AgingParents.com provides coaching and consulting programs for those who are having difficulty with aging loved ones or clients. We address issues about loss of financial capacity, family conflicts and other matters of aging. We serve financial service professionals, families, caregivers and those in the elder services industry.
Death and dying are almost taboo to talk about. Since most
folks avoid this topic altogether, we at AgingParents.com thought it
deserved some attention. We personally had to face a conversation about it
during the last part of my mother-in-law, Alice’s life. She was 96, had
pneumonia and advanced kidney failure and was in the hospital. Things were not
going well there and she knew it.
I had been with her every day, attending to small things,
advocating for staff to remember her hearing aids, glasses and dentures in the
morning. She was not in pain, but everything was a struggle.
As I sat quietly near her bed one afternoon, she woke up and
asked, “Carolyn, am I dying?” I was very glad for my nursing experience at that
moment! I said “Mom, the part of you that is capable of receiving love is doing
very well right now. Your body, not so much. How do you feel about it?” She
said she was scared. We discussed that she was with those of us in her family
who loved her and we would be with her all the time, no matter what. I shared
with her some things about people’s near-death experiences which they’d written
about after coming back. Going to the light, being reunited with loved ones,
and the overwhelming feeling of being fully embraced by a loving presence were
some of those experiences others had described. She took this in and agreed
that it didn’t sound so scary.
While she was in the hospital I asked her if she would say a
“mantra” for me when we arrived each day. She said she would. The mantra was “I
am loved”. She always remembered it and I asked her every day, “What’s the
mantra, Mom?” She came up with it in a clear voice every time.
As the week wore on and it became obvious that the end was
close, we asked for Hospice. The hospice representative came within an hour and
we arranged for her to be discharged so she could spend her last days in her
own bed in her own apartment. There was a bit of scrambling by the company, as
this was on the weekend, but it got done. Medicare pays for hospice, on the
MD’s order and also covers all equipment needed at home at that point.
Alice passed peacefully several days later in her own bed,
held by her daughter and granddaughter. The last private conversation I had
with her was to say that when she felt ready, she could let go, it was okay. We
loved her and would miss her and we knew her time was coming. Surprisingly, she
had the presence of mind to thank me for all I had done in being with her. I
asked her to say the mantra one more time. “I am loved” she said. And those
were our last words together. I believe she was at peace and we were too. She
was conscious and could hear and feel caring all around her. Not a bad way to
your experiences with us at AgingParents.com. We would like
to hear from you about your own aging loved ones.
Most of us understand how pets bring joy to people and why they are important. This is particularly true for older folks who may have lost loved ones and who have also lost regular human companionship. A dog or cat can provide that unconditional love we all need.
More assisted living facilities and homes where elders live independently now allow pets, with certain restrictions, such as size and weight of the pet. When visiting my 95-year-old mother in law, Alice, we often see people walking their dogs around the place. It’s a senior’s community which offers independent living apartments as well as assisted living. Like many of that type, it’s pet-friendly. In other locations, such as nursing homes, pet programs include bringing in dogs, birds or other small creatures for the residents to pet and play with on scheduled visits. The residents love it. Elders with dementia often relate very well to the creatures who visit.
It’s not all fun though. When an older person lives alone in declining health, he or she may not be able to adequately care for the pooch or kitty. Someone has to take their animal to the vet for their shots or for treatment with the various ailments older pets suffer from just as their human counterparts do: arthritis, pneumonia, flu, etc. And a frail elder with balance issues may not be entirely safe with a rambunctious dog that likes to jump up, run around them and increase the risk of tripping or falling on Rover. Canes and walkers don’t always mix well with beloved pets.
Families have to consider the pros and cons of keeping the pet on hand as a parent ages, perhaps has vision problems or is unsteady on his feet. Some families take in the parent’s cherished animal and bring the pet to visit Mom or Dad at the seniors’ residence. Some elders are forced to part with their favorite four-legged friend when a move to a new residence and loss of ability to drive makes it impossible to care for the pet properly.
