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

If you need help with these concerns, contact us today. We can provide advice to you as well as help with an independent assessment of your loved one’s situation. We offer consultations for families and support for the healthcare decision makers. We provide 24/7 emergency on call services so your loved one has an advocate in the E.R. or other crisis situation. We help families in conflict over what is best as well, and help everyone to gain a better understanding of the situation and options. Getting professional input can make a world of difference.

Related posts:

1. Health Advocacy
2. Controlling Your Healthcare Destiny
3. Electronic Medical Records

Here’s one of our checklists on some basics of planning a funeral:

Planning for a Funeral
1. Shop around in advance. Compare prices from at least two funeral homes. Remember that you can supply your own casket or urn.
2. Ask for a price list. The law requires funeral homes to give you written price lists for products and services.
3. Resist pressure to buy goods and services you don’t really want or need.
4. Avoid emotional overspending. It’s not necessary to have the fanciest casket or the most elaborate funeral to properly honor a loved one.
5. Recognize your rights. Laws regarding funerals and burials vary from state to state. It’s a smart move to know which goods or services the law requires you to purchase and which are optional.
6. Apply the same smart shopping techniques you use for other major purchases. You can cut costs by limiting the viewing to one day or one hour before the funeral, and by dressing your loved one in a favorite outfit instead of costly burial clothing.
7. Plan ahead. It allows you to comparison shop without time constraints, creates an opportunity for family discussion, and lifts some of the burden from your family.

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1. Funeral Arrangements

The two major causes of falls are Health related changes such as certain medications, slow reflexes, poor eyesight and balance problems.
Dangerous situations in the home include slippery floors, poor lighting, electrical wires and cords in pathways, loose rugs, raised thresholds and clutter.
Most falls occur in bathrooms, bedrooms and on stairs. Use this checklist to help minimize the risk of falls in your home.
Approach to House
 Park close to your door.
 Be sure there is a clear pathway from the car to the door.
 Make sure the surface of the pathway is smooth and does not have cracks.
 Make sure there is a good light to show you the way to the door.
 If you have stairs, are the handrails steady and secure?
 Is the door wide enough to get through without straining?
 Make sure the door is easy to open and close.
 Paint the edges of outdoor steps and any steps that are especially narrow or uneven.
Living Room
 Is the seating adequate and safe?
 Can you get in and out of the furniture easily.
 Be sure the pathways are clear of electrical wires, clutter or cords.
 Be sure you have adequate lighting in the room.
 Be sure light switches are easy to reach and are at the entrance to the room.
 Make sure you have the telephone near and access to turn the television off and on without getting up from your chair.
 If you have floor rugs, remove them and wear non-slip, low heeled shoes or slippers with rubber grippers on the bottom. Do not walk around in stocking feet.
Kitchen
 Is the seating adequate and safe?
 Be sure there is good lighting both in the room and in the work areas.
 Move the items you use most often to shelves that you can easily reach without a step stool.
 Do not use a step stool. Ask someone to help you if you must reach for something.
 Are your appliances in good condition and accessible?
Bedroom
 Place a lamp close to the bed where it is easy to reach without getting out of bed.
 Be sure the path from the bed to the bathroom is clear of clutter and is lit by a nightlight.
 Put a nightlight in the bedroom and hallways.
 Remove any floor rugs.
 Have the telephone close to the bed so you can reach it without getting out of bed.
 Have the television remote near the bed to avoid getting up to turn it on and off.
Bathroom
 Clear the pathway to the bathroom of any clutter, wires or cords.
 Be sure to turn the lights on when you enter.
 Do you have grab bars in the shower, tub and toilet areas? If not, have these installed.
 Remove any bathroom area rugs.
 Use non-slip adhesive strips or bath mats with strong suction grip.
 Consider sitting on a chair or stool in the shower.
 Use an elevated toilet seat to make it easier to sit and stand.
 Is there a telephone in the bathroom close to floor or is safety device
worn during showering?
Stairs and Steps
 Pick up things on stairs such as books, shoes, laundry or other objects.
 Be sure the stairway is well lit.
 Have glowing light switches installed at the top and bottom of the stairwell.
 Repair any broken or loose steps.
 Repair any broken or loose handrails.
 Paint a brightly colored strip on the top and bottom steps.
General Safety
 Do you have smoke detectors in place?
 Use helping devices such as walkers or canes if necessary.
 Store items you use often on the counter or in an easy to reach drawer.
 Wear skid-free shoes.
 Keep a flash light with a fresh battery in the bedroom, kitchen and living room in case of loss of power.
 Review medications with your doctor or pharmacist.
 Have your hearing and eyesight checked. Inner ear problems can affect balance and visi0on problems make it difficult to see potential fall hazards.
 Exercise regularly to improve balance, flexibility, strength and overall well-being.
 If you feel dizzy, sit down and allow enough time for the dizziness to clear. Stand up slowly and hold onto something steady.
 If a step stool is absolutely necessary, use one with high and steady handrails. Do not use wobbly stools or chairs to reach things.
 Think about wearing an alarm device that will bring help- in case you fall and can’t get up.
 Be aware that alcohol affects your balance.

