Photo used under Creative Commons from Casey Serin.
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Deciding to enter hospice care is never easy. Everyone involved in the decision may find themselves experiencing regret, sorrow, and confusion about what to expect. While issues of death and dying are always extremely difficult, knowing what to expect can help make the process a little more bearable.
Most know hospice as a form of care for those who are suffering from terminal illness. It’s more than just medical care, however, as clergy and social workers may be part of the hospice team in addition to physicians and nurses. Hospice helps patients and their families come to terms with this difficult event. The main goal of hospice is to make the final days of a dying person’s life as painless and comfortable as possible, while helping to bring about a sense of resolution.
One of the main qualifications in order to be eligible for hospice is that the individual must be expected to live for no longer than six months. In most cases, if the person requires additional time, their physician can extend their care. Hospice can be discontinued if the person receiving it begins to recover.
One of the first steps in going about retaining hospice services is to consult with the loved one’s primary care physician. You can also contact a hospice group or a facility, such as Raya’s Paradise, that provides hospice care. Once a hospice team is assembled, all aspects of the patient’s care will be considered and a comprehensive plan will be developed. This would include the patient’s comfort level, finances, necessary medical care and medication, as well as religious beliefs.
When determining whether hospice is appropriate, physicians will usually use the Karnofsky Performance scale. This is a set of criteria to help evaluate the patient’s general health in order to determine life expectancy. Common diseases that usually resolve in hospice include cancer and Alzheimer’s disease.
Some may consider opting for hospice to be giving up. This couldn’t be further from the truth! In fact, it takes a very strong person to be willing to accept help and support when it’s needed. This is not a matter of giving up, but more of doing what’s necessary at that point in time. Furthermore, by choosing hospice, your loved one will receive increased comfort and support, leading to more fulfilling and meaningful final months of life.
Discussing hospice is never easy. Nobody wants to be the first person to bring up the topic of death and dying. If you or someone you love is considering hospice, it’s important to realize that not saying anything could in fact delay hospice and cause unnecessary pain. Hospice is all about making the last stage of life as comfortable as possible. There’s no point in prolonging discomfort. Take a moment to begin the conversation now and you may help ease the suffering of a loved one.
Photo used under Creative Commons from Bunches and Bits.
Today, seniors enjoy a wide range of options to choose from when it comes to finding a place to spend their later years. Things haven’t always been this way. In fact, not too long ago, assisted living wasn’t even an option. Prior to the advent of these facilities, older people could only choose between staying at home under the care of a family member or a hired caregiver, or going to a nursing home.
Going to a nursing home was not something one wanted to do, as it often meant forfeiting basic rights, such as the right to privacy. Many times, residents were not permitted to have locks on their doors and would have to share bathrooms. The institutionalized setting and communal bathing and showering areas created an environment all too reminiscent of some of the facilities used to care for the mentally ill. To make matters worse, nursing homes were gaining a reputation for being places where the elderly were frequently mistreated, neglected or even abused.
Dr. Keren Brown Wilson, whose own mother lived in a nursing home, made it her life’s work to develop alternative means to care for the elderly. She was integral in the inception of the first assisted living facility, which would serve as a model for such facilities all across the country. One of Dr. Wilson’s major priorities when developing the assisted living model was to restore the privacy and dignity that were missing in the institutionalized settings of nursing homes. In addition to this, Dr. Wilson made sure that these facilities were adequately staffed with round-the-clock supervision and a more individualized level of care with one-on-one support.
This prototype for a new and innovative way to provide care for the elderly drew attention from many other organizations that then helped turn assisted living into a viable alternative for older adults looking to make the transition to a living situation that provided more support.
The need for supportive living accommodations for seniors is greater than ever, and fortunately, there are a variety of desirable arrangements available. Today’s seniors can choose from different types of assisted living facilities depending on the specific care they need, their budget, and lifestyle choices. Their options, rather than demeaning them at the end of their lives, can help make these years a golden time to enjoy the sunset of their days with few worries.
