Among the challenges you may face as a caregiver for an aging parent is the refusal to see a doctor. Most people assume a person who has the financial means to get medical care will do so – just simple scheduling, right? Not always.
So what do you do?
First, go for backup. While it may sound silly, if you have been a caregiver (or in contact with other caregivers) for any length of time, you understand that family dynamics can often come into play in these situations. Your parent took you to the doctor as a child, and in your adulthood has been offering you advice over the years. Having those tables begin to turn – even if it is ever so slightly – can cause some resistance.
As their loved one, the caregiver often thinks their advice is first to be considered, but the nature of family dynamics sometimes proves otherwise. Often, you can enlist the help of an objective third party, such as a doctor or nurse. Preferably, this person is already known to and trusted by your parent. He or she is likely to be viewed very differently since they’ll be seen as a professional and not subject to the parent-child power struggle. If possible, a geriatric physician is even better, because he or she deals with patients in their age range every day and can often hint at possibilities that others (loved ones or not) may miss. They can often be your best advocate.
Second, if the objective third party doesn’t work, or if you cannot secure one easily, getting one of your parent’s friends on board may work wonders. The friend may have already seen a geriatric physician or know someone who has similar symptoms who sought medical attention. Cast your net to include relatives (perhaps your parent’s sibling) to weigh in on the subject as well. Though the friend or sibling definitely has an interest in the matter, they also have more life experience and can relate to your parent on an entirely different level.
Third, create a positive reward. As a person ages, the “stuff” of life becomes less important than the experiences of life. So, perhaps the two of you can have breakfast or lunch at their favorite diner after the appointment. It becomes a positive memory for your parent and it creates a convenient focal point should another doctor’s visit be necessary.
Fourth, be aware of the time span between appointments. Often, when we are scheduling appointments at the front desk, the scheduler may offer you the very first appointment available. If there is no medical emergency, some time between appointments may make the experience seem less invasive and unpleasant.
As a caregiver, you will often need to gain a greater level of perspective in order to relieve frustration. For example, your parent may give you what you deem an absolutely ridiculous reason for not wanting to go to the doctor. For some people, aging brings with it a fear (albeit sometimes irrational) of doctors or hospitals. It may create a very unpleasant association – for example: it may conjure up memories of time spent with their loved ones following an illness or it may bring to the surface fears of hearing that he or she may need to have a surgical procedure. For an elderly person who has been relatively healthy and independent all their lives, the thought of losing that independence can be extremely bothersome.
Though younger generations have embraced pharmaceuticals, many older adults have relied heavily on the home remedies and tinctures their mothers and grandmothers used on them. Certainly, a level of distrust can exist toward these “newer” treatment options (and their side effects).
Either way, try to assure the discussion (and the trip) is as pleasant as possible… but do schedule that appointment at the first sign of an okay…. okay?
Posts
While some people work and save for years so they can have a very comfortable lifestyle during their retirement years, others find keeping their retirement nest egg intact to be a challenge. A 2010 survey conducted by Wells Fargo Bank revealed that more than a quarter of the American population has concerns about their finances for retirement. Thus, we’ve put together a short list of common financial blunders to avoid when you’re working to protect your valuable assets.
Have a Clear Understanding of Medicare and Medicaid: While Medicare is a very valuable healthcare management program, many retirees do not have the best handle on what is – and is not – covered by Medicare. One of the most financially devastating challenges to your financial health in retirement years is the need to enter an assisted living facility. While Medicare does, in most instances, cover a short-term stay in a rehabilitation center, Medicare will not cover a long stay in assisted living since assisted living is not medical care.
Unlike Medicare, the federally funded Medicaid program will cover long term care, but Medicaid is a program designed for seniors who have exhausted all their assets (for a considerable period of time) and is generally considered an absolute last resort option. Many assisted living facilities do not accept Medicaid.
Make no mistake – just one serious health challenge faced in the absence of a long term care plan can wipe out years of financial planning. It can also leave you with little options should you face a second, or third, health challenge. If you do not have a long-term care plan, or if yours is not comprehensive enough, start planning for that rainy day now.
