a relatively young age. That's millions of people.

“If you did this, you know your benefits were reduced because taking benefits early meant Social Security would have to pay benefits for more years.
“But you easily can reapply from scratch.”
Burns says go to Social Security and “make use of a little-known and seldom-exercised provision - request a ‘Withdrawal of Application.’ By filing an SSA Form 521, Social Security will treat you as if you had never applied for benefits. It will let you immediately reapply for benefits - at your current age.”

There is one big catch he points out, “You must repay every dime you've received in past benefits. But because Social Security charges no interest, reapplying turns out to be a really good deal. It represents a way to buy an inflation-adjusted annuity for a price that beats anything offered by the financial services industry.” (To read the complete Burns column at Boston.com, Click Here.)
Have your retirement cake and eat it, too
Shortly after the Burns column, Sandra Block of USA Today followed with, “Turning 62: Have your retirement cake and eat it, too.”
She approached the subject from the viewpoint of the current crop of Baby Boomers just now reaching age 62, when you can opt to start receiving early Social Security benefit payments.
She writes that Baby Boomers are beginning to face the decision almost all senior citizens have faced before them - “whether to claim their Social Security benefits early.”
“A little-known Social Security option, though, gives early retirees a way to have their cake and eat it, too,” she says.
“Here's the quandary: If you claim benefits at 62, you can retire while you're young enough to enjoy it, but you'll receive reduced benefits for the rest of your life. By contrast, waiting to file until at least full retirement age (66 for boomers who turn 62 this year) will increase your monthly payments, reducing the risk that you'll run out of money in your old age.
“For many boomers, though, that means working longer — a hard pill to swallow if you hate your job and want to spend more time with your grandchildren.
“What most retirees don't realize is that they can change their minds. Under the Social Security Act, individuals who receive early-retirement benefits from Social Security can withdraw their application, repay the benefits they've received and refile for higher benefits at a later date.”
She quotes Laurence Kotlikoff, a Boston University finance professor and developer of ESPlanner, a financial-planning software program, who offers the following example of how this can work.
“A 70-year-old retiree has $400,000 in regular assets and $200,000 in retirement savings. She claimed early-retirement benefits and receives $11,556 a year. Had she waited until age 70 to file, her benefits would total $20,000 a year.
“To withdraw and reapply for benefits, the retiree would have to repay $79,305. But even with that payment, reapplying for Social Security would raise her standard of living by 14%, Kotlikoff says.
“This strategy, he says, would provide her with the equivalent of an inflation-indexed annuity — a contract sold by an insurance company that guarantees regular payments for life — for about 40% less than the lowest-cost annuity available on the private market.
Read the complete report by Block in USA Today – Click Here.
More about the strategy by Kotlikoff
An even longer and more detail coverage of the strategy promoted by Kotlikoff is in Forbes, which was probably the first to report on this strategy. The title is “Trade in Your Social Security Check.” Click Here for story online.
Kotlikoff has a Website to promote his financial planning tool – the ESPlanner - and has several presentation on how he has used this tool to solve financial questions. Click here to his detailed report on reapplying for Social Security. He has lots of detail on how to do it and where to find more information.
>> For the ESPlanner home page – Click Here.

>> Before beginning this process senior citizens should talk with an adviser at their local Social Security office. To locate your local office, Click Here (SSA), and enter your Zip Code.
>> This links goes to an explanation by Social Security on withdrawing from the program. Click Here.
>> The form needed is Form 521, “Request for Withdrawal of Application,” which is available at http://www.ssa.gov/. To go direct, click here.
>> Here is an explanation in the form:
“IMPORTANT NOTICE - This is a request to cancel your application. If it is approved, the decision we made on your application will have no legal effect, all rights attached to an application, including the rights of reconsideration, hearing, and appeal will be forfeited, and any payments we made to you or anyone else on the basis of that application will have to be returned. You must then reapply if you want a determination of your Social Security rights at any time in the future but any subsequent application may not involve the same retroactive period. This procedure is intended to be used only when your decision to file has resulted, or will result, in a disadvantage to you. Your local Social Security office will be glad to explain whether, and how, this procedure will help you.”

Again, my friends - you can consider this to see if it might work for you. But, if you think it does, be SURE to check it out with your local Social Security office, and be very careful to make sure it works as planned.

Many good books to browse to help you prepare or find answers for all aspects of eldercare and caregiving

2009-03-31T21:46:00.013-04:00

Good books are available to help you prepare for caring for your Gramps, or to find answers on the spot. First, a thought - don't buy such a book to give someone else, unless that other person specifically requests it. Meaning, why send someone else the message, "you be the caregiver". Why not step up and buy - and read - the book for yourself? Then you can also help yourself prepare, and learn more about what you can do for your Gramps.

Also, I do not get any fees from book sales, etc. (I've got my day job for my personal income).] Just want to share, since I noticed that Amazon is offering a number of these - I'm sure you can find them at your local bookstores too.

First, here's How to Care for Aging Parents (Morris, How to Care for Aging) by Virginia Morris (Author) and Robert M. Butler (Author); list is $18.95, Amazon is discounting to $12.89. Readers seem to like it - here are a couple of reviews:
"As we venture into this new and unknown territory - taking care to those whom we always depended on to take care of us - this is the first, second and only book you need. In a gentle and humorous way, Ms. Morris guides you through all of the aspects of this unknown road including the medical, legal, mental, physical, etc. Maybe my favorite chapter is the one in which Ms. Morris insists that you make sure of taking care of yourself first. I saw Ms. Morris on "Oprah" and bought the book for my "first parent". Now the book comes out "bigger, better, and improved" for my second parent. Strange to think that a book can be such a gift to our real lives. I can not recommend this book more strongly."

"I picked this up to learn how I could help my mother take care of her father and found it extremely helpful. It is written in clear, understandable language, with several personal accounts scattered throughout, as well as information on where to go for more help. And you WILL need more help - but this book does a great job of pointing you in the right direction. It makes a very complex problem seem manageable. There are at least 50 pages at the back of the book that provide contact information on elder care agencies, geriactric care managers, elder care lawyers, etc. "

Amazon is pricing "How to Care for Aging Parents" with a package deal at $24.55 if you buy it simultaneously with another book, Coping With Your Difficult Older Parent : A Guide for Stressed-Out Children by Grace Lebow. (I remember reading this "Coping" book a few years ago but don't remember much - I'm guessing that Amazon is pairing it up in a special package price to help move it out, so I don't know if it's the best book, but depending on your situation you might find it quite helpful of course. Being elderly doesn't cure being difficult!) (Note to self: I want to be sure I'm not difficult, when it's my turn to be elderly!)

NOTE - I may copy in some more information about some of these books, than others. That does not imply I am endorsing one over the other. It's just a fluke of my available time and what I can do conveniently. You should probably browse a bit (that's why I'm including the Amazon links for these books) before you make any decisions for what suits you best.

American Medical Association Guide to Home Caregiving by the American Medical Association (paperback), listed at $14.95, Amazon is discounting to $10.17. Here's the publisher's description:
"Many families have to care for an aging or ill relative at home, an undertaking that requires planning and support. In the American Medical Association Guide to Home Caregiving, Angela Perry, M.D., and the AMA draw upon the experience and advice of experts to address the emotional and practical aspects faced in home care. They cover home preparation, basic and special caregiving skills, choosing and paying a provider, long-term care, nursing home care, care for the caregiver and caring for someone who lives alone, someone with Alzheimer's disease and the terminally ill. Especially useful is a section on organizations and resources. This guide offers manageable alternatives to residential treatment.
"At some time, most families will need to provide home care for an aging family member who is ill or disabled. While home caregiving provides many benefits, it takes careful planning, support, and patience.
The American Medical Association Guide to Home Caregiving provides the information you need to take the best possible care of an elderly, ill, or disabled person in a home setting. Written by experts from the American Medical Association, the book explains such essentials as how to:
*Plan and arrange a room to adapt to a loved one’s needs
*Give medications, maintain hygiene, monitor symptoms, deal with incontinence, provide emotional support, and relieve boredom
*Choose a home healthcare provider
*Pay for home healthcare, including Medicare and Medicaid, and long-term care insurance
*Care for a person with Alzheimer’s disease or a terminal illness
*Choose between alternative living arrangements such as assisted living facilities or nursing homes
*Take care of yourself, the caregiver"

The Comfort of Home: A Complete Guide for Caregivers (Comfort of Home, The) by Maria M. Meyer (Author), Paula Derr (Author); listed at $24.95, Amazon discounting to $16.47. Here's the publisher's description of this book:
"Burnout — the complete drain of physical, spiritual, and emotional reserves — occurs when a caregiver slips into exhaustion or depression. More and more frequently, the responsibility of caring for the chronically ill child, the disabled spouse, or the aging parent falls on a family member. From the decision to be a caregiver to dealing with day-to-day activities, this guide provides help with every aspect of home care. Also included in this edition are a checklist of tasks, a chapter on self-care and avoiding caregiver burnout, a glossary, and list of helpful resources."

Caring for Your Parents: The Complete Family Guide (AARP) (Paperback) by Hugh Delehanty (Author), Elinor Ginzler (Author), Mary Pipher (Foreword). Listed at $12.95, Amazon is discounting it to $10.15. Here's the AARP's description of this book (it's an AARP book):
"Drawing on AARP’s deep wellspring of expertise in the topic, AARP’s Caring for Your Parents offers both sensitive counsel and a practical road map through the complex emotional terrain many of us face as our parents age. This eye-opening book guides readers through a new, creative approach to caregiving that turns familial duty into a journey of emotional development and resolution.
Based on a 32-page National Magazine Award-nominated special feature, Caring for Your Parents documents the innovative ways that real people cope with this age-old issue. Throughout the book you will find useful, field-tested recommendations from AARP’s staff of experts. Topics explored in depth run the gamut from locating quality health care and dealing with the bureaucracy of Medicare to avoiding consumer scams, organizing caregiving from afar, and planning the disposition of an estate. There are tips on designing your parents’ house to make it more elder-friendly, navigating the hidden dangers of assisted living, and dealing with the invisible sibling issue. A resource guide in each chapter lists help lines, websites, and consumer action groups.
Thirty million Americans are looking for a new, more effective approach to eldercare. Caring for Your Parents is the answer. "

Amazon has it priced as a package, for $23.37, if you simultaneously buy The Eldercare Handbook: Difficult Choices, Compassionate Solutions by Stella Henry (Author), Ann Convery (Author).

Here's a description of "The Eldercare Handbook" (remember, this is part of the sales pitch, not my own words - it's just a quote to help you know what the book covers):

"In this comprehensive and accessible guide, long-term care expert Stella Henry helps readers navigate the daunting logistics and powerful emotions of making care decisions for an elderly parent or loved one. Drawing from her 36 years as a registered nurse and a nursing home administrator, as well as her experience caring for both her parents (both of whom suffered the ravages of Alzheimer's disease), Henry tackles all the tough issues: spotting the warning signs of dementia, redefining sibling roles, doing a walk-through at an assisted living facility or nursing home, making the move, and coping with "take me home!" demands.She also explains the medical, legal, and insurance maze. In a time when almost 10 million Americans currently need long-term care, The Eldercare Handbook is an essential read.

"The Eldercare Handbook combines a daughter’s compassion with the expertise of a trusted professional, thanks to Stella Henry’s unique experiences as both a daughter who cared for her father at home and her mother in long-term care, and a 36-year veteran administrator who has counseled thousands of families on care giving. In this accessible book, she helps readers navigate the daunting logistics and powerful emotions of making care decisions for a loved one. She tackles all the tough issues, from spotting the warning signs of dementia to redefining sibling roles; from the all-important walk-through at the assisted living facility or nursing home to making the move; from when and how to visit to coping with demands of “Take me home!” She also demystifies the medical/legal/insurance maze."

The Complete Eldercare Planner, Revised and Updated Edition: Where to Start, Which Questions to Ask, and How to Find Help
by Joy Loverde. List Price is $19.95 , but Amazon is offering a reduced price of $13.57 if you pre-order before the release date of April 14, 2009. Here's an example description (this is of the prior edition, but seems fitting):
"Loverde's goal is to provide the caregiver the support and efficient, practical guidance he or she needs to be able to enjoy the often-rewarding and moving experience of caring for an aging loved one. And in an era when the fastest growing segment of the population is those 80 and older (among those, the majority are women), it becomes increasingly important for caregivers, who are themselves one day going to need care, to be informed about eldercare facts.
"With a clarity and authority that comes from years of consulting experience, Loverde shares techniques and step-by-step tactics for all aspects of eldercare, from how to first broach the topic with an elder that he or she needs care and finding the best insurance coverage to emergency preparedness and managing the process of dying. Thirteen chapters are organized by a series of plans that instruct and advise the caregiver on how to research, prepare for, and manage a particular issue. An "Action Checklist" and, when applicable, a list of low-cost or free resources punctuate each chapter's end. The chapters on legal matters (estate planning, insurance fraud), money (cost-cutting strategies), and insurance (options beyond Medicare, supplementary coverage, long-term policies) will be particularly helpful to those first grappling with their elder's financial position."

Eldercare 911: The Caregiver's Complete Handbook for Making Decisions by Susan Beerman (Author), Judith Rappaport-Musson (Author); listed at $26.98, Amazon discounting to $17.81 (and package-deal priced at $30.40, if you also buy "Eldercare for Dummies" at the same time). Here's what the publisher says about it:
"Beerman and Rappaport-Musson, eldercare specialists, offer a comprehensive guide to caregiving issues, calmly presenting information readers may not have even considered. For example, the first chapter addresses how to deal directly with one's parents, what to do if the parents don't want help and how to determine if parents, in fact, need help. The authors include sample dialogues, which will be particularly helpful with parents who refuse to acknowledge they need help. The section on long-distance caregiving is also quite useful-the authors advise readers to call ahead of time to schedule appointments with everyone connected to family care, from physicians to caregivers to support agencies. They also advise having a portable folder with key contact numbers so people will have essential information at their fingertips. This excellent, comprehensive guidebook offers information on nursing homes, hospice care and home heath professionals."

When Your Loved One Has Dementia: A Simple Guide for Caregivers by Joy A. Glenner (note - Amazon also has an Alzheimer's forum, which you'll probably find if you click on the link for this book).

The Caregiver's Survival Handbook: How to Care for Your Aging Parent Without Losing Yourself by Alexis Abramson (Paperback - Aug 3, 2004)
A Caregiver's Survival Guide: How to Stay Healthy When Your Loved One Is Sick by Kay Marshall Strom (Paperback - Jul 2000)
The Emotional Survival Guide for Caregivers: Looking After Yourself and Your Family While Helping an Aging Parent by Barry J. Jacobs (Paperback - Mar 17, 2006)

Self-Care for Caregivers: A Twelve Step Approach by Pat Samples, Diane Larsen, and Marvin Larsen (Paperback - Sep 7, 2000)

Eldercare for Dummies by Dr. Rachelle Zukerman (paperback); list $19.99, Amazon discounts to $12.59. Package deal-priced if you also buy Eldercare 911. Hey, what an appealing name, anyway!
Here's the publisher's description of it:
Cope with legal, financial, and medical issues.
Minimize anxiety and stress and make the later years golden.
Need help caring for an elderly loved one? This sensitive, reassuring guide provides strategies for assessing older persons’ needs, arranging for care, ensuring their safety, and enhancing quality of life – all while respecting their dignity. You’ll see how to manage physical disabilities and chronic health problems, evaluate nursing homes, and help elders control their destinies.
The Dummies Way:
*Explanations in plain English
*"Get in, get out" information
*Icons and other navigational aids
*Tear-out cheat sheet
*Top ten lists
*A dash of humor and fun

Amazon seems to have a couple of guides and lists that might be worth checking out - I am not sure if they are provided by readers - but for what they may be worth:
Lists - Adjusting to Life with an Elderly Parent, Helping Your Elderly Parents, and Best Elder Care Books.
Guides - Care for your elders at home: A guide by Claudia Kishi "Claudia Kishi"
and
Help Your Elderly Parents: A guide by Grant Reeves

You probably cannot go very wrong with any of these books - or with other books that I haven't seen or listed here. Amazon has webpages that focus on topics such as Aging parents, Home care , Eldercare, Caregivers and Caregiving, and Social Services & Welfare, to help you locate books on just these topics. Sometimes it isn't so important exactly which step you take, it's just important to take a step! So if you are thinking about getting a book like one of these, focus on the specific questions you are likely to have. Again - you don't have to buy any of these - you may be able to locate them at your local public library! (Used book stores may also have copies for well-discounted prices too.) Then just try one or two books that look like they may answer those questions in a way that's most helpful for you.

Additional resources recommended by readers - PACE (Medicare/Medicaid), Alzheimer's, and Caregiving

2009-03-27T22:52:00.009-04:00

Readers here have submitted links to other resources helpful for Gramps and caregivers, so let's take a quick look.

