Hospice Care: When Should It Begin?

Hospice care was developed as a care solution for terminally ill patients.  Usually family members are involved in care services when a senior or someone younger is terminally ill.  Medicare does provide for hospice care services for seniors and provides certified nursing aide caregivers, social workers and registered nurses to visit the home to assist with the senior's care needs.  Family caregivers often do not realize Medicare will pay for hospice care services for seniors to help support them.  Yet the support of hospice can make a difficult situation a little easier to manage.

Hospice will also assist with the emotional aspects of terminal illness for both the senior and their family and for professional caregivers, along with bereavement care. In addition, hospice will provide a Certified Nursing Aide to assist with tasks such as bathing.  My grandmother moved in with my Aunt when she became terminal with cancer.  While my Aunt wanted to provide for her care, it was exhausting.  She appreciated the regular check -in visits by the hospice staff.  The hospice Certified Nursing Aide assisted her with bathing assistance visits and the Registered Nurse gave her feedback on the progression of the cancer.

Hospice care may begin as soon as someone is diagnosed as terminally ill.  There are many companies which provide hospice care and your medical doctor can usually provide a referral.

Learn more about hospice care services directly from the hospice foundation.  http://www.hospicefoundation.org/


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The Five Wishes: An Easy Living Will

The Five Wishes is a document which was created to serve as a living will and provides questions to prompt you to think about how you would like your medical treatments and care to be provided if you were unable to speak or communicate these desires for yourself.  This living will document accounts for your medical, personal, emotional and physical needs.  It has been called a "living will with a heart". 

When I owned a Senior Home Care Agency, I placed a bulk order for the Five Wishes and gave many copies to client's family members.  The Five Wishes makes sure all the specific questions about care are answered.  For instance, laws can vary slightly in each state regarding to what is life support (is it both a feeding tube and a breathing apparatus)?  The Five Wishes is honored in 40 states and provides a starting point for you if you don't live in one of the 40 states.

Save money on Last Will and Testament

People of all ages, not just seniors, should take the time to create a living will so that family caregivers will know your desires.  The Five Wishes makes this an educational and easy task.  Definitely if you are a senior or if you do not know what your senior parent's wishes are, the Five Wishes can be a nice starting place for a discussion.

I really like The Five Wishes because it breaks it all down into specifics:  do you want life-support if you are sure to die in a short time or if you are in a coma and not expected to wake up or if you have permanent and severe brain damage and are not expected to recover?

The Five Wishes

Wish 1:  The person I want to make health care decisions for me when I can't make them for myself

Wish 2:  My wish for the kind of medical treatment I want or don't want

Wish 3:  My wish for how comfortable I want to be

Wish 4:  My wish for how I want people to treat me

Wish 5:  My wish for what I want my loved ones to know

There is a page for witness signatures and wallet cards are provided.

Creating a living will in the form of the Five Wishes makes sure you will have your desires spelled out and will prevent added stress for family members who may all have their own beliefs and desires, which may differ from yours.  You will be able to avoid a Terry Schiavo situation where the husband wanted life support removed after 15 years and her parents did not (the autopsy did confirm her brain was severly damaged, weighing half of a normal human brain, which meant she was unable to think, feel, see or interact in any way with her environment - for all that time).

The Five Wishes was introduced and originally distributed with support from a grant by The Robert Wood Johnson Foundation, the nation's largest philanthropy devoted exclusively to health and health care.

You may order a copy of The Five Wishes for $5.00 from www.agingwithdignity.com (just $1.00 per copy if you order 25 or more copies).




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Chicago Marathon: Older Runners and Wheelchairs

We know that exercise is good for our health, at all ages.  But if you are ever finding yourself thinking of excuses for why you shouldn't exercise, let these Chicago Marathon finishers provide you with some inspiration.

Aussie Kurt Fearnley won the men's wheelchair division and set a course record, too.  This was his second year to win the wheelchair division of the Chicago Marathon.  He was born with lumbar sacral agenesis, a condition that paralyzed his legs.

