Aging Wisely

Concerns About Aging Parents: Why Won't They Listen to Me???

2010-10-11T13:38:00.000-07:00

We often hear from adult children of aging parents who are worried about Mom or Dad, but struggle with how to approach the subject...or have tried with little success. The approach and the way things are presented can make all the difference in the outcome. Here are some pointers:

 Think about the person’s perspective and take time to listen to their concerns, thoughts and questions.
 Don’t push—sometimes it is better to drop the subject and let your relative process the information and come to some conclusions on his/her own.
 Be aware of differing communication styles, which often have an age and/or generational basis. You may want action and lose patience with styles you view as rambling, indecisive,and repetitive. Pick appropriate time and place for discussions and set aside time. Realize how your own emotions may be impacting the conversation and increasing resistance.
 Enlist the help of a professional geriatric care manager, trusted advisor, or other family members. Sometimes a different approach, differences in relationships (or the neutrality of not having a personal stake) makes a difference.
 Attempt to talk about proactive changes prior to crisis, with a focus on maintaining independence and choice. However, when a crisis occurs, use the opportunity to introduce necessary changes (i.e. this may be time for a “respite” or “rehab” stay at a care facility which perhaps will lead to an easier transition).
 Prioritize and rethink what you feel are “necessary” changes. Perhaps there is a compromise that can be reached that doesn’t compromise your loved one’s safety.
 Act as a facilitator. How can you help your loved one? Have your listened to them and looked for options that may better suit their desires? What are their objections and values underlying their choices?
 Talk to an expert when Alzheimer’s or other forms of dementia are involved. Memory disorders may change the needs, and mean your loved one is less able to logically process choices and make safe decisions, but it can be hard to draw these lines.
 Know what resources to turn to, particularly if your loved one becomes a danger to themselves or others. Visit www.eldercare.gov for local agencies and 1-800ABUSE in Florida for elder abuse or neglect reports.

We invite you to read more on our website, including books we recommend to help you better prepare for eldercare issues, addressing caregiving concerns with aging parents and resources to assist your family.

New Medicare Assistance Available to Help Retirees

2010-09-27T11:28:00.000-07:00

In 2010, there were about 1500 stand alone (private drug plans, Part D) in the Medicare program. Average nationwide premiums for 2010 are about $38/month. However, in Florida there are Medicare Advantage plans that include drug costs for as little as $0/month and a range of options for receiving coverage, from standard Medicare with a stand alone drug plan, to Medicare Advantage (bundled services provided through insurance companies instead of standard Medicare), or dual eligibility such as Medicare/Medicaid, VA, and private employer/retiree plans.

As healthcare costs across the board continue to increase and as we each more carefully analyze how we will fund our longevity, healthcare coverage during retirement is a key component.

Aging Wisely offers a new service to help retirees and families with these important decisions:
New Medicare Assistance Available to Help Retirees

We also invite you to download our Medicare Fact Sheet for 2010.

Aging Wisely Care Manager Chosen as Finalist in National Healthcare Awards

2010-09-24T09:03:00.000-07:00

Aging Wisely, LLC, is proud to announce that Julie Scott, Geriatric Care Manager, has been chosen as a national finalist in the Dorland Health People Awards.

Dorland Health, an influential healthcare publishing and educational organization, offers this description: “The Dorland Health People Awards set the benchmark for outstanding patient care and systems delivery achieved across the diverse healthcare team…the Awards honor the diligent, the influential—in short, the special—practitioners who coordinate and provide care.” The finalists will be honored at a banquet on October 4th at the National Press Club in Washington, D.C.

“Julie has worked as a Professional Geriatric Care Manager for Aging Wisely for 9 years and has had a tremendous impact on clients, families, our internal team/colleagues and the other professionals we see as part of our team,” states Linda Chamberlain, President of Aging Wisely, LLC. “We receive many thankful letters from families that Julie helps, but we also see the ways she uses her creativity, knowledge and leadership to help strengthen our team and processes.”

In addition to her work with older adults and their families, Julie specializes in care management for clients with special needs, Alzheimer’s client and family support and comprehensive assessments for complex cases and legal matters. Julie recently led the development of a new Medicare Analysis program. Last year, she contributed to a chapter on disaster preparedness in a textbook widely used by the geriatric care management profession. Click to view Julie Scott’s bio.

'News from Aging Wisely'

2010-08-03T08:22:00.000-07:00

'News from Aging Wisely'

Tips for Being a Good Medical Advocate

2010-07-30T12:54:00.000-07:00

Whether caring for an aging parent or helping a friend or spouse facing a diagnosis and treatment options, everyone needs an advocate at times. When any person is facing a diagnosis, surgery, or hospitalization, having such an advocate can be invaluable. Even if you are very savvy, there is a lot to absorb and consider in these situations. Here are some tips for you to be a good advocate:

1. Help gather important information. Help your loved one organize their medical records, health history and important documents (advance directives, insurance information).

2. If your loved one has not completed advance healthcare directives and decision making paperwork, encourage them to do so (including Durable Power of Attorney, Healthcare Surrogate/Power of Attorney, Living Will).

3. Help in preparation for the appointment, procedure, hospitalization (as feasible). Prepare purpose of the visit, symptoms, concerns, list of questions. For procedures or treatments, find out what to expect and ask questions. How long will you be there? What do you need to bring? Will the patient need a ride home? Will they need aftercare? While many people don’t need formal aftercare, consider the challenges one ofte faces after a surgery or hospital stay. Often, you can drive the patient home and get them settled, but it may be easier to have additional help as you may need to pick up prescriptions or may not be able to help if the patient is very weak or ill.