One is about Programs of All-inclusive Care for the Elderly (PACE) which apparently is available for those on Medicare or Medicaid (but in participating states/locations only), with an article in USA Today at http://www.usatoday.com/news/health/2008-11-16-PACE_N.htm. It describes PACE as a "concierge medicine for elderly and poor people. The government gives this program the money it would give to Medicaid, and PACE provides its patients all health services." The article focuses on how PACE tries to help elderly patients stay with home care living "independently" longer, and avoid nursing homes. Apparently there are only about 16,000 patients in PACE nationwide so far! If you think that you or your Gramps might benefit, definitely check with your PACE coordinator for your state.

What You Pay for PACE Depends on Your Financial Situation
If you qualify for Medicare, all Medicare-covered services are paid for by Medicare. If you also qualify for your State’s Medicaid program, you will either have a small monthly payment or pay nothing for the long-term care portion of the PACE benefit.
If you don’t qualify for Medicaid, you will be charged a monthly premiumto cover the long-term care portion the PACE benefit and a premium for MedicarePart D drugs. However, in PACE there is never a deductible or copayment for anydrug, service, or care approved by the PACE team.

For more information about PACE:
•Visit the PACE website, http://www.npaonline.org/ on the web. This website is sponsored by the NationalPACE Association.
•Visit www.medicare.gov/Nursing/Alternatives/PACE.asp on the web.
•Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

The PACE website is at , and their address, email and telephone are:

National PACE Association™
801 North Fairfax Street • Suite 309
Alexandria, Virginia 22314
Phone: 703.535.1565 • Fax: 703.535.1566
Email: info@npaonline.org

Also worth a look - USA Today's archive of eldercare and caregiver information:

ROLE REVERSAL: YOUR AGING PARENTS AND YOU
USA TODAY's 2007 series on the millions of Americans caring for elderly parents and how they handle the murky worlds of medicine, law, hospitals, nursing homes, guilt, fear and family ties:
Day 1 • The burden of caring for elderly parents
• A shift away from nursing homes
• Valuable resources for caregivers
Day 2 • Coping with an aging parent: The emotional toll
• Balancing work and caregiving
• Claiming your parent as a dependent
Day 3 • Navigating sibling relationships
• Re-emergence of multigenerational households
• Avoiding scams that target your parents
Day 4 • Long-term care insurance has its own risks
• When a parent has Alzheimer's or dementia
Day 5 • Planning for retirement and elder care (including links to great information at Creating effective powers of attorney, and the combined National Association of Home Builders/AARP Certified Aging-in-Place Specialist program, which trains specialists in home design and remodeling for the elderly, nahb.org; and more)
• How to spend down assets to pay for care

=============

Alzheimer's - Another reader alerted us to new information about Alzheimer's disease at http://www.alz.org/news_and_events_2009_facts_figures.asp, published by the Alzheimer's Association (their national website is http://www.alz.org/index.asp where you can navigate to find local community information too). This article is about how Alzheimer’s disease and dementia triple healthcare costs for Americans age 65 and older.

Alzheimer's is a major issue, growing in importance. For any questions at all relating to this, definitely contact the Alzheimer's Association they have a 24-hour helpline at 1.800.272.3900 or email info@alz.org.

=============

[Another reader left a comment with a website about switching MediGap plans, but I cannot determine much about the site and it is not affiliated with Medicare or Medicaid. I have the impression it may be a site that is affiliated with specific insurance plans, so it may not be a neutral source. Because I cannot determine whether it is worth endorsing, I won't post the information about it. But thanks for your interest! Folks - if you need information on Medigap policies, check with the resources I identified in my prior post here on that topic.]

Encouraging Gramps to exercise can help everyone

2009-03-25T09:17:00.001-04:00

Exercise is good for everyone and Gramps is no exception. We all know that exercise is good for the body but there's increasing evidence it's good for the mind as well. Think about the ripple effects of these benefits - the more that Gramps can remain self-sufficient, the more that helps everyone else in the family! Besides, encouraging Gramps to exercise can help remind us to keep up with our own programs.

I used to have a t'ai chi teacher when we lived in another city. One day a student asked, which forms of exercise really are the best? To which my teacher replied, "The best exercise is the one that you actually will do!" So don't get too caught up in questions about walking versus dancing, versus weight-lifting or stretching.

If you actually take walks with your Gramps, you get the benefits too. If you're long distance, you can at least give verbal encouragement when you call Gramps. If Gramps is eligible for physical therapy, by all means make sure that the entire course of therapy is used - don't stop it prematurely. And if a physical therapist has been seeing your Gramps and finished that course of treatment, be sure to get written materials from the therapist demonstrating the types of exercises - and make sure that Gramps continues to do the exercises on his or her own.

If Gramps loves to garden, that can be great exercise. Even housekeeping is beneficial. If Gramps has moved to a retirement community and is losing the incentive to do these activities due to a communal structure, find other ways. The community may have gardens, walking paths - and who knows, maybe can benefit if Gramps wants to volunteer with shelving books in a library, etc. Often there are group exercise activities at these communities, or at senior centers nearby. Check into these activities and encourage Gramps to get enrolled. The social benefits will augment the physical benefits.

Here's a fascinating bit of news that came out a few months ago, which should encourage ALL of us to get moving:

First Study Using Exercise to Slow Cognitive Decline in Older Americans Finds Success
Slowing Alzheimer’s by a year could prevent 9.2 million cases, as world prepares for 106 million victims by 2050

Sept. 2, 2008 – A study to be reported in the Journal of the American Medical Association tomorrow says testing of older Americans with memory problems, who participated in a home-based physical activity program, shows they experienced modest improvement in cognitive function. The researchers believe this trial is the first to demonstrate that exercise improves cognitive function in older adults with subjective and objective mild cognitive impairment.

It will, too, almost surely attract the attention of millions of senior citizens that are worried about memory problems, because the exercise program that achieved the positive results was not that stressful. Most of the participants used walking.
There is a rush by researchers to slow the advance of Alzheimer’s disease, which is expected to increase its victims in the world from 26.6 million today to over 106 million in 2050.

“If illness onset could be delayed by 12 months, 9.2 million fewer cases of AD would occur worldwide. For this reason, attempts have been made to identify individuals who are at increased risk of AD and to test interventions that might delay the progression of prodromal symptoms (early non-specific symptom, or set of symptoms) to full-blown dementia,” the authors write.

Cognitive Decline Slowed by Walking (video) - click to video
>> Click here to read story.

Nicola T. Lautenschlager, M.D., of the University of Melbourne, Australia, and her colleagues conducted a randomized controlled trial to test whether a physical activity intervention would reduce the rate of cognitive decline among 138 adults age 50 years and older at increased risk of dementia. The participants, who reported memory problems but did not meet criteria for dementia, were randomly allocated to an education and usual care group or to a 24-week home-based program of physical activity. The aim of the intervention was to encourage participants to perform at least 150 minutes of moderate-intensity physical activity per week, which participants were asked to complete in three 50-minute sessions each week.
The most frequently recommended type of activity was walking. The intervention resulted in 142 minutes more physical activity per week or 20 minutes per day than with usual care.

Cognitive function was assessed with the Alzheimer Disease Assessment Scale–Cognitive Subscale (ADAS-Cog; a measuring tool that consists of a number of cognitive tests) over 18 months.

The researchers found that by study end, participants in the exercise group had better ADAS-Cog scores and delayed recall than those in the usual care control group. Participants in the physical activity group also had lower Clinical Dementia Rating scores than those in the usual care group.

“To our knowledge, this trial is the first to demonstrate that exercise improves cognitive function in older adults with subjective and objective mild cognitive impairment. The benefits of physical activity were apparent after 6 months and persisted for at least another 12 months after the intervention had been discontinued,” the authors write. “The average improvement of 0.69 points on the ADAS-Cog score compared with the usual care control group at 18 months is small but potentially important when one considers the relatively modest amount of physical activity undertaken by participants in the study.”

“Unlike medication, which was found to have no significant effect on mild cognitive impairment at 36 months, physical activity has the advantage of health benefits that are not confined to cognitive function alone, as suggested by findings on depression, quality of life, falls, cardiovascular function, and disability.”
Editorial: Physical activity for older adults at risk for alzheimer disease
“Health advances of the past century have led to more individuals surviving to extreme old age, when their risk of Alzheimer disease and related dementias increases substantially,” writes Eric B. Larson, M.D., of the Group Health Center for Health Studies, Seattle, in an editorial in the magazine.

“Exercise—and possibly other lifestyle factors—appear to affect vascular risk and late-life brain health. In addition to traditional medical approaches to prevent this dreaded disease, social factors such as providing universal education, general medical care, a suitable environment, adequate nutrition, habitual exercise, and opportunities for continued social interactions throughout the lifespan also may contribute significantly to improve well-being in late life.”

Remote relatives can help Gramps with Medicare/Medicaid, financial, legal and similar issues

2009-03-22T13:25:00.007-04:00

There are many ways that adult children and other relatives of the elderly can help, even if you aren't actively caring for Gramps in-home or otherwise. One of the first signs that Gramps needs help is when they have some trouble paying their bills. Sure, they may have the resources to avoid bouncing checks, but they may forget to pay a bill, or may pay the wrong amount, or forget to sign the check. You can offer to help them once a month with these little chores, or even help set them up on an automatic bill payment system through the e-bill system at their bank.

You may also consider signing on as a joint owner on their bank account. However, if they have substantial resources, you might want to consult an attorney experienced in elder law before you make their bank accounts into joint accounts. There may be unintended consequences that you need to understand first.

How about their Medicare choices? It's difficult enough for us younger folks to figure out - how do you think your Gramps can deal with it effectively? Talk with your Gramps about it and help them get information and make the best choices to suit their personal needs.

Here's some information you'll want to know about too, for Medicare choices this month:

Last Chance to Change Medicare Health Plans Before You are Locked-In on April 1
This special open enrollment period has restrictions and opportunities every senior citizen should know

March 18, 2009 - People with Medicare have one last chance to change their Medicare health plan before they are locked into their plan for the rest of the calendar year. During this special Open Enrollment Period, which began January 1 and lasts through March 31, people with Medicare are allowed to change their choice of Medicare health coverage once. Read more...

Legal issues are another area you don't need to be on-site to help with. One set of examples relates to the powers of attorney, wills, living wills, and advance medical directives that we've discussed in previous posts. Once the contents of such documents has been decided and put on paper, then there will need to be attention to helping Gramps sign with appropriate witnesses, etc. But much of the preparation can be done long-distance when necessary.

These are the types of things your Gramps needs help with, even when you are not living in the same city as your Gramps.

Make sure you aren't losing money on choice of Medicare vs. Medicare Advantage, or Medigap plan

2009-03-14T08:10:00.007-04:00

Are you paying too much because of the wrong, or outdated, choice of Medicare versus a Medigap or Advantage plan? Maybe the choice you (or Gramps) made, does not fit the needs today.

If you or Gramps is on any type of Medicare, or Medicare Advantage, or Medigap plan, take some time to understand the alternatives available. You may be surprised by the differences in what the plans provide and what they may cost you. For example, you may think you're saving a lot of money with one choice, but be totally unaware that your choice is costing you even more! Also, your needs can change, so the alternative you selected a few years ago may not be the best deal today.

One example may be that when you or your Gramps first sign up, you may prefer an Advantage or Medigap plan because it pays for items that Medicare doesn't. But in later years, you or Gramps may need home health care that Medicare would pay for, but these plans would not. So you could end up paying more to meet your needs under one of these plans, than you would with original Medicare.

Medicare pays only 80 percent of most type of medical bills. So many seniors cover the remaining 20 percent by buying supplemental, or "Medigap", policies for an average premium of $200 a month. Others find that too costly and sign up for an "Advantage" plan. The Advantage insurance plans, from companies such as Humana Inc., UnitedHealth Group Inc., Wellcare, etc., combines Medicare's basic benefits with additional physician and hospital coverage and, often, prescription drug coverage for a single premium. Sometimes the Advantage plan is "free" (i.e., no more than the $96.40 that seniors pay for Medicare's basic outpatient coverage) or only a small amount monthly. Enrollment has doubled over the last five years, as the government has increased its payments to insurers. More than 10 million beneficiaries now belong to a plan.

But the Advantage and Medigap plans can have shortcomings. One big one nowadays is not paying for home health care. So, the savings from having the extra medical bills and prescription drug coverage can be more than offset by home health care costs, depending on your situation.

For example, there's good information available in this article: Obama proposes cuts to private insurers who cover Medicare patients, Dallas Morning News, USA. Now, the article's main point is about the Obama administration's proposal to cut what the government pays private insurers for Medicare "Advantage" plans (to cover about one in five Medicare beneficiaries and using the savings to help finance comprehensive health coverage. But it also points out some important information for Gramps who need home health care: The Medicare Advantage plans normally do not pay for in-home health care, but Medicare often does!

But don't rush to assume that Medicare is better for you than either a Medi-Gap plan, or an Advantage plan. Get more complete information first. Here's a quote:

Virginia Leconti of Grand Prairie, on the other hand, joined a Medicare Advantage plan only to discover that her home health care agency wouldn't accept it. To keep her in-home care, she switched back to traditional Medicare.

"When the plan's salesman visited me, he played up the fact that the policy came with dental and vision benefits at no extra cost," she said. "I just assumed that my home health care was part of the package."

Warner says some health care providers don't take Advantage plans because they don't want to deal with more insurers.

Confusing options

Lue Taff, who oversees the elder-support staff at The Senior Source in Dallas, says people easily become confused by the dozens of available plans and sometimes find their insurance isn't as good as it was in traditional Medicare.

"Seniors may sign up for a private plan because of the low premium," she said. "Then they fall, break a leg, and learn that the physical therapy will cost them much more than it would have under original Medicare."

The Obama administration wants to use a system of competitive bidding to pay private insurers for Medicare Advantage plans. Its proposal calls for trimming $177 billion over 10 years from the program's costs. ...
Harold Rodgers, a financial planner who sells Advantage plans through The Brokerage Inc. in Lewisville, expects that some insurers would withdraw from unprofitable markets and that others would add $30 to $40 to their monthly premiums. That would especially hurt lower-income seniors who now rely on the Advantage plans because they can't afford the supplemental policies that many seniors buy to fill Medicare's gaps in coverage, he said. "They don't have $200 a month to spend on a supplemental [Medigap] policy," Rodgers said.

Long-term savings

Mike Smith, president of The Brokerage, says the proposed payment cuts would be shortsighted, since the private plans emphasize prevention and cover annual physicals and many diagnostic screenings. The Advantage plans may cost the government more upfront, he says, but they save the health care system some money over the long term by discovering and treating problems early.

Consumer advocates, however, say that the private Medicare [Advantage and Medigap] plans have been cash cows for the insurance companies and that their additional costs have been unfairly borne by taxpayers and other Medicare beneficiaries. "Medicare's monthly premium for outpatient services would be $3 less if the government didn't subsidize these private plans," said Paul Precht, director of policy and communications for the Medicare Rights Center. ...

If Congress reins in the private plans, it should use some of the savings to help lower-income seniors with their out-of-pocket medical costs, says Jacqueline Angel, a professor of public affairs at the University of Texas at Austin. "Lawmakers could expand some of the assistance programs and do more to spread the word that help is out there," she said. "Many seniors aren't even aware that they're entitled to this help, so they never sign up for it."

Under the current Medicare savings programs, beneficiaries with annual incomes below $10,644 may qualify for a break on premiums, deductibles and co-payments. Those with slightly higher incomes may get help on premiums.

The best advice is to take some time to do two things:

(1) Determine the types of medical needs you, or your Gramps, has today. And, what you can reasonably expect during the next year or two. These can include:
- repetitive doctor visits for specific conditions?
- physical therapy?
- medical equipment, oxygen, etc.?
- home nursing care?
- home assistance with personal care?
- prescription drugs (how many and which ones)?
- likelihood of hospitalizations?
- other types of needs?

(2) Once you've surveyed the types of medical needs you or Gramps is facing, then collect and compare information about the alternatives. You can start with information on the Medicare website (the photo with this post, upper right, is what that website looks like this morning as I'm writing this). You can also find some links with information at the right side of this page, and also look under the labels here with prior posts on Medicare, Medicaid, Financial Issues and Getting Started for additional resources). For Advantage and Medigap plans, review your existing plan documents if you have any, or obtain them from the insurance sales people who sell these plans. Make a checklist with your needs, and check off what each type of plan - original Medicare, Advantage, and Medigap - will cover for those needs.

This exercise will pay off by giving you more information and control over your medical costs. For help with this, you can find information right at Medicare's website for caregivers at medicare.gov/caregivers. You can also get help at the Medicare Rights Center at medicarerights.org (or toll-free at 800-333-4114), or a state health insurance assistance program at shiptalk.org. Some states have adopted PACE in which case you can consult http://www.medicare.gov/nursing/Alternatives/Pace.asp. Be careful to compare, and don't just trust what the insurance sales people tell you. Verify and double-check. The choices you make can have a big effect on your money and your quality of life!

What they DON'T tell you about those nifty "mobility scooters" for seniors!

