• Remaining independent in my own home.
• Maintaining good health and receiving adequate health care.
• Having enough money for everyday needs and not outliving my income.

Although seniors are definitely concerned about the need for long term care it is not high on the list of concerns. And yet, to address these concerns or wishes and maintain the quality of life wanted in their senior years, it simply takes a little pre-planning.

Unfortunately, as a rule, that is not happening.

For seniors, the need for home care or assisted living is one of the most catastrophic unexpected events that could happen to them. Why? Because the need for care typically removes any level of security an older person may have with the three major lifestyle concerns mentioned above.

With the need for long term care the older person fears:

• Losing their independence
• A decline in their health
• Depleting their assets sooner than expected.

No other late-life event can be as devastating to the lifestyle seniors are so concerned about maintaining. No wonder many seniors who lose their ability to care for themselves withdraw, become angry, and suffer from severe depression.

Ironically, many older people painstakingly scrape together $100-$200 a month to buy Medicare supplemental insurance to cover a risk which is about equal to their yearly premiums. Or, they will go without the things they need, and sacrifice food, recreation and activities in order to hold on to the last few dollars in their savings accounts.

Yet very few seniors spend money or time to plan for the event of long term care. It seems a paradox that someone would be more concerned about buying insurance for a home fire when the risk of needing home care help is 600 times more likely. Or what about the cost of insuring for an auto accident when the risk of long term care is 120 times more likely and is potentially 20 times more expense? Or why the overwhelming concern to buy Medicare supplement insurance when, without it, Medicare would still cover the bulk of their health needs after deductibles and co-pays? And please understand … I’m not recommending going without insurance coverage.  I’m simply using it as an example of how people refuse to deal with the issue of long term care.

No one knows why people beyond age 65 are not more concerned about preparing for long term care needs. Perhaps they mistakenly think the government will take care of them. Or, they are assured that family and friends will provide the care when needed. Whatever the case, without proper planning, the need for care services can result in the one of the greatest challenges in a person’s senior years.

In addition, this lack of planning will always have an adverse effect on the older person’s family. It usually results in great sacrifice or financial burden on the part of the spouse or children. Or, for those with no immediate family, long term care can be a burden to extended family members, neighbors and friends.

I would urge anyone reading this column, who are planning for retirement, or are now in their retirement years, and who has not prepared for long term care, to at least do some research, seek professional guidance, look at the options, and give this matter some careful attention.

As Benjamin Franklin so aptly put it “an ounce of prevention is worth a pound of cure.”

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

^{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}

In today’s column, I want to address the specific issue of financial abuse, or exploitation, and share some tips that seniors and their families can employ to avoid the pitfalls of this growing problem.  Next month, we’ll tackle the issue of physical abuse.

What do I mean by senior “financial abuse or exploitation”?  Simply, this refers to any situation where someone causes a senior to make a financial decision that’s based on threats … pressure … or incomplete or misleading information … and a decision that leads them to do something with their assets that isn’t in their best interests.

Seniors can be exploited by lots of people for lots of reasons, and not just crooks or con men, but by family and friends as well.  Exploited NOT because they’re in the wrong crowd, but because they’re apart from the crowd altogether.  NOT because they’re uneducated, but because they’re uninformed.  NOT because they’re greedy, but because they’re generous.  And NOT because they want someone to take care of them, but rather because they want to take care of themselves.   In some cases, as a senior begins exhibiting signs of dementia, this can also be an opening for a friend or family member or con artist to exploit that forgetfulness.

For many seniors today, there is a growing sense of fear that their resources may not be sufficient to weather the economic storms we’re currently experiencing, or the unexpected physical setbacks that will inevitably confront us.  As we get older, and retire, we realize we aren’t sure whether we’ll outlive our resources.  And that makes us susceptible to those who promise easy solutions and big returns.  Which leads to another fear … the fear of fraud.  In fact, a recent survey by the Financial Freedom company asked Americans between the ages of 62 and 75 to rank a list of fears.  And what do you think was Number One?  That’s right … fraud.  Seniors fear fraud ahead of health crises and terrorism.

So we know that fraud targeted toward seniors is real, and we know that seniors worry about it.  The question is … what can we do to protect ourselves, whether we’re seniors or those who care about them?

