Sunday, January 17, 2010

Keep an Eye on the Family Caregiver - Part II

Keep an Eye on the Family Caregiver – Part II
by Joy Loverde

There are no blueprints in caregiving. Each of us will carve our own path. The following self-assessment questionnaire is meant to help guide you to better choices. If anything else, the answers to these questions and the questions in Keep an Eye on the Family Caregiver – Part III will reveal when it’s time for you to supplement your care plans.

Do you get along with your elders, and have a fair amount of influence over them?

Perhaps at times your sister gets along with Mom better than you do. People outside the family circle or an “authority figure” may be more influential and able to accomplish what you cannot – it might be a doctor, a member of the clergy, a geriatric case manager or an attorney who may be able to step in on your behalf.

Do you live far away?

Be realistic about your ability to handle all of the eldercare details from a distance. Are there some things you simply cannot accomplish from far away? Is it realistic right now for you to pick up and move or ask your elder to do the same? Can you share duties with someone who lives closer?

Are you willing to ask for and accept help?

There is no getting around this one. If you have trouble delegating tasks or accepting help from others, then it’s simply a matter of time before the quality of your own life will begin to crumble.

Do you have strong problem-solving abilities?

Day-to-day eldercare problems are complex, multi-dimensional and sure to challenge the brightest of minds. If your confidence in researching options and making difficult decisions is low, you are better off surrounding yourself with professional advisors and, in some cases, letting geriatric case managers assess the situation and supplement the care and decision-making process.

Are you good at learning new things and taking advice?

Everybody — from health care professionals to the neighbor down the street — will have a strong opinion on how your elder should be cared for. While some of their suggestions may be off target, others may be worth considering. How flexible and open-minded are you? Are you will to make changes in mid-stream?

Sunday, January 10, 2010

Keep an Eye on the Family Caregiver - Part 1

Keep an Eye on the Family Caregiver – Part I

Posted on Jan. 7th, 2010

by Joy Loverde

If I had to create a “Help Wanted” ad as a way to hire a family caregiver, this is how the advertisement would read:

HELP WANTED

Person available and on-call seven days a week, twenty-four hours a day with no days off and little or no financial compensation. Qualifications:

•Can speak medical, insurance, and legalese
•Financial planning and bookkeeping
•Juggle multiple scheduling systems
•Car with valid driver’s license
•Heavy lifting
•Expertise in home maintenance and repairs
•Dietician, meal planning, and chef
•Medication management
•Limitless patience
•Ability to change plans in mid-stream
•Social worker and spiritual director
•Willingness to sacrifice personal time and put career plans on hold
•Can withstand criticism and ongoing feelings of isolation
•Loves surprises
Seasoned family caregivers know all too well about the stresses of eldercare even under the best of circumstances, and family caregiving is not necessarily a short-term commitment. Responsibilities very often last for decades.

If you are not acknowledging how family caregiving may be affecting he quality of your own life, and you do not recognize yourself in the “Help Wanted” ad above, then I beg you to ask people you trust if they think you are taking on way too much by yourself.

Too often, family caregivers have rigid beliefs on who does the care and how it should be implemented. Making hasty statements like, “My mother will never go to a nursing home!” and taking pride in not asking others to pitch in will surely get the best of you.

Unrealistic goals and unhealthy attitudes can sabotage the caregiving process. When we come face-to-face with our own limitations and can’t provide the kind of care we wish we could, we feel it’s our own fault. The truth is we may not be the most qualified person to take on all of the caregiving responsibilities all of the time. Limitations of relationships, time, stamina, and skill dictate how much help we can realistically offer.

Keep an Eye on the Family Caregiver – Part II and Part III will offer a self-assessment questionnaire.

Sunday, January 3, 2010

Leisure Activities Help the Brain Stay Sharp

12/22/2009
Leisure Activities Help the Brain Stay Sharp
By: Tufts University

Keeping your brain busy, even with leisure activities like reading or visiting with friends, may help you stay mentally sharp.

Research has shown that keeping your brain intellectually "active" may provide some protection against Alzheimer's disease. But what about less intellectual pursuits, like taking a walk or visiting with friends? Could they also protect your brain? It's possible, according to a study published recently in the journal Neurology .

While previous studies have found intellectual activities, such as career-related and educational work, to be associated with a lower risk for Alzheimer's disease, few studies have looked at the potential effect of leisurely pursuits on brain health. So researchers in New York set out to do just that. They recruited a group of 1,772 older men and women with no clinical signs of dementia, and asked them how often they participated in any one of 13 leisure activities. The choices ranged from physical activities such as walking and participating in an exercise class, to social activities such as playing cards, listening to music, and going to movies. The researchers then tracked the participants for up to 7 years, noting those who developed dementia during that time.

The results showed that those with a high participation in leisure activities were 38% less likely than others in the study to develop dementia. This effect held even after the researchers factored in other things, like occupation and health limitations, known to affect risk of dementia. The activities most strongly associated with lower risk were walking, visiting with friends, and going to movies or restaurants.

