There are 65 million Americans who care for an elderly or disabled loved one, a role that can be extraordinarily taxing, both physically and emotionally. Family caregivers often find themselves “teetering by a thread.” They report higher levels of stress, physical strain and poorer health than non-caregivers. Fortunately, relief is available in the form of respite care.

Respite care is short-term care provided by senior communities, homecare agencies and adult daycares. It allows family caregivers to rest or attend to other responsibilities without worrying about their loved one’s wellbeing. Respite care can last from just a few hours up to a few weeks. It can be used as an opportunity for family caregivers to run errands, travel or just enjoy a well-deserved night out.

Respite can also be a godsend for families during an emergency. For this reason, experts recommend that families research respite care options before the need arises. The National Respite Network writes, “To be most effective, you should use respite services much earlier than you think you will need them. Respite will be most helpful if you use it before you become exhausted, isolated or overwhelmed by your responsibilities.”

According to a study by the National Alliance of Caregiving and AARP, only 12% of family caregivers ever take advantage of respite care services. This is an unfortunate statistic considering the strain of caregiving. One factor may be that some family caregivers are reluctant to admit that they could use a break. Another obstacle may be that many caregivers simply don’t know what respite services are available: I this area you can contact elder services like Highland Valley Elder Services (413-586-2000) or Franklin County Home Care Corporation (413-773-5555) or any of the local Council on Aging or Senior Centers in your town.

Respite service is available at the Elite Adult Day Care Program (413-256-4663) by making advance arrangements. As the article suggest, making arrangements in advance of the need makes the process smoother. Knowing you have options for respite is one of the first steps in helping to take control of your own care and better preparing yourself to take care of your loved ones.

Marguerite Manteau-Rao - 

This story is for the 2.3 million long-distance caregivers who have a loved one with Alzheimer’s.

Being a long-distance caregiver is hard, especially when a loved one’s mind can no longer dwell on the memory of prior times together, or the anticipation of a future visit. One can easily feel helpless and overcome with grief, and guilt, and frustration.

I would like to share one small thing I have discovered with my mother, that’s made a huge difference in how I feel about living so far from her.

My mother resides 5,000 miles away — and she is in the late stage of Alzheimer’s. My contacts with her are mostly in the form of short, daily phone calls. At first, I wondered, what’s the point? A few minutes can’t possibly make a difference. And then, one day, I had to go on a long vacation without easy access to the phone. I did not call my mother for three weeks. When I returned, I learned from my brother that my mother had been out of sorts during my absence. After a few days of resuming my calls, her agitation subsided, and she was back to her normal self. Since then, I have observed the same phenomenon over and over again. My daily calls pay off big in my mother’s heart.

More (time at once) is not necessarily more. Rather, it is the frequency, predictability, and quality of the connection that matter most:

Make that daily call
Better to have daily contact, even if very short and on the phone, than to spend a whole day with your loved one and then not have any interaction for three months. I have found that establishing a connection usually carries over the whole day. By the next day, the effect has dissipated, and it is time to recharge the person’s heart with some more reassurance and love.

Call at the same time 
People with Alzheimer’s have a keen internal clock, and routine is extremely important. That routine includes your daily long-distance call. The more consistent you can be in terms of the timing of your call, the better. I time my calls at 8:30 every morning, just in time to catch my mother before dinner in France where she lives.

Be fully present when you call
The words almost do not matter, but your authentic presence does. Before making the call, free your mind from all “your stuff” and fill up your heart with loving kindness, readying yourself to be with your loved one. I visualize my mother’s face and I smile before I pick up the phone. Sit down while you talk, and be all to your conversation, nothing else. Treat each call as a brand new call, no matter how repetitive it may seem from one day to the next.

Pack your talk with emotional goodies
Touch upon your loved one’s emotional needs all at once. Stick to safe topics that don’t test memory and preserve self-esteem. “What is the weather like where you are?” “How is your health?” “How are you feeling?” Keep the conversation simple. Bring in good news. I usually talk about my daughter and how well she is doing in college. End with an affirmation of your love and a reassurance that you will reconnect the next day. “I love you lots, mom.” When she reciprocates, tell her how good it makes you feel to hear those words from her.