I would like to offer the following recommendations:  (1) Take your time.   Don’t be pressured into making quick decisions such as wiring money or writing a check at a seminar.  (2) Be suspicious of anyone who promises you inflated returns on an investment.  (3) Be wary of an advisor who doesn’t talk about risk or says an investment carries no risk.  Recognize that not all financial products are insured.  There’s nothing wrong with that, but know the difference. (4) Involve others.  Resist pressure to act right away.  (5) Verify the credentials and background of the person you’re dealing with.  Legitimate professionals welcome your scrutiny.  Three centuries ago, Thomas Cooper said, “Fraud and falsehood only dread examination.  Truth invites it.” (6) Remember when you were a little kid and your parents told you to beware of strangers?  It’s time to repeat their advice: Beware of strangers.  (7) Understand the nature of the investment.  Get all of the facts.  What something is called means nothing; what something does means everything. (8) Monitor your account statements closely.  And, finally, (9) the single best way to avoid being exploited financially is to have a plan.  No matter what your age, it is never too late to put together a financial plan.

Financial exploitation is real, and it’s a growing issue among seniors today.  Remember, the best defense is the best offense.  Seniors are most susceptible to financial exploitation when they’re fearful, and when they’re alone.  Let’s take steps now to avoid those pitfalls.

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

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

Obviously, such a subject is not something people are eager to discuss or plan for.  Most people tend to avoid such discussions, and put it off for as long as possible.  Frankly, it’s uncomfortable, because it exposes hidden fears and anxieties that we would rather not face.  In fact, it’s taken over 48 years of married life for my wife and I to finally recognize the necessity to face our mortality and make appropriate preparations. But given the realities of our day, and the state of physical challenges we all face as we age, such a discussion and planning becomes imperative.

In a previous column, I referred to a document called the Five Wishes, which I believe serves to intelligently and intentionally engage in a conversation about life-ending decisions.  It also represents a wonderful “tool” to implement actions that accomplish our physical, emotional, and spiritual wishes and values.

In light of the recently passed “Death with Dignity” initiative, it becomes even more relevant and timely to address these end-of-life issues, and to establish a clear and well-defined “plan” that meets our beliefs and wishes.  The fact is … for most people, assisted suicide is not a viable consideration, and yet, without a clearly defined plan, it’s possible that circumstances could manipulate us into an unwise, emotionally based decision.  Now is the time to take action that prevents that from happening.

So why the Five Wishes?

First of all … it’s comprehensive.  It lets you talk with your family, friends and doctor about how you want to be treated if you become seriously ill.  Your family members won’t have to guess what you want, and it protects them because they won’t have to make hard choices without knowing your wishes.  The document allows you to: 1) select the person of your choice to be your Health Care Agent; 2) define and specify the kind of medical treatment you want or don’t want; 3) establish how comfortable you want to be; 4) designate how you want people to treat you; and 5) specify what you want your loved ones to know about your beliefs, wishes, and final arrangements.

Secondly … it’s dynamic.  It’s a “living” document that is flexible, and that allows changes to be made when necessary.  It’s also easy to use because all you have to do is check a box, circle a direction, or write a few sentences.

Finally … it’s legal.  40 states, plus the District of Columbia, now acknowledge that the Five Wishes substantially meets their requirements under the law for such a document, and one of those states is the State of Washington.

By the way … Five Wishes isn’t just for seniors, it’s for anyone 18 or older … married or single.  Over eight million Americans of all ages have already used it, because it works so well.  In fact, lawyers, doctors, hospitals and hospices, faith communities, employers, and retiree groups are handing out this document to interested people all across the country.  If you want more information, and a copy of your own, you can contact Aging with Dignity at 888-594-7437, or go to their website at: www.agingwithdignity.org.  It truly is a great resource.

I know for my wife and I we now have the confidence and assurance that our loved ones will be spared the difficult task of making end-of-life decisions because we loved them enough to plan ahead.  So can you.

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

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.  As Jo Myers, author of Good to Go: The ABC’s of Death and Dying observes: “Some of these aging offspring already suffer strained sibling relationships left over from childhood.  So, potentially, a large number of grown-up baby boomers will act like children when their parents are not around to provide supervision.”

How sad!  And yet … how avoidable.