As a dog lover myself, I can only say that all solutions should be considered before the heartbreak of separating anyone from an animal they love. There are dog walkers who can be paid to exercise a loved one’s pooch every day, run them to the vet, ensure that pet medication is given and that the dog or cat gets all needed care. Caregivers helping an aging parent may be recruited to care for a pet right along with caring for its owner. When recruiting a caregiver, that additional responsibility could be included in the job description, perhaps with a pay bonus for certain additional chores. Finally, if it is impossible to keep the pet where the parent lives, it is an act of caring to find a way for someone in the family, a neighbor or friend to adopt the animal and bring it for regular visits to see its owner. That’s good for the human and good for the pet too.
It’s not fair to any pet to allow it to be neglected as an aging parent becomes cognitively impaired. Memory loss might mean forgetting to feed the animal or keep it safe. We don’t want to see any pet with less care than it needs because the elder’s family forgot about the risks of aging and how the aging parent might do unintentional harm to the animal. Cognitive decline, “early dementia”, Alzheimer’s disease and many other problems can pose a danger to the pet. Considering long-term care plans for your elders, be sure to consider a matching long-term care plan for the elder’s animals. Their pets are indeed family too and do a lot to comfort and support an aging person with communication difficulty or even with the loneliness that so many elders face. That furry cuddle from the cat or that doggie smile with a wagging tail can give your aging parent a lift that goes beyond what words can say.
If your family is finding a challenge now with how to care for aging loved ones, get the expert help you need at AgingParents.com. Our nurse-lawyer, psychologist team can save you hours of time and aggravation in helping you solve the stickiest problems.
My mother in law, Alice, 95, was looking forward to getting fixed up and going to the birthday party for her friend of many years. He just turned 100. She had help from her caregiver to find the right outfit. She donned her fancy clothes. Her hair and makeup were done and her nails manicured. She looked terrific.
At the head table of the party were other friends, one her accountant, also 95. He still works at his profession and still drives. Her other buddies were there, a married couple. The husband is 100 and the wife is 99. Imagine living that long and being friends that long. Alice had a great time at the party.
No matter who at the party has cognitive impairment (most of them) or who can manage without help at home (one of them), the common denominator is that all of them can enjoy a celebration. We don’t lose our emotional need for companionship and fun with aging. We don’t lose our need for social connection. And most of us are going to need some kind of care in the meantime.
Consider that due to advances in medicine, science, and technology, the world’s population of centenarians is projected to reach nearly 6 million by midcentury. We are already seeing more walkers and wheelchairs around than baby strollers. The number of centenarians is projected to grow at more than 20 times the rates of the total population by 2050, making them the fastest growing age segment. It would be great of all the centenarians were in good health, but that is not the case. Many are in declining health and many have dementia. (If that describes your aging parents, learn how to manage them best at AgingParents.com).
As with Alice, we provide the needed care for these frail elders. On top of that, we need to offer opportunities for fun.
Boomers with aging parents are taking care of these parents, with some of us on the job of caregiving in our 70s. The images we see of Alice and her friends tell us we may be doing some level of caregiving for at least 30 years in many cases. That’s longer than we spent raising our own kids. If you’re doing retirement planning, you might need to add the work of caregiver into that plan.
No matter what we need to do to meet their physical needs for safety and comfort, to transport them to the endless doctor’s appointments, to watch over their financial health and to provide company, we must not forget that we need to plan some parties, some enjoyable outings and things that make them smile. As long as we are with it enough to have a good time, we never get too old to laugh.
Fear of getting Alzheimer’s disease or dementia has overtaken fear of developing cancer among our aging population. There are numerous treatments for cancer, some offering true hope of mitigating the diseases. The same is not true for Alzheimer’s. There is still too much we just don’t know. Treatment is in discussion among many researchers but little of it has been successful, except that which involves a major lifestyle change. Over 5.5 million people are diagnosed with Alzheimer’s disease in the U.S. now and a huge rise in that number is expected by 2030.
The leading edge researchers who seem to be on the path toward effective management of dementia are not finding a cure with drugs. Stunningly, all pharmacological approaches to dementia have failed miserably. No company producing any of the medications offered to “treat” dementia can tell the consumer that their drug is going to slow or stop this relentless, deteriorating brain disease that steals the elder from you by degrees.
What we do know is that many common conditions older people in our country have will put us at higher risk for dementia, a term I use here interchangeably with Alzheimer’s disease. (Dementia is actually an Alzheimer’s symptom, but people use the terms without distinction). These are the same things that put us at higher risk for heart disease, the biggest killer in the U.S. They include being overweight and obese; lack of regular, moderate exercise, eating foods that aren’t good for us, particularly those with high salt and sugar, smoking, lack of enough sleep, and diabetes. There are others, but these are some of the most common. Doctors urge their patients to change their habits. It’s not working very well.