The desire to stay in your own home and remain independent as long as possible is a strong one. Unfortunately, as we get older we eventually reach a point where this is no longer viable or safe. How can you convince a parent that it’s time to make a move to assisted living, where they can get the support they need, and help them see the transition as a positive one? Here are several tips for having this difficult conversation.
Enlist the help of a medical professional. If your parent is like most of us, he or she will have a sense of pride regarding the ability to care for him or herself. This is completely natural, and the idea that one can no longer do this is a severe blow. It is for this reason that seeking the opinion of their doctor or another healthcare provider they trust can help to add weight to your suggestions when discussing the potential move to an assisted living facility.
Avoid potentially condescending sympathy. It is important to realize that, despite any health complications that your parent may be experiencing, your sympathy is not what’s needed at this moment. Of course, it is always nice to have compassion for your parent. Yet discussing the move to an assisted living facility can elicit feelings of powerlessness, and providing heaping doses of sympathy could make matters worse.
Approach your parent with respect. Treat your parent as an independent person capable of making decisions and deserving of the same respect and considerations as anyone else. There are some situations where maintaining this tone could prove challenging. Diseases such as dementia can greatly impair your parent’s ability to process and understand what is happening, and may force you to take on a more guardian-like role in such cases. The underlying idea that you can still treat your parent with respect and value his or her preferences still applies more than ever.
Emphasize safety. The number one priority and guiding factor in all discussions and arrangements surrounding a parent’s move to an assisted living facility should be their health and well-being. The more that you can bring this point into focus, the better the transition process will likely be. If, for example, your parent has fallen several times while unsupervised, resulting in hospital stays and broken bones, reminding them of this in a gentle and understanding manner may help them see the logic in making this transition.
Above all, listen. Listening may be all you need to do to help your parent accept the idea of assisted living. It’s very possible that he or she will want to make the move, yet also feels a need to express all of his or her resentments and worries about doing so. By listening, you will help your parent feel more understood and will also help make him or her more receptive to your own feedback.
There is no simple and easy way to discuss assisted living care with a parent. The process can, however, be an opportunity for you two to grow closer as you share your thoughts and feelings about the matter in an open and non-judgmental atmosphere.Unfortunately, there are some out there who will mistreat those who are vulnerable, including the elderly. At a certain point, it becomes elder abuse, and it’s one of the worst fears of those who have a loved one who is not fully able to fend for themselves. Elder abuse can be inflicted by a staff member in a residential institution, a fellow resident, a hired caregiver in the home, or even a family member. Our seniors deserve our gratitude and our respect, but a significant number of them are victimized and disrespected by the very people they trust. They cannot always do what it required to keep themselves safe.
Elder abuse is under-reported because so few of those who are harmed by it can speak out for themselves. Because of this, it is important that family members, assisted living staff, and friends know the signs and symptoms of elder abuse. Being able to recognize abuse is the first step to putting a stop to it. There are several types, including:
- Malnourishment – refusing to provide required food or water which can lead to serious medical problems, starvation, dehydration, and sometimes death.
- Physical Abuse – committing physically violent acts; punching, kicking, slapping, pushing, and pinching are a few examples.
- Sexual Abuse – committing unwanted sexual acts; molestation, harassment, rape, forced oral sex, and unwelcomed sexual language are considered forms of sexual abuse.
- Financial Abuse – refusing seniors access to their own money, stealing, or embezzling.
- Refusal of Medical Care – refusing them access to their physician, or refusing to provide them with their required treatments or medications.
- Psychological Abuse – verbal abuse, name calling, demoralization, refusing seniors access to psychological care
- Emotional Abuse – refusing them access to loved ones, telling them that no one loves them or wants to visit with them, making them believe that they are alone and utterly unloved.
- Neglect – not providing seniors with the necessary hygienic care (bathing, brushing their hair, changing their diapers), leaving them alone for long periods of time, not providing a clean, safe and comfortable environment (no heat or air conditioning, allowing for filthy living conditions), or allowing others to abuse them.
