ElderCare Solutions

Penny’s Two Cents

It’s All About Family! 

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The phrase “you can’t choose your family” is one that often comes up in difficult times. As our loved ones age, we are faced with navigating a healthcare system that can be challenging even for those working in healthcare. This is a time when we need our family most. However, family members are human beings, and humans are all different. I have four children and each one is blessed with talents and gifts that make them who they are. Their strengths compliment each other, but can also put them at odds with one another. For example, one of my daughters is very organized and a planner which makes her a great project leader. Her younger sister is quiet and takes direction well. This sounds like a perfect team, and it is…until it’s not. Everyone, even quiet people, want to be able to express opinions and be heard. It takes mutual respect and open communication to create a cohesive and healthy team. And a cohesive team approach is often what works best when facing care planning for our loved ones. 

One of the challenges with the team approach for care planning is that families come with years of baggage. It can be difficult to set aside our feelings about things that happened in our childhood with our siblings or parents. People spend huge amounts of time and money in therapy to deal with life’s problems. I have seen, after several years of working with geriatric clients and their families, that old hurts are often the biggest obstacles to working together to plan care. How can we overlook that our older sibling was mom’s favorite, so mom doesn’t care about anyone else’s opinion? What about our younger brother who never shows up when he says he will? 

If a family cannot work together and focus on their loved one’s safety and care as a common goal, what can they do? This is often when a geriatric care manger can help. Care managers are objective experts in the areas of assessment and care planning. They can look at a situation with fresh eyes and bring with them knowledge and resources to help provide older people with quality of life while maintaining their dignity. Care managers can also help mediate in family conflicts.  

Family working together as a team to help our loved ones have the best quality of life possible takes work! And sometimes we have to ask for help to get a job done. The first step is identifying safety and care as the primary goal. The next step is identifying the strengths of our team and assigning roles that will help meet our loved ones’ needs. The third step is recognizing if or when we need professional assistance. And remember: at the end of the, it’s all about family! 

Just my two cents, 

Penny 

Let’s Talk About Death 

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After working with elderly clients and families for several years I have found that end-of-life planning is one of the most challenging topics of conversation. Facing one’s own mortality is daunting. Not knowing how someone has been affected by death and loss in their life makes discussing their end even more complicated. However, having the conversations and putting plans in place while healthy gives one control over their end and reduces the burden on the grieving loved ones. 

Talking about death and funeral planning is best when done early, calmly, and incrementally. The topic can be introduced after watching a movie where a funeral was central, or even after attending or hearing about the funeral of a friend or acquaintance. It may help to share your own wishes for end-of-life plans by saying “I think I’d like to be cremated/buried when I die. What do you think you would want?” Another way to introduce the topic is to stress that you want to honor your loved one’s wishes but need to know what they want in order to do so.  

Once your loved one has identified how they want their body treated after death, itis important to talk about how they want to be remembered. Asking about family traditions, other funerals or memorials, or even how they picture remembering them can help. f you’re not comfortable talking about this yourself, our team can help guide the conversation and make it easier.

My own family was reserved when talking about important topics but surprisingly open about how they wanted to be memorialized. An uncle requested a cocktail party with no religious service or prayers, and a burial on the family cemetery plot. My father wanted a lunch at his favorite local restaurant and no burial. And my mother wanted a memorial service with her grandchildren providing music and for her ashes to be “scattered to the wind.” Although planning was involved in all three scenarios, knowing their wishes was the first step. 

My father always said, “death is part of life.” Viewing end- of-life as a natural transition and talking about it openly can take some of the sting out of something that has long been a taboo topic.  

Just my two cents, 

Penny 

The Gift of Time 

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I hear so many people pondering over what to give to their older loved ones for the holidays. I’ve even had my children ask me what I want for Christmas and was at a loss. There is nothing I need; and most things I might want I usually get myself. When my son called recently and asked me what I would like for Christmas, I told him we should plan to go out for a movie night after the holidays are over. That is when I realized that what I want most from my family and close friends, not just at the holidays but all year long, is to spend time with them. 