If you have an aging parent with dementia, it has probably crossed your mind that it could happen to you too. It’s a terrifying thought. We do know that specific lifestyle habits are very likely to protect us against this disease. Let’s look at just two of them. 150 minutes a week of moderate exercise is recommended, which could mean just walking briskly for 25 minutes, six times a week. Another is avoidance of refined sugar. If you look at labels, sugar is in just about everything that comes in a package, box or can. Is it worth giving up sugar, high salt and starting a basic exercise program? Consider the alternative. You may not just kick the bucket suddenly when disease conditions like Alzheimer’s disease creep up. No, the medical world will save you, revive you, treat you and keep you going. And then you live with those unpleasant consequences of all the years of your own choices.
Here at AgingParents.com, we see the struggles everyone has with an aging parent with dementia, the devastating financial costs, the heartbreak of a brain disease that can last as long as 20 years. We listen, consult, and advise. There is nothing like seeing how bad it is for others to motivate me to get off my duff, trying to avoid this happening to me.
I’m all in with prevention. I’m off to the community center pool tonight for a workout. I’ve got some kind of “moving my body” on the calendar six days this week. Hope you’ll find it in you, Boomers, to put on those walking shoes and get going, even if it’s walking up and down the mall for a half hour today. There are some risk factors within our control and breaking the sitting-down-all-day habit is one of them. Controlling our own risk factors is smart, so let’s be that, one step at a time. If you need help getting started, email us: firstname.lastname@example.org.
Many of us are probably unfamiliar with the concept of care managers. That may be because geriatric care management is not a clear-cut, licensed profession like nursing or social work. Further, they now call themselves Aging Life Care Managers, a catchall title that does not specify what they can and cannot do.
There is no requirement that someone using this title have a license in any profession. What that means is that the state where they do their work has not set a standard, measured by testing, to use the title nor deliver the services offered. If there is a license in any state there is accountability if a failure occurs to maintain professionalism. However, with appropriate vetting by the consumer of services, the care manager can be an invaluable help to families and elders alike.
In our family, we personally benefitted from the help of a care manager when my mother in law made a sudden trip to the hospital and we had no way to find out what was going on. The nearest family member was over two hours away. We had previously found a care manager, hired her before this happened, and she was at the ready to get to the hospital when we were informed by paramedics of this emergency. We suggest this proactive approach at AgingParents.com for distant family and we were living what we preached.
It can be very useful to have “boots on the ground” when you need a person to oversee what is going on with your aging parent. We were greatly relieved to have someone with whom to communicate when our parent was in the ER. Hours of nervous waiting, not knowing what happened would otherwise have been dreadful.
The advantages of working with a manager can be great. The disadvantages are that insurance does not cover a care manager’s services unless the manager works for a long-term care insurer and that is part of the benefit they offer. Another disadvantage, because there is no state board to check on the status of a licensee is that family must do their own research, reference and background checking to see if the person is legitimate and a right fit. There is a self-governing managers’ organization, and it controls membership without government oversight.
Based on experience, I offer these tips for anyone who is considering finding a care manager for an aging loved one.
Consider the needs your loved one has. If mostly social, find a manager with a social worker background who is licensed and who is familiar with all local community resources, such as home care agencies, in your parent’s area.
If your aging parent has complex medical needs, find a manager who is a licensed RN. No one else can spot medication side effects efficiently, determine whether changes in a medical condition are present or communicate as well with physicians. Some social worker managers team with a nurse to address both social and medical issues.
3. Every manager should start with an assessment of your loved one and offer you a written report of their findings and recommendations. If this is not the normal protocol for a candidate, find someone else.
Before you hire anyone, check all references and if licensed as a nurse or social worker, find out of the license is in good standing.
Get a written contract with the manager, which should again be done in the manager’s normal course of business. The consumer pays out of pocket.
We recommend the use of care managers for those who can afford the expense. The manager can be your eyes and ears, your liaison with doctors and hospitals and can keep you informed when you live at a distance.
By Carolyn Rosenblatt, RN, Elder law attorney, consultant
When asked, about 90% of elders will say that they don’t want to go to any kind of “home” as they get older. They want to stay in their own homes. Aging in place can be more of a fantasy than a realistic look at what is really needed.