Beware of Con Men: Today’s seniors grew up in a world that was more trusting and more caring. However, that innocence, along with the availability of funds and assets, makes them a huge target for the unscrupulous (to the tune of $2.6 billion annually). A good rule of thumb: if it sounds too good to be true, it is.
Estate Planning 101: Most individuals recognize the importance of having a will in place to leave their assets to the beneficiaries they hold dear. However, wills are not a set-it-and-forget-it type of document, and depending on when the will was initially drafted, it may have to be amended more than once. Pay attention to major life changes you experience, such as divorce, the death of a beneficiary, a birth in your family, or adoption. Note: if your will’s executor passes away, run (don’t walk) to have a new one appointed.
The general rule of thumb is to review and update your estate plan portfolio at least once a year (with, of course, revisions done in between when there’s a major change). Doing so will help you notice when your documents have become outdated.
Enlist the Help of Professional Estate Planners: While most family members mean well, the fact is that retirement planning is a specialized field best handled by professionals. Unless you have a family member who is both trained and experienced in this field, not just dibble-dabbling and reading market trends, it is best to maintain a relationship with a trusted advisor. Having the input from family members is fine, but before acting on their opinions, be sure your financial planner agrees./by Moti Gamburd
- Create A Distraction-Free Zone: Background noises can distract anyone – even those with no cognitive challenges at all. But for a loved one suffering from Alzheimer’s disease, the television, radio, or other device can easily compete with your conversation. Give your loved one’s conversation your full – and undivided – attention in a peaceful environment.
- One-On-One Conversation: While it may sound silly, having multiple individuals gathered together for conversation can create an overwhelming and highly confusing environment for your loved one. After all, the more individuals who are present, the more apt each party is to contribute to the conversation. It can prove to be extremely agitating to your loved one, whose brain may still be trying to process what has been said as well as who has offered the input. Keep the conversations simple – one person at a time.
- Simple, Lighthearted Conversation: There’s always something to be said for small talk, but especially so when your loved one is experiencing cognitive decline. Most of us are taught to converse with others using open-ended questions to spark conversation. However, for an Alzheimer’s patient, this leaves entirely too many choices. Remember, your loved one may not remember the significance of certain titles, such as “nurse.” Therefore, he or she may ask questions like, “What’s a nurse?” Combat these challenges by simply referring to your loved one by name, and referring to yourself (or another person) by name. It helps the Alzheimer’s patient to orient themselves. If you’re speaking to your loved one about an animal, address the animal either by name (if it’s a pet) or by species (for example, “cat”) instead of saying “it.” Again, it helps your loved one keep track within the conversation.
- Be Patient and Non-Combative: It is easy to understand how difficult it becomes for you, as the loved one of a person suffering from such a debilitating disease, to repeat yourself or explain the who-what-and-where’s of very familiar things. But engaging in arguments will most likely end in one result – agitation for yourself and your loved one. Stay calm and repeat yourself if necessary. If your loved one seems to be having difficulty in making a request, do your best to state the question you feel he or she is attempting to ask. For example, if your loved one is fumbling around for something on a table nearby, you may say, “Are you looking for a tissue? Are you looking for your glasses?”
- Watch Yourself! Everyone understands that non-verbal communication is as important as, if not more than, verbal cues. Cognitive decline, especially as it progresses, will undermine a person’s confidence as simple, routine tasks become increasingly more difficult. Thus, your loved one is likely to be highly sensitive to everything you say and do. The tone of your voice and your body language is important. Expressing your acceptance with friendly eye contact and kind facial expressions is important. After all, the goal is to maintain positive communication with your loved one and to minimize feelings of confusion or distress which may lead to negative, hostile reactions or to your loved one “shutting down” due to feelings of isolation.
- Moving tables and furniture out of high traffic areas to keep travel areas free of obstructions.
- Securing throw rugs or taking them up if that’s not possible.
- Making sure walkways are properly lit (this will especially help those with vision impairments).
- Adding non-skid mats to bathrooms and bathtubs, along with hand rails.
- Buying a raised toilet seat with hand rails.
- Installing grip rails where they’re needed.
- Insuring that there is room for the use of mobility aids such as a walker.