Another finisher was octogenarian Arturo Guzman, 84, who says he has been a runner all of his life.  He gets up at 5 a.m. every morning to go for an hour long run.

Yes, it must be true that you can build muscle mass at all ages.  The secret is to keep it moving!

And to find out about how to enter next year's marathon, visit:   www.chicagomarathon.com

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Caregiving as a Career

As the financial crisis in the U.S. continues to unravel and we experience an increase in unemployment, it is relevant to note the ongoing shortage of qualified caregivers in many cities across the U.S.

If you are transitioning in the job market, or looking for fulfilling part-time work, you may want to consider working as a senior caregiver.

Senior Home Care Agencies, Assisted Living Communities and Nursing Homes hire part-time and full-time caregivers to assist seniors with Activities of Daily Living.  Many Senior Home Care Agencies also hire 24-hour "live-in" caregivers.  Live-in means the caregiver stays with the senior for a few days at a time, preparing meals and eating with the client, and sleeping over night but they do not actually permanently live with the senior client.  A minimum of two caregivers will staff a live-in client, rotating days during the week to meet employment law requirements. 

What experience is required?  Companion caregivers, Certified Nursing Aides and Home Health Aides are hired as Caregivers.  Some of the best professional caregivers gained personal experience first by caring for a family member or friend.  Many Senior Home Care Agencies provide caregiver training on senior care.  Caregiver training may include specialty training for stroke care, dementia care, hospice care and education on age-related diseases.

Certification as a Nursing Aide can be obtained from nursing schools or community colleges.  Sometimes social service agencies and health care companies sponsor certification programs.  The nursing aide certification requirements vary in each state.  Most nursing aide certification classes can be completed  in  6 to 12 weeks.

Caregivers earn from $8.00 to $14.00 per hour and from $90 to $140 per day for live-in care,  depending on the geographic location. The hiring company provides for payroll taxes and Worker's Compensation insurance and other benefits

Senior care delivers fulfillment beyond a paycheck.  If you enjoyed visiting your Grandparents and appreciate the wisdom an older adult can share, you will probably enjoy working as a caregiver.  A caring personality, patience and dependability are qualities which senior care companies look for in caregivers.  Caregiver job applicants will also be required to pass a criminal background check.

If you are interested in working as a caregiver, contact your local Department on Aging for names of local companies which may be hiring or fill out a Caregiver Job Application on Caregiverlist.  You may also want to look into volunteer opportunities through local churches and senior centers to gain experience.




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Social Security Benefits: Not Enough to Pay for Medications

Sunday's Chicago Tribune profiled 5 senior citizens and how they are paying for their living and medical expenses on Social Security and Medicare or Medicaid.

How much money will you receive each month on Social Security?

The maximum Social Security benefits in 2008, for seniors who have reached the maximum taxable earnings is:

$1,682 per month if retiring at age 62

$2,030 per month if retiring at age 65

$2,794 per month if retiring at age 70

Let's assume your home is paid for and that you have limited expenses.  This amount probably seems adequate but the challenges arise when a senior has additional medical expenses and caregiving needs.  Medications are not completely covered by Medicare and can be rather expensive. 

One of the senior couples profiled by the Tribune were earning $3,000 per month in retirement income.  But when the husband was diagnosed with pancreatic cancer, the co-pays for medical visits and the costs of medications quickly amounted to more than their monthly income.  Fortunately the wife is able to serve as his Caregiver for free.  Another senior profiled lives on $800 per month from Social Security and another receives $998.  Unfortunately, when on a limited income, medications are typically the item the senior will do without as they will choose to pay their rent and buy food first.

A couple of these seniors found additional assistance through churches and social service agencies to help pay for their expenses.  There was no extra money to pay for Caregiving services, which also are not covered by Medicare. 