Don’t get hung up on reality
I have learned to let my imagination run wild, and say anything that leaves a positive impression in my mother’s heart. She will not remember the exact content, but she will remember the emotion. That I love her, and care for her, and am a constant in her life. That there are still things for her to look forward to. That she can still treat me to lunch, even though it’s been years… “When are you coming?” I have my response ready, “I am coming next week.” “How long will you be staying?” she always asks. And each time, I answer, “One week”. That brings her so much happiness.

Such a small thing, and it means so much to her! I can do this, every day.

2.
Free Legal Advice on May 16 from 3:30 to 7:30 pm ONLY
1-413-782-1659
This DIAL-A-LAWYER day is brought to you by the MA Bar Assn

3.
Dementia’s make communication difficult. Come learn how to improve communication when dementias, like Alzheimer’s, are in the picture. May 22 from 1-3 pm at Great Falls Discovery Center , 2 Ave A, Turners falls, MA. This workshop is free and open to the public. Call 1-800-272-3900 to register. It is co-sponsored by Franklin County Home Care and the Alzheimer’s Association. Respite may be available. Call Laurie Deskavich at 773-5555 Ext 2211.

This checklist is based on the original version printed by the Centers for Disease Control and Prevention.

FALLS AT HOME

Each year, thousands of older Americans fall at home. Many of them are seriously injured, and some are disabled. In 2002, more than 12,800 people over age 65 died and 1.6 million were treated in emergency departments because of falls. Falls are often due to hazards that are easy to overlook but easy to fix. This checklist will help you find and fix those hazards in your home. The checklist asks about hazards found in each room of your home. For each hazard, the checklist tells you how to fix the problem. At the end of the checklist, you’ll find other tips for preventing falls.

FLOORS:

Look at the floor in each room.

Q: When you walk through a room, do you have to walk around furniture? Ask someone to move the furniture so your path is clear.

Q: Do you have throw rugs on the floor? Remove the rugs or use double-sided tape or a non-slip backing so the rugs won’t slip.

Q: Are there papers, books, towels, shoes, magazines, boxes, blankets, or other objects on the floor? Pick up things that are on the floor. Always keep objects off the floor.

Q: Do you have to walk over or around wires or cords (like lamp, telephone, or extension cords)? Coil or tape cords and wires next to the wall so you can’t trip over them. If needed, have an electrician put in another outlet.

STAIRS AND STEPS:

Look at the stairs you use both inside and outside your home.

Q: Are there papers, shoes, books, or other objects on the stairs? Pick up things on the stairs. Always keep objects off stairs.

Q: Are some steps broken or uneven? Fix loose or uneven steps.

Q: Are you missing a light over the stairway? Have an electrician put in an over-head light at the top and bottom of the stairs.

Q: Do you have only one light switch for your stairs (only at the top or at the bottom of the stairs)? Have an electrician put in a light switch at the top and bottom of the stairs. You can get light switches that glow.

Q: Has the stairway light bulb burned out? Have a friend or family member change the light bulb.

Q: Is the carpet on the steps loose or torn? Make sure the carpet is firmly attached to every step, or remove the carpet and attach non-slip rubber treads to the stairs.

Q: Are the handrails loose or broken? Is there a handrail on only one side of the stairs? Fix loose handrails or put in new ones. Make sure handrails are on both sides of the stairs and are as long as the stairs.

KITCHEN:

Look at your kitchen and eating area.

Q: Are the things you use often on high shelves? Move items in your cabinets. Keep things you use often on the lower shelves (about waist level).

Q: Is your step stool unsteady? If you must use a step stool, get one with a bar to hold on to. Never use a chair as a step stool.

BATHROOMS:

Look at all your bathrooms.

Q: Is the tub or shower floor slippery? Put a non-slip rubber mat or self-stick strips on the floor of the tub or shower.

Q: Do you need some support when you get in and out of the tub or up from the toilet? Have a carpenter put grab bars inside the tub and next to the toilet.

BEDROOMS:

Look at all your bedrooms.

Q: Is the light near the bed hard to reach? Place a lamp close to the bed where it’s easy to reach.

Q: Is the path from your bed to the bathroom dark? Put in a night-light so you can see where you’re walking. Some night-lights go on by themselves after dark.

Other Things You Can Do to Prevent Falls

Exercise regularly. Exercise makes you stronger and improves your balance and coordination.