We live in a society where materialism and commercialism have taken over the holiday season. The average American spends $700.00 at Christmas. It seems that the real meaning of Christmas has been replaced by things, resulting in mounting debt. And every parent can likely remember spending time and money to find the “toy of the year” for a child, only to have the toy forgotten by mid-January.  

In Dr. Seuss’s How the Grinch Stole Christmas, we see a sad, lonely, Christmas-hating guy try to squelch the joy of the people of Whoville by stealing all their Christmas gifts and decorations, thinking it will ruin the holiday for them. What he finds, instead, is summed up in this passage: “And the Grinch, with his Grinch-feet ice cold in the snow, stood puzzling, and puzzling, how could it be so? It came without ribbons, it came without tags, it came without packages, boxes or bags. And he puzzled and puzzled ‘til his puzzler was sore. Then the Grinch thought of something he hadn’t before. What if Christmas, he thought, doesn’t come from a store? What if Christmas, perhaps, means a little bit more.” 

Often our elderly friends, neighbors, and relatives become more isolated as they age due to physical and mobility changes. Just losing the ability to drive can cause one to feel like a prisoner in their own home. I am met with this reality regularly when I do home visits. My clients love the social aspect of our visits, often asking about the weather, my family, or how many people were walking dogs in their neighborhood. Imagine how much they would love having regular visits from people they don’t get to see too often! Imagine how much it would improve their mood and quality of life! Of course, people who have jobs have limited time. But all of us also have limited time on earth. And I have never attended a funeral or memorial service where anyone said they regretted spending TOO MUCH time with someone. I have, however, heard the opposite.  

Make a promise to yourself this holiday season to spend your time with no regrets and make it a gift to others. Perhaps, like the Grinch, you will feel your heart grow three sizes by living the real meaning of the holiday season and giving the gift of time. 

Just my two cents, 

Penny 

Celebrating Gratitude  

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The role of a care manager is varied. Often, I operate as a professional problem-solver. Some days I feel more like a house manager. On my best days, I am a support person. But there are also days I feel like a one-woman complaint department; a bottomless repository for a client’s negative thoughts and feelings. Those days are more frequent than I would like, especially since I tend to be an optimist by nature.  Several years ago I decided to direct my clients’ negativity in more positive directions and began recommending keeping a gratitude journal. 

Journaling has long been used as a tool to encourage individuals to view and work through feelings by writing or even drawing about them. While this can be effective for some, it can also be an exercise in frustration if not guided and analyzed in some meaningful way. A gratitude journal, on the other hand, is a simple and straightforward way to encourage positive thoughts.  

The directives I use with clients is to spend a few minutes at the end of each day listing the things that they were grateful for that day. I often have them start with a list of three things and guide them through the process if they are having a hard time on their own. The list may include something as simple as a cold glass of water, a phone call from a friend, or getting outside to feel the sun on their face. Some clients start slowly but eventually are able to write exhaustive lists that include both simple pleasures and more complex events. 

Although it may seem like a simplistic way to change the direction of someone’s thoughts, research has shown that gratitude can affect us mentally and physically. An article from envivehealthcare.com lists seven health benefits of gratitude. These include lower blood pressure, lower risk of depression, better sleep, reduced stress, increased energy, improved self-care, and improved mental strength. Other articles listed benefits of gratitude as improved productivity, decreased anxiety, a more positive general outlook, and improved self-esteem. 

Although some articles did list the pitfalls of gratitude journal, namely avoiding dealing with the feelings associated with loss or conflicts, the literature touting the positive aspects far outweighs the negative.  

During the month of November when we celebrate Thanksgiving as one day to focus on gratitude, why not try to make gratitude a regular practice and see if it makes a difference in our outlook of the world and our circumstances?  

Just my two cents, 

Penny 

Reading and our Brains

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Anyone who knows me knows I am an avid reader. I learned to read early and the joy of reading never left me. I started book clubs with my children and their friends, I have been in book clubs with my peers since my early twenties, and I even started a program with a local arts center to interview area authors. And I’m not alone! Any search on the various social media platforms can connect one to other readers. But how does this affect my work with the elderly? 

In every assessment of a potential client I ask about hobbies, and nothing is more satisfying than meeting another reader. My clients who read always ask me during visits what I am reading. They also make recommendations and often loan me books they want me to read. I have found my clients who are readers are often more engaged in conversation, have a better grasp on language, and have better recall than those who do not consider themselves readers. These observations led me to look into how reading affects our brains. 