Regardless of who wins the upcoming election, I hope they will look at the need for affordable medications for seniors of all income levels.  It seems Barack Obama is a fan of affordable medical care for everyone, understanding the challenges his Mother experienced when she was diagnosed with cancer.  AARP supports more issues supported by Barack,and you can read more on their Voter Guide.  John McCain is a senior so should understand well the need for affordable medications.  This recent New Yorker article profiles Cindy McCain and her experiences with prescription medications.



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New Federal Exercise Guidelines

Today the U.S. Government released guidelines for physical activities that offer health benefits to Americans, including seniors.  This is a first from the feds.

And, the bar has been raised.  The guidelines suggest adults should exercise at moderate-intensity for 2 1/2 hours each week along with 1 1/4 hours of vigorous-intensity exercise to get the most health benefits.  Moderate-intensity includes brisk walking and vigorous-intensity means stepping it up a notch to running or swimming laps. Adults includes senior adults, which the guidelines refer to as "Older Americans".

This means both Caregivers and their senior clients can go for a walk each day to meet the guidelines, as older adults also will experience health benefits from exercising.

The guidelines suggest adults should include muscle-strengthening (resistance) activities at moderate- or high-intensity levels, which includes free weights, resistance bands, or exercises which use body weight such as sit-ups and push-ups.

Older Americans should follow the guidelines if they are able. If not, they should be as active as their physical condition allows. Exercises to improve balance are also suggested.

Physical exercise can also improve the emotional and mental outlook for seniors.  Caregivers can find these new guidelines on the government website.


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Estate Planning: Caring for Pets

Leona Helmsley, nicknamed "the Queen of Mean", left $12 million in her trust to care for her Maltese dog, Trouble.  Rumor has it that she had few friends, so it was appropriate for her to leave more money to her dog than to people.  She left around $10 million to two grandsons and the rest of her estate, estimated as worth between $3 billion and $8 billion, went to the Helmsley Charitable trust.  She stated that the mission of the trust should be to provide for the care of dogs.  Even though she only owned a dog later in life and gave away another dog which she was given as a gift (named "Double Trouble), because she didn't really like him.  She still decided to change her trust two years prior to death to only provide for dogs and deleted the previous mission which also included caring for "poor children". 

The interesting part of this trust, is that even though it would seem Leona, as a bilionaire, would have had very experienced attorneys, they did make some legal mistakes in writing her will.

First, Leona requests her dog to be buried beside her when it passes away.  However, she is buried in a human cemetery and New York state law does not allow animals to be buried in human cemeteries.  People can be buried in pet cemeteries but not the other way around in New York.  This was an error by her attorney in not checking New York state law regarding pet burial. 

Second, her dog is 9 years old and has a variety of medical issues, which combined with the life-expectancy of a Maltese means Trouble will probably live only another 5 years.  It seems that the attorneys managing her trust could not come up with a way to spend $12 million on a dog (even with the best dog food and spa treatments) in 5 years.  And, Leona didn't specify how the dog should be cared for and what the money should be spent on.  Lawyers managing her trust have decided $2 million will be more than ample for the dog's care (and because the relatives Leona left the dog to actually didn't want the burden of caring for the dog, one of her hotel employees is being paid $5,000 a month to care for Trouble).  The lawyers then arranged for the other $10 million that was left to Trouble to go back to Leona's charitable trust.

According to a recent New Yorker magazine article, only 38 states allow for "pet trusts" in order for people to provide for the care of their pets after they die.  However, the law is still catching up with the nuances these trusts present.  It is probably important to be a little more specific in how the money is to be used when leaving it in a trust to a pet, since the pet cannot effectively communicate their wishes for spending the money.  Especially in Leona's case, since it turns out the people she wanted to care for Trouble did not really want the dog, and the day-to-day care and love from a human owner is probably what a pet most wants when their owner passes away.

A website that assists with pet trusts:  www.mypetprotection.com






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People of All Ages & Physical Conditions Benefit from Exercise

Use it or lose it.  Older adults can build muscle mass just as quickly as younger adults.