Have your doctor or pharmacist look at all the medicines you take, even over-the-counter medicines. Some medicines can make you sleepy or dizzy.

Have your vision checked at least once a year by an eye doctor. Poor vision can increase your risk of falling.

Get up slowly after you sit or lie down.

Wear shoes both inside and outside the house. Avoid going barefoot or wearing slippers. Improve the lighting in your home.

Put in brighter light bulbs. Florescent bulbs are bright and cost less to use. It’s safest to have uniform lighting in a room. Add lighting to dark areas. Hang lightweight curtains or shades to reduce glare.

Paint a contrasting color on the top edge of all steps so you can see the stairs better. For example, use a light color paint on dark wood.

Other Safety Tips

Keep emergency numbers in large print near each phone.

Put a phone near the floor in case you fall and can’t get up.

Think about wearing an alarm device that will bring help in case you fall and can’t get up.

Mother’s Day has been celebrated in the United States for almost 100 years. In 1914 it was made a national holiday by proclamation of President Woodrow Wilson, and it has been going strong ever since. In terms of greeting card sales, it ranks third in the U.S. behind Christmas and Valentine’s Day. But Mother’s Day means more than a bull-market for greeting cards. It’s a chance to say “thank you” to the woman helped make us who we are. Even those whose mothers have passed can use the day to honor her memory.

For those of us with an older mother, gift giving can be especially challenging. Here are a few Mother’s Day ideas to get your gears turning in advance of Mother’s Day, which is on May 13th this year:

1. Get her a massage or facial from a local spa. There’s nothing like a gentle massage to refresh the aches and pains of an aging body, or a rejuvenating facial to relax and invigorate the skin.

2. Get her a smart-phone and teach her how to use it. This will help you to stay connected and will open up a whole world to her.

3. Get her a locket containing a photo of an important loved one.

4. Have the whole family help make a delicious home-cooked meal for Mom. Make sure she doesn’t have to lift a finger!

5. Take her on an unhurried, carefree Sunday drive. Take in the spring sights of the country, or tour her old neighborhood. Reminisce and have lunch along the way.

6. Create a scrapbook of her life. From her times as a girl to her years as a young mother, photos and keepsakes are a great way to unlock powerful memories.

Deciding the best course of medical treatment for seniors is more complex than for other groups. A key challenge is finding a balance between too much medical intervention, and not enough- making sure that the cure isn’t worse than the illness. Seniors’ medications, pre-existing conditions, and general fragility can mean that side effects that would be bearable in a younger person become life threatening in a senior.

The healthcare community increasingly recognizes that there has been a trend towards over-testing, over-treatment, and over-hospitalization of older people. Despite the best intentions, these practices can have dire consequences. That’s why it’s so critical for older patients, their families, and their physicians to honestly assess risks and benefits when making medical decisions.

Over-Tested
Medical guidelines now recommend fewer screening tests for older people. This doesn’t mean “skip any and all screening”, as there are many essential screening tests. But some tests are now believed to carry more risk than benefit for the elderly. For example, the United States Preventative Services Task Force (USPSTF) no longer recommends routine colon cancer screening for people over 75 because of the risk of infection (among other considerations). The USPSTF also questions the wisdom of mammograms and prostate screening for the very old.

Over-Treated
Aggressive treatments aren’t always ideal. For example, it may be preferable for an 89 year-old with advanced dementia to forego an elective knee replacement surgery that would be recommended to someone much younger. When a potential treatment seems to carry a high risk, it can be worthwhile to explore whether there are viable alternatives that are safer.

Over-Hospitalized
Hospitalization, according to Dr. Morton Creditor of Emory University, often “results in functional decline despite cure or repair of the condition for which the senior was admitted.” For example, Elders who are hospitalized often suffer a dramatic decrease in cognitive abilities. For this reason it may be prudent to consider alternatives to inpatient care whenever appropriate.

Decisions about treatment and care are inherently difficult, and there are rarely clear-cut answers. Ultimately, finding the balance is between patients, families, and physicians. It’s a physician’s responsibility to educate patients and families about risks as well as benefits. Families and patients are wise to carefully and candidly weigh these risks against potential benefits, and to consider not only length of life, but also quality of life, when making healthcare decisions.

