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Nurturing Care Assisted Living Help Is Just Around the Corner By Kathy Harmon Families often struggle with the fact that they cannot adequately care for a loved one at home. An aging caregiver spouse may bear the burden of care and the stress of concern for many years fearing the only choice is a nursing home. But in neighborhoods throughout the country there is a wonderful alternative. These are small residential care homes, usually housing 4-7 residents in a home-like setting with 24 hour awake staff and competitive daily rates. The caregiver spouse or other family member is only a short drive or walk away so the transition can be amazingly painless for everyone involved. The family suffers less guilt, separation anxiety and loneliness. But, best of all, the elder patient receives more stimulation, socialization and activities to engage in. Patients often rally. Within a short distance of my home are three such communities. Their décor is warm and inviting, the home cooking is delicious but best of all the owners are dedicated to providing the best care for the patients in their charge. Not all care facilities meet this standard. Do your homework, meet with the owner and staff, check licensure and review inspection reports. As the old saying goes: “Help is just around the corner”. "Dear Kathy" by Kathy Harmon Dear Kathy, My parents live in a small town in Colorado. Mom was diagnosed with Alzheimer's several years ago and dad has cared for her with the love that was so exemplary during their marriage. We have all had years to adjust as she gradually slipped away, but the situation has recently become more serious. I live on the east coast and I'm able to visit my parents about every six weeks or so. I have one sister whose husband is in the military. They're stationed in Germany and they get to Colorado only a couple of times a year. My parents don't socialize any more because mom doesn't communicate and becomes anxious when she's in a group setting. Dad gets a little help from neighbors, but they live in a small community and many of the older folks have moved away to be closer to their kids. I've asked dad to move in with me but he will have none of it. When I was home for the holidays, dad told me that mom has been wandering a lot, and he has trouble sleeping because he worries she will leave the house in the middle of the night and die of exposure. One night he said that he locked them both in the house and then couldn't sleep because he imagined them trapped in a fire. It is really taking a toll on him. He's aged terribly this past year, but I know he would be lost without her. Can you give me any advice? Becky from Boston Dear Becky, Let me suggest a couple of things. First, you're right: you should be concerned. Caregivers frequently die earlier than the patients they care for. Undoubtedly, the constant stress, lack of sleep and the difficulty of the work are contributing factors. Fortunately, you can help your parents in several ways. There are many reliable companies nationwide that install in-home security systems specifically to keep people safely inside. These systems usually have keypads that require codes for entry and exit and alarms that will signal attempts to leave the home (and fire detection, by the way). This may be enough for the short term, and it should give your dad some peace of mind, but eventually he may want to consider additional help. He could start by getting in-home health care providers for a few hours a week or taking your mom to an adult day care facility a day or two. These services are available even in small communities. Caution your father to check for license compliance and references, but I have found these caregivers to be kind, gentle and empathetic and the costs to be extremely reasonable. He should call his insurance carrier to determine if he has coverage for home health assistance or respite day care. If there is a local senior center there are likely other services that may be available at low or no cost through the county. You might also investigate whether any small residential care homes exist in his community. You may be surprised to find several within a one-mile radius - even in a small town. Many of them specialize in memory care, offer a homelike setting, a good caregiver-to-patient ratio, and can provide a very loving environment. Most welcome the family members and encourage them to visit often and stay as long as they wish. Your parents' dwindling socialization has likely left your father feeling progressively more isolated, which may lead to depression. Encourage him to reach out to the community, find others in similar situations to share his feelings, and accept some assistance. Your parents are members of a generation who understand devotion to duty at the expense of the individual. It will be difficult for you to convince him that your mother's quality of life depends on his continued good health. Any move, however, will take a good deal of adjustment for both of your parents. Ask your father if he'd like you to research some options. These facilities are called "group homes," "residential care homes," "adult foster care," "adult family homes," or simply "assisted living communities with memory care." You might want to search our home page in your father's zip code or city/state and check "assisted living" for a sampling of what is available within a 40-mile radius of his home. You can narrow the search to as little as 10 miles if you wish. Share with him what you discover and ask if he would like to visit a few on your next visit. I've known several elderly couples whom have found a small care facility close to the family homestead. In most cases, the patient became acclimated quickly because the caregiver spouse was able to visit daily. The caregiver, although initially riddled with conflict and guilt, began to sleep more, worry less and became energized by the daily contacts with facility staff and other caregivers. How wonderful it must have been to grow up in a loving home with parents who understood the vow, "in sickness and in health." You clearly understand the problem, are anxious to be of assistance and hopefully have the patience to work your parents through this difficult transition. Given what I have experienced in the last year with dementia patients, I would ask you to include your mother in all of these discussions. I have become firmly convinced that there is "someone in there" (Even though the person with Alzheimer's or dementia appears to be unresponsive) and that we should not exclude them from decisions that involve their future. But I will leave that topic for a future blog debate. Please send your comments, questions and great stories to kathy@greatplacesinc.com and send someone a Valentine's card who hasn't gotten one in years. It will bring you both great satisfaction.
