^{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}

Sadly, physical abuse of senior citizens is not that uncommon.  According to the American Psychological Association, “Every year an estimated 2.1 million older Americans are victims of physical, psychological, or other forms of abuse and neglect. For every case of elder abuse and neglect reported to authorities, experts estimate that there may be as many as 5 cases not reported. Research suggests elders who have been abused tend to die earlier than those who are not abused, even in the absence of chronic conditions or life threatening disease.”

With the senior population continuing to grow, we can anticipate that this problem will become even more prevalent, and anything we can do to minimize or reduce these occurrences is critical to the health and well being of our elders.

How to Identity Elder Abuse

Before we can take action to prevent elder physical abuse, we first need to understand and identify abuse when we encounter it.  According to the law firm of Brayton Purcell, “Physical abuse is force that causes injury or pain. Striking, hitting, beating, pushing, shoving, shaking, slapping, or kicking is considered physical abuse.” However, abuse can also involve the inappropriate use of physical restraints, as well as overmedicating with tranquilizing drugs.  If a patient in a skilled nursing facility or hospital is in severe pain, providing inadequate pain medication may also constitute elder physical abuse. Similarly, failing to administer prescribed drugs may be neglect or elder physical abuse.

Although the conditions I just described often occur in healthcare facilities, they can also be employed by a family member (or caregiver) in a home environment.  In fact, statistics from the National Center On Elder Abuse (NCEA) show only 10% of the elderly people who need assistance or care live in a long-term care facility such as a nursing home.  The remaining 90% either lives alone or with loved ones.  And although it’s hard to imagine a son, daughter or grandchild abusing an elder, the fact is … they make up 36% of the reported incidents of elder abuse.

So what do we look for that would help us to identify if an elder is being abused?  Some telltale signs include:

1. bruises, especially in clusters or regular patterns in areas such as the neck or groin;
2. black eyes, welts, lacerations, rope marks, broken bones, open wounds, cuts, and untreated injuries in various stages of healing;
3. burns (commonly on soles, palms, or buttocks);
4. laboratory evidence of medication overdose or failure to administer prescribed drugs;
5. an elder’s report of abuse; and
6. an elder’s sudden withdrawn behavior, or the refusal of the caregiver to allow visitors to see the elder alone.

What to do about it

If you know an elderly person, or are a family member of an elder who is dependent upon others for their care, take the time to visit them.  If possible, and the elder person is living with family, give the caregiver time to take a break and get away for a little while.  In some cases, it may be best to hire a professional caregiver to provide that respite break.  For those in nursing homes, check in with them at different times of the day.  Ask questions, make observations, and write them down.  If at anytime you suspect abuse is occurring, report it immediately to the proper authorities.  Here in Kitsap County, that would be Adult Protective Services (888-833-4925) for a person who lives in their own home, and Gayle Helseth-Kenison (360-337-5700) for people living in care facilities.

Remember… to know of abuse and not take action against it is the same as condoning the act. We must all take responsibility to defeat this tragedy being experienced by far too many seniors.

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/nine-tips-for-seniors-to-avoid-financial-abuse http://abidinghomecare.com/nine-tips-for-seniors-to-avoid-financial-abuse#comments Thu, 09 Jul 2009 03:41:00 +0000 carl http://abidinghomecare.com/?p=245 While seniors face a growing number of challenges just trying to stay physically, mentally, and emotionally “fit,” I’m sad to say that there is another challenge that is taking its toll on our senior population today … and that is physical and financial abuse.  And what makes this even more troubling is that it often comes at the hands of trusted family members and friends.

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

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

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

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.