“I’m not going anywhere”, said my mother in law, Alice, age 91 at the time. Widowed a few years earlier she had managed to stay in their large house by herself. She ignored the gentle urgings from family that it was not the safest choice. She stubbornly clung to the notion that she was fine and was going to be independent forever.
The frustration of having arthritis in her hands and not being able to grip things finally got to her. She decided to move into a smaller rental house in the same community as the big house was, where she could keep her usual routine with the friends she had left there. Alice had to get rid of many things and donated truckloads to charity.
Then one day, a year and a half later, out of the blue, she decided it was time to move closer to family. At that point, she was at least two hours away from relatives. We found a seniors’ community near her daughter. We had to get rid of most of her remaining possessions. The new apartment had very limited space.
The move to the new community proved to be helpful to everyone. There was someone at the front desk to call if help was needed. However, as time passed Alice’s physical and mental abilities declined slowly, she was not able to manage by herself any longer. A caregiver was needed to supplement what family could do. It started with several hours a day, four days a week, but as her vision declined, the hours needed to be increased. Her decline continued with an increased need for more caregiving and more expenses.
Currently, Alice’s “aging in place” in her apartment is accomplished with full-time caregivers. She does not have to be in a nursing home, something she dreads. Our goal is to help keep her at home. She is fortunate that she can afford the current setup and more caregiving as needed.
The takeaways from Alice’s story about aging in place are these:
The concept of aging in place may be a fantasy based on the belief that nothing will change to make moving out of the elder’s home a necessity.
A gradual transition from complete independence in one’s home can be less traumatic and easier than an abrupt change brought on by a hospitalization and unplanned loss of independence.
Stubborn aging parents can make any transition very hard on family members. It may take major physical declines to convince an elder that living alone is no longer safe. Count on them resisting as long as they can.
As long as your aging parent is legally competent to make decisions, they have a right to make unsafe decisions, even though you may vehemently disagree. You can’t force them to move if they retain the capacity for decision-making.
Alice was indeed stubborn but she gave into the need for help that she historically refused. Ultimately, she wanted the caregivers she had fought against hiring for so long. Now, she depends on them for everything.
For anyone with a stubborn aging loved one, don’t give up hope that they can eventually accept help. Physical impairments can become very persuasive. If you’re having problems with your aging parent, we offer some great resources. Our book The Family Guide to Aging Parents answers your legal, financial, and health questions about caring for an aging loved one. Get your copy here: https://www.aginginvestor.com/familyguide
Changing the diet of your parent/s is a long-term commitment. Gradually replacing some food groups with healthier counterparts is a great way to ease them into the new meal plan. The Mediterranean-DASH Diet Intervention for Neurodegenerative Delay or MIND diet is a popular meal plan to follow. As its name implies, it is derived from the Mediterranean diet and Dietary Approaches to Stop Hypertension (DASH). They all serve the purpose of delivering brain-friendly food to the table, according to a feature on dementia by Patient.info. Here are some tips to incorporate these types of food:
• Avoid processed food – Alzheimers.net explained that processed meat contains nitrosamines, which increase fat in the liver that are toxic to the brain. So the diet’s focus must be on vegetables and whole grains. Leafy greens like kale, spinach, and broccoli have been found to have nutrients that support better memory function.
• Eat more fish and less dairy – Salmon and other cold-water fish are great examples. Try to avoid processed cheese as they cause protein build up in the bloodstream linked to memory loss.
• Switch to extra virgin olive oil – Extra virgin olive oil contains a substance which helps boost the production of proteins and enzymes that break down plaques associated with Alzheimer’s disease. Try preparing meals with this ingredient, which works best with salads.
• Berries and dark-skinned fruits as go-to snacks – If they’re craving for a light snack, a bag of berries is great because they are rich in antioxidants. Free radicals affect every part of the body, including the brain, and food rich in antioxidants fights these harmful molecules.
• Cut out beer – Older people digest alcohol differently, meaning the safe intake levels might have gotten lower. Research also shows that beer contains nitrites which are harmful to the brain. Regulating their drinking habits or stopping it entirely will be immensely beneficial.