There are several studies and articles available about the effects of reading on brain development. Here are five points that I found to be particularly interesting. 

  1. Reading changes brain structure. In a six-month daily reading program from Carnegie Mellon, scientists found an increase in white matter in the language area of the brain. The positive outcome of this increase for the elderly is that it may delay the onset of dementia symptoms. 
  1. Reading makes individuals more empathetic. Readers of fiction have been found to escape the emotional and mental burden of the real world and develop the ability to feel what characters in a story feel. This translates into readers having more empathy for people in real life. 
  1. Audiobooks can help improve cognition. Being read to has long been touted as important for shaping the minds of young children. But some studies have found that listening to audiobooks can also improve cognition and processing in older adults. These improvements are achieved in several ways including providing mental stimulation, aiding in the improvement of memory and recall, reducing stress, and promoting continued learning and curiosity. 
  1. Engaged reading strengthens memory. Some studies show that reading strengthens older adults’ memory skills, especially episodic memory, language comprehension, and long-term memory. Reading is like exercise for the brain, stimulating existing neurons and even accelerating the formation of new connections and neurons! 
  1. While reading may be difficult for those already afflicted with dementia, reading aloud with a caregiver or group can have healing qualities. Hearing detailed descriptions may help listeners connect with memories from their pasts, as well as providing caregivers and families with a shared activity and a new way to connect with a loved one. 

These are only five summaries of how reading can have positive effects on the brain. So many studies and articles exist lauding the benefits of reading that I am even MORE convinced we should all be promoting reading with all ages of people. October is National 

Book Month! I can’t think of a better time to start or continue a hobby that keeps our brains in topnotch condition. Happy Reading! 

Just my two cents, 

Penny 

Keeping the Wrinkles Out of Elder Care

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Tips for Helping Aging Loved Ones

By Penny Golden, RN

As science progresses and people are living longer, many of us find ourselves faced with helping to care for aging family members. This can be a confusing process. Which doctor does Mom see for her heart? Where does she get her prescriptions filled? If Dad can’t drive, how will he get his groceries? With a few simple organizational and practical tips, navigating your way through elder care can become manageable.

Ideally, steps should be taken before an aged person becomes too incapacitated to help with the process of planning for elder care.

Unfortunately, many people are uncomfortable discussing getting older, but trying to sort out doctors and medications and even who to call when a loved one dies can add more stress to an already stressful time. This is a situation where “an ounce of prevention REALLY IS worth a pound of cure!”

Accurate and regularly updated lists can help organize care of your elderly loved ones: medications; doctors and their specialties, phone numbers, fax numbers and addresses; health history, hospitalizations and surgeries; friends’ names and phone numbers. Keep all important lists in a file in a safe but easy to find location – i.e. a brightly colored file folder on top of the refrigerator.

Medications

Older people often take multiple medications prescribed by multiple doctors. Keeping a current list of medications is imperative — there can be dire consequences if some medications are mixed. Bring the list with when your loved one goes to a doctor; it can save time and possibly a life. Include on the list the medication name, dose, what it is for, times it is taken, and who prescribed it. If a medication is added or a dosage is changed, be sure to update the list accordingly. Include the phone number or email for the pharmacy where prescriptions are filled. If you have questions about a medication, ask the pharmacist!

Doctors

Because so many doctors are specialists, your family member may have several doctors to visit on a regular basis. Keeping a list of doctors and their contact information can help determine who should be contacted in an emergency or for specific symptoms. Keep a printout of directions to and from the doctors’ offices to help people who are bringing the patient to appointments.

Health History

Keeping an accurate health history with important papers can save valuable time at doctors’ appointments or emergency room visits. No one wants to have a test redone if it was done recently, and knowing when tests were done can also be helpful for comparisons. Keeping a running list of illnesses, injuries, tests and hospitalizations can help during current health crises.

Friends

Often people overlook the role friends play in their lives. At times, older people might feel more comfortable turning to a friend than turning to family. Keep a list of friends and their contact information handy. If you need answers to questions about your parents, aunt or uncle or grandparent, their friends may be your best resource. In addition, your loved one would want his or her friends contacted in the event of their death, so having all those names and numbers on one list can help at that time as well.