4. After an appointment, use your notes to review what was discussed and consider next steps/pros and cons, for example regarding treatment options. It is important to help the patient think through things in a less rushed/stressful manner, when possible. If you are making decisions on behalf of a loved one who cannot do so any longer, have an advocate for yourself…someone you can talk things through with. Sometimes an outside party is best for this and can help you think through all the ramifications, and gain a clearer picture.

5. Help your loved one ascertain second opinions when needed. However, bogging someone down with a lot of information (or misinformation) from the internet, for example, can be less than helpful. It is most helpful to identify the most expert resources and assist in clarifying information and making a comfortable decision feeling informed, not overwhelmed.

6. Review this NY Times article about 6 questions to ask for elderly patients being hospitalized. If you cannot be with your loved one at the hospital or emergency room, it is a good idea to get a friend, relative or geriatric care manager to be there. This is not only for your loved one’s well being, but to ensure the hospital staff gets the accurate information they need to do the best job. http://well.blogs.nytimes.com/2010/06/24/six-questions-to-protect-elderly-patients/?emc=eta1

Visit www.agingwisely.com for more information on healthcare advocacy services and ways you can prepare yourself or your loved one to take on your health needs head on.

Driving Safety & the Elderly

2010-07-02T08:28:00.000-07:00

Every time I speak about this topic with people, they nod their heads knowingly and tell me a story about an older relative or client and their concerns...and usually the stress over trying to convince them it was time to stop driving. Here is a good article from the Mayo Clinic on this topic:
http://bit.ly/ahuY2O

We also have a handout which helps families consider how to approach this issue, and provides some resources to help: www.agingwisely.com .

It is important when you approach this issue with a loved one to consider how you are going to help your loved one maintain their life--so that taking away the car keys is not the end of life as they know it. Most areas of our country, unfortunately, don't have readily accessible, convenient public transportation systems--so if you don't live in an urban area, you'll probably have to search out options. Some aging services organizations offer transportation, particularly for medical needs. Most bus systems have an application process for individuals who cannot navigate the bus system due to disability, where there is access to either van or cab service at special rates. And, hiring private driving services is often more affordable than one might think. When you consider the average cost of operating a vehicle is about $600/month (per the Dept. of Labor Bureau of Statistics), that buys you a great deal of time/services. Most local private duty home care companies can provide these services. Check all of this out before you approach this issue...have a plan and options...

Long Distance Caregiving

2010-06-08T08:34:00.000-07:00

If you are caring for a loved one from a distance, it can leave a scary feeling in the pit of your stomach--especially when the phone rings...

I hear many family members talk about "the call"--when they were suspicious Mom or Dad wasn't doing so well (or maybe they really were doing quite well), but were hoping for the best...and it all changes when you receive that dreaded call that he or she has fallen, is in the hospital, etc.

Here's a couple good articles to review on the subject:

http://www.agingwisely.com/what-happens-when-moms-neighbors-head-north-for-the-summer/

http://networkedblogs.com/4Axly

Family Conflicts in Elder Care

2010-05-17T11:55:00.001-07:00

Sibling rivalry, family dynamics...in some families we laugh about these things and share funny stories from youth, but in others there is a lot of deep seated anger and hurt. For other families, anger and hurt come out when highly charged issues arise. Perhaps you are not that close to your siblings, but now find yourselves thrown together at Dad's hospital bedside, forced to make tough decisions together. Or, maybe you were once very close to your Mom but have become distant since she remarried and you don't get along with her new husband.

The decisions that need to be made towards the end of life can be tough enough--fighting over them with family members can be heartwrenching. And, if you're the one who Mom or Dad has chosen to help them (with finances, healthcare decisions) and you have a "disgruntled" sibling, it is not unusual nowadays to find yourself in the middle of a legal battle (for example, over guardianship, or later estate litigation).

Here are a couple things to think about:
1. We're big proponents of planning ahead--for all of us as we age, having conversations about what we want and completing the proper legal documents (healthcare power of attorney/surrogate, Durable Power of Attorney, Living Will, estate planning docs).

2. Consider family mediation if conflicts or concerns arise. Consider working with a professional care manager who can lead discussions, coach family members through challenges and act as a liaison to different parties. As well, a professional opinion and assessment often helps everyone see things more clearly.

3. Consider a family or care agreement/putting wishes in writing. This may help everyone be clear about my wishes and how I wish money to be spent for my care, even if it is more guidance than an official document. Meet with a professional to discuss how to do this, or to do a family consultation/meeting early on to lay out your desires and create a plan(for example, my husband and I could say we wish to use all our assets-as need be-to remain in our own home and we acknowledge we have purchased long term care insurance but may also need to use our assets and wish to exhaust those before considering a care facility--or--if I am alone, I wish for my family to help locate a good care facility for me, I prefer to be moved to be near my oldest son and suggest the family seek professional help finding the place that is best for me). A professional care manager can also answer your questions about what is available and realistic as you talk about these issues.

4. Know your family and plan accordingly. Consider things like the value of a professional trustee or other professional advisor being on board.

Health Reform: What Changes Are in Store for the Elderly? - ElderLawAnswers Articles

2010-05-06T07:24:00.000-07:00

Health Reform: What Changes Are in Store for the Elderly? - ElderLawAnswers Articles

Florida Boomer Lifestyle Conference: Inspiring!

