• 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

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-part-3 http://abidinghomecare.com/what-happens-when-mom-and-dad-are-gone-part-3#comments Sun, 05 Jul 2009 14:07:30 +0000 carl http://abidinghomecare.com/?p=208

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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