2009-02-28T23:06:00.004-05:00

Folks, there are things you need to know BEFORE you or your beloved elderly Gramps acquires a scooter for mobility purposes! First - I'll agree, these scooters can be great. I'm just going to tell you some things you need to know, BEFORE you go down this path.
For one thing, you need to make sure that you get it for FREE. Why? Well guess what we found out, now that our Gramps doesn't need hers anymore and we are trying to sell it - it is IMpossible to find anyone who will buy this used scooter! Why? Well, just pay attention to the advertising (see example at left) - these companies advertise that you can buy a brand NEW scooter for FREE because it's paid by Medicare or Medicaid.

So who in their right mind would buy your old, used scooter, when they can get a brand new one for free, paid for by the friendly U.S. government (i.e., taxpayers)? That's right - no one. That's exactly why you are foolish if you spend your own $$ money on a scooter, because there is no way you will get that back again ... the next person behind you, would rather get a nice, new one for free, instead of paying any amount of money for your old one.

Next, are you or your Gramps going to be able to use it at the residence? If at home, be sure the home has a sufficiently flat floor so that the scooter can roll around easily - not to mention fitting around corners, getting into the bathroom, etc., etc. Don't be fooled by the idea that the scooter is "easy to lift" or even "easy to separate into pieces that can be lifted" - those things are HEAVY and you are only placing a burden on others, if you expect others to pick up those HEAVY components every day.

If at a retirement home, assisted living center or nursing home - find out what the rules are, in advance! These community residences just cannot have so many residents buzzing about in motorized scooters. At minimum, they will probably require that the scooter be registered. Scooters may not be permitted on elevators, or in certain other areas of the community.

And there's going to be liability if the person sitting in the scooter, perhaps with limited vision or other impairment (or simply negligently), causes an accident by hitting and injuring another person with this motorized scooter. Even property damage can be caused (and costly) due to scooters ramming into tables, doors, etc. But of greatest concern, serious or even life-threatening injury can be caused if someone driving one of these motorized scooters hits another elderly person, causing falls, broken bones, and worse.

Look - I am NOT advocating against these devices. I'm just pointing out what the advertisers and sellers of scooters are probably not going to tell you. Consider all angles, and be careful not to let something that should be a convenience, wind up causing problems of its own.

Roundup of recent headlines caregives may want to browse

2009-02-28T22:36:00.005-05:00

Here's a roundup of recent headlines at Senior Journal News that caregivers may want to browse for information on these topics:

Program to Help Seniors Make Their Homes Safer Announced by Administration on Aging
The agency’s Eldercare Locator will partner with Rebuilding Together in three-point plan to prevent falls by senior citizens
Dec. 8, 2008 – A program to prevent devastating falls by senior citizens by helping them make their homes safer, getting their families involved and helping steer them to local assistance was announced today by the Eldercare Locator, a service of the U.S. Administration on Aging, and Rebuilding Together, a non-profit that helps low-income Americans maintain their homes. Read more...

Older People Who Care for Disabled Spouse May Add Years to Their Own Lives
Previous studies show negative health effects of caregiving. But current results show difference in the presumed stress of providing help from the stress of witnessing a loved one suffer
Dec. 1, 2008 – Much has been written about the burden of carrying for a spouse or loved one but a new study has encouraging news - older people who spent at least 14 hours a week taking care of a disabled spouse lived longer than others. Read more...Watch Video.

Diaries Reveal Stress, Declining Health in Children Caring for Their Elderly Parents
Those who believed in personal growth, mastery and self-acceptance experienced fewer negative consequences
Sept. 22, 2008 – Even though it makes logical sense that carrying for an elderly parent will take a terrible toll on the caregiver, researchers continue to study it. The latest study is unique in that it studied diaries that examined the stresses of daily life in conjunction with helping a parent. They not only noted the consequences, however, they also discovered ways caregivers can make life easier.

Results clearly suggest a downward trajectory of health and well-being among midlife adults helping an elderly parent, according to Jyoti Savla, assistant professor of human development and gerontology at Virginia Tech, team leader of the researchers.

“The accumulation of small and large daily stressors such as work deadlines, PTA meetings, supporting family and friends as well as providing routine assistance to a parent living outside one’s house can build up,” said Savla.
...
Savla and her colleagues found that several personal characteristics could decrease the experienced conflict and demands on time, such as having a spouse and higher education.

Those who believed in personal growth, mastery, and self-acceptance experienced fewer negative consequences in providing help to parents.

Programs that specifically target the everyday care events that are stressful for baby boomers are likely to be most beneficial.

One more month - to March 31 - to exercise "buyer's regret" on changed Medicare advantage providers

2009-02-28T22:08:00.007-05:00

If you or your Gramps changed Medicare advantage plan providers at the end of 2008, then you still have one month - until March 31 - to change back if you wish.

As described in the article, Seniors Still Have Chance to Change Their Medicare Health Coverage for 2009, at Senior Journal News - The enrollment period through March 31 allows change in health coverage. However, you should be aware that this does not allow you to add or drop drug plans. Still, this can be important for many seniors.

Many senior citizens think they are now locked into their current Medicare health coverage for 2009, but actually there is still time to make a change, according to the Medicare Interactive newsletter at http://www.medicareinteractive.org/. If you changed your Medicare advantage plan, but miss your old doctor or have any other reason for changing, then you still have that option.

Here's what the article explains:

During the Open Enrollment Period, which began January 1 and lasts through March 31, you can change your choice of Medicare health coverage once, but you cannot choose to add or drop the Medicare drug benefit (Part D).
Your new coverage will start the first of the month after you make your selection.
For example, if you are in a Medicare private health plan (such as a HMO, PPO or Private-Fee-for-Service Plan) with drug coverage, you can change to Original Medicare - with a stand-alone drug plan, since you must continue to have drug coverage - or another Medicare private health plan with drug coverage.
You cannot switch to a private health plan without drug coverage.
If you have Original Medicare and have a stand-alone drug plan, you cannot use this period to switch to another stand-alone drug plan. This would be considered as only a drug coverage change—not a health plan change.
You can however, change to a Medicare private health plan with drug coverage.
Under certain circumstances, you may be eligible for a Special Enrollment Period (SEP) to change health or drug plans. You qualify for an SEP if, for example, you move out of your plan’s service area, or if you’ve been misled into enrolling into a private Medicare health or drug plan.
But you do not have the right to switch plans if your doctor leaves the plan’s network in the middle of the year, or if your plan decides to raise the price of a drug you take. Providers can drop out of your plan at any time, but you can only change at certain times of year.
To see a chart of different circumstances that can be considered for an SEP, please go to: http://www.medicareinteractive.org/uploadedDocuments/sep_chart.pdf.
Another thing to keep in mind is your right to purchase a Medigap policy.
A Medigap policy is supplemental insurance for which you pay a monthly premium. It fills gaps in Original Medicare. It allows you to keep the flexibility of Original Medicare - which lets you see any doctor that takes Medicare without having to get permission first - and keeps costs predictable.
However, you can only buy Medigaps at certain times and have the most choice when you first become eligible for Medicare if you are 65 or older (there is no similar protection under federal law for people under 65 but some states offer additional safeguards).
If you are enrolled in a Medicare private health plan for longer than 12 months, you may be giving up - for life - your right to purchase a Medigap policy or to purchase one without medical underwriting (a premium that is higher if you have health problems).
If you are over 65, had the right to buy a Medigap policy to supplement Original Medicare but chose to enroll in a Medicare private health plan instead, or if you dropped a Medigap policy to join a Medicare private health plan, you have the right to purchase a Medigap policy only if you disenroll from the Medicare private health plan within 12 months.
Some insurance companies may be willing to sell you a Medigap policy after that but there is no guarantee that you will be able to get one unless you live in a state that offers more protection than the federal government requires.
Let’s say, for example that you had Original Medicare with a Medigap plan in 2007. You then switched to a Medicare private health plan beginning in January 2008. Now, during the Open Enrollment Period, you want to go back to Original Medicare with a Medigap plan. However, since more than 12 months have passed since you enrolled in the Medicare private health plan, there is no guarantee that you will be able to buy a Medigap policy again unless your state has additional protections.
To learn more about the Open Enrollment Period, Special Enrollment Periods and when you have the right to buy a Medigap plan, log on to Medicare Interactive Counselor at http://www.medicareinteractive.org/. Medicare Interactive Counselor is a resource provided by the Medicare Rights Center, the largest independent source of health care information and assistance in the United States for people with Medicare.

Why Medicaid should be considered sooner, not later

2009-02-14T13:50:00.005-05:00

Qualifying Gramps for Medicaid eligibility means being able to show that Gramps is practically broke, without appreciable assets and very little income. It's obviously important for if and when Gramps does not have the resources to pay for critical medical care and, when needed, nursing home life. Qualifying will be difficult, because the state governments' budgets are being cut back for Medicaid (and lots of other items of course). Also, the state will do a "look-back" to see if Gramps gave away funds or assets to you, or to other family members or friends, at any time during the past five (5) years. The state will presume that Gramps gave away any such funds or assets as a way to qualify for Medicaid. This obviously makes it more difficult for Gramps to get onto Medicaid, even if there's a critical need.

You can start getting basic information on Medicaid by going straight to the federal government's Medicaid eligibility information site. While the federal government coordinates Medicaid, much of the funding and actual administration of this welfare program actually occurs through the individual states.

The state has a natural interest in doing the "look-back" - they don't want to allow fraud, where wealthy people hide their assets in order to drain governmentally-funded programs. But it will be intrusive if you and your Gramps have to go in and show financial documents to prove that any monies given away by Gramps were not simply gifts but were for legitimate reasons, such as paying for caregiving.

Remember - Medicaid is different from Medicare. Medicare is more similar to retirement Social Security. Medicaid is a federal medical assistance program for low income individuals and families who lack access to private health insurance. It was enacted in 1964 under Title XIX of the Social Security Act. Essentially, Medicaid is welfare, and that's why Gramps needs to be legitimately "poor" in order to get this governmental support.

The states are having a difficult time paying for Medicaid support, as document in articles like this: Growing Need for Medicaid Strains States, and New U.S. Rule Pares Outpatient Medicaid Services, and U.S. Curtailing Bids to Expand Medicaid Rolls. So let's face it - the state has an incentive to keep your Gramps out of the Medicaid program! If Gramps is denied, then you or a lawyer may be needed to submit a timely appeal (check the Medicaid denial notice for info on this) to ask for a reconsideration.

And here's another consideration: According to this article about Stimulus Funds Offer Relief to City and State in the New York Times, recently, new federal legislation may increase the amount of Medicaid funding support provided by the federal government. This may help counteract budget cuts that state governments have been forced to make in their Medicaid budgets.

If your Gramps has true wealth, and the family doesn't wish to see Gramps forced into poverty without Medicaid but also wants to comply with the Medicaid rules, then you must consult an attorney who is very familiar with the regulations. I'm NOT suggesting that you try to hide assets or avoid using Gramps' wealth to pay for Gramps' legitimate expensess. It's just that some families want to avoid situations where family wealth intended for the younger generation gets tied up and lost in paying massive medical or nursing home expenses toward the end of grandparents' or great-grandparents' lives - so experienced attorneys should be consulted. Such attorneys can help set up a trust fund that will properly allocate funds to care for Gramps, while protecting wealth that's intended to benefit the family at the same time. These can be very complicated - so consult such an attorney well in advance of the need. Literally, this can mean consulting a lawyer like this at least five (5) years BEFORE there might be a need for Gramps to obtain Medicaid assistance.

Here's a more worrisome concern - your Gramps may legitimately qualify for Medicaid, but need help submitting the paperwork to qualify. Or maybe your Gramps gave you or a family member or friend money that was then used to pay for caregiving of Gramps - the state may deny Gramps for Medicaid, and then you'll have to go through a very time-consuming process of showing why Gramps should get onto Medicaid. All this may take months ... and months ... in order to get Gramps into the Medicaid system ... and meantime, who's paying for those doctor bills, nursing expenses, rent, and Gramps' other, very real costs??

If you have any questions about this at all, consult your local state's Medicaid office, and any private-practice attorneys who specialize in these areas. In the "other sites/resources" listed at the right side of this page, you can find a link to professionals who specialize in elder law and should be familiar with these Medicaid regulations.
=============

Why a photo of the Parthenon to go with this post? Well, nothing deep - just a reminder that governmental structures of various types can be monumental at one time, then diminish later. Medicaid is still available for now ... but it would be a good idea, if Gramps may have a need for Medicaid assistance, to get started early for qualifying Gramps as soon as possible. ... just in case!

Decluttering - dealing with "all that stuff!" when Gramps moves

2009-02-11T07:42:00.002-05:00

If and when your Gramps moves, whether it's to move in with you or to go live in a retirement community, assisted living or nursing home, etc. - you'll probably find yourself facing many questions about "what to do with all that stuff?!"

Many people tend to hold onto things of all sorts over the years. If Gramps has been living in the same place for 10, 20, or even 30 or more years, Gramps probably has some serious amounts of stuff that will be difficult or impossible to fit into the new space. Just the furniture alone may be too much.

And that doesn't even include all the "memories." You probably know what I mean ... you'll see collections, memorabilia, and boxes, bags, and containers full of all sorts of things that Gramps kept around his/her home.

You must be sensitive to the probability that Gramps doesn't want to let go of all those things. They have some kind of importance to your Gramps, which must be understood. Kinda like all those things you cherish around your own home ... except Gramps had more years to collect them.

And now, if Gramps comes to live with you, those "special things" threaten to move in and overwhelm all your stuff! Or if Gramps is moving into a retirement or special-needs home, there probably won't be enough space there for everything Gramps kept in his/her home.

And so the task begins:

* Separate what's kept and brought with Gramps, and what isn't. The benefits of doing this as soon as possible are obvious - why move stuff along with Gramps that won't even fit in? why pay to move stuff in, then pay to move it out again? Here you've got to balance the psychology of Gramps who may not even look forward to moving, and who wants to "hold onto" all that stuff as a way of psychologically "holding onto" his/her home!

*Lay the groundwork for this as soon as possible. Have Gramps as involved as possible in separating what's kept and what isn't. And - this is important - help Gramps to see that things not kept, go somewhere that Gramps can approve. For example, some of the furniture could go to other family members, such as grandchildren who are setting up their own homes and could use some extra pieces. Gramps may also have special charities, or a church, synagogue, temple or social group, that Gramps would feel good about benefitting by donations.

*Many of these groups will accept donations of such used items, and can either use them directly or can place them via auctions that raise money for the group. Gramps can feel good about these uses, or about having children or grandchildren take items. This is a great way to help Gramps "let go," because Gramps won't have to fear that these once-special items are just trashed into garbage.

* If Gramps is being difficult about letting go, then some more techniques may help. One example is to help Gramps understand that there's a limited amount of space available - such as, one bedroom plus a closet - and Gramps simply has to make choices about what will fit into these limited spaces.

*Don't choose the easy way out and just have everything boxed up and put away. One problem is that there may be important documents (or even coins, money, jewelry, etc.) tucked away in places you don't expect. Here's a true story: I was looking through a box that had old travel brochures, letters, etc., all of which seemed ready for the trash can. I opened up one of the folders with a travel company's name stamped on it, and found my Gramps' Medicare card! It had been missing for years. Turns out Gramps had stuffed it into the folder when going on an overseas trip, and then forgot about it later. If I hadn't sorted through "all that stuff," it would have been a major project to obtain a replacement Medicare card!

*Another problem of just boxing stuff up and putting it away without sorting through it, is that it just postpones the task and makes it seem even bigger than it is. Instead, set a realistic goal - such as three boxes per week, and find ways to share the task with siblings or friends, do it while watching old movies to help pass the time more enjoyably, etc. - whatever works for you. Just find ways to work it into your schedule and make it workable for you.

* If you absolutely must rent a storage unit and have some of all that stuff put into storage, then be careful. Who's going to pay for the storage unit? If you bear the costs, then sooner or later it will become a sort of resentment. Also, it's just physically difficult to go there, put stuff in, visit from time to time to put more stuff in or take stuff out, go there looking for stuff if Gramps requests some items out of the storage, etc. etc. So be extremely careful with this. It seems like an "easy fix" at first, but doesn't really make sense.

*Use this opportunity to examine your own possessions. When many years have passed and it's your turn to move into a diminished lifestyle with less space, what will you do with all your own stuff? Think this through and be prepared to make rational choices that don't burden either yourself or your loved ones. Then - the more easily you can accept "letting go" of things you won't be needing, the more easily you can also work with your own Gramps to help your Gramps "let go" too.

*As with many other issues surrounding caregiving of your Gramps, don't let these issues get to you. Keep your sense of humor and balance. Deal with the emotional issues surrounding the letting go of possessions, with as much tact and discretion as you can muster. Remember that, ultimately, it's never the stuff that's important, it's the people who are important. As long as possessions help and serve people, the relationship is correct ... so don't let yourself and your family become servants to "all that stuff!"