As parents age, adult children gradually find familiar roles shifting. More and more, their elders turn to them for help, rather than the other way around.
The individual circumstances will vary. A fall and broken hip can incapacitate a parent, requiring temporary assistance at the least. Degenerative diseases can reduce mobility or vision, making it harder for a senior to drive or even venture far from home on foot. For even basic needs such as groceries or meeting with friends, they’re dependent on others. Alzheimer’s Disease or dementia can also create a need for consistent monitoring and care.
When these changes take place, there’s a greater chance of family conflict. Older parents resist the idea of slowly losing their independence and having to rely on others for help. They often will still try to assert a sense of parental authority when in fact it doesn’t exist at all anymore. Their children themselves are already middle-aged or older, well-experienced in life. Acting out of concern, they may try to take control of the situation, sometimes creating hurt feelings as they make difficult decisions for the best care of an older parent.
Much of the problem in conflict usually occurs with faulty communication or a lack of it altogether. Parents can feel downright offended being relegated to a dependent status where they are guided or restricted in decision-making. That emotion can make it hard for an older parent to see reason. At the same time, the older child is balancing a new demand for parent care with everything else in life including raising his or her own kids, holding down a full-time job, paying the bills, and perhaps mid-life relationship issues. Their spouse’s parents may need help too, bringing another set of problems to the mix.
Under these circumstances, an adult child’s need or choice to bring up the subject of assisted living can come across to the parent as a rash decision. There is no question that most older parents would love to retain and keep their independence for as long as possible. However, as mobility and mental faculties begin to falter, the need for monitored care begins to increase. Assisted living can serve a real benefit for everyone involved, especially when adult children live a significant distance from their parents.
Regular and constant communication between an older parent and caring adult child towards each other is the key. Granted, someone usually has to make a final decision, but as long as they’re able to participate the parent should play a prominent role in the planning for their care. If adult children maintain communication and actively seek the parent’s input, they will generally feel more at ease with the transition to assisted living. But acceptance takes time. Adult children have to be patient and work with their parents as they grapple with the changes that take place during the aging process.
/by Moti Gamburd
Has dealing with your elderly parent become an encounter with Oscar the Grouch? If so, you certainly are not alone. However, as their child, it can help to view these encounters from an entirely different perspective.
For a person who has always been independent, athletic, and able to recall many details, losing these faculties brings many underlying fears to the surface. Feelings of both helplessness and hopelessness can overtake their thought processes. It is important to remember that anger is often an outward expression of inner fears, and that while the complaints may seem to be hurled in your direction, it often has little if anything to do with you. Be patient, be kind, and reassure your loved one that he or she can talk to you. Understand though that no matter your age, parents generally do not want to place excess burden on their children. If your mother or father is uncomfortable expressing their innermost feelings with you, perhaps arranging sessions with a professional counselor will help your parent to truly process those raging emotions.
It’s important for adult children to really assess the situation thoroughly–and honestly. For instance, some individuals always see the glass half empty, regardless of the circumstance. If your aging parent was always negative, illness will not bring out the best in them. Complaining personalities generally remain negative, complaining personalities… and sometimes you, as the caregiver, must be honest with yourself about this. Also, most people are more irritable when they do not feel well.
But, there are some elderly individuals who feel that by virtue of their years on this earth, they have somehow earned the right to “not hold back”… and some will use it with a vengeance! In this case, there may be a glimmer of hope for change in circumstance.
When your loved one begins taking a new medication, it often can wreak havoc on the body. This is further exaggerated by negative interactions between multiple drugs used to treat symptoms. If you notice a recent change in behavior or attitude that seems to coincide with a new prescription, a pharmacist or your loved one’s doctor can often help you get to the root of the issue. Personality changes can come on quickly and strongly in these scenarios. Bladder infections can also cause severe shifts in mood and personality.
Cognitive decline (such as that found in Alzheimer’s disease, dementia and Pick’s Disease) can trigger severe levels of frustration. That is due, in part, to the inability to perform certain tasks that have been routine for years. These disorders cause a person to lose the ability to recognize objects or to remember things and people that are very familiar. It’s a tough time for both the individual as well as their family members; the frustration can spark the types of personality changes that surprise even those closest to the individual.
