^{I can’t stress strongly enough that when a senior begins exhibiting “signs” of neglecting basic activities of personal care, or experiences a fall, or manifests the early stages of dementia, that is the time to take seriously making provision for family care, or hiring a home caregiver to assist the senior with those issues.}

^{However, before such assistance is needed, there are actually some marvelous innovations in technology that have been developed that can provide a level of security and confidence for seniors living at home. And although I don’t have space in this column to identify all of these products and services, I do want to highlight several of the more relevant and practical ones.}

^{The first one that is especially useful is a Personal Emergency Response System.  This “system” is typically comprised of a two-way voice console unit that connects to an existing phone line and a lightweight water-resistant activator, worn around the neck or wrist.  If assistance is needed, the senior simply presses the button and the console unit dials the Response Center which opens a two-way voice connection with a trained response operator.  Seven days a week, 24 hours a day, a trained operator will immediately respond to determine the level of help required.}

^{The second product that has great value for seniors (and especially their families) is one of the most highly sophisticated innovations on the market today – an advanced sensor system that discretely monitors the daily activities of someone living alone. This system provides the highest level of passive security available for an elderly person living alone. Family members or friends can be granted access to a secure web site so they can check the status at any time. The system recognizes and reports normal, healthy behaviors—and significant changes—during the times the senior is alone in their residence. When there are changes in behavior that indicate potential health problems or dangerous situations, the system alerts caregivers so that they can provide appropriate medical attention.}

^{The third innovation is actually a service designed to call a senior one to three times per day with either a medication reminder or a “well-being” check up.  If the call is for a medication reminder, the calls are made at prescribed times, describing the medication to be taken by name, and then notifies the caregiver if the senior doesn’t confirm the call.  For “well-being” calls, the system is automated and interactive, up to three calls per day, and is also designed to notify the caregiver if the senior doesn’t confirm the call.}

^{Although I’ve only been able to briefly describe these products and service, there is information available that gives a much more comprehensive explanation of each one.  If you would like to obtain information on any of these, please call (360) 692-6929 and a brochure will be mailed, or your questions answered.}

^{While technology has provided us with many “tools” for keeping ourselves and our loved ones safe and secure, there is nothing more valuable than the love and care we receive from family and friends. As we look ahead to this coming year, I trust that you will experience a very happy and prosperous New Year.}

^{Carl R. Johnson}

^{Certified Senior Advisor (CSA)®}

^{Community Relations Director}

^{Abiding HomeCare}

^{Silverdale, WA}

This is now the time to evaluate the home to make it safe and secure for your loved ones — now and in the near future — in anticipation of aging disabilities that may occur. Help and support are available. The nation as a whole is more aware of elderly needs and services and products are becoming available at an outstanding pace.

The Bureau of Labor Statistics states,

“Employment of personal and home care aides is projected to grow by 51 percent between 2006 and 2016, which is much faster than the average for all occupations. The expected growth is due, in large part, to the projected rise in the number of elderly people, an age group that often has mounting health problems and that needs some assistance with daily activities.” Bureau of labor Statistics-Occupational Outlook Handbook, 2008-09 Edition

This growing need for aides and services also encompasses

• home remodeling services — making a home more serviceable to the elderly;
• safety alert systems and technology;
• motion sensors to monitor movement;
• telehealth services — using home-based computer systems for the doctors office or a nurse to monitor vital signs and
• even a pill dispenser that notifies when it is time to take medication.

Where do you begin to make sure your elderly family member is safe and managing well in his or her home?

Visit often and at different times of the day and night. Make note of daily activities that appear challenging and where changes might be made to add safety and convenience. Remove rugs that slide — causing a fall — and move furniture with sharp edges. Set the water heater at a lower temperature. This will protect their older sensitive skin from scalds and burns. Be sure smoke detectors and carbon monoxide detectors are in place.

Bathrooms are a hazard area for the elderly. Grab bars by the toilet and shower are a must to help prevent falls. There are easy to install bars at your local hardware store if you want to do the work yourself. Another item that is good to have is a shower stool or chair.

