• 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

^{Sadly, there are many prejudices and stereotypes that are applied to persons based solely on their age.  This is what we call ageism, and one of the most frequent “stereotypes” is the view of later life as a period of decline and disaster. However, whether you’re a senior, or you have a loved one who is experiencing the challenges of senior life, having the right attitude can make all the difference in the world.}

^{Of course, not all fears about old age are based on prejudice or imagination.  Some fears are all too real, and we need to take account of those fears in making plans for the later years.}

^{While not a given, advancing age increases the probability of chronic illness, dementia, and death.  A quick look at life insurance rates will tell you that mortality is a realistic fear for elders.  Yet survey research suggests that older people are actually less afraid of death than younger people.}

^{So what are they afraid of?  Older people typically express fears of dependency and loss of control. In comparison, death may even seem preferable.  For example, the history of assisted suicide in Oregon suggests that very few people, even with terminal illness, actually make use of the option.  When they do, it is mostly not for reasons of pain, but because they fear dependency and loss of autonomy.}

^{Fear of dependency is also the reason behind common attitudes about nursing homes.  It is not unusual for older people to say, “I’d rather die than go into a nursing home.” Ironically, many who do enter long-term care facilities adapt to the situation and may even find more opportunities for activities, social contact, and support.  But the fear of being “put away in a nursing home” is still widespread.}

^{Another important fear among seniors is that of impoverishment – outliving one’s income or assets.  Here again, the fear is not unrealistic because poverty rates rise dramatically among those over age 80.}

^{Lastly, there is the fear of losing one’s mind, an informal way of referring to dementia or diminished mental capacity.  Unfortunately, rates of dementia do rise dramatically as people age.  However … developing dementia is not inevitable, and there are encouraging “methods” and techniques being utilized today that are quite successful.}

^{The overall picture of fears in later life was captured well by King Solomon in the book of Ecclesiastes.  As Solomon is summing up his thoughts he says, “When people live to be very old, let them rejoice in every day of life.  But let them also remember there will be many dark days. Everything still to come is meaningless.}

^{Don’t let the excitement of youth cause you to forget your Creator. Honor him in your youth before you grow old and say, ‘Life is not pleasant anymore.’ Remember him before the light of the sun, moon, and stars is dim to your old eyes, and rain clouds continually darken your sky. Remember him before your legs—the guards of your house—start to tremble; and before your shoulders—the strong men—stoop. Remember him before your teeth—your few remaining servants—stop grinding; and before your eyes … see dimly. Remember him before the door to life’s opportunities is closed and the sound of work fades. Now you rise at the first chirping of the birds, but then all their sounds will grow faint. Remember him before you become fearful of falling and worry about danger in the streets; before your hair turns white like an almond tree in bloom, and you drag along without energy like a dying grasshopper, and the caper berry (i.e. an ancient aphrodisiac) no longer inspires sexual desire. Remember him before you near the grave, your everlasting home, when the mourners will weep at your funeral.” (Ecclesiastes 11:8; 12:1-5 NLT)}

^{As Solomon understood that, no matter how powerful we are, old age can bring with it a loss of power and therefore greater vulnerability.}

^{Growing older is definitely a challenge, but it’s great to know we’re not alone, and we’re not without resources to make the journey manageable.}

^{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}

For those children who live away, the change they see in their parent’s health and mental capacity may be alarming — whereas siblings that have daily contact are working with these issues constantly. Here is the chance to compare notes and work together as a complete family in the long term care planning process.

For you parents who are well and active, this is a good time to hold a family meeting and share with your children your plan for long term care. Tell them where financial and legal documents are located. Review health care directives, living wills and long term care alternatives.

Experience has shown that even families that are close can quickly grow angry, jealous and hostile towards each other when an aging parent begins to need long term care. If a

sibling moves into the parent’s home, others can easily be suspicious of ulterior motives and fear losing their inheritance. On the other hand, the child providing the elder care becomes bitter and feels there is no support or help from siblings. Pre-need meetings for the purpose of making a plan, before eldercare becomes imminent, avoids these types of conflicts.

In its book, “The 4 Steps of Long Term Care Planning,” the National Care Planning Council provides guidelines and checklists for family planning meetings. Here’s an excerpt from the book:

“The first step to holding a meeting, and perhaps the most difficult

one, is to get all interested persons together in one place at one time.