A study by the U.S. Department of Health and Human Services says that “people who reach age 65 will likely have a 40 percent chance of entering a nursing home. About 10 percent of the people who enter a nursing home will stay there five years or more. This year, about nine million men and women over the age of 65 will need eldercare. By 2020, 12 million older Americans will need eldercare. Most will be cared for at home; with family and friends as the sole caregivers for 70 percent of the elderly”. Medicare.gov

A new population of seniors and those nearing the senior status are looking for some type of financial means to pay for long term care (eldercare) in case of failing health. Many have taken care of family members who had no means to pay for their care or have seen their parents entire retirement savings wiped out because of medical and nursing home costs.

Does the government Medicare program pay for eldercare costs?

A statement on the Medicare.gov website clarifies what Medicare will pay for.

“Generally, Medicare doesn’t pay for long-term care. Medicare pays only for medically necessary skilled nursing facility or home health care. However, you must meet certain conditions for Medicare to pay for these types of care. Most long-term care is to assist people with support services such as activities of daily living like dressing, bathing, and using the bathroom. Medicare doesn’t pay for this type of care called “custodial care”. Custodial care (non-skilled care) is care that helps you with activities of daily living. It may also include care that most people do for themselves, for example, diabetes monitoring. Some Medicare Advantage Plans (formerly Medicare + Choice) may offer limited skilled nursing facility and home care (skilled care) coverage if the care is medically necessary.”

How does Medicaid cover long term care costs?

Fortunately, there is a government program that will help pay for long term care costs – Medicaid. Unfortunately, this program is unfairly discriminatory and will only pay for care for individuals who have less than $1,500 to $2,000 in assets (and in about 22 states, the program will only cover individuals who fall below a certain income threshold). All other individuals wanting help from Medicaid must impoverish themselves paying for their own eldercare services first, before Medicaid will help them.

Planning for the final years of life and dovetailing government programs, care provider systems and funding sources can be invaluable yet complicated. This area of planning can be one of the most challenging endeavors undertaken by anyone attempting to help seniors in this final phase of life.

The National Care Planning Council has introduced a new long term care planning tool called “Care Resource Planning“. It is impossible to predict what your future eldercare needs will be. You cannot determine in advance if you will need home care, assisted living or even nursing home care, but you can have a plan in place that will provide the financial, legal and family support as well as protecting your assets, no matter what happens.

The goal of Care Resource Planning is to provide strategies and solutions pertaining to any or all of the items outlined below that may be unique to the client’s situation.

1. Understand and Use Eldercare Support Systems

• Objective 1 — Understand the Nature of Eldercare
• Objective 2 — Understand Living Arrangements for Eldercare
• Objective 3 — Understand How to Use the Life Resource Planning Team

2. Identify Sources of Final Years Funding and Services

• Objective 4 — Identify Programs to Increase Income
• Objective 5 — Identify Government Programs to Pay Costs
• Objective 6 — Understand and Use Community Aging Support Services

3. Protect the Estate from Depletion

• Objective 7 — Understand Strategies to Protect Assets
• Objective 8 — Review and Update Legal Arrangements and Insurance
• Objective 9 — Identify Tax Saving Strategies

With the help of a trained professionals who understand all of the issues pertaining to eldercare, a plan can be prepared to protect assets, locate appropriate funding and provide the necessary support to ease the burden for the final years of life.

We recently noticed that people often search the Internet to answer questions like, “Do only blue-eyed people have Alzheimer’s?” A visit to any memory care community will confirm that Alzheimer’s isn’t limited to the blue-eyed. In fact, the genes that influence eye color have not been linked to Alzheimer’s in any way. Let’s explore some other popular beliefs about Alzheimer’s:

“Alzheimer’s only affects the elderly.”
This is a myth. While Alzheimer’s disease is certainly most common among the elderly, it can afflict people as early as in their 30s. When Alzheimer’s develops before age 65, as it does in up to 5 percent of cases, it’s considered “early onset”.

“A healthy diet and exercise can help prevent Alzheimer’s disease.”
This is fact. Studies have shown that certain nutrients are linked to a lowered risk of Alzheimer’s disease. Omega 3 fatty acids, folate and vitamins E, C and B12 are all linked to a lower risk of Alzheimer’s Disease. Polyphenols, which are found in high quantities in red wine, may lower risk too.