It can't be said for sure why high participation in leisure activities was associated with a lower risk for dementia in this study. The researchers speculate that participating in leisure activities may give people a "reserve" that allows their brain to stay sharp for a longer period of time before symptoms of dementia set in. It's also possible, say the authors, that the constant thought that goes into all kinds of activity, even leisure pursuits, helps the brain to function properly.

It's important to note that low participation in leisure activities may not reflect increased risk of dementia. These people may perhaps have already had the beginnings of dementia, and that impeded their ability to participate in leisure activities.
While further research is needed to confirm and expand upon these results, this study is evidence that living a life rich in both intellectual and leisurely pursuits may be good for both physical and mental well being.

Source
Influence of leisure activity on the incidence of Alzheimer's disease. N. Scarmeas, G. Levy, M-X. Tang, et al., Neurology, 2001, vol. 57, pp. 2236--2242

Tuesday, December 22, 2009

How to Hire a Home Health Aide & Keep Future Medicaid Eligibility

Spotlight on Elder Law: How to Hire a Home Health Aide and Keep Future Medicaid Eligibility

As long term care needs increase, hiring home health aides often becomes necessary. Paying an aide, however, if not done correctly, can cause Medicaid ineligibility years later, after funds run out.

Qualifying for Medicaid requires spending down assets below $2000. Transferring assets may cause Medicaid ineligibility if you do not receive something of equal value back. Medicaid calls this a "penalty". However, and this is key, you must prove to Medicaid that assets transferred are not subject to a penalty. If you pay the aide cash (or check) but don't keep proper records Medicaid will assess a penalty. The aide may be reluctant to give you anything in writing, either because of immigration or income tax issues.

The penalty is calculated by dividing the transferred amount by the average cost of nursing home care. When one applies for Medicaid there is now a 5 year lookback period, meaning Medicaid will look back 5 years from the date of the application to find transfers. They will add together all the transfers made during that time. The penalty will begin when all other assets have been spent down and the individual enters a nursing home and applies for Medicaid.

Let's say Jane hires a home health aide at $700 per week cash, or $3000 per month. She keeps the aide 3 years until her funds run out and now needs round the clock care. A nursing home becomes the only option. She applies for Medicaid but is told, "Sorry, you're not eligible for 16.2 months. You'll have to private pay until then." Of course, Jane has no more money. She'll have to come up with the funds some other way, perhaps from family members. But at $8500 per month or more that may not be possible.

How did Jane get into this mess? Because Medicaid treated her payments to the aide ($108,000) as transfers subject to a penalty. How can you avoid Jane's problem? By keeping records to prove the payments were not gifts, which probably means paying withholding taxes and workers compensation insurance. Another, perhaps better, solution is to hire a home health agency that will supply the aide. Your contract with the agency will satisfy Medicaid that no gift is involved.
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Tune in to Yale Hauptman's monthly audio podcast on elder law issues at www.elderlawtodaypodcast.com.If you're not yet on our mailing list go to http://hauptmanlaw.com/requestinfo.asp to sign up.

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Spotlight on Elder Law is distributed for informational purposes only and does not constitute legal advice. For more information or to receive future mailings contact Yale S. Hauptman at Hauptman & Hauptman, P.C.

Wednesday, December 16, 2009

Time is Not on Your Caregiving Side

Time is not on your caregiving side

by Joy Loverde

If you don’t make good use of your time when you are gathered together as family during this holiday season, you will never ever get that kind of quality time to make plans for the future with your aging parents. In the eldercare world, change happens quickly. If you choose to say and do nothing this time of year, you lose. There is a reason why my book, The Complete Eldercare Planner is over 350 pages long. THERE’S A LOT OF STUFF TO PLAN FOR AND TALK ABOUT right now.

The possibility that your parents may need the family’s help down the road is real. And while it may be difficult to think about the day you hope will never come, doing nothing to plan for family caregiving responsibilities will leave the entire family in even worse shape — emotionally, financially and otherwise.

As a rule, family holiday gatherings are not the ideal time to discuss parent-care issues or to resolve them. Besides, who wants to spoil the festive atmosphere by talking about a potential hotbed of depressing emotional issues such as eldercare? Instead of trying to talk to your parents about their future well being during family holiday visits, try these three tips instead:

1. Before the holiday family visit – pick up the phone and call your siblings. Tell them of any present and future concerns you may have about your parents. Let them know how you feel about the importance of planning ahead should anything happen to Mom or Dad. Make a specific request that when everybody is together in person that they join you in looking and listening for clues that your parents may need help sooner rather than later.

2. During holiday family visits – the most efficient use of physically being together is watching for tell-tale signs that problems may exist. Are your parents walking slower or having difficulty climbing stairs? Are you sensing they are becoming more forgetful? Do you suspect they are having trouble making ends meet financially?

3. After the holidays – Arrange a family meeting – over the phone or in-person, and discuss your observations with your siblings; then make a date to talk with your parents about your concerns.