*Remember to collect donation receipts for all items donated to charity, to document the deductions for tax purposes. And for items "adopted" by family members or friends, take photographs that Gramps can see, if that will help Gramps feel good about letting go of those special items.

=============

Cartoon courtesy of http://clangnuts.blogspot.com/2007/10/clutter-fairy.html:

Clutter Fairy Cartoon.
As all the best ideas, this is inspired by real life. Just had a massive clear out at home. It's this evil fairy that created the years of collected clutter, but she has been banished from this house. 70% of useless clutter has been disposed of, and it feels great. I have new trousers I didn't even know I had!

Third-Wheelers - Spouses and others "abandoned" by caregivers tied to Gramps

2009-01-31T19:10:00.007-05:00

"Third-wheelers" is one term for the spouses and others who felt bereft when their special person becomes a caregiver to Gramps. Let's say that a woman becomes a primary caregiver to one or both of her elderly parents. Then her husband is at risk of feeling like that "third wheel" - the one whose life is also derailed because his wife is suddenly taken away from all the times and plans together they used to have. Because now his wife has to take so much time and energy away from him ... so she can take care of Gramps. These issues aren't new. But they feel new to you when you're faced with them for the first time! Don't suffer in silence - speak up, be willing to face them, and work them out.

Family. Mural in lunette from the Family and Education series by Charles Sprague Pearce. North Corridor, Great Hall, Library of Congress Thomas Jefferson Building, Washington, D.C. Mural contains artist's logo and "COPYRIGHT 1896 BY C.S.PEARCE".

How to balance this and address it? At the outset, acknowledge the situation so that all concerned can be aware and find ways to work things out. Don't pretend the issue doesn't exist, or that it will somehow go away on its own.

Second, be realistic about what the various needs are, and what are the options for balancing and where appropriate, prioritizing. In fact the sooner you can be realistic about the situation, the better. Here are a few facts you must face, better sooner than later:

1. Gramps isn't going to get "better" (in most situations, and for the most part), or require less care. It's totally the opposite of raising children - as time goes by, Gramps becomes less independent and more helpless. Face this concept ahead of time and decide on your plans for when (not if but when) Gramps will need more and different kinds of help.

2. You are not required to make Gramps "happy." A parent's happiness is not the job of the child. Instead, the filial obligation is to see to it that one's parents are comfortable. Meaning that Gramps' basic needs must be met - medical, nutrition, a safe comfortable place to live, and the essential dignities of life. If you try to go too far, do too much - if you try to go the extra mile to ensure Gramps' happiness, then you will wear yourself out. If your Gramps tries to pull your emotional strings trying to manipulate you into giving too much of yourself - your time, your money, your energy - just for Gramps' happiness (and not for basic needs), then learn to draw the line and don't give in. Otherwise, the problems caused by your lack of balance and boundaries will cause serious problems in your own life, and in the lives of those around you.

3. Your siblings may not step forward to help. Or different siblings may be more - or less - willing to do anything. For those that are willling and able to help, they may only be able to help in different ways. But if you find yourself in the situation of being a primary caregiver and you find that your siblings aren't doing much or anything to help - don't get bitter, and don't resent them for their attitude. Take a deep breath, figure out what you do and don't have to work with (in terms of help and resources), figure out what your own personal "bottom line" is ... and then work with that. You only hurt yourself if you let resentment eat away at you. And, maybe worse, your feelings may lead to trying to compensate by giving even more of yourself ... therefore hurting yourself, and the others around you who miss you.

By the way, if you are not the child that lives nearby Gramps, don't lull yourself into that sense of complacency that the other child who does has ample time and energy to "deal with it." Don't try to pretend that you make up for it in some other way. If you are not contributing to caring for Gramps, then you're not contributing - period.

(I realize that anyone who isn't a caregiver and reads this, will probably assume it doesn't apply to them, and therefore won't do much good to say it here - but why not give a try!)

4. Caregivers - make time for yourself, both the "alone time" you need as well as time you need with your other loved ones - spouse, family, friends.

As for those who are in the "third wheel" situation - take a moment to evaluate whether your wishes for more attention from your loved one who's a caregiver for Gramps, are realistic. As just one example, if you wish for more dinners alone one-on-one, are you willing to work out a schedule so that it can happen, worked out in a way that also lets your loved one make arrangements for Gramps or alternate evenings? Are you willing to expend some extra energy of your own to make the situation better? to make something nice happen (maybe a hired or substitute caregiver, or to help run some of the errands, etc.)? What are your own feelings and thoughts about what adult children should do for their elderly parents or relatives?

If your loved one, perhaps your spouse, decided to turn a cold shoulder on Gramps, meaning just stop any caregiving (yes, this is an extreme example) - what would your judgment tell you, how would you feel about your loved one's value system? Conversely, if you believe that your loved one is doing too much for Gramps - be willing to state that, and then have a discussion about whether that's really happening, and if so how to address it.

Many of these issues call for you to examine not only your emotions, and your abilities to establish boundaries so you don't lose yourself in caring for others ... but also your values, your core beliefs about the "golden rule" and family relationships.

Gail Sheehy's and AARP's "Labyrinth of Caregiving" site

2009-01-31T13:24:00.006-05:00

The American Association of Retired Persons (AARP) has started a webpage column for families involved with caregiving. It's definitely a hot topic for many Baby Boomers who may be retired - or may be working full-time (like me) - and coping with the caregiving requirements of elderly family members.

I've added this new AARP webpage to the list of website resources at the right-hand side of this blogspot (it will appear there no matter which page of my site you're viewing). So you can click it anytime to see what's showing there.

The photo at left is a "screen-shot image" of the AARP website, on which I marked to show you how to navigate to this new Caregivers page from the main AARP website. Basically, at the main AARP website, first click their tab "Family", and then click "Caregiving" to get to it.

Here's what AARP is announcing about this caregiving webpage:

AARP Caregiving Ambassador Gail Sheehy leads us through the Labyrinth of Caregiving, which she describes as a path of nine "turnings."

Gail, author of the groundbreaking book "Passages," traveled around the country capturing the personal stories of a handful of the more than 44 million Americans caring for adult loved ones. Each with its own take on a different phase of caregiving, these stories will appear here weekly.

In her Online Community profile, Gail will also share her journal observations about these families, their stories, and her experiences as a caregiver.

9 'Turnings' of Caregiving

Gail Sheehy describes the nine "turnings," or phases, of caregiving. Her videos, produced exclusively with AARP.org, will demonstrate how real-life families—including yours—can navigate each turning:

Shock & Mobilization
The New Normal
Boomerang
Playing God
I Can't Do This Anymore
Circle of Care
Coming Back
The Long Goodbye
Afterlife of the Caregiver

Learn more about the turnings.

The site also includes a place where you can ask Gail any question, and even visit Gail in the online community. Nice features for anyone curious or seeking to reach out with others in similar situations! As AARP's webpage explains:

"Ms. Sheehy is collaborating with AARP to write the first draft of her next book, about the caregiving crisis, using new media. On her Web pages at http://www.aarp.org/family/caregiving/gail_sheehy/, she will present videos of families she has filmed around the country who are finding creative ways around of the obstacles of caregiving. Throughout 2009, Ms. Sheehy will write journals about her own caregiving experiences in the AARP.org Online Community, where readers can interact with her. "It is a tale both cautionary and inspirational, and one that readers will identify with both emotionally and situationally," she says. Her mission is to collect the voices of many caregivers in all kinds of situations, and to create a powerful network that can grow into a movement."

Giving the ever-growing proportions of these issues, this is sure to be important and very helpful to most families around the country and perhaps around the globe.

Don't let loss of photo ID happen to your Gramps!

2009-01-30T00:54:00.005-05:00

FOLKS, DON'T LET THIS HAPPEN TO YOUR GRAMPS!

Your Gramps may have an expired driver's license and/or an expiring (or expired) passport. Do you realize how often people need to show a photo ID nowadays? Gramps may be unable to get medical care, because the doctor's office will demand to see (and take a photocopy of) Gramps' photo ID!

Check and find out what is the status of any photo ID for your Gramps. Most if not all states will issue a photo ID that isn't a driver's license, which is great for Gramps for two reasons:
(1) Gramps may not be driving anymore so a driver's license isn't needed.
(2) the photo ID probably doesn't expire, so (unlike with driver's licenses) you don't need to worry about the identification expiring and becoming unavailable at a critical moment.

Obviously if Gramps already has a valid driver's license or passport, it's so much easier. But still very important, because Gramps needs a photo ID that won't have an expiration date. So get your Gramps over to the right state agency (probably the same one that issues driver's licenses), help fill out the paperwork, and get it done. Before you find yourself stuck at the doctor's office without the ID needed before the doctor will even see your Gramps.

What if Gramps doesn't have a valid, non-expired driver's license or passport? Check with your state agency that issues these photo ID's, to find out what documents they require. It will probably require a document like a birth certificate, or a certificate of naturalization or citizenship if Gramps was born outside the U.S.A.

Probably not a bad idea to check into the requirements for yourself too, or for other relatives who either might be approaching the threhold of seniority, or who don't drive or for any other reason don't have a current, valid photo ID. These days, you don't want to have denials or delays in medical care or other needed services because of a failure to have this simple but important documentation.

Medicare's new website for caregivers

2009-01-18T15:23:00.003-05:00

Medicare has a new website for caregivers! According to an article at the Chicago Tribune today:
Medicare site a boon to doctors, caregivers
By Francesca Lunzer Kritz The Washington Post - January 18, 2009

We can thank the people at Medicare's call centers for a new Web portal specifically designed for caregivers. ...

The new site (medicare.gov/caregivers), says Kerry Weems, acting administrator of the Centers for Medicare and Medicaid Services, aims to answer basic questions that Medicare staffers have been fielding by phone.

The site points users to basic information with labels such as "Medicare Basics" and "Is It Covered?" And the site has a new ratings feature for thousands of nursing homes in the United States. ....

Other sources, public and private, offer drug plan guidance, including one-on-one counseling. Contact the Medicare Rights Center at medicarerights.org or 800-333-4114, or a state health insurance assistance program at shiptalk.org.

=============

I've added this new Medicare site for caregivers to the list of "other sites of interest" at the right side of this page. So anytime you come back to this GrampsCare.com site, you'll find it listed there and can simply click to go right to that new Medicare webpage.
_________________________________________________________________

Recognize a stroke and get help ASAP

2009-01-18T12:40:00.006-05:00

Stroke is a medical emergency.
Know these warning signs of stroke and teach them to others.
Every second counts!:

*Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
*Sudden confusion, trouble speaking or understanding
*Sudden trouble seeing in one or both eyes
*Sudden trouble walking, dizziness, loss of balance or coordination
*Sudden, severe headache with no known cause

If you or someone with you has one or more of these signs, don't delay! Immediately call 9-1-1 or the emergency medical services (EMS) number so an ambulance (ideally with advanced life support) can be sent for you.

Also, check the time so you'll know when the first symptoms appeared. It's very important to take immediate action. If given within three hours of the start of symptoms, a clot-busting drug called tissue plasminogen activator (tPA) can reduce long-term disability for the most common type of stroke. tPA is the only FDA-approved medication for the treatment of stroke within three hours of stroke symptom onset.

Here's some more helpful information for caregivers, relatives and friends (it's circulating on Internet and email, not as American Stroke Association info but as people "sharing the word" to help one another with this issue):

Sometimes symptoms of a stroke seem difficult to identify. Unfortunately, the lack of awareness spells disaster. The stroke victim may suffer severe brain damage when people nearby fail to recognize the symptoms of a stroke. But it's essential to get medical help immediately. Fortunately, doctors can now work wonders in alleviating the devastating effects of stroke, but only if they can apply help within 3 hours!

The person may feel dizzy and sound like he/she is mumbling or slurring words. S/he may have numbness on one side. If you're not sure, call an ambulance and ask for help. Also, if the person has trouble with ANY ONE of the following tasks, call emergency response (911, or ambulance dispatch if you have their number handy) immediately and describe the symptoms to the dispatcher:

RECOGNIZING A STROKE

Remember the '3' steps, STR. Read and Learn! Doctors say a bystander can recognize a stroke by asking three simple questions:

S * Ask the individual to SMILE.
Lopsided/fallen side of face can mean a stroke.

T * Ask the person to TALK and SPEAK A SIMPLE SENTENCE (Coherently) (e.g. "It is sunny out today.")
Slurring words can mean a stroke.

R * Ask him or her to RAISE BOTH ARMS.
Can't raise both? a weak side can mean a stroke.

**New 4th Sign of a Stroke -------- Stick out Your Tongue
Ask the person to 'stick out' their tongue.
If the tongue is 'crooked', pulling to one side or the other, that's also a sign of a stroke.

A neurologist says that if he can get to a stroke victim within 3 hours he can
reverse the effects of a stroke. He said the trick is getting a stroke recognized, diagnosed, and then getting the patient medically cared for within 3 hours, which is tough. So be prepared!

A cardiologist says if everyone who gets this information sends it to 10 people, you can bet at least one life will be saved. I have done my part. Will you?

Here's more information from the nonprofit American Stroke Association (a division of the American Heart Association):

A TIA or transient ischemic attack is a "warning stroke" or "mini-stroke" that produces stroke-like symptoms but no lasting damage. Recognizing and treating TIAs can reduce your risk of a major stroke. The usual TIA symptoms are the same as those of stroke, only temporary. The short duration of these symptoms and lack of permanent brain injury is the main difference between TIA and stroke.

The American Stroke Association's webpage at http://www.strokeassociation.org/presenter.jhtml?identifier=1020 shows the warning signs, and you can also download those warning signs of stroke and a fact sheet you can keep and print, to learn the warning signs and teach others. more on this from American Stroke Association

The American Stroke Association also makese these helpful links available:
Power To End Stroke - The power is in your hands to prevent and overcome stroke in African Americans. more on this from American Stroke Association
Send a stroke warning signs E-card - Be sure the people you love are aware of the warning signs of stroke. Send them an e-card today. click here for American Stroke Association e-cards
_________________________________________________________________

More about that wireless doorbell for Gramps to ring

2009-01-18T11:32:00.003-05:00

Here's our wireless doorbell idea again, because it's the single best thing we did for Gramps and ourselves!

Look under the "Simple fixes" label (listed at right side of this page), you'll find my original post about the wireless doorbell with a photo of the actual ringer unit we keep in the kitchen. (Can be placed anywhere).

Here's a photo of the ringer button Gramps pushes to ring the bell for help. (I edited it with a gray ring around the button so you can see the actual button better.) It's great - you can fix it with the included adhesive backing, if you like (or attach with the included screws). The button comes this way with the wireless doorbell unit when you buy it at any hardware store (probably Radio Shak and other stores have wireless doorbells too). Easy for Gramps and easy for you!

_________________________________________________________________

Eating and food arrangements for Gramps

2009-01-18T11:27:00.006-05:00

Here are some simple things you can do to help Gramps - and yourself - make eating and food arrangements better. First, just for convenience if it's too cumbersome to have Gramps at a dining table for any reason ... in our case, it's because Gramps prefers to spend the day in her own lounger chair, along which we have a narrow folding table for her beverage, tissues, glasses, etc. (so we cannot even fit a dining table into her space) - your Gramps may have similar reasons, such as a favorite lounger, or even staying in bed. So, here's a "lap desk":

I placed it into the washing machine so you can see its size - perfect for Gramps' lap, and at the back it rests on an attached "beanbag" type pillow for comfort. Above is a closeup of the brand name of this particular lap desk.

Of course this lap desk is designed for reading and especially writing, and it does work very well for that. We put it to extra use as an eating pad and Gramps loves it! Now, you see a placemat on top of it - that's not an original part of it. In fact, that placemat is not actually a "normal" placemat - I just took a roll of that tacky (Rubbermaid?) type of shelf liner (you can buy at any general store). It's just slightly tacky which helps hold the plate and utensils in place without slipping.

Don't put a cup or glass with liquid onto it - it won't keep balance and can spill, potentially hurting Gramps if the liquid is too hot. So, just use this for food, as an aid to help Gramps have a plate in their lap. The folding table at Gramps' side is where we put any beverages.

What if your Gramps, like mine, can't see well? Ours has AMD (Age-related Macular Degeneration) which means Gramps doesn't see well, especially directly in front of her. She has to use peripheral vision, so visual acuity is poor. It's literally difficult for her to find her food on her plate! Here's a fix that works well: use a plain white plate. Here's a picture of the ones we use (at right) - these particular ones are by Corelle (R) (the Corningware company). It's great they also have the black circle around the edge so Gramps can see the edge of the plate.

The plates by Corelle are also great because they are lightweight - won't weigh down the lap desk - easy to clean, hassle-free in the dishwasher, and non-breakable (a real plus)! This is not an advertisement for the company, I'm just saying that we love them and would recommend them to anyone.

Finally on this topic for now, here's a photo (at left) of a refrigerator we got to help with food storage and preparation for Gramps. Since we've been assisted by hired caregivers coming into the home, we found one problem was that their prepared food and leftovers for Gramps would get "mixed up" with our food and leftovers. Sometimes we'd find "mystery leftovers," especially if a hired caregiver one day was replaced the next day or so by someone else who didn't know which food was for whom. These "mystery leftovers" would not have any identifying information, especially nothing about the date when prepared.