Good cardiovascular health has also been connected to a decreased likelihood of developing Alzheimer’s. The National Institute of Health is even preparing a major initiative for 2013 to encourage older adults to keep active so that they can prevent Alzheimer’s and maintain a good quality of life.

“My mom remembers all kinds of things. She can’t possibly have Alzheimer’s!”
This is a myth. Alzheimer’s disease first affects short-term memory, so someone with early to mid-stage Alzheimer’s disease may remember every detail about senior prom but not remember what she ate for breakfast. These remarkably vivid memories of events that occurred decades ago are actually characteristic of the disease. Only in the late stages does long-term memory fade.

“People with Alzheimer’s are oblivious to their symptoms.”
This is a myth. People with Alzheimer’s disease are often the first to know something is amiss. Just as someone with a normal memory may be perturbed by misplacing his keys, someone with early Alzheimer’s may be troubled by his own forgetting. It’s not at all uncommon for people with Alzheimer’s to notice these episodes are becoming too frequent, and to proactively address the topic first with a physician. In later stages of the disease, insight and self-awareness are diminished, but moments of clarity may still occur.

“Aluminum cans, silver dental fillings, aspartame and flu shots cause Alzheimer’s Disease.”
This is a myth. A large body of evidence suggests there’s no correlation between exposure to any of these substances and Alzheimer’s disease. In fact, according to the Alzheimer’s Association, “several mainstream studies link flu shots and other vaccinations to a reduced risk of Alzheimer’s disease.”

If your elder still lives at home or lives in your home, you should pay special attention to making sure that the home is safe. In particular, falls can cause injuries that incapacitate an elder or even lead to death. Falls are the most frequent cause of injury-related death among the elderly. A fall can also result in injuries that prevent an elder from getting around and increase the stress and length of caregiving. About 200,000 hip fractures are due to falls, and less than half of those people return to their prior level of function. Falls lead to a “fear of falling,” which just in itself leads to decreased mobility, stiffness and more falls.

Risk Factors in Falling

Inaccurate Perceptions: Hearing loss, vision problems, mental confusion and decreased feeling in feet can all cause the elder to incorrectly sense the situation;

Medications: Some drugs such as vasodilators, sedatives, anti-hypertensives or pain medicine can have side effects that reduce perceptions or cause dizziness;

Physical Conditions: Disorders and chronic conditions such as arthritis or osteoporosis can make walking or standing up difficult;

Memory Loss/Impaired Judgement: People can forget household hazards that they have lived with for years and impaired judgement can cause people to have unrealistic expectations about their abilities;

Prior Falls: Earlier injuries can lead to stiffness, decreased mobility and more falls;

Diminished Control of Body: Weak muscles and joints that won’t fully bend and straighten interfere with balance. Vertigo, hearing disorders and Parkinson’s Disease may also contribute to poor coordination and balance;

Environmental Hazards: Unstable or rolling furniture; leaning on a table leaf or sink; poor lighting; and no hand rails can cause falls;

Flooring Problems: Scatter rugs, thick plush carpet, uneven surfaces and bathroom rugs can be trip hazards;
Incontinence

Alcohol Use: Drinking alcohol or taking other drugs can impair judgement and disrupt balance;
Underlying Infection

Footwear: Shoes with slippery bottoms, rubber bottoms or heels greater than 1 ½ inches can cause a person to slip, trip or topple over;

Poorly Maintained Equipment: Make sure all wheelchairs or walking aids are sturdy and in a locked position before getting in or out;

Social Isolation: People who live alone are more likely to fall.