So the question is … what are some practical actions and preparations a senior and their family can take to lessen the impact when death occurs?  How can we more adequately prepare for the inevitable challenges a family will face … before … during … and after … the death of a parent?

The reality today is that many seniors display avoidance behavior rather than pre-plan for their death.  They often make statements like, “My kids can take care of things after I’m gone.” Unfortunately, they don’t realize that their lack of planning is often a recipe for the breakup of their survivors.  And it’s not just the financial and physical aspects of their absence, but the emotional and relational aspects as well.

Beginning with today’s opinion column, I would like to address some of the issues facing seniors and their families, and how to best meet these challenges.  In this segment, I want to focus on what a senior and their family can do “before” they face the reality of death, and to identify the most basic elements in that process.

First, as seniors age, they increasingly experience diminished capacity to function in their daily activities of life.  This may be due to illness, accidents, surgery, or just the effects of a body that is growing older.  In such cases, the senior needs to face the truth of their condition, and be willing to accept support from family, friends, and caregivers.  Unfortunately, many seniors cling so tightly to their independence that they are unwilling to seek or accept such support, and the result often leads to “assisted” living (or even skilled nursing) care long before such care should have been necessary.  Granted, sometimes family members just aren’t available to provide assistance, but there are outstanding home care agencies that do provide services to seniors at very affordable rates.  Whatever the case, this is an important issue to discuss NOW before the senior’s health requires extensive care.

Another important consideration that seniors and their families need to address is the preparation of a will.  Even if there are few assets, at least a simple Last Will and Testament will provide a suitable “closure”, and spare the family unnecessary challenges.  Today, with the availability of very affordable forms of will preparation, there really is no excuse for not having one.  But don’t procrastinate!  Even if the senior is reluctant, someone in the family needs to take the lead and insist that a meeting with the parent(s) to discuss this issue take place ASAP.

Which leads me to the situation that confronts many families today … a lack of communication.  Sadly, this is often due to a strained relationship, which may have occurred many years before, but has never been resolved.  I have been increasingly confronted with stories of families that are torn apart by parent-child or sibling conflict, and an obstinate unwillingness to forgive.  Unfortunately, unless there is an effort to “heal” that relationship, the conflict only fuels further alienation and division in the family, especially after a parent dies.  I can’t stress strongly enough the importance of resolving these issues before death takes that opportunity away.

Let me add one final consideration that a senior and their family needs to address “before” they face the reality of death … the completion of an “advance directive” document that names a substitute decision maker, and identifies desired medical treatments.  Although end-of-life planning includes a number of considerations (i.e., a will or trust, a durable power of attorney, funeral and burial plans), an advance directive is a key element in being well prepared.

Today, with advances in medical treatment, the possibility of prolonging the life of a patient continues to increase.  However, that may not be the desire of the patient.  With an advance directive, the senior can not only specify who they want to make those “end-of-life” decisions, but what, if any, medical interventions they wish to be employed.

There is one additional option, that seniors and their families might want to seriously consider, and that is the Five Wishes form.   With this document, several of the previously mentioned actions can be rolled into one format … a living will, advanced directives, and specific words and sentiments that the senior wants their loved ones to know.  For more information regarding the Five Wishes document contact Aging with Dignity at 888-594-7437, or go to their website at: http://www.agingwithdignity.org.  It’s a great resource.

As you can imagine, all of these considerations I’ve mentioned in this column are issues that require the senior and their family to confront a subject that most people want to avoid … death.  And that’s not easy.  In fact, it’s quite uncomfortable for most people to address.  But address it we must if we’re going to be prudent and responsible adults.

Next time I want to focus on an even weightier issue of what to do when Mom or Dad are in the midst of dying.

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

Tiredness

Is the client tired for a good reason? Perhaps they overworked themselves during the day, have been suffering from insomnia due to certain medications, or are readjusting to being out of the hospital. Are they able to catch up on their sleep and seem rested enough during the day that they aren’t taking frequent naps? If they seem tired, it’s important to know how long it has been going on.

Withdrawn

Does the senior suddenly have no desire to interact with people that they once liked spending time with? Do they tend to keep to themselves more and more often? It is important to note what the senior’s disposition is normally. If they are naturally shy or soft spoken, not wanting to draw attention to themselves or interact with people, this may be a harder call to make.