Addressing personality changes brought on by medical challenges is easiest to deal with; simply get your loved one to a physician for treatment. These types of personality changes can disappear very quickly with medical attention or a change in prescription.
However, if your parent was always the “Debbie Downer” type, or if he or she had tendencies toward verbal abuse (or worse) in the past, you have to establish reasonable boundaries so that you, as the adult child and caregiver, do not walk away hurt, frustrated, and disrespected constantly. If that still doesn’t work, you may also have to distance yourself from your parent, assisting on a limited basis. If you cannot find a workable solution on your own, you may need to speak with your local Social Services office to find a reasonable solution for everyone involved.
/by Moti Gamburd
Caring for an ailing loved one is demanding, time-consuming, and quite stressful. Often, caregivers spend a great deal of time making sure their loved one’s needs are met and their affairs are on track. What often goes quickly out the window? The caregiver’s own needs. The following are ways to detect if you, as a caregiver, have neglected yourself to the point of burnout.
Isolation. As human beings, we thrive upon healthy relationships. When you find yourself regularly failing to engage in healthy social interaction–even with your own friends and family–this may be a huge signal that caregiving has begun draining you. Avoiding calls from people you enjoy, making excuses for not going out, etc… can indicate you may be well on your way to isolating yourself from others, which is never good.
Feeling Overwhelmed. Caregiving can be an emotional rollercoaster for sure. There is the physical toll of spending so much time attending to the needs of your loved one. Further, there’s an emotional toll that comes with facing the shift in relational roles, seeing both physical and emotional decline in your loved one, and having to face day-to-day tasks which reinforce that life as you have known it has changed.
It is natural to grieve, especially at the beginning of your caregiving experience. Frustration can arise. Anxiety and exhaustion can arise. But over time and left untreated, those feelings can lead straight into depression. If you become angry to the point of wanting to hurt your loved one or even yourself, get help fast. Your doctor should be able to diagnose whether there is a medical condition driving these symptoms. If medical challenges have been eliminated as a probability, you may have reached the point of extreme burnout and may possibly be experiencing depression.
It is important to remember that while you serve as a support system for your loved one, you will also need to create a team of others who can step in to help. Being kind to your loved one is important, but it is also important for you to be kind to–and eliminate excess pressure on–yourself.
Loss of Interest. One of the biggest warning signs of depression is loss of interest, especially in things that were once a huge source of happiness and enjoyment. When your hobbies, big and small, no longer inspire you… you may need help.
Significant Changes in Your Sleeping or Eating Patterns. Can’t sleep at night? Can’t get enough sleep, no matter how long you’ve been in bed? Binge eating or hardly eating at all? Major shifts in your habits generally indicate huge shifts in your stress levels and turmoil in your emotions.
Ceasing Your Exercise Routine Despite Enjoying It Before. Exercise is one of the best stress-busters available. It leaves a person invigorated and energized. So, when you used to enjoy exercise and suddenly stop, start again! The endorphins released while you’re exercising will relieve tension and help elevate your mood, plus you will get a better night’s sleep.
Failing To Keep Up Your Appearance. Unfortunately, many caregivers fall into the mode of caring for a loved one so much that simple grooming (haircuts, manicures, etc…) become neglected. Some who once were fashion-conscious and took particular efforts to care for their appearance can suddenly become apathetic in this area. Generally, your outward appearance reflects what’s happening inside. This challenge may require some input from others you trust–close confidants, social workers, or healthcare therapists can help you sort things out to decide if you’re experiencing burnout and if additional help is necessary.
Frequently Susceptible To Illness. If you catch every cold or flu that comes your way, and especially if you cannot shake the cold once you get it, your immune system is likely compromised. Our bodies are not created to handle excessive stress for long periods of time. If this is you, caregiving could be getting to you.
Take these symptoms seriously. You can only be a good caregiver for your loved one if you yourself are healthy and happy.
/by Moti GamburdMany of us know that living wills are a smart decision, but even with this document in place many find that making medical choices for a loved one is still complicated in practice. This post discusses some of the common problems with living wills and steps that you might be able to take to make sure that your wishes are followed.