It's a food hazard if someone - especially Gramps - accidentally eats food that's too old! The elderly, like babies, have weaker immune systems. So the extra microbes that grow on leftovers aren't a problem for you or I after only 2 or 3 days, but can be a problem for Gramps.

The "fix" for this was to have a separate refrigerator to help hired caregivers know which food is Gramps'. We also required the hired caregivers to put a Post-It label on each leftover container they put in, showing the date. It became much easier to tell when leftovers became out-of-date. Outdated leftovers get thrown away - don't worry about the waste, it's a potential hazard for Gramps so just do it!

These are just some of the simple fixes you can do in the home arrangements to make it better and easier for Gramps, and for you. Diet and nutrition are important for everyone, but especially important for Gramps. We hope you find these ideas helpful.

_________________________________________________________________

Seniors may get help with Medicare payments for brand-name prescriptions

2009-01-11T12:27:00.006-05:00

Important news for seniors taking brand-name prescription drugs: currently, Gramps may have to pay substantially extra for certain brands, compared with either standared brands or generics. These dollars can really add up!

Now, according to this article, Medicare Seeks to Ban Some Penalties for Picking Brand-Name Drugs, the Centers for Medicare and Medicaid Services (the federal agency that manages Medicare), this practice may be stopped.

AARP has been asking CMS to ban this so-called "reference-based pricing" practice. (The AARP-branded plans operated by UnitedHealth Group Inc. do not use reference-based pricing.)

Does your Gramps' plan have referenced-based pricing? You can find out by looking at any literature you can locate that relates to your Gramps' Medicare or Medicare Advantage (managed care) plan. And you can keep up with this issue by using the news feed at the right side of this page, using the "Medicare" label there, as articles come out on this and other Medicare-related news.

Note - if your or your Gramps has a Medicare Advantage type of plan that manages Medicare, and it isn't the AARP type mentioned above, or it isn't another managed plan that protects you or your Gramps from this referenced-based pricing, then be sure to check the "formulary" listed in your plan's literature to find out how much more you're paying (or ask your pharmacist when you go to pick up the filled prescription). See if the "formulary" shows another, similar drug that's either a cheaper brand, or a generic - if so, take a copy of the formulary to the doctor when you ask whether a cheaper brand (or generic) can be substituted to save you/Gramps money.

If you or your Gramps has the referenced-based pricing in you or Gramps' Medicare or Medicare managed plan, then what can you do to save money now? Well, it is worth asking your doctor or Gramps' doctor if a different brand, or a generic, can be substituted. Be candid and explain that the extra costs for the special brand are a problem. Maybe the doctor has a good reason for specifying that particular brand - it could be better suited to help your Gramps - in that case, it might be worth it to pay the extra money (until Medicare takes action). But then again, the doctor may be able to prescribe a generic, or a cheaper brand, instead. (This is when the doctor might be helped by looking at a copy of the formulary from your Medicare managed plan, if that applies.)
_________________________________________________________________

HAPPY NEW YEAR!

2008-12-31T18:31:00.001-05:00

_________________________________________________________________

Enjoy your Gramps this holiday!

2008-12-24T12:07:00.006-05:00

Some ideas for enjoying your Gramps this holiday:

* Help make sure Gramps is as comfortable as possible; well nourished, with enough fluids, and if Gramps is allowed to have some extra nice things to eat or drink - make sure it happens!

* Share family photos and stories with Gramps - share a few laughs!

* For families and friends far away, get them on the phone with Gramps if possible, or let Gramps know how much they appreciated the cards and/or gifts from Gramps (which you may have helped to send)!

* Free holiday materials (including songs, poems, etc.) you can print and use with your Gramps (this includes activity directors at senior homes), at Music-Outreach Books, Recordings & Videos for Use with the Elderly.

* Here are some similar family-based ideas in articles: Kwanzaa activity ideas with some addressing the elderly; Hanukkah activities; and How to Help the Elderly at Christmas. These ideas include one of the smallest but very most important things - spend a little quality time with Gramps! Even 15 or so minutes just talking with Gramps and finding out what's on his or her mind, how they're feeling - or singing songs - or playing easy but fun family games - too often Gramps gets insufficient attention, or attention only to routine things and not focused on Gramps as an important family member.

* Going out to eat? You can take Gramps with you (maybe in a folding wheelchair, one of the items I've discussed before at this blogsite) - not difficult, especially with extra family members helping out, and you're likely to get sympathetic treatment at the restaurant too!

* Still need gift or activity ideas? Consider Arts and Crafts For the Elderly; or The Jewish Family Fun Book (specific ideas at pages 73, 93, 95, 96, 97 and 169); events in your community such as the Dec. 26 Kwanzaa Community Celebration (Tallahassee, FL), which include special recognition for the elderly; also try this article, Gift Tips for Less Active Seniors and Elderly; and, there are Yahoo Groups discussing Christmas gifts for the elderly as well.
_________________________________________________________________

Is Gramps taking medications dangerously?

2008-12-24T10:44:00.004-05:00

Taking the right medications, in the right doses and at the right times, is a very serious issue especially for the elderly. A disturbing new study shows that Millions of seniors use risky drug combos, with "one in 10 taking potentially deadly mixes"!

The research, funded by the National Institutes of Health and University of Chicago, appears in Wednesday's Journal of the American Medical Association. You can look at the full article on MSNBC using the link in the paragraph above. Here are some quotes:

CHICAGO (12/23/2008)* - At least 2 million older Americans are taking a combination of drugs or supplements that can be a risky mix — from blood thinners and cholesterol pills to aspirin and ginkgo capsules — a new study warns.

Among older men, the numbers are particularly alarming — one in 10 are taking potentially harmful combinations, according to the study.

The results aren't always disastrous, but older people are more vulnerable to side effects and drug-to-drug interactions. And patients need to know that just because lots of medicines and supplements don't require prescriptions doesn't mean they're harmless. Nor are some of these safe to take when you're prescribed other medications.

Experts say the take-home advice is to ask about any side effects of prescription drugs, and tell your doctor before taking other medicines.

.... For example, warfarin, a potent prescription clot-fighting drug, was often taken with aspirin. Both increase the risk of bleeding, so the odds are even higher when both drugs are taken. The researchers said these risks also occur when warfarin is taken with garlic pills, which some studies have suggested can benefit the heart and help prevent blood clots. ....

Other commonly used and risky combinations included:

* Aspirin taken with over-the-counter ginkgo supplements, increasing chances for excess bleeding.
* Lisinopril, a blood pressure drug, taken with potassium, which combined can cause abnormal heart rhythms. Potassium is often prescribed to restore low levels of this important mineral caused by certain blood pressure drugs.
* Prescription cholesterol drugs called statins taken with over-the-counter niacin, a type of vitamin B that also lowers cholesterol. This combination increases risks for muscle damage.

....Dr. Jerry Gurwitz, chief of the geriatric medicine division at University of Massachusetts Medical School, said taking multiple medications, despite possible bad interactions, isn't necessarily a bad idea as long as patients are in close contact with their doctor. ....

Michael Cohen, a pharmacist and president of the Institute for Safe Medication Practices, called the study an important snapshot of medication use in older Americans. But as someone who takes at least five medications himself, Cohen said the widespread prevalence isn't surprising.

Cohen said his group recently launched a new Web site, http://www.consumermedsafety.org/ that will allow consumers to enter names of their medications to check for any potentially dangerous interactions.

*© 2008 The Associated Press
_________________________________________________________________

Ask Gramps about US savings bonds

2008-12-21T22:00:00.003-05:00

Especially since you may have more time with your Gramps these holidays, here's something you can easily ask about that can be a big help to Gramps and the family (article posted at http://www.mercurynews.com/personalfinance/ci_11256090):

Tight on cash? Redeem those old savings bonds
By Kathy Kristof
Los Angeles Times

Article Launched: 12/21/2008 12:00:00 AM PST

Looking for cash to tide you over during these lean times? The Treasury Department is urging Americans to quiz their parents and grandparents this holiday season about whether they squirreled away U.S. savings bonds that have stopped earning interest.

The reason: About $16 billion of these bonds haven't been redeemed.

The government suspects that the owners have either died or forgotten about the investments that they bought in the 1940s, '50s, '60s and '70s.

Some of them are engraved certificates suitable for framing. But if you find one gathering dust in Grandma's attic, know that it is worth much more than its face value — perhaps almost 10 times as much. In other words, a bond that says it's worth $100 could be worth nearly $1,000. But don't be fooled into thinking that the oldest ones are the most precious.

A $100 bond issued in January 1943, which stopped earning interest in 1983, is worth just $399.80. But a $100 bond issued in January 1965, which earned a more generous rate until 2005, is worth a cool $936.44.

Bonds issued after 1965, however, earned interest for just 30 years. As a result, a $100 bond issued in January 1966 is worth just $512.52 today — a bit more than half the value of the bond issued a year before.

If your search turns up a bond certificate, you can find out how much it is worth with the Treasury Department's savings bond calculator at http://www.treasurydirect.gov/.

You can plug in the bond's serial number, or enter the bond series (EE, E, I or "savings note") and the month and year the bond was issued.

The resulting chart will show the original purchase price and how much it's currently worth. If the bond is still earning interest, the chart also will tell you the interest rate.

If you have multiple bonds — millions of people bought as many as a dozen bonds a year through payroll deductions — you can keep plugging in bond numbers or issue dates and the calculator will create a running tally.

If you have misplaced a savings bond, you can use the Treasury Hunt tool on the TreasuryDirect Web site [http://www.treasurydirect.gov/indiv/tools/tools_treasuryhunt.htm], which searches using the owner's Social Security number.

If you find a bond through Treasury Hunt, your next step is to ask the government to replace it or to send you the amount of money it's worth. To do that, you must submit a form called PD F 1048, which you can either download from the Web site or receive by mail after making a request through the Web site.

Treasury Hunt, however, goes back only to 1974. If you're convinced that you own a bond purchased before then, you need to fill out the PD F 1048 form to have the Treasury search its paper files.

If you suspect your late parents or grandparents owned savings bonds, you can find out by entering their Social Security numbers into the Treasury Hunt tool. If that turns up any unredeemed bonds, you'll need to go through the same process as if you'd lost a bond.

But in this case the Treasury will ask for additional documentation to show that you are the rightful heir, said Stephen Meyerhardt, spokesman for the savings bond program.

If there are multiple heirs, another form on the Treasury's Web site allows you to ask for the bond's value to be divided and for each share to be sent to its owner.

If you're looking for the fastest way to get cash for your savings bonds, take them to a local bank, credit union or savings and loan. Most serve as redemption agents for savings bonds.

At a time when money is scarce, Meyerhardt said, make sure you're not sitting on bonds that are no longer earning interest.

"Some people know they have them, but they don't want to cash them in for some reason," he said. "These are registered government securities, and we stand ready to replace them or cash them out to the person who is entitled at any time."
_________________________________________________________________

Holiday Gift Ideas for Gramps

2008-12-07T12:35:00.010-05:00

What does Gramps want for the holidays? Here are some ideas to help you select gifts that Gramps wants and needs:

* Gift cards to Gramps' favorite restaurants, if Gramps is still ambulatory and enjoys going out to eat once in a while. (If you are not sure, then make a discreet inquiry to find out first - it won't help if Gramps cannot get to the restaurant, or if that particular restaurant is not located fairly close to where Gramps lives.)

* Gift cards to a local grocery or discount store, if Gramps (or a caregiver) is cooking at home.

* DTV coupons - help Gramps apply (or apply on Gramps' behalf) for the two (2) DTV coupons available free from the government, each to save $40 off the TV converter boxes needed to switch from analog to digital broadcast signals before February 17.* Apply at http://www.dtv2009.gov/ or call (toll-free) at 1-888-388-2009.

* Cotton pajamas. (Not polyester! Gramps may get wet overnight and the cotton is needed to absorb and protect the skin.)

* Framed photographs of family members, especially new arrivals and children. Either frame them, or place them into a photo album. Gramps wants to see these folks and doesn't have the time (or resources) to take or frame photos himself/herself.

* A home-made calendar with a photograph of the grandchildren, other family members, etc., for each month - and marking family birthdays, and holidays, etc., on the specific dates (to help Gramps keep track).

* A holiday basket with items Gramps can actually eat and enjoy (check Gramps' nutritional requirements and dental situation)

* Time helping Gramps with errands - some examples:
** Taking Gramps' car in for a maintenance checkup - oil, belts, tires, antifreeze, heat/air conditioning, etc.
** Winterizing Gramps' home
** Fixup and maintenance around Gramps' home - light bulbs, moving furniture
** Helping put up holiday decorations at Gramps' home (and/or, helping to take them down after the holidays are over)
** Determining Gramps' medical needs and making arrangements to help take Gramps to the doctor, dentist, etc., during the upcoming year
** Arranging a schedule to help Gramps get the mail, pay the bills, etc., during the year

And here's one that Gramps will probably really appreciate - talk with Gramps soon, and find out how you can help Gramps to provide gifts to other family members! Gramps probably wants to give something to grandchildren, for example, but doesn't know what kinds of toys are popular for children nowadays ... or cannot get to the store (or the Internet), or cannot wrap any gifts. Perhaps Gramps also is financially strapped and just needs help baking some brownes or toasting some spiced pecans (add Worcestershire sauce to raw pecans, toss well, then bake in the oven about 325 F. for about 20-30 minutes), putting into a pretty container, and adding a bow to present to family and friends.

Gramps may also need help addressing and mailing holiday cards to family and friends ... what a nice gift of your time in helping with that little task - Gramps will appreciate it!

_____________
*These converter boxes will be needed to get over-the-air ("rabbit ears" antenna) TV broadcast signals, unless your TV is the new digital (DTV) kind. They will not be needed if you receive TV programming by cable or satellite company ... but if you ever want to switch over to over-the-air (free) TV broadcasts, you will need to buy either the new digital kind of television, or use one of these DTV converter boxes
_________________________________________________________________

Hearing aids

2008-12-02T08:17:00.002-05:00

Folks, I'll add more to these comments in the future. Just a quick note for now - hearing aids can be very important. But beware of the following items:

* First, have Gramps checked out by a true ear/nose/throat medical doctor. There is a strong possibility that Gramps has impacted ear wax that's impeding his/her ability to hear well. You will be surprised what a difference it makes just to have Gramps' ear canals properly cleaned out. This may even involve followup with ear drops over a week or so, which can be administered by anyone who can follow the instructions and do it carefully. (E.g., don't put too much of the oil into Gramps' ear at one time and be sure to let it properly drain.)

* If getting rid of ear wax isn't enough, then you can go down the path of hearing aids. Be sure that Gramps really wants hearing aids and will use them. In our experience, we had Gramps spend thousands of dollars on sophisticated hearing aids, but now she just won't wear them. Money wasted! (Anyone have a Gramps that wants some almost-new hearing aids?!)

* If Gramps really does want hearing aids, then test several types before you buy. They have to actually work for Gramps. The cheap ones may not do the job (although they may be getting better over the years).

* Be sure that Gramps actually can handle them, and knows how to use them. They will simply go unused and gather dust, unless Gramps (or the caregiver) knows how to, and can, put them in and take them out properly; install any batteries if/when needed; and troubleshoot any problems or issues that may arise.

If you are able to navigate all these issues, then Gramps' quality of life (and yours) should improve considerably. The ability to hear, and to converse knowledgeably, actually helps Gramps' brain to remain more active, and keeps Gramps more functional for a longer period of time.

Some humor during this "eating season"

2008-12-01T15:18:00.004-05:00

The Importance of Walking

Walking can add minutes to your life. This enables you at 85 years old to spend an additional 5 months in a nursing home at $7000 per month.

My mother-in-law started walking five miles a day when she was 80. Now she's 81 years old and we don't know where the heck she is.

I like long walks, especially when they are taken by people who annoy me.

The only reason I would take up walking is so that I could hear heavy breathing again!

I have to walk early in the morning, before my brain figures out what I'm doing.

I joined a health club last year, spent about 400 bucks. Haven't lost a pound. Apparently you have to go there.

Every time I hear the dirty word 'exercise', I wash my mouth out with chocolate.

I do have flabby thighs, but fortunately my stomach covers them.

The advantage of exercising every day is so when you die, they'll say, 'Well, she looks good doesn't she.'

If you are going to try cross-country skiing, start with a small country.

I know I got a lot of exercise the last few years,...... just getting over the hill.

We all get heavier as we get older, because there's a lot more information in our heads. That's my story and I'm sticking to it!!
_________________________________________________________________

Happy Thanksgiving to all "Gramps" and Gramps' families!

2008-11-26T16:40:00.003-05:00

Just remember to breathe deeply and appreciate all the people and things, great and small, that bring joy to our lives!