There are some great products and services to make the home safer for seniors–everything from in home technologies to aging in place certified remodelers and products to address specific mobility issues. We keep up to date on the latest and greatest, so we can be a resource to you! If you would like a comprehensive assessment of home safety and custom recommendations for a variety of issues: Aging Wisely’s here to help.

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1. Home Safety & Fall Prevention

One of the messages we think is important in this process is that individuals can still thrive and live their lives minus a car. But, this requires exploring the options and giving them ways to still get to important activities. Before approaching this issue, take time to learn about transportation options in your loved one’s area (or consult with a care manager on what those are). If your loved one’s lucky enough to live in an urban area with great public transportation, this may not even be an issue in the first place. However, for most of us, that is not the case. However, many aging service organizations offer transportation and there are disabled transportation services via many bus systems.

The option we commonly recommend for clients, in addition or combination perhaps with the above, is to hire a private duty home care company who will provide a homemaker/companion to drive the client. We work out a plan that fits the clients’ needs and schedule. This can not only include transportation to doctors and appointments, but to favorite activities, the hairdresser, dinner dates and more.

This service is often more affordable than people think. According to the Dept. of Labor’s Bureau of Labor Statistics, car ownership costs are the second largest household expense in the U.S. Owning and operating a car costs an average of $8,000/year or about $600/month—which is equal to more than 30 hours of drive time, for example, with our sister company, EasyLiving, Inc. (www.easylivingfl.com).

As you prepare to discuss the “driving issue”, do some homework and learn about the options to help your loved one stay active. For most people, a combination of resources can make this transition much easier. Friends, family and neighbors may be willing to help–but don’t leave the person with that as their only option. That really reduces the person to relying on, and potentially feeling like a burden to others. Your local Area Agency on Aging (www.eldercare.gov) can provide a list of resources, or contact us to discuss options in the Tampa Bay area.

Related posts:

1. Assisted living options in Florida
2. When a Loved One is Resistant to Help
3. Holidays a Good Time to Check In With Aging Loved Ones

As good professional advisors, having resources to help clients deal with these critical life planning issues is the key to being successful, in my humble opinion. We are fortunate to work with advisors who do just that…and I believe that is why they continue to thrive. Personally, having my financial advisor ask about our life plans, family, goals, worries…and then being able to connect us to good resources for estate planning, long term care, and caregiving for aging parents…is what makes me feel my advisor is worth it–and makes me loyal (as well as confident in referring others). Don’t you want to be the “go to” resource for your clients–even if it is outside your purview? Those clients are sure to stick by you, when they know they can pick up the phone and you can help. There’s an inherent trust there that goes “beyond the numbers”.

Every day my phone rings and it is one of those clients (or even the professional advisor themselves) calling about their concerns (typically caring for an aging parent or aging and trying to coordinate a plan that works with the resources they have). Often, after we help, we get letters of thanks from the families and very often, they give great thanks and praise to that professional advisor who had the solution for them when they most needed it.