2010-04-16T09:49:00.000-07:00

Yesterday was an action-packed day at Ruth Eckerd Hall, with hundreds of people coming together to explore the trends and opportunities around the Boomer generation--everything from Boomer reinvention (especially given the impacts of the recession), The Boomer Economy, Florida's Boomers, Boomer Trends and Caregiving. The day started with a great report from Schwartz Consulting (http://www.schwartzconsulting.com/) with their latest research on Florida's Boomers. Timely information and a great snapshot...not just old, stale data. A lively presentation about Boomer Men followed, given by the creative, energetic Brent Green, author of Marketing to Leading Edge Baby Boomers. Mark Miller (author, The Hard Times Guide to Retirement Security and President of 50+Digital) and Roger Chiocchi (author, Baby Boomer Bust? How the Generation of Promise Became the Generation of Panic) did a great job reflecting on the generation's struggles during the recession--looking back and looking forward.

Some of the other highlights: Laurie Orlov's trend report on aging in place technologies. I hope her visions for where we can be come to fruition at the fast pace that technology in general is moving. Check out Laurie's great Aging in Place Technology Watch blog. Lots of good presentations re: technology including Bernie Borges (Find and Convert) and Jody Haneke (Haneke Design)'s great discussion re: social media and mobile apps. I had no idea almost 1/2 the U.S. population is on Facebook! And, for a social media, viral marketing success story...who hasn't seen "Will it Blend?"--if you haven't and your an iphone or ipad fan, you may want to think twice about watching:-)

We had great audience interaction at our session about multigenerational family trends. It was an honor to be on the panel with Alex Chamberlain, Executive Director of Easy Living and Jack Levine, Founder of 4Generations Institute. We could have talked for hours about all the trends and needs of family caregivers and the multigenerational (many with 4 generations now!) family. Aging Wisely and Easy Living plan to continue striving to meet those needs and finding ways to innovate. With individuals like Linda Chamberlain, Jack Levine and Sallie Parks advocating for elders and the families who care for them, we're sure to see positive strides.

Check out the conference webpage for all the great speakers, sponsors, and press releases: http://www.floridaboomerlifestyle.com/.

Controlling Your Healthcare Destiny

2010-03-30T11:29:00.000-07:00

April 16th: National Healthcare Decisions Day (www.nationalhealthcaredecisionsday.org).

Putting aside the heated discussions and implications around healthcare reform...if you want to have some control over the way you are cared for, especially at the end of life, you should consider advanced care planning. Our laws allow us to put our wishes in writing through advance directives, and one of the most important pieces of that puzzle is appointing a healthcare surrogate (sometimes called Healthcare POA or proxy) to make decisions on our behalf if we are unable. Although there's been some progress in the number of people completing advance directives, still only about 1/3 of elders have these documents.

And...even those who have completed the documents often neglect to talk to their family/healthcare surrogate and doctor about what they want. We find time and time again, individuals have gone down a path they would not have intended, or start to ask why they are completing certain tests and procedures. It can be hard to take a step back, especially in the middle of a crisis, and consider desires, goals/expected outcomes and options.

Reflect on these things as we approach National Healthcare Decisions Day and consider putting your wishes in writing if you have not already done so. Talk to your family, especially if you are facing a new diagnosis or chronic illness. Consider talking to a professional care manager (healthcare advocate) as you face decisions...whether for yourself or when acting as your loved one's surrogate. See: http://www.agingwisely.com/advocacy/ for more info.

The American Bar Association offers a Proxy Quiz, which is an interesting exercise in what you would want, and what your proxy perceives you would want...great starting point for a discussion...

Medicare Out of Pocket Costs: Plan Ahead

2010-03-08T08:28:00.000-08:00

There was recently a NY Times blog post (http://economix.blogs.nytimes.com/2010/03/02/getting-old-is-expensive/) regarding a subject I have covered for many years in presentations regarding Medicare, Aging Wisely and planning ahead--the cost of healthcare in later years. Very few people think about this stuff ahead of time...why would you? We're all busy dealing with our current health insurance, employment, etc. So, people generally know Medicare exists (and often seem to have the impression it will take care of everything with little/no cost) but rarely understand all of it's working parts, costs, etc.

As this article quotes as recent study and has been shown in studies for a # of years, out of pocket/uncovered costs from 65 til death usually rank in the $250,000 range. Check out our Medicare 2010 Fact Sheet for some info. on the many premiums, copays and deductibles of the various parts of Medicare for the primary costs: http://www.agingwisely.com/2010-medicare-fact-sheet/. Still, as one person pointed out in response to the NY Times blog, when you consider similar costs for employer based insurance, this may not be such a bad deal or the horrific figure it is made out to be. I just worry that people don't factor it in to their retirement planning or get much education about Medicare prior to the need. I always get a lot of great questions when doing my "Medicare 101" presentations or when we do a consultation with someone as they plan to retire...just wish more people would get that type of info. This should be an absolute part of anyone's retirement planning process.

Early Onset Alzheimer's Disease and Social Security Benefits

2010-02-18T12:02:00.000-08:00

Social Security Administration (SSA) has added early-onset/younger onset Alzheimer's to the list of conditions under its Compassionate Allowance Initiative, giving those with the disease expedited access to Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). This is potentially great news for individuals and families devastated by such a touch diagnosis. The Alzheimer's Association played a key role in advocating for this change and has information about what it means and other important checklists and information for families on their site and the specific link below:

http://www.alz.org/living_with_alzheimers_social_security_disability.asp?type=homepage

Also, visit Aging Wisely's page about Alzheimer's and Dementia support: http://www.agingwisely.com/alzheimers-and-dementia-support/ and assistance with benefits such as Social Security Disability, Veteran's benefits, Medicaid, Medicare and community services.