If it’s a family gathering, perhaps a birthday, an anniversary or

another special event could be used as a way to get all to meet. Or

maybe even a special dinner might be an incentive.

The person conducting the meeting can be a parent or one person of

a couple who are doing their planning, years before the need for care

arises. A meeting on behalf of someone already receiving care or

needing care in the immediate future could be conducted by that

person or by a member of the family, by an adviser or a friend.

The agenda could be formal or informal. If you want a formal

agenda, we suggest using our care planning checklist as the agenda.

Copies of the care plan should be prepared prior to the meeting and

presented to those attending. Discussion is encouraged and we

recommend that the person in charge not dictate but encourage input

from everyone.

After a thorough discussion of the issues and the presentation of the

solutions to the problems that will be encountered, there should be a

consensus of all attending to support the plan. If the plan needs to

be altered to meet everyone’s expectations then by all means do so if

that can be done. But it is not always possible to please everyone so

there must sometimes be compromise.

The end of the meeting should consist of asking everyone present to

make his or her commitment to support the plan.

GET IT IN WRITING! All good intentions seem to be forgotten

with time. It may be years after this meeting before the long term

care plan begins. If there are vocal commitments to help with

transportation to doctors, give respite to the caregiver or other

commitments, write them down on the care agreement. You can

even have each person put a signature to his or her commitment if

you think that is important.”

“The 4 Steps of Long Term Care Planning ,” by The National Care Planning Council

The U.S Department of Health and Human Services states:

“No one wants to think about a time when they might need long-term care. So planning ahead for this possibility often gets put off. Most people first learn about long-term care when they or a loved one need care. Then their options are often limited by lack of information, the immediate need for services, and insufficient resources to pay for preferred services. Planning ahead allows you to have more control over your future”.

http://www.longtermcare.gov

“Whether you plan a formal meeting with an agenda or informally gather for a discussion, when the family is together make it a point to start the long term care planning process.

There is a lot to learn and many decisions to make concerning finances, health issues and legal work. It may take research and a lot of time to put a plan together, but if everyone is involved it will work, and be worth it.” National Care Planning Council, www.longtermcarelink.net

]]> http://abidinghomecare.com/family-reunion-a-good-time-for-family-planning/feed 0 http://abidinghomecare.com/what-happens-when-mom-and-dad-are-gone-2 http://abidinghomecare.com/what-happens-when-mom-and-dad-are-gone-2#comments Fri, 12 Jun 2009 22:21:42 +0000 carl http://abidinghomecare.com/?p=176 In my previous column, in consideration of some practical actions and preparations a senior and their family can take to lessen the inevitable challenges before … during … and after … the death of a parent, we focused on the “before” aspects of how to be prepared.  I suggested the following actions: 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; and 4) address unresolved family conflicts.

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

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

Layout of the home

• How to lock outside doors and windows and where to find the keys to each
• The location of and any special operating instructions for washers and dryers
• Where to find household supplies such as cleaners, detergents, light bulbs, and paper towels
• Where to find cooking implements and any special operating instructions for stoves, dishwashers, or other appliances
• Location of phones and phone lines in the home
• Location of towels, bed linens, and clothing in the case of an accident or change in the weather

Emergency information

• Name and address of primary care physician
• Name and address of preferred hospital
• Location of and how to operate any in-home alarm systems
• Contact information for several family members, friends, and neighbors – including cell phone numbers if available

Personal information about the client

• Food allergies or dietary restrictions
• Likes and dislikes in regards to foods, hobbies, clothing, and activities
• Location of the client’s clothing, shoes, and accessories
• Any special instructions on mobility issues or equipment such as wheelchairs, canes, and walkers
• Any important medical conditions or history that may cause a problem for the client or require medical attention
• A list of things the client is not allowed to do – such as go outside alone, cook for themselves, or bathe unassisted
• Information about the client’s need for dentures, eyeglasses, or contact lenses and any special instructions for each one
• Whether there are any activities the client should be doing, such as an exercise program or specific daily routine
• What the family anticipates the client needing assistance with and to what degree
• Any additional information that would be helpful to the care provider