Any of us in an advisory role to clients need to equip oursleves with an understanding of their concerns, motivations and goals. Then, we need to make sure we have the tools and partners to address them. As humans, our financial, legal, medical, social, spiritual (etc.) lives are intricately connected and each can have a huge impact on the other.

One parting thought, from the same publication, this stat: 55% of Americans say being a burden on their family is their #1 concern when it comes to long term care needs. The best advisors will help clients address their top concerns, such as this, and will “do well by doing good”.

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I am writing this article out of professional and personal experience. My mother lives out of state, so I know the worries associated with the helpless feeling you can get when you can’t be there to help. I have met dozens of families that have come home to visit their parent(s), only to be shocked by the condition they find them in. Many times parents are able to conceal their real needs in a phone call, that leaves you feeling like everything is going well, only to find out that all is not well. So what do you do when you are unable to be near your parents, and a move isn’t in the near future?

Consider visiting them for at least a week, so you are able to assess the entire situation. Or, use a geriatric care manager to provide an assessment (or meet with one while in town to use them as an extension of yourself and share these duties so you can have some visiting time and benefit from their expertise). Below are 11 tips for getting the most out of a week visit. It may be an exhaustive week, but could save you from endless phone calls and trips to attend to your aging parents’ needs.

1. Attend a doctor’s appointment with your parent. Have him or her sign a release of information so the doctor is able to share medical information with you when you return home. Get a current list of their diagnosis, medications, allergies and health history. Give the doctor’s office your emergency contact information, and ask them to contact you with any significant changes. If your parent doesn’t have advance directives in place, or a medical power of attorney, this is a great time to get those very important documents taken care of.

2. Check with the pharmacy to make sure your parent is getting all his or her prescriptions filled and on a timely basis. If your parent is seeing more than one doctor, check to make sure these doctors are communicating. If your parent is using more than one pharmacy, this is a problem. Multiple pharmacies and physicians are a recipe for disaster. One pharmacy can quickly identify drug interactions, or over-medicating. Check your parents’ medications for expired or discontinued medications, and discard any non current meds.

3. Assess your parents’ ability to purchase groceries, and prepare meals. Weight loss is a great indication of poorly managed meals. It can also be an indication of something more serious, so report weight loss to the physician. Check the refrigerator for outdated food and leftovers. Make sure your parent(s) is able to obtain groceries and prepare healthy meals.

4. Assess their driving ability, if they are still driving. Many adult children will drive their parents while they’re visiting, never checking if their parent is able to safely continue to drive. You may want to do this prior to the doctor appointment. If you find your parent is not driving safely, but you know it will be a battle to get him or her to stop, you can call the doctor in advance of the appointment and have the doctor assess, and discuss this very delicate issue. Understand, giving up this part of independence is extremely difficult for a senior, but safety needs to be first and foremost. If your parent will continue to drive, check for current auto insurance. See our article “Taking Away the Care Keys” for more specifics on how to handle this concern.

5. Meet your parents’ neighbors and close friends. Get their phone numbers, and provide your emergency contact information. Ask them to check on your parent, particularly if you have one parent living alone, and contact you if there are any needs or problems. If your parent does not know his or her neighbors, or has no friends, this is a cause for concern. When our elderly lack socialization, it contributes to declining health, and depression. Lack of socialization may be caused by depression, which is often undiagnosed in the elderly. If there is someone that can regularly visit, get them involved. Take a proactive approach with this, understanding neighbors may hesitate to reach out to you or may be limited in what they can assess/see. Make similar contacts with various people involved in your parent’s life: church community (is there a parish nurse?), professionals (doctor was mentioned, but also their attorney, financial advisor, etc. as your parent will allow), caregivers, etc.

6. Discuss your parents’ wishes for health care and finances if they are unable to make those decisions in the future. Make sure your parents’ have chosen a power of attorney for health care and finances, and the documentation is complete and available.