If you are not sure of what needs to be done, consider hiring a professional. There are companies that specialize in home remodeling and accommodation for seniors. Michelle Graham of Accessible Design by Studio G4 says about senior home remodel projects,

“The main thing we incorporate in all of our projects is a careful study of needs and potential needs that may develop throughout a client’s lifespan.”

Keep in mind what future home adjustments might be needed for your parents to “age in place” in their home.

Home safety or medical alert companies provide GPS-based bracelets or pendants to track the elderly at home who tend to wander. Or the companies may provide alarm devices such as pendants or bracelets which allow the elderly to alert someone if there has been a fall or a sudden health-related attack. In the event an alarm has been triggered, a 24 hour monitoring service will alert the family or medical emergency services or call a neighbor depending on previous instructions. In addition there are companies that will install motion sensors in the home to monitor the elderly on a 24 hour basis.

Don’t forget your parents’ community as a valuable resource for helping them stay in their home. Take Margaret Muller as an example. At 82 years of age, Margaret lives alone in her small home. She manages very well with the help of her local Senior Center. The Center’s “Senior Companion” program sees that Margaret is taken to the store for groceries and other needs and checks in with her often to see how she is doing. Once a day, the Senior Center delivers a hot healthy meal to her door. Having these services and visits gives Margaret the help she needs and peace of mind that she is not alone.

Neighbors, local church groups, senior centers and city centers are some places to look for assistance. Most of the time there is little or no cost for these services.

Your state aging services unit is a valuable community resource. The National Area on Aging website www.aoa.gov states:

“AoA, through the Older Americans Act and other legislation, supports programs that help older adults maintain their independence and dignity in their homes and communities. In addition AoA provides funding for a range of supports to family caregivers.”

Some of the programs the site lists are:

“Supportive Services and Senior Centers

Nutrition Services

National Family Caregiver Support Program

Grants for Native Americans

Nursing Home Diversion Grants

Aging & Disability Resource Centers

Evidence-Based Disease Prevention

Long-Term Care Planning

Alzheimer’s Disease Grants

Naturally Occurring Retirement Communities”

A few thoughts on hiring home care aides or live-in care givers.

The classifieds are filled with people looking for work as aides to the elderly. Many of these aides are well-qualified, honest people who will do a good job; but, of course, there will be some not so reputable. If you are looking to hire someone, be sure you interview and check references and qualifications. You will be responsible for scheduling that person and doing payroll and taxes as well. Be very sure you hire someone trustworthy, as the elderly seem to trust these helpers more than they should and therefore can easily be taken advantage of.

A professional home care service will eliminate your employment concerns. Professionally-provided aides are usually bonded and service is guaranteed. Home care companies take care of the scheduling and payment of their employees. Home care companies cater to the elderly in their homes by offering a variety of services. The National Care Planning Council lists many of these companies throughout the country on its website www.longtermcarelink.net .

These providers represent a rapidly growing trend to allow people needing help with long term care to remain in their home or in the community instead of going to a care facility. The services offered may include:

• companionship
• grooming and dressing
• recreational activities
• incontinent care
• handyman services
• teeth brushing
• medication reminders
• bathing or showering
• light housekeeping
• meal preparation
• respite for family caregivers
• errands and shopping
• reading email or letters
• overseeing home deliveries
• dealing with vendors
• transportation services
• changing linens
• laundry and ironing
• organizing closets
• care of house plants
• 24-hour emergency response
• family counseling
• phone call checks
• and much more.

Thomas Day, Director of the National Care Planning Council states,

“Care in the home provided by a spouse or a child is the most common form of long-term care in this country. About 73% of all long term care is provided in the home environment typically by family caregivers.”

As their caregiver, you can make the difference in the quality of life for your aging parents and if staying in their home is a possibility, you have the resources to make it happen.

In the previous two columns dealing with this subject, I specifically addressed some of the practical actions and preparations a senior and their family can take to lessen the inevitable challenges “before” and “during” the death of a parent.  In today’s column I want to focus on how to handle the actual death experience, and the circumstances that follow.

As I noted in my first column on this issue, it was estimated that at least 1.7 million Americans age sixty-five and older would die in 2008, and an equal or larger number in 2009.  If only half of these older Americans leave behind three children (many will leave more), almost 3 million adults will be without parents in the United States this coming year.