| "BIG PHARMA" PROFITS TIED TO DRUG ABUSE IN NURSING HOMES by Laurence Harmon
During the past several years, I've toured perhaps 75 nursing homes, Alzheimer's/dementia and memory care facilities, primarily in the Upper Midwest. When I've been able to observe residents in these places, with few exceptions I've seen many of them strapped into their wheelchairs, helpless and unattended, drug-addled, seemingly comatose. Consider: During the 1980s, reports of nursing home abuse and neglect surfaced in alarming numbers. In response, Congress passed the Nursing Home Reform Act in 1987, which provides in part as follows: "Residents have the right to dignity, respect, and freedom. Residents have the right to be free from . . . physical and chemical restraints." Medicaid spends more money on antipsychotic drugs than any other prescription drug. Why? Because nursing homes dose residents with antipsychotics to "quiet" them, even though they have no diagnosis of psychosis. Alzheimer's and dementia-related care is intentionally structured according to the "win/win/lose" archetype that is unfortunately characteristic of the American healthcare system. Pharmaceutical giants and nursing homes are the overwhelming winners, while the vulnerable and helpless are inevitably steamrolled by the system. Facts: According to the Centers for Medicare & Medicaid Services, nearly 30 percent of nursing home patients--70 percent who have been diagnosed with dementia--are being dosed with psychotropic drugs, which comprise antipsychotics, antidepressants, and anti-anxiety medications. Antipsychotics generally pose the greatest risks to nursing home residents because they're intended to treat serious mental illnesses, such as schizophrenia. Nonetheless, nursing homes dispense these drugs, primarily "atypicals," as chemical restraints. Risperdal is an atypical antipsychotic medication manufactured by Johnson & Johnson, which reported $4.7 billion in sales of the drug last year. Risperdal carries the following warning label: "WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS. RISPERDAL® (risperidone) is not approved for the treatment of patients with dementia-related psychosis." The Arkansas attorney general has filed suit against Johnson & Johnson and two of its units, claiming, among other things, that they "engaged in a false and misleading campaign" to promote its antipsychotic drug Risperdal to geriatric patients.
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IS YOUR LEGAL HOUSE IN ORDER?
by Sonya Mittelman .jpg)
As we begin a new year, we all tend to think about and plan for the future. What we're unable to plan, of course, is when we'll die and when--or if--we'll become unable to care for ourselves. That's why we need to do some thinking about both possibilities. Incapacity planning: caring and managing. For the possibility of incapacity, we need two-pronged planning: caring for ourselves and managing our money. The rest of this discussion applies to New York law, but there are similar rules in every state
Using an agent to make your healthcare decisions. In arranging care for ourselves, we need to select someone to make ordinary and extraordinary health care decisions for us if we're incapacitated. In New York, a "health care proxy" lets you name an agent and alternate agents to make healthcare decisions for you if you're unable to do so. If, for example, you want artificial feeding and/or hydration withdrawn or withheld from you, the health care proxy provides your agent with that authority. Everyone over age 18 should have one of these.