Caregivers headed to Tallahassee with message for lawmakers: Stop cutting - OrlandoSentinel.com

2010-02-03T07:39:00.001-08:00

Caregivers headed to Tallahassee with message for lawmakers: Stop cutting - OrlandoSentinel.com

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Holidays a Good Time to Check In With Aging Loved Ones

2009-12-23T11:16:00.001-08:00

When families visit with older relatives for the holidays, especially those normally geographically separated, might notice some things that cause concern. Check out this article for a list of warning signs: http://www.caremanager.org/displaycommon.cfm?an=1&subarticlenbr=243 and consider talking to a professional geriatric care manager about your concerns. We do consultations with families this time of year, often discussing what concerns they have, what options might be available to help, how to approach their loved ones, or how to get them to accept help without causing friction and allowing the person to maintain a sense of independence.

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2009-12-15T07:37:00.000-08:00

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Medicare Hospital Readmissions: A Major, Costly Problem

2009-12-10T06:56:00.000-08:00

Nearly 20 percent of hospitalizations of Medicare beneficiaries result in the readmission of patients within 30 days of leaving the hospital. This costs the Medicare program an annual $15 billion, according to the Medicare Payment Advisory Commission, or Medpac.

This is an area of focus in looking to reduce unnecessary costs in the Medicare program. To reach cost saving objectives, hospitals with high rates of readmission will be paid less if patients are readmitted to the hospital within 30 days of discharge.

To study this issue and initiate some solutions, the John A. Hartford Foundation provided a $1.4 million grant to the Society of Hospital Medicine, a national organization representing hospitalists and the practice of hospital medicine. Boost, Better Outcomes for Older adults through Safe Transitions, focuses on one main goal of improving the care of patients as they transition from the hospital to the home. Six hospitals began the project’s pilot program in September 2008, and the other 24, including Rush, joined in March after completing an application process proving adequate resources to support the program. Our local Morton Plant Hospital is one of the hospitals participating in this program. It is commendable to see those efforts being made, and very important in an area with a large senior population (and one of the fastest growing 85 and older populations), many of whom are geographically separated from family supports.

Many elderly patients seen in the hospital have a multitude of factors impacting their health and safety upon return home. Some readmissions will always occur, but perhaps this program will help identify some simple steps that can remedy gaps. For example, note this quote: “The most concerning fact of this study was that these patients who were rehospitalized, half of them never saw a doctor in the outpatient setting after the initial hospitalization,” said Dr. Williams, who mentors hospitals involved in Project Boost. Most of the experts involved agree care coordination is the missing link, which would enhance follow up and communication.

As a community based care coordination program that has been working with thousands of clients since 1998, we see the importance of this communication and resource allocation. Many times it is the "little things" in the process of discharge and time following hospitalization that can make all the difference. From transportation and meal services to ensuring someone has a full understanding of medication changes (and a way to get those medications) to some additional support or care while regaining strength for a few days, it often does not take a great amount of resources to enhance patient safety and well being. The disconnect between providers is a real issue. Imagine a confused (whether due to memory loss or medical issues) patient arriving at the hospital alone...with little history to report and no one to explain the person's past and current situation, let alone an idea of prior medications, diagnoses and supports. There is often a disconnect both going in to the hospital and coming back out, but also with coordination between community-based providers. I shudder to think of it every time I am there as care manager with a client, providing all that information...knowing the person in the next room may be that one who is alone.

Efforts to address this problem must be supported. We are talking with local providers and figuring out some ways to pull together to address these issues in our community. We have great medical and eldercare/aging resources in our community so we should really be able to have an impact...often it's only a matter of bringing these resources together and coming up with creative solutions. A number of years ago we did something similar with Falls Prevention, as a result of a discussion between Aging Wisely and EMS/Sunstar Ambulance. That coalition has done a # of innovative things and brought together parties that often had no collaboration prior.

As individuals, we can address this issue through advocacy for our loved ones and awareness of the process and gaps. Until we find ourselves in these situations, most of us have no idea how these systems work (and why would we?). Most patients and families are surprised by some aspect of what is available or not, what insurance provides, or what the processes are.

We recently did an article on the Top 10 surprises in healthcare and eldercare, and can email that to anyone interested in learning more (visit us at www.agingwisely.com). Let us know what you think--what would help? What do you find frustrating either as a care provider or family member? What do you think the major problems and gaps are? Tell us about your good and bad experiences...

Worried about healthcare reform? Get the latest facts on Medicare

2009-11-12T07:19:00.001-08:00

There is a lot of uncertainty for everyone about healthcare these days and much of what will happen remains to be seen. The one given is that everyone needs to pay close attention to their options and coverage, now and as changes occur in our system. There has been much said about the financial devastation of healthcare crises for individuals who are uninsured or underinsured. Even when people feel they are well covered, costs can be staggering. Hopefully any reform will help to address some of the gaps...most everyone agrees that is needed, but how to do it?? The million dollar question (billion....trillion??)...

In the meantime, our work focuses primarily on clients in their Medicare years (whether 65+ or disabled) so we await what impacts will be on that program. But, no matter what, it is important for all insured persons to understand what they have, potential costs and gaps, and to carefully review coverages and bills. So...for our Medicare recipients, we have provided our annual "Medicare Fact Sheet" for 2010 (http://www.agingwisely.com/2010-medicare-fact-sheet/) which provides all the latest copays, deductibles, and premiums plus a valuable summary about the various "parts" of Medicare and things to keep in mind.

It is important to keep in mind that the average Medicare recipient spends more than $250,000 out of pocket while covered (from eligibility to death)...like most insurance, health insurance doesn't cover everything at 100%. We all bear the responsibility of understanding our coverages. However, that can be extremely confusing especially when it comes to Medicare because it has so many moving parts & options and often as people age, they have a myriad of health concerns. The good news is there is help...Medicare has great info. on their website, each state provides volunteer counselors (SHIP or SHINE programs, available through the Area Agency on Aging/state agencies), and consultations with experts like my colleagues at Aging Wisely (who do not sell any insurance). As family members with aging loved ones, we must be advocates for our family members and help them get the right information. If you don't feel comfortable navigating this, get help from the experts.