Inevitably, everyone reading this column has (or will) experience the death of a parent, and how we prepare for that event will in large part determine its impact on our lives.  Of course, there is a sense in which one is never completely prepared for the death of a loved one, but in the case of our parents, we know that as we grow older that prospect becomes more imminent and real.

Perhaps, the most difficult aspect of a parent’s death is when it occurs suddenly, without time to prepare.  Whether by accident, a physiological malfunction, or some unforeseen circumstance, we’re just not ready.  In fact, depending on our relationship with our parent, their sudden death can be one of the most devastating and challenging things that can happen to you.  If your parent dies suddenly or violently, coping is even harder. There is no time to prepare together. For the first day and night it is better to not be alone. Try to stay with the other parent, a brother or sister, or a close relative or friend. And recognize that there will be a flood of emotions, and even some internal confusion, for a period of time.

Now, having said that, and assuming we’ve taken all of the necessary “steps” (as I’ve outlined them in the previous two columns), and we’ve been able to establish a reasonable degree of closure and understanding with our parent, we now have to face the details of mortuary and burial arrangements … a service (if one is planned) …  and eventually … the disposition of assets (and in some cases – liabilities) of the deceased.

It’s not my intention to prescribe the details involved in each of these activities, but merely to remind us that there are such responsibilities and actions.  And … to the degree that we are prepared … we can more effectively transition through these necessary tasks.

However, what I do want to address is often one of the most contentious and divisive issues facing the surviving children of deceased parents, and that is … who gets what?  Even if there’s a will, and the parent’s wishes were very explicit, too often that isn’t sufficient to stem the expectations and selfishness that ensues.  Now that Mom and Dad are gone, it’s like adults suddenly become little children again, and they simply “want their way, and they want it now!”

As Jo Myers, the author of Good to Go: The ABC’s of Death and Dying observes: “People can accumulate a mountain of possessions or wealth during a lifetime.  If gifts are not made before death, look out for the circling buzzards.  Some families hire security guards for their home during a memorial service for protection against thieves, including family members.”

Ms. Myers then goes on to relate an incident shared by a coroner in her community.  He tells this story … “The family was at the funeral and as the casket was lowered into the ground, a group of family members sped back to the decedent’s home where they broke in and started stealing things.  The burglar alarm was turned on, so the police showed up as these people were carrying stuff out of the house.  One person was hiding silverware in her thigh-high stockings with a silver tray crammed in her backside waistband.  The cops made them all disrobe on the front lawn.”

Ms. Myers concludes, “A sense of entitlement, need, or intense desire may override a person’s normal tendencies if he or she is tempted with material or monetary windfall.  Posturing might begin long before a life ends.”

It doesn’t have to be this way.  And fortunately, for many families, it isn’t, but it does take commitment and effort to successfully work through the challenges that will come when Mom and Dad are gone.

So … let’s see if we can sum up these past three columns.  First, be prepared BEFORE having to face the death of a parent:  1) Acknowledge the need and provide for care assistance before it becomes necessary for assisted living or skilled nursing care. 2) Prepare a will (or the Five Wishes document). 3) Open the channels of communication. 4) Address unresolved family conflicts.  Second, do everything possible to make the final stages of life for a parent sweet and memorable.  Remember … it’s NOT about you … it’s about US and a healthy relationship.  Finally, accept responsibility and practice integrity.

Carl R. Johnson
Certified Senior Advisor (CSA)^®
Community Relations Director
Abiding HomeCare
Silverdale, WA

Today, I want to address some important considerations when a parent is in the final stages of life, and how those last days can actually be sweet and memorable, even in the midst of sadness and pain.

Several years ago my father came to visit my wife and I following his second open-heart surgery. We knew his recovery had been very difficult, and that this visit might be our last time together.  What we didn’t anticipate was that from the time he arrived we only had five days until his death.  Although the first several days were filled with great fellowship and sharing, on the evening of the third day, after rushing him to the hospital, we were painfully aware that the end was near.