And extra thanks to all those who, while maintaining balance in your own lives, are able to bring any amounts of joy to others!!
_________________________________________________________________

Costs of in-home care for the elderly

2008-11-22T13:59:00.009-05:00

An article entitled "Home Health Care for Your Elderly Parents: When a nursing home doesn't feel like the right move, home health care can be a good option. Here's how to make your decision" (Sept. 10, 2008), at http://www.businessweek.com/investor/content/sep2008/pi20080910_761489.htm?campaign_id=rss_null

"According to the National Academy on Aging Society, there are 8.5 million people over age 70 in America with limitations in walking, dressing, bathing, shopping, paying bills, and preparing meals. This number will increase dramatically in the future, perhaps to 21 million in the next quarter century, according to estimates. In addition, the National Association of Home Care & Hospice Care reports the number of home-care agencies has increased to 17,700 in what has become a $53.4 billion industry."

"There are several important questions to ask yourself before deciding on home health care for an aging parent. The first, and probably most important, comes down to affordability. In New York City, it can cost about $16 per hour for home health care. In Colorado, it's even more expensive, about $24 an hour. In Louisiana, it's less expensive, averaging about $14 an hour. To determine costs in your hometown (or your parents' hometown), check out the Cost of Care calculator available on the Federal Long-Term Care Insurance Web site."

"With costs in mind, you can make a better determination if you can afford round-the-clock live-in care for your parent, or if it might be best to have a home health-care worker stop in for several hours a day to help with organizing medications, preparing meals, paying bills, or any other needs."

"It's important to note that Medicare and most health-insurance policies do not cover home health-care costs. However, long-term care policies generally do. Unfortunately, many people do not think about buying a long-term care policy until they are already in their 70s or 80s and may already have health problems that make insurance companies unlikely to want their business."
==================

This article points out some of the direct and indirect costs of taking care of Gramps at home. Of course, if you are evaluating this, you also need to know what are you comparing it to? Are you comparing it to the option of Gramps in his/her own home, rather than your home? Would Gramps be living in his/her same home (perhaps dealing with home maintenance as well as house-keeping, etc.), or in a senior living community, retirement home, or an assisted living facility or nursing home? These kinds of comparisons make the alternatives more realistic.

We found that caregiving agencies provide aides - not nurses, but caregives who have some basic training - in our area for a range of about $16-$19 per hour. The prices will vary depending on how many hours per day, how many hours per week, and whether the work is during the week or on weekends. We also have been charged a 50% premium (time-and-a-half) when caregivers work on holidays.

You can hire someone directly to come into your home, rather than using an agency, and save money. However, there are definitely issues to deal with in this scenario. Just a few are:
* is the person trained?
* is the person honest and trustworthy? even, licensed and bonded?
* does the person have their own insurance?
* do they have their own car with a valid license and auto insurance?
* will you be deemed an employer who's required to withhold taxes, etc. (remember these issues about "nannies" that arose some years ago)?
* will your insurance company have to be notified that you have an employee working in your home, in case there's a liability suit (e.g., slip and fall)?
* will your home insurance company perhaps even cancel your homeowner's insurance due to having an employee working in your home?

All of the issues I list above are issues I have either dealt with, or have heard about. I'm not trying to give out legal advice, just trying to alert you to some of the issues that go along with hiring someone directly rather than through an agency.

There are other financial aspects to consider if Gramps is coming to live with you in your home, such as whether Gramps should be expected to contribute toward the mortgage or rent payment, utilities, food bills, etc. If you think that you may be providing more than 50% of Gramps' living expenses, you should check with your tax advisor about whether you can or should be claiming Gramps as your dependent for tax purposes.
_________________________________________________________________

Resources from government and private organizations

2008-11-22T13:24:00.009-05:00

Here's more information on a range of governmental and other resources that can help you in getting started and dealing with many issues. This particular list also was taken from the site at http://www.state.gov/m/dghr/flo/c23141.htm which has good information for all families involved with care of elderly parents, relatives or friends:

The Administration on Aging (AoA)

The Administration on Aging (AoA) is part of the U.S. Department of Health and Human Services. It was set up to "remove barriers to the economic and personal independence of older persons and to assure the availability of a range of appropriate community and family based services for older persons in social or economic need." AoA supports a network of the state and Area Agencies on Aging that reinforce and supplement the daily support that the elderly receive from family, friends, and neighbors.

Administration on Aging - Department of Health and Human Services
330 Independence Avenue, SW, Washington, DC 20201
Tel: 202-619-0724 website: http://www.aoa.gov/

To get information on eldercare services in a particular community, contact the Area Agency on Aging. One can locate a specific state agency on aging through the Eldercare Locator Service via telephone (1-800-677-1116) or the website at http://www.eldercare.gov/. The Eldercare Locator Service is sponsored by the AoA and operated by the National Association of Area Agencies on Aging.

National Association of Area Agencies on Aging
927 15th Street, NW, Washington, DC 20005
Tel: 202-296-8130 website: http://www.n4a.org/

Services provided by Area Agencies on Aging include information and referral, homemaker/home health aides, transportation, congregate and home delivered meals, chore and other supportive services. Types of services available vary in each community based upon needs and resources.

Useful Eldercare Resources

AARP Webplace - This advertisement-free site provides information and encourages elder advocacy. http://www.aarp.com/

Aging Parents: The Family Survival Guide. Consisting of a booklet and two videotapes, this guide is designed to help family members respond to eldercare crises and to plan ahead for long-term care giving. To order, call 1-888-777-5585 or order online at http://www.agingparents.com/

Aging Parents and Elder Care - Articles, comprehensive checklists, and links to key resources. The site is designed to make it easier for family caregivers to quickly find the information they need. http://www.aging-parents-and-elder-care.com/

ElderWeb: An Online Eldercare Sourcebook. Designed to assist older Americans, professionals and family members, this web site covers eldercare and related issues with an extensive array of links. http://www.elderweb.com/

Travel Tips for Older Americans from the Department of State Bureau of Consular Affairs http://travel.state.gov/travel/tips/tips_1232.html (see Special Planning Considerations / Senior Travelers).

Alzheimer's Association, Inc.
919 North Michigan Avenue, Suite 1000, Chicago IL 60611
Tel: 1-800-272-3900 website: http://www.alz.org/

American Association of Homes for the Aging
901 E Street NW, Washington, DC 20004
Tel: 202-783-2242 Fax: 202-783-2255 website: http://www.aahsa.org/

American Association of Retired Persons
601 E Street NW, Washington, DC 20049
Tel: 202-434-2277 website: http://www.aarp.org/
Provides the following free pamphlets: Miles Away and Still Caring (D-12748); A Handbook About Care in the Home (D-955); A Path For Caregivers (D-12957)

Guide to Retirement Living - Douglas Publishing Company, Inc.
9302 Lee Highway, Suite 750, Fairfax, VA 22031
Tel: 703-536-5150 or 1-800-394-9990 E-mail: proaging@retirement-living.com website: http://www.retirement-living.com/
Call for a free single copy of this magazine.

Health Insurance Association of America
555 13th Street NW, Suite 600 East, Washington, DC 20004
Tel: 202-824-1600Fax : 202-824-1722 website: http://www.hiaa.org/
Publishes A Consumer's Guide to Long-Term Care.

National Association of Private Geriatric Care Managers
1604 North Country Club Road, Tucson, AZ 85715
Tel: 520-881-8008 Fax: 520-325-7925website: http://www.caremanager.org/
Provides free referrals nationwide and sells a directory of members and managers.

National Council on the Aging, Inc.
409 3rd Street SW, Washington, DC 20061-5087
Tel: 202-479-1200 website: http://www.ncoa.org/
Publishes Perspective on Aging, a bimonthly magazine, and Family Home Caring Guides
National Institute on Aging
9000 Rockville Pike, Bethesda, MD 20892
Tel: 301-496-1752 website: http://www.aoa.dhhs.gov/

Living wills, medical directives, power-of-attorney

2008-11-22T13:03:00.014-05:00

I started to give some basic information on legal issues of helping elderly parents, relatives or friends. A very good discussion of these issues is located at http://www.state.gov/m/dghr/flo/c23141.htm. Since this information is not limited to foreign service families but will help all families, and even volunteers who may be providing services to those needing help with elder care and elderlaw issues, I'm including that discussion about legal issues, below:

"Legal Issues
"If an elderly relative becomes mentally incapacitated, it is necessary that someone step in to take care of affairs. Advance planning on the part of both the elderly person and those who care about him/her will facilitate this process. You should consult an attorney before taking any of the following steps.

"The Document Locator (scroll to bottom ...) is a useful tool for the elderly person and his/her relatives to make contingency plans for future care. Other factors to consider include setting up joint bank or property accounts and signing a durable power of attorney.
Joint property or bank accounts are the simplest way to ensure that someone will be able to handle the elderly person's affairs if s/he becomes incompetent. There are, however, serious financial and tax consequences to such an arrangement. For example, when applying for Medicaid assistance, the assets of both owners are taken into account to determine eligibility. No one should enter into such an arrangement without checking all the legal implications.

"A durable power of attorney is important because an ordinary power of attorney is not valid if the principal becomes incapacitated. This can create serious problems for the person handling the affairs and arranging care. A durable power of attorney is designed to survive disability or incompetence and is an important alternative to guardianship, conservatorship, or trusteeship. Laws vary from state to state so it is important that a durable power of attorney be drawn up by an attorney licensed to practice in the state in which the client resides.

"Guardianship or conservatorship is the legal mechanism by which a court declares a person incompetent and appoints a guardian. The court transfers the responsibility for managing financial affairs, living arrangements, and medical decisions to the guardian. This procedure can take some time, usually when time is of the essence.

"Making Life and Death Decisions
"Because of the amazing advances in health technology, people are living longer. Newspapers are filled with stories of families asking the courts to allow terminally ill family members to be removed from life support systems. Adult children are often asked to make these kinds of decisions for their terminally ill parents. Courts are increasingly asking what preferences about medical care the patient may have expressed. Ideally, everyone should make his/her own wishes known by preparing and signing a medical directive, a health care power of attorney, a durable power of attorney, and/or a living will.

"Some definitions are in order:

Power of Attorney - Ordinary powers of attorney allow an individual ("the principal") to give legal authority to another ("the agent") to handle business or property transactions for the principal. The power of attorney may be general or limited, for a definite or indefinite period of time. As long as the principal remains competent s/he may change or end the power of attorney at any time. These powers of attorney are effective only as long as the principal is competent.

Living Will - This is a written statement of wishes regarding the use of specified medical treatments. It is provided to the doctor, hospital, or medical provider and becomes part of the official medical record. Each state requires the use of its own form for a living will and many states have other limitations. In some states, living wills apply only to those with Alzheimer's Disease, strokes, degenerative disorders, or those in a coma or persistent vegetative state.

Health Care Power of Attorney (also called a medical power of attorney or health care proxy) - This durable power of attorney is for health care (as opposed to financial) issues. It authorizes the agent to make health care decisions for the principal in the event s/he is unable to make such decisions. Without such a document, many health care providers and institutions will make critical decisions for the patient, not necessarily based on what s/he would want.

The health care power of attorney can also include a statement of wishes and preferences in specific situations (for example, a person may want to forego respirators but continue nourishment). A statement of wishes concerning organ donation should also be included. Health care powers of attorney can be used by individuals who want life-sustaining treatments continued as well as those who want to forego such treatments. An increasing number of states are enacting statutes that recognize health care powers of attorney and many states provide forms and procedures for creating the document.

Note: Department of State employees may request a free copy of FIVE WISHES from the Office of Employee Relations, Work/Life Programs (by email to HR-ER-WLP on the global address list or call 202-261-8180), one copy per person. FIVE WISHES is a planning tool and legal document in most U.S. states that combines the features of a living will and a health care power of attorney.

"Questions to Consider
"The most important considerations when preparing a durable health care power of attorney are whether or not to permit life-sustaining procedures and whether or not life-sustaining procedures include nutrition and hydration (food and fluid provided by a nasogastric tube or tube into the stomach, intestines, or veins).
The health care power of attorney should state clearly one of the following:

life-sustaining procedures should be used;

life-sustaining procedures should not be used after diagnosis of a fatal, incurable, or irreversible condition; or

the decision should be left to the agent.

"Another important decision is the agent who will make the health care decisions. Remember that this person is the one to make health care decisions, not manage the money. Choose a trustworthy person who is good under stress and good at talking to doctors.

"Other Points to Consider
"If you want both a health care power of attorney and a living will, they must use the same terms to describe medical treatments and list the same person as the agent or proxy.
Your doctor and other health care providers should know about your health care power of attorney and should have no objection to following it. If they have objections, you must either work them out or change providers.
Also consider appointing a backup agent or proxy in the event that the first person is unable or unwilling to act. Make sure that the backup has all the necessary documents.

"Getting a Lawyer's Help
"It is recommended that a lawyer draw up any durable power of attorney and/or health care power of attorney so that the document meets your special needs and will be acceptable in your state. This is especially important in any state which does not have a statutory form. The Society for the Right to Die provides free information on your state's current laws on both living wills and powers of attorney for health care. The National Academy of Elder Law Attorneys can provide information on how to choose an attorney specializing in elder law. Other referral sources include the local Office on Aging or the local Alzheimer's Association. See Eldercare Resources below (and in the next post on this site referencing this information) for the addresses and telephone numbers of these organizations.

Document Locator List

Name, address, and telephone number of parent's attorney(s).

Location of parents' will and any trust instruments; complete list of beneficiaries with current addresses and telephone numbers.

Location of copies of the parent's living will, medical directive, or durable power of attorney with the name, address, and telephone number of the agent.

Details of desired funeral arrangements; location of burial plot, if any, and deed to it. Name and address of clergy, if appropriate.

Location of any letter of instruction listing personal property not disposed of by will and the parent's wishes for it's distribution.

Location of important papers: birth certificate, social security card, marriage and divorce certificates, education and military records, other legal documents.

List of bank accounts, including name, address, and telephone number of each financial institution, account numbers, location of passbooks, checkbooks, certificates of deposits.

List of stocks, bonds, real estate, and other investments.

Name, addresses, and telephone numbers of financial planner, tax advisor, broker, and/or anyone else with knowledge of or control over finances.

All insurance data (health, life, auto, homeowner/renter policies; any employee benefit or pension plans), including name, address, and telephone number of each insurance company and agent, policy numbers, and locations.

Location of safe-deposit box and key(s) with a list of the contents and names of anyone with access to it.

Location of receipts and appraisals for valuables.

List of active credit accounts (mortgage companies, banks, oil companies, department stores, etc.), including name and address of each company, account number, and type.

Complete information, including substantiating documentation, about any personal loans the parents owe or are owed.

Location of copies of tax returns for the past 3 years, copies of any gift or estate tax returns filed during the period.

Resources:

Academy of Elder Law Attorneys - 1604 North Country Club Road, Tucson, AZ 85716, Telephone: 520-881-4005 Fax: 520-325-7925 website: http://www.naela.org/

Choice in Dying/Partnership for Caring
1035 30th Street NW, Washington, DC 20007
Tel: 202-338-9790 or 800-989-9455 Fax: 202-338-0242 website: http://www.partnershipforcaring.org/HomePage/
Free medical directives and living will samples.

Alzheimer's Association, Inc.
919 North Michigan Avenue, Suite 1000, Chicago IL 60611
Tel: 1-800-272-3900 website: http://www.alz.org/

National Guardianship Association
1604 N. Country Club Rd., Tucson, AZ 85716
Tel: 520-881-6561 website: http://www.guardianship.org/

Long-Term Care Link - A comprehensive web site with links to eldercare services and insurance information. Updated web site addresses for all State Agencies on Aging: http://www.longtermcarelink.net/state_programs3.html

For general resource information: http://www.longtermcarelink.net/index.html

State Agencies on Aging - A listing of web sites is available at http://www.aoa.gov/eldfam/How_To_Find/Agencies/Agencies.asp

Good information on most aspects

2008-11-22T12:40:00.008-05:00

Here's information on Caring for Elderly Parents that's not only good for all families, but also has particular points for foreign service families: http://www.state.gov/m/dghr/flo/c23141.htm Many of these will also be useful for all family members, whether they are close to Gramps or live far away.

Right from the start, the article's information on communication is very good; so, I'll quote it in below:

"Communicating with Elderly Parents
Talking with our elderly parents about their living situations and the possible need for change is not always easy. A successful conversation depends to an extent upon the relationship we have with the parent, as well, of course, as on the parent's mental, emotional and physical condition. While many people put off serious conversations to avoid conflict or awkwardness, both parent and adult child may lose an opportunity for closeness, understanding, access to information that may affect the decision, and optimum peace of mind.

"To the extent possible, talk with your elderly parents gently and honestly about their wishes, their abilities and their options. Far more often than not, these conversations are helpful and put the adult child in a better position to make decisions later when the parent may not be able to do so. The following are suggestions for conversations with your elderly parent:

Share your own feelings, and reassure the parent that you will support them and can be depended upon to help them solve their problems.
Help the parent to retain whatever control is possible in making his or her own decisions.
Respect and try to honor their wishes wherever feasible.
Encourage the smallest change possible at each step, so that the parent is more able to adjust to the change.