How eating healthy can help
CBS News reported on a study conducted at Rush University Medical Center, where participants were asked to follow the MIND diet. The results turned out to be promising: the participants’ risk of developing dementia or Alzheimer’s disease decreased by 53%. This study shows that diet plays a huge factor in avoiding dementia or how affected people can cope with it.
Taking the necessary adjustments for better brain health will be something even you can benefit from. After all, continuing to eat healthily will not just boost brain health but overall health, which is good news for everyone in the family.
Reaching retirement age is maturity, and a different responsibility for us and to our loved ones. Every person needs a checklist to ensure that their new status includes preparing their families with essential information and paperwork.
1- Decide whom you want to communicate with about your future. Set a date and sit down together.
2- Have a signed, notarized durable power of attorney
3- Have a signed advance health care directive (You can get items 2 & 3 free on the internet)
4- Make a list of all bank accounts, passwords, hard drive backup, investment records, and financial planning you have done, with people to contact. Give written permission to your loved ones to talk with your lawyer, accountant, and financial planner.
5- Make a list of all insurance policies, including life, disability, health, property, earthquake and anything else you own that will protect your heirs.
6- Make a copy of your mortgage statement, any other loans, and debts, financial statements and bank statement. Keep in one place. Update quarterly these change.
7- List your physicians, care providers, and medications. Give written permission for your loved ones to speak with your doctors.
8- Create or have on hand information about your wishes for burial or disposition of your remains.
9- Update your will and/or trust with a local attorney. Laws change and these need to be up to date in your state.
10- Have a family meeting to give items 2-9 to your loved ones and explain them.
Women in our country have gotten a lot of attention lately with focus on sexual harassment, domestic violence and unequal treatment by employers. There is another important area that is not getting attention in the focus on women: the role of caregiver for aging parents. This role, too, spreads responsibility very unequally on women compared with men in many families.
At AgingParents.com, we work with families of aging parents all across the US and in doing so, we see common themes. Most often (in our unofficial poll, it’s about 85-90% of the time), women take the lead in spotting warning signs that an aging parent needs help or is going to need help soon. Responsible women, often successful in business, professions, or any work are the ones to bring this up and let other family members know what they see. The response typically is that other family members say in so many words, “OK, go ahead and take care of it.” Unless these forward-thinking women in families insist on equal participation by all capable siblings or others involved, the burden falls squarely on themselves. They take on the caregiving, they quit jobs to do so, they cut back on work and fill the need in the family.
There are many responsible sons, to be sure. There are many brothers, nephews, and uncles who share the load right along with sisters, but from our admittedly limited perspective, they seem to be in the minority. Here are some typical excuses were given by the less-than-involved that we hear repeatedly:
“She’s better at doing that than I am”
“I’m really busy”
“She lives closer”
“I don’t like to see Mom (or Dad) in that condition”
“I make more money than she does, so it’s better if she’s the one to quit her job to take care of our parents”
“She’s a woman and that’s really her thing, so she should do it”
The last comment, jarring as it is, reflects the gender bias that is so much a part of our society’s view of women. Some things, like taking care of frail aging parents, are “our job” which excuses men, in their minds, from having to do that work. The shirking of the burden of caregiving based on gender should no longer go unquestioned.
Our current political dialogue can be beneficial to anyone facing the care of an aging parent if we take the opportunity to raise awareness of inherent gender bias. It is time to overthrow the status quo here too. Taking on responsibility for the care and safety of aging loved ones is everyone’s responsibility. If a male family member lives farther away than a female family member from the aging parent, and hands-on care is not practical, the more distant person can give money, pay for relief caregivers, or take time off and pitch in on your personal or vacation time from your job. That’s what women often do without being asked.
Those who live at a distance from the aging parent and sometimes from the sibling who is the primary caregiver, can pay toward elders’ support, manage the bills, set up appointments, arrange transportation, offer home maintenance, grocery delivery or whatever is needed that can be handled remotely. The excuses for avoidance do not stand up. Every unimpaired person in a family can do something.
On International Women’s Day let’s turn our attention to how inequality in families affects women in their role as caregivers for aging loved ones right here at home. We can change this, just as we are changing the way women are treated in the workplace. To get there, we must stand up and speak up. It’s time.
To learn more about how we help families sort out the challenges of caregiving, visit our website: www.agingparents.com .We also wrote a book that helps answer all your questions and guide you in the right direction: “The Family Guide To Aging Parents, “click Here to learn more.