A Few More Helpful Ideas

Funeral planning should be done when individuals are healthy and able to let you know their wishes. Burial or cremation? Funeral Mass or memorial service? Flowers or memorial donations? What are their favorite hymns? Some individuals may even want to write their own obituary, or make a list of scriptures they want read at their funeral. Once you have these answers, write them down!

For a family member who can no longer drive or needs transportation for a short period of time, some grocery stores and pharmacies offer delivery. Check into these BEFORE you actually need the service. Another option is mail order medications, which can be sent in three month supplies and may be more economical.

Companion services can help your loved one stay in their own home. These services often include not only direct care of individuals, but light housekeeping, meal preparation, transportation services and grocery shopping.

Aging can be difficult for individuals and their families, but being prepared for aging can help! Facing later years head-on in a logical manner can prevent a world of stress and complications. Helena Rubenstein said, “Hard work keeps the wrinkles out of mind and spirit.” A little hard work can also keep the wrinkles out of elder care!

Will Your Family Need an Elder Care Advocate?

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By Signe Gleeson, RNC, CCM, MS

No one should face aging and illness alone. Too often, older adults find themselves without an ally or advocate when they are most vulnerable. Illness and infirmity can diminish the best of us. This is more dramatic for older adults. It is not uncommon for an ill or hospitalized older adult to appear more confused, frail, and incapable than they actually are.

This is why an increasing number of families call on an elder care advocate for assistance. At ElderCare Solutions, we support older and disabled adults and the people who care about them. Our role as elder care advocates is to help older adults achieve their goals and implement their choices when they can’t do it themselves.

Informed advocacy plays a critical role in ensuring the needs, desires and values of a disabled or older adult are recognized, respected and protected. It can be easy and expedient to make assumptions or assign a label to an older adult. It is tempting for physicians and family members to globalize an individual’s physical or cognitive limitations and to disregard the older individual’s strengths and capabilities as short- and long-term decisions are made. But as advocates, we recognize that a deficit in one area does not necessarily translate to deficiencies in other domains. For instance, an older adult who does not know the date may be well able to express his or her wishes regarding treatment.

When an individual is voiceless and/or seen with a limited perspective, the advocate gives a voice and a full sense of the person on their behalf. Advocates seek information about the individual and anticipate their present and future needs. We help to take some of the emotion out of the decisions for care, treatment and medical intervention. Part of our role is to consider the result of intervention and how it will affect the individual’s functioning.

We often see situations where a doctor may make a recommendation for a medical procedure without fully understanding the patient’s circumstances. Most people have a hard time questioning doctors. For older adults, this is particularly difficult. Family members may accede to the advice or pronouncements of professionals without questioning assumptions made with limited information or thoughtful consideration of the older individual. One of the strongest contributions we make as patient advocates, beyond our clinical skills, is to ask questions and paint a picture for the physician or family member of who this person is as an individual, how they live their life and what they value.

When to Call an Elder Care Advocate

Elder care advocates are often called in when an older adult is resisting assistance or intervention. We are also asked to assist when family members are in conflict over difficult care issues. These conflicts can arise between the elder parent and his/her children or between siblings. Our role is to be objective, provide expert assessments of the older adult’s individual needs and make specific recommendations for their care. As the advocate for the older adult, we can provide a point of view from which other family members can make decisions.

Effective advocacy involves:

  • A willingness to listen to and learn about the individual/the whole person — their values and how they derive meaning in life
  • A willingness and ability to intelligently investigate and even uncover options, ask questions, and, when needed, challenge assumptions and conclusions
  • Being an active participant in decisions and bringing the individual into the discussion to the full extent possible.

Health care advocacy requires both fearlessness — identifying and confronting conclusions that are at odds with the best interest of the individual — and humility — openness to ongoing learning about the person and how to best discern and advance his or her needs. Health care today has increasingly become a business, in which hospitals, nursing homes and housing facilities may have interests or values that are at odds with the interest and values of the individual. That makes it increasingly important to take a “buyer beware” stance to ensure that vulnerable individuals are well served.