"Educate yourself on legal, financial and medical matters that pertain to your parent as background for your conversations, including current knowledge on the aging process.
Respect your own needs - be honest with your parents about your time and energy limits.

"If this kind of conversation seems impossible or the situation and relationship with the elderly parent become overwhelming, professional counseling may be very helpful. You may also consider using the Department of State's resources to approach this delicate issue somewhat indirectly. Filling out FIVE WISHES for yourself and sharing your decisions with your parents may encourage them to open up on the subject. You may also wish to raise the subject of long-term care insurance as a practical matter. (For more information about FIVE WISHES and Long-Term Care Insurance, see below).

..... (more information is included, such as danger signs that an elderly person needs help)

"Aging in Place
"Under this option, the elderly person continues to live in his/her own apartment. Many elderly people live in Naturally Occurring Retirement Communities (NORCs), apartment buildings, condominiums, or cooperatives not designed as retirement communities but where at least 50 percent of the residents are 62 years old or older. These buildings often have amenities such as grocery stores, pharmacies, limousine service, or shopping services.

"Recent technological advances often make aging in place easier: Velcro fasteners, lightweight wheelchairs, devices to control appliances and dial telephone numbers. There is even a "walk-in bathtub" for people who have difficulty climbing into an ordinary bathtub.

"Many services are available to help the elderly person stay in his/her home. Information about them can be obtained from contacting IQ: Information Quest (see below) or your local Area Agency on Aging.
...
Adult day care is similar to child day care. The elderly person goes to a community facility daily or 2 or 3 days per week. Activities include exercise programs, singing, guest lectures, and current events discussions. Cost varies and there are often long waiting lists at such centers.
Respite care brings a trained person into the home to give the full-time caregiver time off to get a haircut, visit the dentist, or take a vacation. Service is generally offered through area Departments of Social Services and is based on a sliding fee scale.
....

"Paying for Long-Term Care
"It is important to understand the different types of insurance that are available to older people. Many people believe that Medicare will cover long-term care needs. It will not. ... Medicare is a Federal health insurance program which helps defray many of the medical expenses of most Americans over the age of 65. Medicare has two parts:
"(Part A) Hospital Insurance helps pay the cost of inpatient hospital care. ...
Medicare does not pay for custodial care or nursing home care. It will, however, cover up to 60 days in a nursing home as part of convalescence after hospitalization.
"(Part B) Medical Insurance pays for many medically necessary doctors' services, outpatient services, and some other medical services. Enrollees pay a monthly premium.
...
"Medicaid is a joint federal-state health care program for people with a low income. The program is administered by each state and the type of services covered differs. There are strict income requirements so it is necessary for the person to "spend down" all income and assets to poverty levels before becoming eligible. Medicaid is the major payer of nursing home care.
The Medicaid requirement to "spend down" all income and assets created a great hardship for the spouse of a person needing nursing home care. Changes in the Medicaid rules now allow the spouse to keep a monthly income and some assets, including the primary residence. The amounts allowed change, so you must check for current levels.

"Other Insurance
"Why buy other insurance? The purchase of additional insurance gives the policy holder access to a greater choice of facilities without dipping into additional financial resources. Medigap is the name given to privately-purchased supplemental health insurance. It is designed to help cover some of the gaps in Medicare coverage but does not cover long-term care. Study Medigap policies carefully to be sure they provide the protection needed and do not duplicate other health insurance.
"Long-Term Care Insurance is a private insurance that is usually either an indemnity policy or part of an individual life insurance policy. An indemnity policy pays a set amount per day for nursing home or home health care. Under the life insurance policy, a certain percentage of the death benefit is paid for each month the policyholder requires long-term care. Policies are priced differently depending on the age of the policyholder, the deductible periods chosen, and indemnity value or duration of benefits."

Some of the emotional issues

2008-11-22T12:17:00.004-05:00

Here's a link to an article about some - actually, many - of the emotional and other issues being faced by an increasing number of families: "Becoming 'parent of your parent' an emotionally wrenching process" at http://www.usatoday.com/money/perfi/eldercare/2007-06-24-elder-care-cover_N.htm

Here are some quotes from this article:

"It's estimated that 34 million Americans serve as unpaid caregivers for other adults, usually elderly relatives, and that they spend an average 21 hours a week helping out, according to a study being released today (6/24/2007) by AARP. Millions more grown children are calling regularly, flying into town every few weeks or months or just stopping by to take Mom or Dad to the doctor.

"Caring for elderly parents also can threaten the emotional health of caregivers and their families. Being the "parent of your parent" can unlock your family's hidden dysfunctions — "You were always Mom's favorite!" — and reopen old sibling rivalries and conflicts: "You're trying to kill our father!" If you never really got along with your parents or your siblings, it can be even more stressful. Elder care can exhaust and sometimes demoralize the caregiver who's on the front line. And it can frighten and confuse elderly parents.

"Every rivalry you had with your brothers and sisters, every argument you had with your parents, every effort you ever made to become independent can be put to the test once your parents become old and sick."
==========

Too bad the article didn't give concrete suggestions for how to deal with all this. So, I'll offer some. First, do whatever it takes to resolve - or get help with - any family emotional issues going on. The more you can look and and deal with things objectively, not emotionally, the better everything will be for you, your Gramps, and everyone else.

Pretend that you are looking at the situation as if everything were happening to some neighbors. What would you advise them to do? Are you trying to get satisfaction for some old wounds of your own, or are you being "your best self" in thinking and acting on the needs presented? Are you trying to run away from helping your family for some reason ... maybe you find it difficult to look at the realities of aging, parents who decline mentally and physically, and even death? Or conversely, are you playing martyr or trying to be a hero by pretending you can do it all?

The more you free yourself from acting out of the childhood you experienced years ago, and the more objectively you can see situations ... and the more realistically you can assess your own commitments and limitations ... the better you will be able to use boundaries and keep your balance. For your own good - and for the good of Gramps - and everyone else.

Now, does this give you "answers"? No ... decisions about home care vs. assisted living or nursing home, and decisions about which family members help out in which ways, will always be as unique as each family and each family member. Just think carefully about the consequences of the options available to you and your family. Decide what you will do in certain events (what if Mom falls down, what if Dad gets lost or has an accident driving on his expired license, what if Gramps can't keep track of paying bills). Thinking cooly in advance about the "bad" things that can and will happen, helps you to implement your plans of action with much less stress.

And then you can spend more of the rest of your time relaxing ... and remembering how to have fun!

Information on PACE

2008-11-22T11:13:00.005-05:00

Below is information on the government's "PACE" program. Note that it's available only in states that have chosen to offer it through Medicaid. Also, I cannot speak to how well it operates, since our impressions last year of government-provided alternatives were poor ... in the sense that the people seemed to have the same customer-service attitudes as the post office and driver's license beaurocracies. But your experiences may be better! And, if this works, it should be a good resource

Please keep in mind, all the information below is quoted directly from their website at http://www.medicare.gov/nursing/Alternatives/Pace.asp and does not reflect the conclusions or opinions of this site or the author of this comment posting:

"Program of All-Inclusive Care for the Elderly (PACE)
"PACE is unique. It is an optional benefit under both Medicare and Medicaid that focuses entirely on older people, who are frail enough to meet their State's standards for nursing home care. It features comprehensive medical and social services that can be provided at an adult day health center, home, and/or inpatient facilities. For most patients, the comprehensive service package permits them to continue living at home while receiving services, rather than be institutionalized. A team of doctors, nurses and other health professionals assess participant needs, develop care plans, and deliver all services which are integrated into a complete health care plan. PACE is available only in States which have chosen to offer PACE under Medicaid.

"Eligibility
"Eligible individuals who wish to participate must voluntarily enroll. PACE enrollees also must:

Be at least 55 years of age.
Live in the PACE service area.
Be screened by a team of doctors, nurses, and other health professionals as meeting that state's nursing facility level of care.
At the time of enrollment, be able to safely live in a community setting.

"Services
"PACE offers and manages all of the medical, social and rehabilitative services their enrollees need to preserve or restore their independence, to remain in their homes and communities, and to maintain their quality of life. The PACE service package must include all Medicare and Medicaid services provided by that State. In addition, the PACE organization provides any service determined necessary by the interdisciplinary team. Minimum services that must be provided in the PACE center include primary care services, social services, restorative therapies, personal care and supportive services, nutritional counseling, recreational therapy, and meals. Services are available 24 hours a day, 7 days a week, 365 days a year.

"Generally, these services are provided in an adult day health center setting, but may also include in-home and other referral services that enrollees may need. This includes such services as medical specialists, laboratory and other diagnostic services, hospital and nursing home care.
An enrollee's need is determined by PACE's medical team of care providers. PACE teams include:

Primary care physicians and nurses.
Physical, occupational, and recreational therapists.
Social workers.
Personal care attendants.
Dietitians.
Drivers.

"The PACE team has frequent contact with their enrollees. This helps them to detect subtle changes in their enrollee's condition and they can react quickly to changing medical, functional, and psycho-social problems.

"Payment
"PACE receives a fixed monthly payment per enrollee from Medicare and Medicaid. The amounts are the same during the contract year, regardless of the services an enrollee may need.
Persons enrolled in PACE also may have to pay a monthly premium, depending on their eligibility for Medicare and Medicaid.
Current Sites
For a listing of PACE organizations nationwide, please visit the following website:http://www.cms.hhs.gov/PACE/LPPO/list.asp

==============

So, that's what the government advertises for the PACE program. If it works for you and helps you, then that's great.

A guide (mostly on health) for looking after Gramps at home

2008-11-22T00:15:00.004-05:00

Here's a resource for taking care of Gramps at home: a Comprehensive Guide published by the American Geriatrics Society, Foundation for Health in Aging. They provide a text-only version free at http://www.healthinaging.org/public_education/eldercare/.

Apparently they also offer a version with graphics, plus a PowerPoint version suitable for informational meetings and the like. Might make an interesting resource if anyone's organizing a community group, or a church, synagogue, or temple class, or volunteer or outreach program. Especially since a laptop with a PowerPoint can be connected to overhead displays in many meeting rooms for an easy discussion guide.

Medicare's "doughnut hole"

2008-11-18T17:58:00.002-05:00

Here's important information covered today in the Wall Street Journal's "Health Blog" (http://blogs.wsj.com/health/):

November 18, 2008, 4:39 pm
Seniors Still Mystified By Medicare’s Drug ‘Doughnut Hole’
Posted by Victoria Knight / WSJ

Almost three years since the addition of drug coverage to Medicare, seniors remain confused about the infamous coverage gap known as the “doughnut hole.”

Almost two-thirds of enrollees in Medicare Part D don’t fully understand the concept. More alarmingly, more than one-in-four either don’t know what the coverage gap is or how it works, according to a national survey of 1,000 Medicare Part D participants done for Medco Health Solutions, the big manager of pharmacy benefits.
In case you were wondering about the dimensions of the doughnut hole these days. The coverage gap will open up after beneficiaries and their drug plans have spent a total of $2,700 on medications in 2009. Seniors are then on the hook for the next $4,350. After that, the drug plans picks up most of the tab.
Unfortunately, three-quarters of enrollees mistakenly believe that only their out-of-pocket costs count towards the first $2,700, when in fact they need to factor in the health plan’s contributions as well, according to the Medco study.
“This misunderstanding gives many seniors a false sense of security that the coverage gaps is months away, when it reality, it could hit them with their next refill,” Richard Dupee, president of the Massachusetts Geriatric Society and chief of geriatrics at Tufts Medical Center, told the Health Blog. “Without knowing how the coverage gap works, it’s simply impossible to takes steps to push off or prevent it.”
The WSJ has tips on how to become a doughnut-hole dodger as well as advice on what to look for in coverage this open enrollment season (you have until Dec. 31 to decide). Perhaps unsurprisingly given the study’s findings, Medco, which offers Medicare Part D plans, has just launched a new web site “What’s Your Gap?” with its suggestions on how seniors can save.
Permalink Trackback URL: http://blogs.wsj.com/health/2008/11/18/seniors-still-mystified-by-medicares-doughnut-hole/trackback/

Article with checklist on legal & financial aspects

2008-11-18T12:13:00.005-05:00

I found an article that makes helpful points about legal and related matters to consider, including some checklists of particulars. (I won't copy in the entire article; the link to it is below the quoted excerpts.) For many of the topics, the article links to other resources with information - I'm not sure if some of those may be paid services, and so this may represent a marketing effort to some extent. However, the information remains valid:

"Caring for an Elderly Relative

"As Americans live increasingly longer lives, many require ongoing, long-term care. This care often falls to grown children -- men and women who are in their forties, fifties, and sixties and busy with careers or perhaps children of their own. Getting caught in this care-giving "sandwich" -- growing children on one side, aging parents on the other -- can be an emotional and financial burden, especially if you don't know where to begin or how to get help. ...

"Figuring Out What Needs to Be Done
"Following is a checklist to help you determine what your relative may need. Don't let it overwhelm you. Simply use it to make your own list of things to do or to learn more about, if necessary. Then you'll be in a better position to ask others to help with both discrete and long-term tasks.

"Type of Care Needed
"To determine the types of care your relative may require, ask yourself these questions:
· What kind of care does my relative need now, and is that likely to change in the future?
· Could my relative be taken care of at home if he or she had some help from a skilled nurse and/or a health aide? (...)
· Would assisted living be appropriate for my relative? (....)
· Will he or she require a skilled nursing facility, now or in the future? (...)
· Does my relative's mental condition require him or her to have special care and housing? (....)

"Health Insurance and Medicare
"The following questions will help you understand what kind of health care coverage your loved one has or may need:
· What are the likely costs of the care my relative will need?
· What do Medicare & Medicaid cover? (...)
· What kind of health insurance does my relative have, and what does it cover? (...)
· What if my relative doesn't have long-term care insurance? Does he or she need it? (...)

"Taking Over Finances and Decisions
"The time may come when you or other loved ones need to make basic financial and health care decisions for your relative. Be sure to get answers to these questions:
· Does my relative have a living will (advance health care directive) or power of attorney for finances? If not, how can I help my relative create the necessary documents? (...)
· Is my loved one no longer capable of making his or her own decisions or consenting to a power of attorney? (....)

"End-of-Life Issues
"Finally, here are some important issues to consider about wills and other arrangements at the end of life:
· Does my relative have a will? If not, how can I help my relative create a legally binding will? (...)
· Has my loved one communicated any wishes for final ceremonies and the disposition of his or her body? (...)
· Has my relative shared information on where to find important documents and passwords regarding bank accounts, retirement accounts, safe deposit boxes, stocks, life insurance policies, and wills and trusts? (...)

"Getting Help
"After you've reviewed the list above and have an idea of the tasks and issues involved, take a deep breath and remember that you can ask for help. To begin, you can encourage your relative to be as involved as possible in his or her own care. Avoid taking control of tasks that your loved one can still perform. The more your relative is allowed to do, the longer he or she will be able to maintain a sense of ownership over the course of his or her own life.

"Next, you can turn to others for assistance, such as your immediate family and friends, brothers and sisters, aunts and uncles -- anyone who might be able to lend a hand. (In many families, siblings divide the responsibilities of parent care.) Often, delegating even a small task can mean a great deal, especially if it relieves you from something on your to-do list. You can also turn to professional resources, such as in-home health aides and elder companions. Of course, most of these services cost money, though some are covered under some health insurance plans or Medicaid.

"Caring for an elder relative is not easy, and you deserve all of the support you can get. During the hard times, it might help to remember that what you are doing is noble and generous. Whether or not your loved one is able to express it, he or she is fortunate to have someone who is willing and able to do the job you've taken on."

http://articles.directorym.net/Caring_for_an_Elderly_Relative_Washington_DC-r936047-Washington_DC.html

Ensure this (nutrition)

2008-11-16T19:39:00.004-05:00

Nutrition takes on a new dimension when you take responsibility for feeding Gramps. S/he has ideas about likes and dislikes, but now you have new angles to consider. Is Gramps diabetic, or on some other doctor-required or doctor-recommended restrictions? Sometimes kidney or liver weakness, or other issues, will trigger recommendations like reducing protein intake, limiting potassium or magnesium-rich foods, etc. It helps to use lists and make sure to share them with other family members and caregivers.

Other lists that are helping us are the list of required, recommended, and permissible prescriptions, OTC drugs, and supplements; and, a standardized shopping list that family and caregivers can check-mark and/or write in special items during the week (making weekend shopping more effective and efficient).

We learned to pay closer attention to ingredients labels. Several months ago, Gramps started suffering terribly from constipation - we actually almost had to take her to the hospital for this! After a caregiver improvised successfully with abdomen massage and bending her knees up toward her chest (after standard laxatives hadn't helped), we radically overhauled Gramps' diet in simple ways. First, we removed any supplements containing iron. Guess what - we found iron in those "Ensure" beverages! the ones we'd recently introduced to help balance her nutrition! So, we now ensure there's no more "Ensure" in the house!