Here's a couple good places to get some education:

www.medicare.gov (Plan Compare tools, Medicare and You 2010, review your Medicare drug plan options from 11/15-12/31 open enrollment)

www.medicareadvocacy.org

http://www.agingwisely.com/category/payment-concerns/ Information on paying for long term care, Medicare, Medicaid

Medicare 2010

2009-10-23T06:26:00.000-07:00

As 11/15 gets close, it's time for open enrollment for Medicare prescription drug plans. The new #s and information for 2010 just came out as well. I'm doing a # of talks coming up to give people the "scoop" on all of this. In my talk last week, not surprisingly, there were lots of questions and confusion but hopefully we gave people some clarity about all the working parts of Medicare, what one has to do when turning 65 or retiring, and options. For upcoming talks check out the schedule:

http://theseniorresourcecouncil.com

Tampa Bay Healthcare Heroes Nomination

2009-09-04T12:20:00.001-07:00

Congratulations to our team for being chosen as one of the finalists in the Tampa Bay Business Journal's 2009 Healthcare Heroes awards. We are proud to be amongst great company and appreciate being nominated and being able to share the story of geriatric care management and the ways we work toward improved care for our clients.

Winners will be awarded at a celebration on 10/1/09.

Link to the story:
http://www.bizjournals.com/tampabay/stories/2009/08/31/daily44.html

Electronic Medical Records

2009-08-06T08:52:00.000-07:00

EMRs, EHRs...have been all the buzz in the healthcare world for a while now, as well as a regular part of the conversation about healthcare reform--though it gets much less press than the divisive hot button issues. Like everything in health care, personal issues and concerns make it hard to come to good solutions. And, like much with health care, until you have a problem or encounter with "the system" most people don't think or care much about it. Then, when you are at the E.R. and can't recall you last surgery date or name of that medication you take...it hits you what all the buzz is about.

A lot of individual doctors, hospital systems, etc. are ramping up their technology and have gone electronic. One of our local hospital systems even uses a "hand scan" to identify patients and pull up their records. However, because there is no centralized, unified system, the issue really hasn't been addressed comprehensively. We're all so mobile now that only something universal/web based really solves this issue. But, there are of course the usual confidentiality and privacy concerns, and the logistics of making it all work together. And as healthcare is currently delivered, it is a pretty fragmented system (just spend some time talking to a doctor's office about billing and dealing with 100s of different insurers, Medicare, Medicaid, Worker's Comp, "cash" patients...), adding to the challenge. Not that I'm suggesting we should have one unified system of healthcare (don't want to start that firestorm here--that's enough for many entire blogs and there are plenty out there arguing and addressing that issue), but as that discussion continues, this particular issue is clearly part of the picture.

Even though I live and breathe it every day in the work we do, it does take the personal experience to really drive this home. As I prepared for summer travels a while back, it really hit me. We create these great secure, web based records for our clients, and I don't have one for me! Our clients and their representatives (usually us and maybe their primary caregiver/healthcare surrogate) have easy access to all their information--no more guessing on those surgery dates or trying to recall that medicine. And, wow, my healthcare surrogate paperwork is right here to print out no matter where I end up in the hospital--even if its across the pond. True continuity of care!

The program we use, Life Ledger, is very robust since it was created by people in our field who deal with these issues daily...so it includes "Discontinued Meds" so that you have good background when working with doctors on new medications, what hasn't worked in the past, etc. And, it has room for "non health" stuff that is often key, like funeral plans, who to contact in different situations, and who are my key advisors, such as my attorney and financial planner. I'm working on learning more about the products by Microsoft and Google and seeing what other systems are out there too. There isn't one that's perfect yet, but the way technology moves, it could happen tomorrow. Implementing anything system wide...well, that's a different story. So, for now, I'll create my own and continue to do so for our clients so that we're ahead of the game and not waiting on that to happen...

"Experiencing" Aging

2009-08-04T10:13:00.000-07:00

I recently attended a "Virtual Dementia" experience, created to simulate what life might be like for a person with dementia. It sounds strange to say I highly recommend it, but I really do. It really provides a greater awareness, even though one can never truly mimic what an individual may experience. This session was similar to an experience I provide to my eldercare students and occasional professional trainings. It is an "aging simulation" kit which mimics conditions like glaucoma, macular degeneration, hearing loss, stroke, and arthritis through a series of hands on activities.

This dementia experience really combined all of those sensory deprivations to create a sense of confusion and fear, while giving you the pressure of completing tasks and having somoene else in the room with you, so that all your fears were heightened. Of course, many people with dementia do not have all or any of those particular sensory issues or conditions, but the overall feelings seemed likely to mimic how people must feel. And, how it feels to have someone tell you to complete a number of complex (things we think are simple, but really involved much complex processing) tasks and feel completely overwhelmed and frustrated by this. I recall feeling frustrated that I was not the capable person I identify myself to be. Another participant, said "I just wanted to lie on the bed and curl up in a little ball and go to sleep". Others expressed "paranoia", thinking the other person was playing a trick on them, as is often expressed by people with dementia. Everyone felt very disoriented and somewhat fearful. I noticed I startled very easily and yearned for a friendly face. We all could imagine how nice it would have been to have someone come and comfort and guide us gently through the situation.

Interestingly, like persons with dementia, we all had slightly different experiences and reactions. We each brought our own history, experiences, strengths and weaknesses to the moment.