Sadness

Is the client experiencing prolong bouts with sadness? Do they have a reason to be sad, such as the recent loss of a beloved pet or dear friend? Do they seem sad because of something specific or melancholy in general? Are they making progress in dealing with their sadness such as grieving for their losses? Or do they seem to be taking the loss very hard and unable to cope?

The key to picking up on and alerting a senior’s health care professional to the potential onset of depression is being intimately familiar with the client on a variety of levels. As a caregiver having a true understanding of the senior’s moods, attitudes, and outlook on things will make changes in these characteristics easier to pick up on.

Any frequent and constant changes that a family member or caregiver notices in an elderly individual should be discussed with their doctor at the first opportunity. The sooner depression is diagnosed in the client, the better the prognosis and treatment will be.

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.

The following advice really not only goes for people receiving elderly care or even providing the elderly care, but for everyone.

What are dietary supplements?

Dietary supplements are pills, capsules, or drink mixes that contain a mixture of vitamin and minerals to supplement the body‘s intake of the daily requirements of each one that, for whatever reason, is not being achieved through diet alone. Optionally, there is a supplement for each individual vitamin and mineral so that people can pick and choose what’s right for them based on their deficiencies. Supplements may include herbs, animal extracts, and amino acids in addition to their vitamin and mineral content.

Who may need to take a dietary supplement?

People who are not consuming the recommended daily amounts of vitamins or minerals should consider taking a dietary supplement. Meeting the body’s required amount of each one is crucial for maintaining a healthy body and lifestyle. The elderly population often consumes the bulk of dietary supplements due to increased risk factors from having a deficiency that accompanies age.

Who should not take dietary supplements?

People who are taking regular medications, whether they are prescribed or the over-the-counter variety, should seek the advice of their dietician, doctor, and/or pharmacist to rule out any possible interactions between the supplements and their medications. Just because the supplements contain important vitamins and minerals does not ensure that they are safe to take in every circumstance.

People who have recently had surgery or are scheduled for surgery in the near future should not consume dietary supplements. The consumption of dietary supplements before or after a surgical procedure could lead to severe complications such as blood pressure and bleeding issues. People who are already consuming dietary supplements should discontinue their usage two to three weeks prior to having a surgical procedure performed.

Whether you are providing the elderly care yourself or you are using a company like ours to provide the elderly care dietary supplements are best used under the supervision of a qualified health professional. Always consult your doctor with questions and concerns before taking any dietary supplements.

Seniors who experience bouts with insomnia do so for the same reasons as the rest of us. However, the elderly population is highly sensitive to change on many levels. Even the tiniest detour from their normal way of doing things can be upsetting enough to them that they will actually lose sleep over it. A new doctor, a new medication, or even a new nightgown can make the senior uncomfortable enough to where they are unable to sleep. Sometimes, there could be more sinister reasons behind a senior’s inability to sleep such as the onset of dementia or depression and then it would help to monitor the senior. Home care is one option.

Here are some things we have found, as senior home care providers, for you to consider if you notice an elderly loved one who is having trouble sleeping.

Look for a simple explanation

There are several harmless reasons that a senior might have trouble sleeping at night. Maybe their clothing or their bed covers make them itch. Perhaps their mattress is lumpy or uncomfortable. They could require more pillow support to sleep comfortably. Is their bedroom too hot or too cold? Is there too much light shining on them or is it too dark for their liking? Did they have too much coffee during the day and the caffeine is keeping them awake at night?

Digestive issues

Are they experiencing heartburn, indigestion, or acid reflux that would make lying down uncomfortable? Perhaps they have an upset stomach from something they ate earlier in the day. Do they need to go to the bathroom before bed? Could the senior be constipated or have painful gas pressure that’s causing them distress?

Causes of stress, anxiety, or other emotions

Is the senior preoccupied with something such as a task they didn’t finish that day or an errand they forgot to run? Are they anxious over an approaching doctor visit? Have they experienced a recent loss of close friend, family member, or pet? Are the afraid of something? Talking to them about why they believe they are losing sleep could provide caregivers and family members with the information needed to find a simple solution to their loved one’s sleeping problem.

If you, yourself, are providing the senior home care then the above points are not too dificult to carry out and don’t require any medical training