The living will document was designed to give the patient the right to determine–ahead of time–the type of medical care desired in the event he or she is unable to communicate those wishes. However, the language commonly used within a living will (which is also referred to as a substantive or instructional advanced directive) tends to be rather vague, often lending itself to interpretation. For example, in this age of advanced medical technology and cutting edge treatments, verbiage such as “little to no chance of recovery” is becoming obsolete.
Some living wills, indeed, spell out possible scenarios and the patient’s desired outcomes for each scenario. While this is helpful, with medical technology evolving at its current rate, listing every alternative is virtually impossible, which then forces medical professionals and/or family members to then determine what’s best for the patient. Making matters even more difficult is the fact that for many what they want changes following an illness or hospitalization. One research study on medical decision-making revealed that three of every 10 patients change their minds about the type of care they desire, but those changes are not often reflected as quickly on the living will.
So then, we’re back to the challenge of interpretation. It’s important to note that even when the patient’s wishes have been clearly written out, family members are still faced with making these decisions at a very emotional time. Arguments often arise between family members in the midst of the crisis about what their loved one really wanted, when their energies would often be better utilized in coming together to support one another as well as the patient.
According to a February 2001 study published in the Archives of Internal Medicine, family members presented with various health crisis scenarios were about 70% accurate in predicting their loved one’s desires if faced with the scenarios given (whether the patient had a living will or not). That’s good news because three out of five patients who have living wills in the first place never give them to their doctors or to family members.
While that fact is baffling to most, it leads directly into the necessity for medical doctors to exercise their professional opinions regarding care that is in the best interest of the patient. Family members must often draw from their knowledge of their loved one’s lifestyle and wishes, perhaps even going back to conversations that happened before a crisis ever arose. Sometimes, though, the decisions made can go directly against the wishes of the patient.
Having a living will does not always negate a medical team’s decision to perform invasive procedures on the terminally ill. And again, family members who are facing difficult decisions are often reluctant to accept a diagnosis of imminent death and will, in some cases, fail to follow the instructions in a living will (hoping for a turnaround).
A number of legal and health care professionals who once championed the idea of each patient having a living will are now suggesting that patients designate a health care advocate. Generally this would be a family member or perhaps a close friend who would exercise what the legal community calls “substituted judgment.” In short, the health care advocate is responsible for making the decision you would make if you were able to. To protect that individual, a patient may even record verbally or write out their wishes, to confirm that the decision made–no matter how difficult–was in accordance with the patient’s desire.
There’s really no way to guarantee that what actually happens during a serious medical situation is what you would have chosen for yourself. But you can increase the chance of receiving the care you desire by communicating with your loved ones, with your doctor, and in writing the outcome you would want.
/by Moti Gamburd
As parents become older, there comes a point where you realize that you need to step in and help them with their finances. The red flag may be a bounced check or noticing that some bills are past due, or you could discover much more serious problems like the fact that mom or dad has been taken in by a telemarketing scammer. The steps below are your roadmap to getting your loved one back on track.
1. Know Your Parent’s Finances
The first thing every adult child needs to know is the condition of your parent’s finances. This means that you need to know what debts they have (credit cards, loans, mortgages, etc…), as well as what their living expenses are. Familiarize yourself with utilities, credit cards, and any bills they have and make sure you start paying them right away. You also need to know if there are any safe deposit boxes, and if you parents already have a financial advisor. It may be beneficial to take a look at your parent’s tax returns to get an idea of their financial situation.
2. Learn About Your Parent’s Income and Insurance Situation
Find out what sources of income your parent has. Find out of if your parent is receiving income from social security, what Medicare options they’ve chosen, and whether they receive Medicaid. Also find out if they have purchased long-term care insurance or other forms of insurance to make sure any premiums are kept up to date and policies are still in order.
3. Establish Who Has Legal Authority Over Your Parent’s Finances
When a parent becomes unable to care for their finances, it is especially important for adult children to know who has legal authority to manage the estate. Find out if your parents have already established legal guardianship with a relative, financial advisor, or with an executor. Pre-planning in this area can be especially important as it‘s more difficult to establish power of attorney if your parent develops dementia or Alzheimer’s. If you parents haven’t established a legal guardian before they become incapacitated, you’ll need to seek guardianship through the court system. A judge must agree that your parent is not legally competent to handle their own finances and that you are, which may take time.