There was a reluctance to “let him go”, and yet, it was obvious that he was ready and at peace with his soon departure.  At the time we were only thinking about OUR loss, instead of HIS gain.   Fortunately, this became a teachable moment for our whole family … to realize that we need to listen to our loved ones, and respect their wishes … even in the last days and hours of life.

While our experience of spending time with a dying loved one was brief, there are many today that have that process prolonged … even for weeks and months.  Fortunately, our society has established one of the most caring, loving, and compassionate vehicles for those in the final stages of life … hospice care (which includes palliative care), and there isn’t any finer organization than our own Hospice of Kitsap County.  For almost 30 years, they have been providing the families of our community with the highest quality and compassionate care and dignity to those at the end of life’s journey, regardless of their ability to pay. Because of them, families can face these “end-of-life” challenges with confidence and the knowledge that their loved one is being provided outstanding care.

By the way … it should be noted that palliative care, sometimes called comfort care, which is designed to preserve the best quality of life by relieving pain, controlling symptoms, and supporting the patient’s continuing involvement with life, isn’t limited to those in the last stages of life, but is a significant element in the overall hospice program.

Earlier in this column I indicated that despite the obvious sadness and sense of loss at the death of a parent, those last days could actually be sweet and memorable.  Let me explain.

Although the impending death of a parent is often filled with a wide range of emotions … from despair, regret, and heartache to happy memories and blessed assurance and peace, the answer to dealing with this experience in a positive and life-affirming manner can only be achieved in the “now” … not when the event occurs in the future.

What I mean by that statement is that TODAY (not tomorrow) is when we have to begin the process of preparing ourselves for a parent’s death.  If we think we can leave unresolved conflicts and misunderstandings to the closing days of a parent’s life, then we’re not being realistic, and we’re only setting ourselves up for great disappointment and guilt.

All too often I see members of families that have been torn apart by unforgiveness and unresolved conflicts, struggling to cope with their quilt and bitterness after a parent has died.  But it doesn’t have to be that way.  If only there had been a willingness and resolve to heal the relationship, those final days could have been spent in freedom from the tyranny of a wounded spirit, and the parent set “free” to depart in peace.

If I can accomplish nothing else in this column today, I trust that I have touched a sensitive area in people’s lives that will result in positive actions to restore hurting family relationships between parents and their children.  Nothing is more important and relevant to our health and well-being, than being free from the burden of unresolved conflict.

It’s never too late to make the “end-of-life” experience for a parent (and their children) “sweet and memorable”.  But if the groundwork hasn’t already been laid, TODAY is the day to get started.

Carl R. Johnson
Certified Senior Advisor (CSA)®
Community Relations Director
Abiding HomeCare
Silverdale, WA

Some of the ways the elderly may express anger are:

• being combative
• breaking things
• cursing
• shouting 
• name calling
• withdrawing

Caregivers have to take the time to sit down with an angry senior and find out the source of their anger. Family members and friends can help caregivers with the senior to work through the issue and redirect their anger toward more productive things.

Some of the ways a senior may express feelings of sadness are:

• crying
• withdrawing
• losing interest in things or activities
• sleeping a lot

It’s very important that family members and caregivers find the source of the client’s sadness. Making repeated efforts to lift the client’s spirits is essential to deterring the onset of mental illnesses such as depression.

Some of the ways a senior may express feelings of anxiety are:

• shaking
• trembling
• trouble concentrating
• wringing hands
• decreased appetite
• insomnia
• crying

Because the continued presence of anxiety can lead to more serious conditions such as panic disorder, it is very important that caregivers and family members find effective ways to soothing an anxious client. Talking to them to find out exactly what they are nervous or anxious about can lead to the creation of a plan to effectively put the worries to rest.

The most important thing to remember is to address a senior’s feelings and emotions with dignity, respect, and compassion. Seniors may not know how to communicate their feelings, even if they have an audience to share them with. Careful and considerate methods of helping the senior cope with their emotions should be employed by everyone who comes in contact with the senior to reinforce the idea that whatever they may be feeling is okay and that they are entitled to feel any way they want to feel. Ensuring that the senior has a dependable group of supportive people can and will make all the difference in the world.