Thursday, December 10, 2009

Elderly and Depression: How to Understand Depression in the Elderly

11/30/2009 - Articles
Elderly and depression: How to understand Depression in the elderly 1/4
By: Heinz Redwood

Depression in the elderly is very common. It can be triggered by social isolation and the emotional reaction to the loss of loved family members or friends. Depression in the elderly can make them withdraw from all social contact. ‘Depression is perhaps the most frequent cause of emotional suffering in later life’ said Dan G Blazer, Professor of Psychiatry at DukeUniversity. Being socially isolated, particularly after the death of a partner, and co-existing illness may contribute towards depression in elderly. Depression often goes undiagnosed or untreated so it becomes an increasing public health issue in our ageing society. The challenge, then, is more one of managing depression effectively in later life rather than understanding the condition.

How widespread is depression among older people? Recent surveys suggest a prevalence between 1.8% in the over 55s to 15% in those over 85. While depression is actually less prevalent among the old, compared to the young, major depression may be more common. There is also a clear link between chronic disease and depression, with those in nursing homes showing higher rates than those living in the community. But is the link a causal one? We know that illness can cause depression (and vice versa), but we cannot be sure residents of nursing homes are depressed because they are ill or because their care is not sufficiently ‘caring’.

And when it comes to the gender gap, it’s well known that women are more prone to depression in Europe and North America. But a new study from China, covering 2,633 adults, showed that the gender difference is insignificant, save in the 35-49 age group where lifetime prevalence for major depression for men was 3.6% compared to 2.3% for women.

There is also a cultural dimension to elderly depression. A meta-analysis of nine European centres revealed a prevalence of 8.8% in Iceland in the 88-89 age group compared to 23.6% in Munich in the over 85s. And, among the ‘oldest old’ 2% declared ‘life not worth living’ and 3% ‘wish to be dead’ in Iceland, compared to 16% and 25% in Berlin and 30% and 29% in Munich. The researchers wondered if some lingering distress from the Second World War could account for high rates of depression among very elderly Germans.

Causes of depression in the elderly:

Pain, functional limitations, visual impairment, stroke, loneliness, lack of social support, negative life events, and perceived inadequacy of care have all been linked to depression in the elderly. Living alone or being socially isolated is also a risk factor for depression. It is certainly possible that, if personal privacy were very important to the resident, a perceived lack of privacy could contribute to feelings of depression. Browse through HealthandAge's Information for Caregivers for tips on choosing nursing homes/care facilities and recognizing depression in the elderly.

Finally, a number of risk factors for elderly depression have been identified, including medical burden, bereavement, chronic insomnia, cerebrovascular disease, Alzheimer’s disease and Parkinson’s disease.

If you are concerned about Depression in the elderly, you might want to read the following articles:
Menopause and Depression: Myth versus RealityAlcohol and Depression: Is There a Relationship?Depression and Sexual ActivityWhen the Problem is 'Depression'
Source:
adapted from ‘Elderly depression. 1. Its prevalence, causes and implications for society’ Heinz Redwood, August 2009.

Monday, December 7, 2009

Holidays with Alzheimer's Disease

Posted on Dec. 6th, 2009
By Jo Nelson

Holiday time is coming up, and for caregivers of loved ones with Alzheimer’s disease, it can be a very challenging time of the year. Here are some suggestions to help you and your loved one to have a safe and happy season together in spite of the obstacles.

In the midst of putting up decorations, rearranging furniture and putting up Christmas trees, the person with Alzheimer’s will do better in an environment that is as consistent as possible. Try not to move the furniture more than absolutely necessary, and watch for danger spots, like electrical cords or throw rugs that could cause a fall. Don’t have candles burning in places that could easily be brushed up against with clothing. Avoid using blinking lights or decorations that look edible. Use your loved one’s best-loved decorations to spark memories and increase their ability to enjoy the festivities. Play familiar Christmas songs, and fix traditional foods that they will enjoy.

Have young children play in a separate room to keep noise levels down and avoid causing your loved one to feel panicked or agitated. Alzheimer’s patients pick up on the moods of others around them, and the atmosphere needs to feel serene and peaceful for them to enjoy visitors. Have just a few guests at one time, and avoid large crowds of people. Name tags are very helpful and will keep your loved one from feeling frustrated and embarrassed when they can’t remember people they should know. Have a quiet room that the Alzheimer patient is accustomed to in case they feel overwhelmed by too much noisy activity. If you notice signs of increased confusion or agitation, assist them to their quiet place to rest for a while.

Christmas stories from years gone by will help draw your loved one in and keep them involved in the celebration. It’s much easier for people with Alzheimer’s Disease to remember things that happened long ago than something that happened yesterday, so reminisce!

Try simple tasks to occupy the time, like frosting cookies, stamping envelopes for cards, or making simple ornaments. Look at catalogs together and help your special one to order gifts for people they care about. Take time to look at photo albums and talk about happy holiday times together. This could be just what they need to reconnect and appreciate the holidays, creating more memories that you will hold dear for years to come.

Jo Nelson, RN is the owner of Servant’s Heart Homemaker Services, a personal care assistance company located in North Central Indiana.
Article Source: http://EzineArticles.com/?expert=Jo_Nelson