4. Contact a Financial Advisor
A financial advisor or accountant can help you not only sort out your parent’s current finances, but also help you plan for the future. Depending on how you parent’s have invested, there may be other ways to maximize their assets to help finance their transition to assisted living. A financial advisor can help you navigate the options and ensure the best possible course for your parent’s financial future.
5. Get Everything in Writing
In order to safeguard both your parent’s and your own financial future, it’s best to make sure you have written documentation of everything related to their finances. Make sure you have legal authorization to act on their behalf. Any access to funds should be documented and any decisions with a financial advisor should be copied into a written document so there is a paper trail to help protect you and your parent legally. Having written records will also help if conflict or concern arises among siblings or other relatives.
Watching a parent age can be a difficult process emotionally for adult children, but it doesn’t have to be difficult financially. By following these steps, adult children can help ease the transition for their parents, ensuring a brighter and more secure financial future./by Moti Gamburd
Being the caregiver to an aging parent may be one of the toughest family roles imaginable. The task can be as demanding as watching a small child, with the added heartbreak of seeing mom or dad decline…plus the challenge of navigating the changing parent-child dynamic. But there is hope: stress can always be managed. Here are a few tips to use during those times when you feel like it’s all too much.
First, do not attempt to become a lone ranger. One of the greatest areas of stress comes from the feeling of taking on more than we can handle, and that is as true in the caregiving role as it is in other areas of our lives. Other relatives may be both willing and able to help. You may also be surprised to find that those outside the family, such as family friends or neighbors, may also be there to lend a hand. It is important to remember that aside from the task of caring for your aging loved one, there are necessary tasks related to caregiving, and having someone else shoulder those for a while may help you build in some much needed time for yourself.
Second, schedule in your “me” time. One of the greatest challenges family caregivers have is the overwhelming tendency to neglect their own needs in favor of their loved one. It is critical for caregivers to schedule some non-negotiable time to participate in activities that stimulate and interest them, because caregiving can (and often does) demand a significant amount of time and can deplete an individual both physically and emotionally. Schedule such activities as an exercise class, a movie, date night with a significant other, a massage, dinner with friends, taking classes on a subject of interest, etc… By doing so, the caregiver remains in touch with his or her own life.
Third, pay attention to your body. While most caregivers begin their roles in an overall state of good health, statistics show that they are more likely to develop symptoms of depression, anxiety, obesity, and weaker immune response as time goes on. Exercise is a particularly effective method of de-stressing the body, with the added bonus of boosting overall energy levels. Getting outside for fresh air can also be highly invigorating. All the great advice we give our loved ones — about eating balanced meals, drinking plenty of water and getting adequate rest — are just great rules of thumb for everyone to live by… including caregivers.
Fourth, building in a support system can be very beneficial. Providing care for an aging loved one brings forth a flood of emotions. After all, it is during this time that the caregiver witnesses the frailty and physical decline of the person whom they have always looked to for their own care. Seeking the services of a psychotherapist or joining a support group (through a church, synagogue, or local agency on aging), caregivers can often receive sound advice on how to cope during this emotionally taxing period. It is important also for the caregiver to not place unrealistic demands upon themselves but to simply do the very best they can.
Finally, cherish every moment. Glean the wisdom of these years and forgive any past disappointments you may be harboring against your loved one. Resolve any issues that may still linger, and commit to enjoying each precious moment available. Remember to be kind to others, understanding that each person operates the best they can with the knowledge they have. Be gentle even when expectations go unfulfilled. With a slight shift in perspective, you may find — as others have — much greater enjoyment of life’s simplest gifts as an unexpected bonus from caregiving./by Moti Gamburd
Corporate Office / General Information
Raya’s Paradise, Inc.
1156 N Gardner St.
West Hollywood, CA 90046
Tel: (310) 289-8834
Fax: (323) 851-0375
E-mail:Info@RayasParadise.com
Featured by Assisted Living Magazine as one of the best communities in Orange County