- Unexplained or poorly explained bruises, broken bones, burns, abrasions, and pressure marks
- Sudden changes in personality not explained by mental illness
- Tension in personal relationships with family, friends, or assisted living staff
- Unexplained withdrawal from activities that used to bring joy
Deciding whether to choose assisted living or home care is tough, and many emotions come up which influence the decision-making process. When you realize that you or a loved one needs some outside help, which option will work better? The answer of course is different for each individual and family, but there are certain considerations that tend to come up again and again.
Two of the key features of assisted living facilities are that they’re designed so that seniors can be as independent as possible while remaining safe, and that they provide services in a cost-efficient manner (since they are shared by several or more people). On the other hand, home care has the undeniable advantage of the senior being able to remain in their home and/or with loved ones.
However, the coziness of home care can also be one of its disadvantages. Having someone in the household with such extensive needs can be a burden for others in the family. We all want to feel like we’re doing as much as we can for aging loved ones, but caregiver burn-out is a real issue. Remember that before you can help others, you must help yourself: if you’re stressed or feeling negative, the senior in your life isn’t getting the best help. Allowing assisted living to take on the chores of daily care may allow you to spend the time connecting with your loved one and enjoying each other’s company.
Another major issue that you should consider is the cost of the two options. Assisted living can be a very affordable solution that gives you a lot of value for your money. Just about all of life’s needs are taken care of in one fee: housing, food, utilities, housekeeping, and social activities, plus the care and assistance that helps the senior get through daily life. Many feel that a lot of worries have been taken off their shoulders when they move to assisted living.
With home care, though, you’re paying on an hourly basis. The average cost of home care in California is $20 per hour, so that adds up quickly even before you throw in other needs like food and housing. Since you are managing home care yourself, you’ll need to have a plan when a hired caregiver cannot come in due to illness or any other reason. This can be addressed by using an agency, but the agency will charge higher-than-average fees for the convenience of knowing someone will always be there.
Again, be sure to take into account your individual needs. There are some situations in which home care may be more appropriate. Before committing to one choice or the other, do thorough research on the actual cost and make sure you truly understand your options. Then this challenging decision may become a little more clear.
Few things can brighten a senior’s day like a visit from their grandchildren and great-grandchildren. These visits can help add purpose to a senior’s life and help them maintain a connection to a world outside the facility and to the family. It also gives the grandchildren a valuable chance to get to know the grandparent. Being able to see how much they mean to older family members is an important experience for the child. But it can be challenging to think of ways to make this time meaningful and enjoyable.
The first step is to prepare the child for visiting the facility. Describe what it’s like and perhaps even show pictures. Explain the purpose of assisted living and why the family decided grandma or grandpa should be there. Explain what behavior will be expected. Be sure to emphasize how happy the senior will be to see the child, but also make sure they know that their grandparent may not be feeling well that day.
What to do during the visit can be a challenge. If everyone just sits around in grandma’s room, it will be boring for the children and unsatisfying for the senior. Instead, have a plan. Here are some ideas:
- Bring children at a time when the residents are socializing. That way, the senior can introduce the child to friends and have a chance to show off their wonderful grandchildren.
- Wear Halloween costumes so that the grandparent can see in person how cute they look and what creative ideas everyone came up with. There may be other holidays where the children are dressing up, such as Purim or Christmas, and they can show their grandparent their special outfits for these times too.
- Have children bring a recent school project that they can show to their grandparent. Seniors are likely to be very interested in seeing what kids are learning in school these days. If the project is about something the senior doesn’t know about, that gives the child a chance to be the teacher.
- Play games. The child can bring a favorite game to share with the grandparent, and it’s likely that the grandparent has a favorite game of their own that they can teach the child.
- Decorate the senior’s room for an upcoming holiday. Decorations often bring out lots of excitement in children, and seniors will feel loved and have a reminder of the visit after the children have left.
- Share riddles and jokes and silly songs. Children might be very interested to hear some of the songs the grandparent remembers from when they were the child’s age.
- Bring photographs or video of a recent event in the child’s life, such as a chorus concert, ball game, or scouting trip. Have the child tell the grandparent stories about what happened.