For professionals, family caregivers, and anyone these types of exercises are so useful. Too often, I encounter professionals, even those who regularly work with seniors, who forget the basics of sensitivity and empathy (and I'm sure I'm not perfect either, especially on a rough day). I recall doctor visits where the doctor spoke to me and virtually ignored the patient/client, until I prompted otherwise. Other times, I've seen people raise their voice to no avail with someone hard of hearing or assume the person has dementia when they are suffering from hearing loss or aphasia. The sensitivity exercises are good reminders for those of us with the training and background as well.

During this exercise (while waiting on each other to go through it) we also watched a very well done video about a lady with Alzheimer's Disease and her daughter. It fit well with the exercise because she talked about her frustrations and realizations as she learned more about the disease and her Mom's experience of it. She tried various techniques to deal with her Mom's constant phone calls and obsessions over certain issues, until she realized many of the things she was doing were only exacerbating the situation. She was surprised at the peace her Mom felt when she was in an environment designed specifically for dementia. She learned to let go of some of the expectations and preconceptions she had. She realized at one point her Mom was truly a person living absolutely "in the moment".

If you ever have a chance to participate in one of these experiential exercises, do so. There are some resources on the web to put together your own "aging sensitivity" kit as well.

The "Boom" of Caregiving

2009-05-29T09:48:00.001-07:00

I attended and exhibited at a recent "Florida Boomer Lifestyles" conference, geared towards businesses serving (or wanting to) serve Baby Boomers. Author Gail Sheehy did a great presentation about her personal experience caring for her ill husband, and the "predictable crisis of midlife" that is caregiving. See a recent article on Gail and her upcoming book on caregiving: http://www.tampabay.com/news/aging/lifetimes/article1003921.ece. Gail, the author of the widely read Passages will I am sure do a great job covering this important topic and key "passage" of midlife.

My other favorite book on this topic is Mothering Mother by Carol O'Dell. I especially like it because there are many "educational" caregiving books, but so few that tell the stories. Her book is told in a conversational tone with humor and personality. You will definitely laugh out loud and that is the medicine most caregivers could really use. She has great insights too for those of us who work with family caregivers, reminding us of what a caregiver may be feeling and going through and how to make it easier, not more difficult.

Hurricane Preparedness for the Elderly and Disabled

2009-05-05T10:12:00.000-07:00

As hurricane season nears, we at Aging Wisely begin preparing our clients for potential storms. We do a thorough review--if they are at home we make sure they are stocked up on supplies, make evacuation plans including alternative arrangements other than emergency shelters, assess their ability to self preserve in various level storms, and more. If they live in a care facility, we carefully review the facility's plans and sometimes bolster our clients with additional supplies, etc.

If you have an elderly parent, a disabled friend, or are yourself experiencing chronic illness or dependent on medical care or technology...here is some food for thought when thinking about the upcoming season:

Do you realize emergency shelters (and special needs shelters) are the last resort option for evacuating? Shelters can only handle small % of residents, and individuals needing care or assistance are not really appropriate for shelters.

Do you know pet shelters are extremely limited in our area? Have you made arrangements for your pets, and stocked up supplies for them as well?

Would your elderly client or loved one be comfortable sleeping on a cot with hundreds of strangers nearby? Would he be able to take care of himself at home, if without electricity or services for ten days or more?

Is your friend who requires Oxygen or nebulizer treatments registered with the power company? Do they understand this does not guarantee power but helps companies prioritize?

Do you know the details of how your client's assisted living deals with evacuation? How will they let you know what is happening? If they are in a non. evac zone what is their plan for other potential natural or manmade disasters? What do their generators power? Will they take in other residents/serve as an evac. site for other facilities?

Do you feel your loved one would be safe remaining at home, even during minor storms or disruptions (do they rely on services like Meals on Wheels, caregivers, transportation?; are they mildly confused?, do they have multiple medical conditions?)?

These are some questions to get you thinking about vulnerability during storms and other disasters. I will blog later on some resources, things to do to prepare, and how we help clients who are elderly or disabled to ensure the best possible plan in face of danger.

See also our disaster prep. info: http://www.agingwisely.com/successful-disaster-preparedness/

Medicare Quandaries

2009-03-31T10:16:00.000-07:00

I have been talking to a lot of people lately about Medicare and understanding all of it's moving parts. Just recently, we were contacted by a very savvy gentleman who was encountering all kinds of difficulties finding physicians that would accept his plan. He had signed up for a new plan (Medicare Advantage) last year and didn't realize this would be an issues until he started needing specialists (and even his PCP didn't want to accept the fees paid under this plan). He was realizing that in an effort to save a few bucks, he was now getting what he paid for. Each person's situation is different, but he really did not need the monthly savings he was getting-he easily could have continued on with his prior choices but of course, the cost savings always sounds good. But, now he was facing real access to care issues. This happens all too often. It is hard to understand all the ins and outs and most of us get a big headache reading through all that stuff, so we don't dig deep--or we trust someone selling us something to give us all the details.

We talk to more and more people that realize this and want some advice, especially when nearing retirement and looking in to all of this for the first time. As each person examines certain questions, different solutions will arise--what is their income and financial picture, what is offered through employer or retirement plan, what is their health situation (and perhaps family history), what are the medical resources in their community (and how accessible will these be with different options), how much security or risk do they want? And, of course, as a person's situation changes, they need to reexamine their choices during enrollment periods. What is right for me as a robust, healthy 65 year old may certainly change as I age and experience chronic health issues.