After consulting my "Tao of Nutrition" book, we made more changes any dietician would love: No fried foods, no spicey foods, and plenty of fruits and vegetables. With this, and some stool softener supplementation (per doctor's recommendation, and with the specific Miralax ready just in case (doctor specified that, with Milk of Magnesia as a last resort because magnesium is not good for our Gramps)) ... We've been doing fine ever since.

Once the basics are in place, we don't get too worked up. We're not the food and beverage police - Gramps is an adult capable of food choices within reason. In fact, food and beverages are high on Gramps' dwindling list of remaining pleasures in life. So have compassion, balance the requirements with some flavor, variety, and fun.

Bed sores

2008-11-16T14:15:00.006-05:00

Bed sores are preventable - and they are a serious issue. They can be treated successfully, but it is so much better to prevent them. We learned that if Gramps develops bed sores, then that could be a signal that Gramps should be moved out of the home care context and into an assisted living or nursing home - where ironically, Gramps actually has a significant risk of developing bed sores!

Most of us normally shift around enough so that our skin doesn't develop a sore from the pressure of sitting or lying down. This isn't the case for Gramps, whose skin is also becoming thinner and more delicate by the year. The single best prevention is shifting so that no one spot receives continued pressure. Other important aspects are good nutrition, and continual looking and checking to see if any areas on Gramps' skin are beginning to show red sores or worse.

Various places sell special mattresses and other devices that are advertised to prevent or treat bed sores. It's beyond the scope of this blog to assess those or make recommendations about any of them.

I'll include some references where you can look up more information. Right here, I'm going to quote some of the information from a commercial source - something I normally would not do, but I found it via a Google search a few months ago (here's the link, you'll have to bookmark this page to come back here after you click on it: http://www.drugstorepharmacy.ca/medical/conditions_detail.aspx?disease_id=17), and found this basic info surprisingly helpful:
=============
Bedsores are also known as pressure sores or decubitus ulcers. They form when your bone squeezes your skin and tissue against an outside surface, usually on weight-bearing parts of your body where the bones are near the skin. Bedsores usually develop below your waist if you are bedridden, although they can occur almost anywhere on your body. Common sites are the hips, shoulder blades, elbows, base of the spine, knees, ankles, heels, and even between fingers and toes.
Bedsores can develop in some people with just a few hours of constant pressure and range from mild reddening to severe craters that extend into the muscle and bone. They're quite a nuisance and often painful. Anyone who must remain in a bed, chair, or wheelchair for extended periods can develop these sores.
Most pressure sores affect patients over 70 years old who are bedridden in hospitals and long-term care facilities. In the United States, it's estimated that up to 20% of patients are admitted to the hospital with a pressure sore, or develop one during their stay in hospital. In nursing homes, the prevalence of pressure sores is even higher (23%) and can affect the death rate.
....
Bedsores are injuries caused by constant and unrelieved pressure that damages the skin and underlying tissue due to lack of mobility and blood circulation (i.e., being bedridden). If you must sit or lie for prolonged periods, the surface of your seat or bed puts excessive pressure on the bony prominences or pressure points in your body. Common pressure points on the body include the tail bone (sacrum), hip bone areas, and the ankle and heel. Less common sites include the elbows, spine, ribs, and back of the head.
Pressure sores may also result from friction caused by your skin rubbing against another surface, or when two layers of skin slide on each other, moving in opposite directions and causing damage to the underlying tissue. This may happen if you are transferred from a bed to a stretcher, or if you slide down in a chair.
Excessive moisture that softens your skin and reduces its resistance can also cause pressure sores. This can occur with excessive perspiration and with urinary or fecal incontinence.
....
If you're bedridden or in a wheelchair, your doctor or nurse should be watching for signs of bedsores. Their appearance and predictable locations on the body make them easy to diagnose. The severity of your skin breakdown may be categorized as follows:
Stage 1: Abnormal redness of the skin. This stage is reversible.
Stage 2: The redness will progress to an abrasion, blister, or shallow crater. This stage is also reversible.
Stage 3: A crater-like sore or ulcer that has begun to extend beneath the skin. This stage may be life-threatening.
Stage 4: Skin loss with extensive destruction or damage to muscle, bone, or supporting structures such as tendons or joint capsules. This stage may prove fatal.
Treatment and Prevention
The best way to prevent bedsores is by moving around frequently to avoid constant pressure against your body and to redistribute your body weight and promote blood flow to the tissues. If you can't move, you should be helped to reposition at least every two hours or every 15 minutes if you are seated in a chair. Pillows or foam wedges can help shift your weight if you're unable to move. Range-of-motion exercises can help prevent contractures, improve circulation, and maintain joint integrity, mobility, and muscle mass.
Your bed should not be elevated more than 30° (except when you're eating) to reduce shearing forces. For the same reason, a pull sheet should be used to help repositioning in bed.
....
=============
Folks, don't rely on your caregiver to tell you whether your Gramps has bed sores - push the issue, because we found that some caregivers know nothing or very little about bed sores!

Certainly there's more to know. So, I strongly recommend you take a bit of time and become more informed from various resources. Here are links to a few more (you'll need to bookmark this page to be sure you can "return here" after clicking on any of these):

Information from the U.S. National Institutes of Health (NIH) and the U.S. National Library of Medicine: http://www.nlm.nih.gov/medlineplus/ency/article/007071.htm

Wikipedia: http://en.wikipedia.org/wiki/Bedsores

Mayo Clinic: http://www.mayoclinic.com/health/bedsores/DS00570/DSECTION=treatments-and-drugs

Potty science (not rocket science)

2008-11-16T13:59:00.006-05:00

Here's an issue that must be dealt with when Gramps can no longer navigate the bathroom (toilet) safely: a potty chair that can be placed in Gramps' bedroom. Our particular twist on this came when we and the caregivers had to take a lot of time - and a lot of soap, bleach and excess wash water - cleaning out the chair's bucket after use. We simply started putting a plastic bag to line the bucket (much as many people do nowadays with trash cans). Cleanup's a snap, now!

Sure, it works for solid waste - what about liquid? Well just between you and me, Gramps already got to the point of using those incontinence pads, pullups and similar protection, well before getting to this point. So it isn't an issue for us. If it's an issue for you, then either this won't work for you, or you may have to place an absorbent liner at the bottom of the bag.

Okay, what about environmental impacts? First, check out your options in biodegradable plastic bags - they are increasingly available, and the newest kind now biodegrade within months rather than years. Second, keep in mind that the process of cleaning out the bucket used to involve soap, chlorine bleach, and lots of wash water - which isn't good for the environment either. This is probably the most environmentally friendly solution when you use biodegradable plastic bags.

Caregivers

2008-11-11T12:02:00.005-05:00

We encountered many issues upon first interviewing and hiring caregivers, and later in managing them. Let's start with some basics first.

By "caregivers," we're referring to in-home services for the elderly. So, we're not talking about people who will simply "babysit" or read magazines to Gramps, or provide special-needs transportation services (like special taxi services to doctors, etc.). Home care agencies can provide people who have the training to provide care to Gramps in the home setting.

Usually they have a minimum number of hours per day that the caregiver works. But sometimes the person is willing to come fewer hours per visit, which the agency may permit, thus saving money. Also, they usually can bill to a credit card. (But in these days, credit card debt isn't a good thing to rack up.)

You can save money by hiring direct, bypassing any agency. But then you assume the risks if the person runs late or doesn't show up (yes, this happens), or if the person doesn't work out and must be replaced (yes, this happens too.)

Another important thing we learned is that the caregiver must get along well with your Gramps. If that isn't happening, first try some of the lessons from that book, "The One Minute Manager." Try to guide and manage the person, before resorting to replacing them and having to break in and train a replacement. It does take time for each new caregiver to learn your Gramps' unique needs - medical, food and drink including diet, nutrition and preferences; hygiene management, clothing and laundry, daily routine, and even things like where utensils belong in your kitchen and how to load your dishwasher.

And always remember - the way you treat the caregiver, strongly influences how they treat Gramps. Smiles are free and, happily, infectious!

Power of attorney

2008-11-10T21:19:00.009-05:00

Setting up power of attorney is important, and also commonly misunderstood. My info here cannot substitute for legal advice to you. So I'll just give general information. Then you'll need to get any legal advice specific to your situation.

There are a few basic elements to decide. First, most power of attorney forms are written so that they are only effective when Gramps who signs it remains fully capable to handle his/her own affairs. Meaning, they become ineffective the very moment the POA could be needed most - i.e., when Gramps becomes unable to deal with things. (There's a good reason for this: the person having POA (power of attorney) is supposed to do only what Gramps specifically directs - a faithful agent, not someone who substitutes their own ideas about what's best for Gramps.)

A Durable POA states that it remains in effect even when the person signing it becomes incompetent (such as being unconscious, in a coma, mentally incapable, etc.). The POA form must say this explicitly, to be effective as a Durable power of attorney.

Any POA must describe what types of things the appointed attorney-agent can do. If it's to include real estate and financial matters, it probably needs to say that explicitly. Also, a Health Care POA goes into the whole topic of living wills and advance medical directives - those documents are ways that Gramps describes in advance whether to allow resuscitation, extraordinary life-saving measures, and so on. It's the Health Care POA that then gives you the authority to implement those decisions if/when Gramps cannot do so. There's a bit more to know about this health care aspect, though, so we will address that in a separate post.
A POA of any type is totally different from a guardianship. You can only get guardianship if you get a court order finding Gramps incompetent to handle his/her own affairs, and appointing you as guardian. Having Gramps sign a Durable POA is quicker and cheaper, but can only be done if Gramps is competent and aware, and properly informed what s/he is signing.

Even a Durable POA doesn't give you any right to start asserting your own ideas and running Gramps' affairs differently from what Gramps wants. Here's a small example: Gramps wants to buy a $200 necklace, but you think it's a waste of good money since no one will really see it, and Gramps already has enough necklaces. Do you refuse to place the order for the necklace as Gramps wants? No - you can try to reason with Gramps of course; but as long as Gramps isn't demented or otherwise "out of it," you're simply an agent and must carry out instructions accordingly. If this doesn't sit well with you, then you need to reconsider accepting the POA role and maybe someone else should serve in that role.

Emergency alert services

2008-11-10T10:18:00.002-05:00

There are several companies offering "life alert" or "emergency alert" services. These include a simple, push-button device worn as a pendant around Gramps' neck, or as a bracelet around the wrist. At this point we don't have any information comparing the quality and pricing of these services (but comments with any specific information on this may be helpful).

We are using a service called Lifefone. For about $160 payable each 6 months, we have the pendant that Gramps wears around her (could be his) neck with a simple push-button. There's also a strong speaker-phone that plugs into a regular telephone jack. When the pendant button is pressed, it activates the speaker-phone which places a call to the company's headquarters. (I think it will override any other telephone call that may be in progress at that time - it would be good to verify that, if there are others at home placing many phone calls on that telephone line (which isn't the case in our home)).

Once the speaker-phone has established the call back to headquarters, it sounds the phrase "emergency alert" several times, and then a live person comes on to ask what's wrong. If they do not receive any answer - or, if they are told something's wrong and help is needed - they immediately start calling phone numbers on a predefined list. For example, they will call me first, and if I tell them to call an ambulance or similar emergency responder, they'll do that.

If instead, we tell them we are merely testing the unit, then they thank us and hang up. They recommend that we conduct tests like this once a month to be sure the unit is working. Testing also helps to remind us that the Lifefone service works and is available to use. It also helps caregivers to know how it's used, in case they aren't familiar with it.

This has actually come in handy at least twice for true medical emergencies for my Gramps! :)

You will normally want this type of "life alert" service when Gramps lives alone. That's why she had it, actually, because she lived alone before moving in with us. We decided to keep it, because it gives us better peace of mind on those rare occasions when we do leave her alone (examples: caregiver arrives late when we have to get to work; or, caregiver has gone home and we want to go out for a quick dinner). Besides, it may come in handy for us also, if she has a bad problem or something bad happens in the home, then we can also use it as a way quickly to summon emergency responders.

Tips for implementing:
* You can give some thought to where to place the speaker-phone. We keep ours in the living room, because that's right next to where Gramps spends most of her true waking hours (in the dining room, right next to the living room without any wall barrier). So true testing is most likely to be successful during her waking hours, in that area. If she had to use it from her bedroom, the speaker-phone wouldn't "hear" her say anything, and therefore assume it's an emergency. Which is good, because if she uses it from her bedroom, it most likely will be an emergency.

* The company providing the service will ask you to fill in a list of telephone numbers for them to call when the emergency happens. You will want to fill in that list of names and numbers in order of who can actually get to Gramps to see what's going on, and/or who can help some other way, or who has the most time to deal with it, or who most needs to know. (You can of course provide more than one phone number per person, so they can try your mobile cell phone if they don't reach you at home or office.)

Setting Boundaries

2008-11-09T08:32:00.001-05:00

If you share some of those "uh, oh" feelings that I had when first facing the idea of having Gramps come live with us, start thinking about how to set boundaries. For us, this all started when hubby and I planned to move far away to another city, and my mother said she didn't want to be left "alone" in the senior "independent living" condominium she owned. After facing the realities of the situation, I talked with her about how it would be if the three of us shared our new home. To my surprise, she was also concerned about being able, as she put it, to continue her lifestyle. She was afraid we were going to dictate how she lived - what time to get up, when and what to eat, drink, listen to on radio or watch on TV. So we talked about our various expectations. I told her candidly that hubby and I needed time to enjoy our own activities, and even that he needed time on his own for his hobbies too.

This conversation will be different for each family (or set of friends, if that's the situation). It may even apply if Gramps won't actually be living with you, but will be coming to live near you and you are expected to be the one to drop by once or more per week, run errands for or with Gramps, make sure the laundry gets done, and all that.

This is important - if you are feeling stressed out by the demands and expectations, step back and take a hard look at the situation, and determine your bottom line. Then adjust your bottom line by building in some extra time and space for yourself (since crises or special demands will push you back to your bottom line). Then make a clear statement of your needs. If you need to justify those, point out that you'll get burned out and won't be able to help anymore if too much is demanded of you. And that will not be good for anyone.

Never be embarrassed by setting boundaries. If you come from a family that doesn't know much about boundaries, then you'll probably have to practice your statements in advance (fortunately, this does help!). It also gets easier to do this, the more often you do it. It's very helpful in reducing, maybe eliminating stress from taking Gramps into your home.

2008-11-06T14:22:00.000-05:00

Speaking of that folding wheelchair, it provides just enough mobility to get your loved one out to a casual restaurant when family visits from out of town. Don't agonize over it - just do it!

Why not get everyone having fun, like here on an outdoor deck near the beach - the older folks can laugh it up wearing seafood bibs, and the grandkids can have fun (supervised of course, yes) on the beach.

Making new memories means a lot ... even the older folks get tired of chewing over the same old memories over and over. Everyone likes new experiences!

Wheelchairs

2008-11-06T13:58:00.000-05:00

There are different types of wheelchairs. The 2 basic types we looked at were folding, and non-folding. The folding types have smaller wheels, so the person sitting cannot reach the wheels in order to turn and move the wheels. So the folding types really don't allow the person sitting in them to move themselves, they have to be pushed. However, the folding wheelchairs are much lighter, and of course, they can be folded to fit into a standard automobile trunk or fit into a car's back seat.

If you are taking gramps to the doctor, or traveling to see relatives, or just occasionally pushing them from the bedroom to the dining room or back again, the folding wheelchairs are economical and easy to use.

Since the folding wheelchairs are lighter, they are even more easy to use when lifting gramps up or down a few stairs! (although you'll still want at least 2 people, one on each side.)

Using a doorbell as a "ringer"

2008-11-06T13:43:00.001-05:00

We bought a wireless doorbell and put the "button" by my mother's bed. The doorbell that sounds when she pushes the button, is normally kept in the kitchen (see the photos - one from the front, then I picked it up, turned it around and took a photo of the back). This way, whenever she wants help, she can simply push the button and wherever we are in our home, we can hear the bell right and go see what she needs.

It cost very little money - we just bought it at a local hardware store. This solved the problem of how to give her a way to let us know when she needs something.

We considered a baby monitor - but didn't want to listen to that when she (often) listens to CNN on her TV at midnight. We considered an old fashioned bell - but what if she couldn't ring a heavy bell loud enough for us to hear? We considered a 2-way radio, but realized she would never be able to navigate the buttons and settings. The wireless doorbell finally dawned on me, when I realized she just needed to be able to push a button, to make a clearly-heard sound within our home.

This does NOT replace the "Lifefone". There are various brands of these monitoring services ... you know, the ones where the elderly person has fallen and cannot get up. She still needs to have that Lifefone button on a pendant around her neck, in case she realizes suddenly that she needs emergency help, or on the rare occasions when we go out and she's home alone. (N.B. - we always tell her first, remind her about that pendant, don't leave her alone very long, and go check on her immediately when we return home.) I'll write a separate post about the "Lifefone."

But the wireless doorbell is a cheap easy fix for giving her a way to summon help inside the home.