Measures to Decrease the Risk of Falling

Remove Environmental Hazards: Remove rugs and furniture on wheels; decrease clutter;

Proper Footwear: Avoid shoes with slippery or rubber sole; avoid too much cushioning which can change perception; laced shoes are better; consider walking shoes with elastic laces;

Obtain Needed Equipment: Install grab bars, raised toilet seats, toilet seat handrails and stair handrails. Make sure the rails are adjusted to the proper height and comfortable to use;
Be sure to use walking aids and keep the aids close to bed;
Obtain proper flooring;

Have a professional review all drugs to identify any potential interactions and side effects; take as few drugs as possible; avoid having multiple physicians order medications without consultations with each other;
Have regular eye and hearing exams;

• Have a daily exercise regimen to keep muscles and joints flexible and moving;
• Have lighting without too much glare or shadows; use night lights; keep stairways well-lit; use higher-wattage bulbs;
• Store items at a convenient height; move frequently used kitchen items to lower shelves and cabinets; if necessary, use a stepladder with extra-wide treads and easy to grab supports;
• Raise dish washers, microwave ovens and clothes dryers a few inches to make it easier to load and unload items;
• Repair holes in carpet;
• Limit or avoid alcohol use;
• Rise slowly after eating or sleeping;
• Use non-skid treads on stairs;

Add non-slip mats or appliques in showers and tubs along with handles and a seat for the shower; Add a handheld shower head on a flexible hose; add water-absorbent floor rugs with rubberized non-skid bottoms; install grab bars that are sturdy enough to support your elder’s weight and make sure they are anchored in wall studs;

• Obtain bells for pets to prevent them for getting underfoot without your awareness;
• Keep nighttime temperatures greater than 65 degrees to prevent joint stiffness and grogginess;
• Know how to get up after a fall.

Adult day centers are an important care option that keep families together and offer quality of life to both the caregiver and their loved one. When an elderly loved one needs additional care or supervision during the day, many families think that they have no choice but to quit their jobs. Others find that their health deteriorates as the stress of round-the clock caregiving prevents them from maintaining their own health. Or, families may think that placement in a facility is their only option.

Adult day services is a day program that supports caregivers in keeping their family members at home. It is a comprehensive program specially tailored for adults who need supervision and assistance during the day. Adult day services centers provide social activities and health care services for adults with physical disabilities and/or cognitive impairments, elders who are frail or may be lonely and need to be with people and participate in activities instead of sitting at home alone. People who attend an adult day services center usually live in their own home or in the home of a family caregiver. Centers are typically open 7am to 6pm Monday through Friday. Adult day services can improve the quality of life for those who attend and help each person function at their best.

Adult Day Services and Funding

Approximately fifty percent of adult day services participants pay privately for the services. Average daily fees range from $40 to $90 and include a wide range of services such as a personal care, therapeutic activities, nursing care, and delicious meals including a light breakfast, hot lunch, and an afternoon snack.

Besides these core services, many centers offer ancillary services, which may include: nursing, physical, speech or occupational therapy, podiatry, psychological services, audiology, oxygen, dentistry, beautician/barber, and massage therapy.

Adult day service centers are also designed to offer family support. They conduct caregiver support groups, offer education on topics such as managing difficult or confusing behaviors and safety in the home, provide counseling, and maintain contacts with community resources.

Elders attending adult day service centers are often eligible for funding from a number of sources including Medicaid-waiver programs, Veteran’s contracts and several Federal Entitlement programs. Guidelines for receiving these funds are different in every state.

Highland Valley Elder Services and Franklin County Home Care Corporation in Hampshire and Franklin County respectfully have funding resources available to families in this area.

Are Adult Day Services For You?

If you answer “yes” to any of the following questions, Adult Day Services will benefit both you and your loved one.

• Do you worry about your loved one’s safety at home while they are alone?
• Do you worry that your loved one is unhappy or bored sitting at home all day?
• Do you worry about the ongoing health of your loved one? Do they need assistance during the day to remember to properly take their medications or to eat healthy meals?
• Do you want help to be able to keep your loved one at home as long as possible?
• Does your loved one seem depressed?
• Does your loved one have no one to talk to?

Here’s what some caregivers and participants have to say about their experience with adult day services.

“When my dad moved in with us due to his inability to live alone, I thought I was going to have to quit my job and stay home to care for him. But adult day has provided a safe, stimulating, and homelike environment. I continue to work and don’t worry about my dad during those hours, thanks to adult day services. And the added benefit is that he has made new friends and loves attending.”
Sandie W.

“Coming to adult day has changed me so much. Before I was in a shell, but now I talk to everybody. My kids say the best thing I could have done is to come to the adult day center.”
Betty H., Age 74

“I felt completely at ease leaving my husband in their care. He looked forward to Monday mornings and was anxious to get back after the weekend.”
Margaret V.