7. Check with your parents’ preferred hospital social work department (or local Area Agency on Aging – www.eldercare.gov) for a list of trustworthy, reputable agencies and facilities, should you need help in the future. This would include home health agencies, private duty agencies, rehabilitation facilities, nursing homes, and care managers. Depending on your parents’ situation, you may want to also have a list of assisted living facilities. If your parent has an unexpected illness or injury, the last thing you will want to do is have to gather all that information at the last minute, while you are trying to plan the trip to be with your parent. Preplanning will significantly reduce the stress in an unexpected crisis. If you hire a care manager initially, they will significantly help the process of any care needs in the future. Care managers also help when family members disagree about choices and decisions, as well.

8. Get copies of your parent’s insurance card(s). Physicians names and phone numbers, and past medical history. Be sure to take a copy with you when you leave. Consider organizing electronically—from simply scanning to a flash drive to using some of the online and mobile programs out there, so you have quick and easy access to this information.

9. Do a safety evaluation of the home. Is all plumbing and electrical in good working order? Are smoke detectors installed with new batteries? Are there precautions in place such as grab bars in the bathroom, and a home free of clutter and throw rugs? Is your parent using steps that are difficult to maneuver? Is there medical equipment your parent may need to stay safe, such as a cane or walker? Would a riser on the toilet or a lift chair help them transfer easier? Does your parent have vision deficits, and are those being addressed, and glasses or assistive devices available and appropriate? If you have found your parent to be weaker, or less steady, speak with the physician about ordering in home therapy, to increase strength, and improve balance and gait. Further decline will mean increased need of care. Also, consider a professional safety and falls prevention evaluation of the home.

10. Does your parent have a personal emergency response system (PERS)? If you have two parents living together, you may think a PERS isn’t necessary, but if one parent is caring for the other or one frequently leaves to run errands, etc, the primary care-giving spouse, or the parent left alone needs the ability to access emergency services. I frequently meet with one spouse caring for another with dementia. If the person who is well has a fall or needs emergency services, the spouse with dementia will not be able to call for help. This is why a PERS can be life saving, even in a two-parent home. There are advancing technologies coming out regularly, including buttons that can sense a fall if someone cannot push it, GPS systems, monitoring systems, medication reminders and more.

11. How is your parents’ personal care? Are they clean and well groomed? Is there an odor in the home? Are they able to care for their feet and nails? Are there incontinent episodes, and are they able to care for that? Is their skin in good condition, particularly their feet and buttocks? How is the oral care? If they have dentures, are they in good repair and fit appropriately? Poor hygiene can be a sign of depression or early dementia.

12. Plan for your parents’ future needs and care. It would be great if our parents all stayed healthy and well. The fact is, too may won’t, and if you are among the millions of families that face a crisis with an aging parent this investment in time and planning will save you from the tremendous stress that families have when they don’t plan.

Depending on what you find on your visit, there are several actions you can take. I’ve listed seven typical areas an aging parent may need assistance with and helpful strategies to those needs.

1. Medication management – There are simple solutions to assist your parents in filling their medications, taking the correct dosage at the correct time, and coordinating the orders of more than one physician. Some possible solutions are Accupax (pre-packaged, dosed meds), and similar services offered by local pharmacies; someone setting up a pill box weekly or monthly, electronic medication reminder systems, and medication management by a home care company (this may especially be needed if your loved one cannot carry out administration of medication using any of the other solutions).

2. Meal Preparation – Meals on Wheels or another meal delivery service can deliver nutritious meals. Contact the local Department of Aging for specific information. Private duty homecare agencies can grocery shop, prepare meals, and monitor intake.

3. Transportation – If your parent doesn’t drive and have difficulty getting to appointments, or running errands, there are a few options. Finding a friend who lives close to assist would be best, but that isn’t always an answer. Most communities have senior transportation available for a small fee. Private duty home care agencies in many communities provide transportation. They also can assist with shopping, putting away groceries, preparing meals, hygiene assistance, and light housekeeping. Changing to a visiting physician is also a great choice for senior unable to get to doctor appointments.

4. Declining mobility or health – Call the primary physician and ask him/her to order home health care, if the physician is aware of the decline. Medicare will pay for a nurse, and/or therapist to visit the home temporarily if there has been a significant change in health status.

