• 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

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

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

Any time a senior person forgets something, especially when receiving in-home senior care, family members generally find cause for alarm. They begin to wonder if these small lapses in memory are innocent or if they have a more sinister side that leans toward dementia and the onset of Alzheimer’s disease. In the majority of the cases, memory lapses that senior people experience are totally harmless and have a simple, underlying cause.

Some examples of forgetfulness that are generally not a cause for concern are:

• forgetting where you left your glasses or keys
• forgetting the names of people and places
• occasionally forgetting an appointment
• trouble recalling something you just read
• going into a room without remembering what for

Some underlying causes for short term memory lapses are:

• Vitamin B-12 deficiencies
• hearing impairment
• certain medications
• exposures to toxins
• thyroidal problems

When providing senior care there are ways we recommend to improve episodes of short term memory lapses. Improving the senior’s diet is one of those ways. Antioxidants and Vitamin B-12 are important nutrients in retaining cognitive function. Getting enough rest at night allows the brain time to process the information it retained over the course of the day. This is why bouts with memory loss are aggravated by insomnia. The brain hasn’t had time to rest.

Continuously challenging the brain is an effective way to maintain its function. This can be achieved by working crossword or ‘brain teaser’ puzzles, playing board games that require strategy, or reading books or papers on an unfamiliar subject. The benefits of engaging other people in these activities are two-fold. Not only is the brain receiving a workout from the puzzles and games, it is also working overtime to balance the communication and interaction that is going on between the individuals involved in the activities, thereby improving and expanding important social skills.

It is important, when providing senior care, for caregivers and family members to keep notes on the frequency of the elderly loved one’s bouts with short term memory lapses. While they could be perfectly normal occurrences, being aware of an increased frequency in the bouts will help establish whether the lapses need to be brought to the attention of a medical professional to rule out any other problems.

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

The following activities are possible in a home care environment due to the ease they can be carried out and the little space, time and cost in setting them up.

Painting

For seniors who have trouble communicating due to speech impediments or dementia, painting can be a wonderful new way of expressing. They can paint out their feelings in bright shades that can depict any number of emotions or messages that they may want to convey. Displaying their creations in a prominent place in the home can instill a sense of pride in the client, which goes a long way in combating mood issues like depression. Optionally, a client can give their creations to friends or family members as gifts, which can provide them with a level of self-confidence as well.

Scrapbooking

Scrapbooking is an ideal activity to promote and maintain long-term memory. Seniors can sift through cherished photographs of their loved ones while creating the perfect page to display them upon. Looking through the photographs will trigger memories of the people depicted in them so that the seniors do not lose the ability to recognize the important people in their lives. As with the paintings, seniors can choose to give away their creations to family members as treasured heirlooms to be passed down for generations to come.

Photography

Taking up photography as a hobby can motivate the elderly to remain active and interested in their surroundings. It can encourage them to get outside and get involved in the world around them, which is very important in maintaining social skills. Further, photography can instill an interest in the outdoors in a senior as they may want to photograph local flora and fauna. The benefits of this can be two-fold as they are both interested in something and able to get fresh air and exercise in the process of pursuing that interest.

If you would like to share with us your ideas for exercising the mind whilst receiving home care please leave a comment below.

Foods that contain ‘empty calories’

Because seniors are less active than the younger population, their bodies require less food, whose calories are later turned into energy for activities. Junk foods should be avoided because of their high fat, calorie, and sugar content – also known as ‘empty calories’. Empty calories are calories that have no nutritional value.

Foods with a high sodium content

Even if they are not on a restricted sodium diet, seniors should avoid foods with a high sodium content due to the increased risk for elevated blood pressure and the host of maladies that can accompany it. Caregivers should also be aware of foods with hidden sodium content. These foods are foods that one doesn’t normally consider as ‘salty’ – such as certain types of breads.

Fried foods

Fried foods contain high levels of LDL or ‘bad cholesterol’. An elevated cholesterol level can present a host of health problems in the elderly and make them susceptible to strokes and heart attacks.

Raw or undercooked foods

This doesn’t mean to just thoroughly cook a senior’s foods. There are a number of foods that aren’t supposed to be cooked that can lead to a variety of food borne illnesses due to the presence of germs and bacteria. Some common food products where bacteria is prevalent are:

• soft cheeses such as feta, Brie, and Camembert
• egg products like cake batter, cookie dough, sauces, and eggnog
• raw fish products such as sushi
• hot dogs 
• non-pasteurized milk, milk products, and juices
• fresh vegetables and fruits that have not been thoroughly cleaned

The reason that raw or undercooked foods pose a health risk in seniors is because a reduction in stomach acid occurs as the body ages. Instead of being broken down by the stomach acid, the bacteria is able to reach the small intestine where most gastrointestinal issues occur.

It should be easier for a senior receiving home health care to eat a healthy diet due to the experience, mobility and motivation of the caregiver.