- If you’re willing to take on a bigger project, talk to the assisted living facility and the child’s school about arranging a class visit. The children could sing for the seniors or perform a skit. Another idea is to have children interview the seniors about their lives, and use the information to write short biographies that can be compiled into a collection for both seniors and the children to keep.
Seniors entering assisted living may need help with daily tasks due to the physical limitations of old age, but often their minds are still relatively healthy. These seniors can benefit from taking simple actions that will help them continue to maintain their mental abilities.
1. Take on puzzles and games. Exercise the mind with logic challenges to keep it active. Card games are a great example: those seniors who enjoy bridge, even without realizing it, are doing more for themselves than simply having a good time enjoying competition with friends. Board games like monopoly are good choices too, and don’t forget the ever-popular Bingo (play with multiple cards to get the most brain-stimulating challenge)! Sodoku and crossword puzzles work well. The best benefit from games comes when there’s a social aspect to them: interacting with others provides additional stimulation and challenge.
2. Be social. If you’re not someone who enjoys games, even social interaction itself can benefit the mind. Talk to other residents and get to know them. Take an interest in the staff members you come into contact with and ask them about their lives outside of work–with their demanding and sometimes emotionally draining jobs, many caregivers will appreciate the chance to make a personal connection and be recognized. Check out activites being offered by the community. Social interaction has had documented positive effects not just on the mind, but on overall health as well. Seniors in assisted living, who have a community readily available, are well-situated to take advantage of these benefits.
3. Eat properly. Good nutrition and regular meals are good for both the body and the brain. Your assisted living facility can be a big help with this, providing healthy food on schedule without you having to worry about it. Eat a variety of things and for mental benefits specifically focus on colorful fruit, leafy green vegetables, and foods with omega-3 fatty acids like nuts and fish. Drink water often: seniors are more likely to become dehydrated than younger adults.
4. Move. We think of exercise as benefiting the body, but our minds thrive on it too. Don’t shy away from the chance to be active. Coordinated movements, especially dancing, can be great for keeping yourself sharp. Line dancing, for example, forces you to use your memory to learn and remember the steps. Another option is to go for a walk, even if it’s just around the hallways of the facility. Seniors have been shown to benefit from light strength training and low-impact aerobic exercises designed for them. Physical activity increases your oxygen use and blood flow to your brain. Whatever exercise you choose, to get the benefits it’s important that you be consistent.
You may have recently heard about the option of life settlements, where you sell your life insurance policy to a third party, and be considering this option in order to fund assisted living. The buyer of the policy takes responsibility for the premiums, and then receives the benefit when you pass away.
These offers are certainly tempting, but make sure you’re considering all the possibilities open to you first. For example, you may be able to take out a loan on the cash value of the policy. You may also be able to reduce the death benefit in exchange for lowered premiums, which will allow you to hold on to the policy and some of its value. Finally, if you are terminally or chronically ill, you may be able to receive an accelerated death benefit while you’re still alive. Don’t make the decision to give up your life insurance lightly: if your policy has value to investors, it also has value to your heirs. Remember why you bought the policy in the first place.
On the other hand, if it’s likely you will lapse on your policy anyway, a life settlement can make a lot of sense. If you have decided that a life settlement is the best choice for your situation, make sure you do your research. Different life settlement providers may make you different offers, so be sure to shop around. You may want to consider using a life settlement broker, who will act in your best interest. Also know that you do not need to sell your whole policy: you may be able to arrange to keep a portion of the benefits.
How much you can get for our policy will depend on your life expectancy, how much needs to be paid in premiums to keep the policy in force, and the policy’s cash value. Think through the various implications of receiving such a large sum of money. Some of the settlement may be taxable, and any creditors you have may be able to claim the money. Also consider whether your social security or any other public benefits you receive will be affected.
Beware of schemes where you buy life insurance with an agreement to sell it later. This is called Stranger-Originated Life Insurance (or STOLI) and it’s illegal in most states. Insurers may refuse to pay benefits on these arrangements.
To learn more and to find out how life settlements apply to your specific situation, consult with your insurance agent, a financial advisor, or lawyer.