5. Memory problems – If you notice a marked deficiency in your parents’ memory, it’s imperative to get a thorough evaluation, preferably from a geriatric specialist or memory clinic, so a diagnosis can be made. It is also imperative to make sure your parent is still able to make appropriate decisions to remain safe or there needs to be immediate supervision.

6. Multiple problems – If you find problems are increasing or all activities of daily living are more difficult, your parent will need some type of care. Whether the family chooses private duty homecare or an appropriate facility is typically based on preferences and finances. Don’t wait until the situation worsens. Get things in place that will help your parent have the best quality of life possible, and help prevent further complications. This is one area you’d probably find high value in hiring a care manager: they can evaluate and lay out the choices and related costs/pros and cons. This typically saves you tremendous time, and gives you confidence in your choices.

7. Household Deficiencies – If your parent is unable to keep up the home; if it is unsafe from clutter; or is in need of repairs, you can hire those services, either to a company that specializes in those tasks, or a company that can do it all. A care manager can also arrange for getting housekeeping, and repair services. Some communities have resources available to assist in home repairs to those with low income. Care managers will usually know of a trustworthy and reputable company that works with seniors.

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1. Caregiving in Stressful Times

While I am continually impressed by the community spirit that exists and the way neighbors, church communities, friends and volunteers reach out to support elders in the community, families need to think about the “what ifs”. Each year, the Dept. of Children and Families receives increased calls in late spring/early summer which can be partly attributed to the phenomena of snowbird support systems heading north. Perhaps we all need to think more comprehensively about what a person might need and how we can accomplish that together. A neighbor can offer support and for example, help pick up some groceries or check in, bring someone their mail, cook meals when ill, etc. But when providing more support, it might be time for a conversation about what other options and services are available.

Some ideas to consider:

1. If you are a neighbor or friend helping an elderly person, help them make some calls for information. Contact your local Area Agency on Aging and related elder services, or a geriatric care manager. Find out what might be available for this person, now and in the future. There may be services and programs that can help where you cannot, or this can free you up to help in other ways. (You may have to think of different ways to approach this as the person may not want to reach out for help. You may need to be firm, elicit help from others the person trusts, and explain that this is important as a way to help make sure the person can stay safe and independent.)

2. As a family member, realize realistic limitations of neighbors. Many families at a distance expect neighbors to be their eyes and ears, and I’ve heard a # of stories where things fell through the cracks this way (why? perhaps the neighbor didn’t know what to look for, the neighbors had their own health issues, or felt strange “tattling” on their friend).

3. Consider introducing some services, even if friends and family can handle everything currently. This gives everyone a comfort level if something changes or an emergency occurs. One way to do this may be for “respite” when for example, you are going on vacation or having surgery. Try using a home health agency or transportation service for specific needs or a limited time, for example (when everyone is pleasantly surprised how well this works out, it can always be extended).

4. Don’t forget about the big emergencies. What would happen if your elderly grandmother fell at home (the neighbors come by daily, but how long would she lie there without help and who would pick her up)? What happens in the event of a visit to the ER (who will be there with her, what if it is the middle of the night, who will keep you informed, who knows her history)? What’s the plan when hurricane season hits (the plan from 5 years ago may not be relevant)? Do not await that dreaded phone call to realize you should have contingency plans in place.

5. If you are that helpful neighbor, give yourself a pat on the back for all you do. Informal caregivers (non-paid–i.e. family, friends, neighbors) provide the bulk of care to the elderly in the U.S. and the value is billions of dollars, plus a huge difference to the person/persons you help. If neighbors and friends help your loved one, say thanks and check in with them on ways you can support them.

As summer approaches, don’t put on your blinders on these issues. Seek out information and help. Get an evaluation or seek a consultation with a professional care manager. Do your loved one, neighbor or friend the biggest favor you can–be prepared and plan ahead.

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1. Do Your Homework: Options When Your Loved One isn’t Safe to Drive

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.

Related posts:

1. Elder Care Costs – Dollars and Sense
2. Caring Connections Women’s Estate Planning and Elder Care Workgroup
3. Controlling Your Healthcare Destiny

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3. Health Advocacy

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/.

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3. NAPGCM (National Association of Professional Geriatric Care Managers) Annual Conference