A "living will" allows you to express your wishes about life/death decisions. If your state law provides an opportunity for an agent to make your healthcare decisions (as we do in New York state), living wills are useful, but less important if you've executed a health care proxy, since the proxy allows your agent to make these decisions. New York doesn't have a particular living will form; instead, anyone who has "clear and convincing" evidence of your wishes can make these decisions for you. The best way to ensure that your agent or family member has such evidence is to write it down. Using an agent to manage your money. Unless you become incapacitated, of course, you have the right to manage your own financial affairs, but you also need to ensure that your finances are properly managed if you should become incapacitated. You may put your accounts in another person's name, or you may use a power of attorney, which allows you to name an agent to make financial decisions for you. The power of attorney goes into effect when you sign it and it applies during your incapacity, but it has no effect after your death. Your agent has only the powers that you give that person. If you are considering transferring assets in order to have Medicaid pay for your care, your power of attorney must expressly grant that authority to the agent.
Trusts and wills. A trust is a hybrid document, one that can be used both during your life and upon your death. Whether you need a trust depends on your personal situation. If you're receiving or might be qualifying for Medicaid, a special or supplemental needs trust allows your assets to be preserved to pay for other expenses. Upon our deaths, a will makes sure that our money and other possessions go where we want them to go. When you first prepare your will, or review and revise it, it's a good idea to to review any trusts or agency documents to make sure they're consistent with your wishes. Sonya Mittelman specializes in elder law and estate planning. The Law Offices of Sonya Mittelman are located in Bronx, New York and New York, New York. You may contact Ms. Mittelman at Sonya@sfmelderlaw.com, or by telephone at 718.863.4647. Visit Our Blog THE EFFECTS OF AGING ON BALANCE by Carolyn Blake 
In the United States, one-third of adults 65 and older fall each year. Injury from falls can result in fractures, nursing home placements--even death. An immeasurable result is the FEAR that a fall may occur, often spinning into a cycle of inactivity, reduced fitness, and thus actual increased risk of falling. What are our systems of balance and what happens as we age that puts us at such risk? What can we do to improve these odds? One system of balance is proprioception. Information is received from nerve endings and receptors located in our skin, muscles, and joints and transmitted to the brain to provide feedback about our body's position. Some aging effects that can diminish this input include vessel stenosis, decreased cardiac output, and various forms of neuropathies. Poor proprioception slows reflexes and may cause numbness and weakness that affects our ability to anticipate and react to changes in surfaces (ramps, steps, obstacles under our feet). This can be countered by wearing good fitting shoes; getting orthotics to provide support to your arches and feet; maintaining good mobility in your ankles through stretching; and doing cardiovascular exercise (biking, walking, pool exercises) to maximize blood flow to your limbs. Another system of balance is vision. Visual input tells our brain information about the environment: Is the surface level? Are there obstacles to avoid? Glaucoma, cataracts, macular degeneration, or the need for bifocals are all changes that can accompany aging, but can't necessarily be prevented. Try using a night-light, wearing sunglasses to avoid glare, letting eyes adjust when moving from light to dark areas (or from normal lighting to movie-theater-darkness) to assist your changing vision. Next is our vestibular system. Our inner ear houses a small but amazing system of canals and organs that sense movement. Think of this as your body's gyroscope! This system may become ineffective due to a virus, trauma, or inactivity. The result can be dizziness, vertigo, or a diminished reflex that can lead to blurred or double vision. It is important to participate in activities that move your eyes and head to keep this reflex finely tuned. Popular group exercises include yoga and tai chi. If you are having dizziness or vertigo, please talk with your doctor about medication side effects. Dizziness is NOT a normal sign of aging and you may benefit from a vestibular assessment by a PT. Read Full Article
SENIORS AND THE INTERNET
by Laurence Harmon
According to the Pew Internet and American Life project, over-65 Web users are just as proficient as the young, although they're less adventurous in the kinds of things they do. Perhaps we shouldn't be so surprised. Old people have lots of free time, an unhealthy obsession with their bodies, and arcane hobbies. They're practically teenagers. Here's more: The researchers at Pew released a report on "Older Americans and the Internet" in 2004, which found that 22 percent of seniors go online. More recent data show that 35 percent of seniors now use the Internet. E-mail is the top motivation for getting up to speed. Health information, checking the retirement account, and genealogical research are next in line. Seniors, rather poignantly, look up more spiritual and religious information than the younger demographics. What's striking about old people on the Internet is they seem to be having fun on there. The Internet is not work, nor is it networking, nor someplace to brand yourself. Seniors often do the amateurish, experimental things that made the Web so interesting in the first place, like, say, lip-synching to "Chiquita Banana." Visit Our Blog |