Some resources to check out, include:
www.medicare.gov
www.medicareadvocacy.org
www.agingwisely.com (updated Medicare fact sheet each year, articles on Medicare, Medicaid, etc.)

Aging Wisely, LLC offers consulting services for these and other medical, insurance, and care issues and helps point you to resources which can help. We do not sell any products or insurance or receive any referral fees.

"Intergenerational Stress"

2009-03-16T12:30:00.001-07:00

Tonight I will be moderating a forum on "Intergenerational Stress" at Emmanual Community Church. Sounds like a great idea--a program idea from the church and the Eckerd College PEL and OLLI programs. The idea is to start some conversations about things like caring for aging parents, adult children moving back in with parents or facing financial struggles, and grandparents raising grandkids.

I've invited a couple expert guests and I hope we have a really interactive audience. I think people have a lot of these issues to discuss and I hope they will use the forum for this purpose. Maybe the forum will spark some neat ideas. Communities embracing these concerns and working together toward solutions is what we need.

Eldercare Consultations

2009-02-19T12:49:00.000-08:00

It seems like more and more of us each day are struggling with caring for aging parents, and some of the concerns have changed nature due to increasing economic concerns. In response to this, we tweaked our services a little recently to help people get some immediate assistance and expertise in a way that was simple and affordable. By offering in office or telephonic consultation appointments for a fixed cost, caregivers can get advice, a toolkit and move forward feeling a lot more comfortable that they know where to begin (or how to keep going). Being able to do things via telephone and with the assistance of electronic communication, means being able to help caregivers anywhere.

Here's some more info. and I also invite you to link to our website: www.agingwisely.com.

Now offering Nationwide Care Consultations

We know many families are concerned about older family members’ wellbeing. In today's economic climate, finding cost effective options is key. We offer the ideal solution for families through our consultation appointments.

Consultations can address concerns such as:

● Choosing the right assisted living or nursing home (and how to make the transition);

● What to do when Mom or Dad is resistant to care;

● Help understanding what it means when the doctor says Mom should not be alone;

● Advice on what to do when diagnosed with Alzheimer’s disease or concerned about memory issues;

● What is available to help after surgery, a fall, or other hospitalization;

● Mediating with family members over disagreements about what is best for parents;

● What to do when you are concerned your parent shouldn’t be driving;

● Your frustrations as a caregiver and support options;

● Insurance issues-understanding Medicare, Medicaid, long term care and other insurance benefits (including pre-retirement consultation to plan for your transition).

● Help planning for disabled children or young adults.

Call us today to make an appointment for a consultation:

727-447-5845 or 813-249-6507 or toll free: 888-807-2551.

Consultations can be done in our office or via telephone. Immediate appointments available to accommodate crises or time sensitive concerns.

Health Advocacy for Aging Parents-David Zoll's article

2009-02-12T09:46:00.000-08:00

David Zoll had a great article on Huffington Post yesterday regarding watching over aging parents and particularly worries about their "health literacy" and how to ensure their safety and wellbeing from afar in navigating their medical needs. This is a great policy and research overview as well as expression of views and opinions. Having been in the trenches of professional care management, I have seen the difference this profession makes, as he mentions. More wide use of care management and better access could provide not only great peace of mind for family caregivers, but eliminate a great deal of unnecessary costs to families, employers, the healthcare system and society in general:

http://www.huffingtonpost.com/david-zoll/someone-to-watch-over-the_b_166099.html

Home Safety & Fall Prevention

2009-02-09T11:14:00.000-08:00

Its a good time of year to start thinking about home safety..."spring cleaning" for our home and our personal safety. No matter our age, extra clutter, throw rugs, environmental hazards, can lead to accidents. As we get older, though, the results of the accidents can affect us more so its worth a closer look. One day, we might all live in "aging friendly" homes but right now a lot of us to a lot of reaching, stepping in to slipper tubs, and climbing on chairs to get to out of reach places. Take a look through your home using one of the many checklists you can find online (Consumer Products Safety Commission has a good one, also search on Fall Prevention) or hire a geriatric care manager to help review home safety for your elder family member. Low cost and no cost changes can go a big way to keeping you safe and independent at home.

Health Advocacy

2009-02-02T14:10:00.000-08:00

Today I enjoyed meeting with a local AARP chapter and providing some information about geriatric care management. Once again, I was not surprised that only one person raised her hand when I asked if anyone had ever heard of geriatric care management. I make it my mission to try to get more hands raised when that question is asked, so people at least know it is an option. With so many people caregiving, we all need to know the resources.

The group had good questions and many of the same concerns I hear often. We especially talked a lot about issues like knowing you have picked a good doctor and concerns about care quality. One gentleman expressed his concern about being admitted to a hospital on a weekend due to perceived care issues. There is some empirical evidence to back him up, so his worry is not without merit, though a lot of hospitals have worked hard on this issue. It is a good issue to focus on, though--getting linked with the best professionals and best quality of care make a big difference. We talked a lot about the need to be your own advocate (and do your research/homework) or have one with you when you are ill (or even facing a diagnosis, surgery, etc.). I'm a big proponent of that and have seen where a professional advocate can make a big difference as a family faces the emotions involved. Families often tell me "I wouldn't have a clue how to review the medical chart or what questions to ask." and those things can make a big difference. Good to keep in mind.

Alzheimer's Disease

2009-01-31T17:22:00.000-08:00

I was watching the great PBS special on Alzheimer's entitled "The Forgetting" today. Although it shows a lot of tough stories and reminds me of the struggles I see clients and their families face, the information on research made me hopeful. Particularly, the advances in imaging are going to make a big difference in advancing the progress of new treatments. It is amazing to think how far imaging has come in general and to be able to see inside some of the innermost parts of the brain which our body so well protects, is remarkable science.

In the meantime, I try to exercise and stay heart healthy which seems to have some protective effects. I think keeping the brain active and social connections are good whether the protective effects are as strong as speculated or not. I'm not always as good as eating my fruits and vegetables as I should be, but generally eat a pretty "Mediterranean diet" and wouldn't mind eating more delicious Indian food with curry/curcumin in it (there are hints this may help). I'm fortunate to have a good family history of longevity with very little disease at all, and strong mental acuity in to old age-- but that's something that we all don't have much control over.

Some of my best pearls of wisdom from my work experience would be not to ignore signs and symptoms in your loved one (or self) and to seek a good diagnostic work up. There's always a tendency to want to bury our heads in the sand, and this is a disease that creates a lot of fear...but being prepared can only help. The medicines can do some good and maybe especially so in Mild Cognitive Impairment or early stages. And, there are a # of things that mimic the symptoms that may be reversible. Though that probably isn't the common result of diagnosis, when it is surely it is a huge relief.

Professionals: Listen to Caregivers

2009-01-29T13:20:00.000-08:00

I was fortunate to have Carol O'Dell, a favorite author and speaker, agree to be a guest speaker for my Eldercare course last night. As always, it was great to hear her story as a family caregiver to her Mom and have her read some of the excerpts from her book, Mothering Mother. One of the things that always strikes me when I hear her talk, is how those of us who work in this field have to remind ourselves who we're here to help and why we do what we do. Which means: the great rewards of these jobs and our responsibility to our clients...but also, remembering that purpose in the day to day process. How can we make life easier and help families caring for aging loved ones? How can we make our policies and procedures more flexible or adapted to meet their needs? How can we tailor solutions to each family? What does the person need in the moment-sometimes a listening ear, sometimes reassurance they're doing the right thing, sometimes a quick answer, responsiveness, an end to "the run around", permission to be upset or take a break, an offer to make that call or do that task for them rather than adding more to their pile of "to dos"...

I'm lucky to work with a team that keeps this as their every day focus. Carol's stories are words of wisdom to us all.

Teachable Moments from Tough Economic Times

2009-01-27T12:25:00.000-08:00

I was just at a luncheon where we were discussing the challenges and positives of these economic times (we didn't want to focus just on the bad) and it was so interesting. Many of us were very fortunate and had a lot to be thankful for, but we also have all felt the realities and had a lot of friends, family, coworkers more directly effected.

We also talked a lot though about the positives, a big theme seeming to be a resetting of values and priorities (i.e. prioritizing spending, distinguishing "needs" v. "wants") and how this has created "teachable moments" with our children. Hopefully this is something we can carry forward even as times get better (and they will:-). I hope perhaps these teachable moments might also carry forward in a more general way...a better openness about talking about money. Sometimes I have felt this is a more taboo subject than death, esp. amongst family members. It can often lead to misunderstandings, misinformation, and real challenges as family members age and we start a more active role in their care. If my parents have asked me to be their POA and perhaps help with their care needs as they age, I would feel ill equipped if I had no idea of their wants and desires and the reality of their situation. Do they have long term care insurance? What type of health insurance/Medicare have they elected? If they elect to remain at home with care or move to a care facility, what could they afford? Or, if I know they might be struggling financially, I also have a better idea of what is going on and how I might help.

I think its still a tough subject-I covered some points and advice on talking about it in my last enewsletter and I think it will continue to be a struggle for a lot of us. But, I'll still encourage people to talk it out...

Not everyone is blessed with an ideal family situation so these conversations can be made even more difficult based on family dynamics, so I know its not always so easy. But, perhaps it is another "teachable moment" we can take away.

And, of course, there are a lot more important conversations to have as well. In "times like these" I think we all try to focus on what is important and it really isn't "things", it really is family and friends and pulling together.

Caregiving in Stressful Times

2009-01-26T12:56:00.000-08:00

So many of us are sharing the common experience of caring for aging parents, grandparents, aunts, uncles, etc. and struggling through this unique and challenging experience. I spoke to 6 different people today facing this situation in their own way. Some have great parental relationships (some not so great or really traumatic), all were trying to balance care and a busy work life (and most, kids, marriages, etc.), all had different financial and physical situations (caring from afar, Mom moving in with daughter, Mom facing worsening eye sight, Dad caring for Mom with Alzheimer's disease now facing his own health issues).

Right now, it seems like these issues are part of a mounting list of stressful circumstances--or at least a mounting feeling of stress (sometimes just hearing all the concerns about the economy and troubles facing others we know adds a tangible stress even when things are going relatively well). Add to the normal pressures of caregiving the fact that we may be worried more about our own financial circumstances and our parents', and if we have a good job, we may worry even more about how we balance these things knowing how crucial it is to keep that good job in this economy.

The best place to start is getting good info. So many people worry because of things they hear, which are often untrue. Today I spoke to someone in just that situation and with some basic info., she felt a lot better. Neighbors and friends can be great support systems but be wary of the misinformation they sometimes have (or maybe correct info. that just doesn't apply to your situation). Almost everyone I know reads several books and gathers a lot of information before becoming a parent--but few do when it comes to eldercare issues. There hasn't been a lot of great info. out there in the past, but there is a lot now. Read up, and seek out good professional advice. If nothing else, it sure makes you feel a lot better and more prepared.

Right now I'm reading a great, inspirational book about aging...not so much the educational/eldercare kind...but I still highly recommend it: If I Live to Be 100: :Lessons from the Centenarians by Neenah Ellis. A great read! For other books on caregiving, eldercare topics, see recommended reading under resources on www.agingwisely.com.