While it is true that there are many age-related illnesses, such as Osteoporosis, Alzheimer's Disease and Parkinson's Disease which can have a negative impact on physical capabilities, it is also true that an inactive lifestyle leads to deterioration of strength, balance and flexibility.

In some countries without the modern conveniences we have here in the U.S., seniors maintain their abilities to function unassisted much longer.  In many parts of China and Africa, for instance, there are no toilets.  There is just a hole in the ground.  The one advantage this provides is that people must truly squat from their knees and then standup each time they visit the toilet.  This is sort of a forced way to continue to maintain strength and flexibility in the legs.  Their aging populations maintain an active lifestyle much longer than we do in the U.S.

The National Institute of Health provides exercise guidelines for older adults and also provides information on scientific studies which show that staying physically active and exercising regularly can help prevent or delay many diseases and disabilities. Even moderate exercise and physical activity can improve the health of older adults who are frail or have diseases that accompany aging.

The four areas exercise can help are:  strength, balance, flexibility and endurance.  Check out NIH's website for more information and videos.

I know it isn't always easy to convince Mom and Dad to exercise.  My girlfriend purchased a health club membership for her parents and they told her they were going.  Everytime she called she would ask them how their workouts went and they would tell her all was going well.  Then after about 6 months her brother finally confided in her that he wasn't sure they were really going.  She called the health club and found out they had only been twice.  As she says, at least she tried.  If you can convince someone to stay with an exercise program for just a couple weeks, they will start to experience the positive benefits which will encourage them to stay with their program.



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Flu Shots: Good Idea for Seniors and Caregivers

It seems it is finally time to accept that summer is over, and all that comes with that, including flu shots.  Such an unpleasant thought.  But getting the flu really is worse than getting the shot and there are plenty of vaccinations on hand (The U.S. has a supply of 140 million vaccinations and only used 113 last year).  The Center for Disease Control recommends flu vaccinations for pregnant women, people 50 and older, younger adults with chronic illnesses such as diabetes or asthma, health-care workers, people who come into contact with infants younger than 6 months, and people in contact with others at high risk of flu complications.

Caregivers can go along with their senior client to get a flu shot.  Many senior centers, churches and area departments on aging provide flu shots.  Some doctors offer flu vaccinations on certain days and many pharmacies host flu shot days.  Walgreens pharmacy will provide flu and pneumonia vaccinations at many of their pharmacies in October and you may find out when and where on their website.

Get the shot, not the flu.

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Caregiver Stress: The Relaxation Breath

I am a big fan of Dr. Andrew Weil.  He has some great books on healthy eating, healthy living and aging well.  He likes to talk about the benefits of aging which include wisdom.  He makes note of other things which are better with age such as wine, violins and friendships.  One of the reasons many people are attracted to senior caregiving is because it gives them the opportunity to be around the wisdom of an elder.

But with caregiving comes stress.  There are both physical and emotional challenges when providing senior care, especially when memory loss is present.  It is important for Caregivers to take days off and to take care of themselves when working on a long-term assignment.  Senior Home Care Agencies honor the 40-hour work week and are able to staff a replacement caregiver when the regular caregiver needs a day off.  This is good for both the senior client and the caregiver.

Dr. Weil offers the relaxing breath technique on his website and it truly works wonders for people of all ages.

The 4-7-8 (or Relaxing Breath) Exercise
This exercise is utterly simple, takes almost no time, requires no equipment and can be done anywhere. Although you can do the exercise in any position, sit with your back straight while learning the exercise. Place the tip of your tongue against the ridge of tissue just behind your upper front teeth, and keep it there through the entire exercise. You will be exhaling through your mouth around your tongue; try pursing your lips slightly if this seems awkward.

  • Exhale completely through your mouth, making a whoosh sound.
  • Close your mouth and inhale quietly through your nose to a mental count of four.
  • Hold your breath for a count of seven.
  • Exhale completely through your mouth, making a whoosh sound to a count of eight.
  • This is one breath. Now inhale again and repeat the cycle three more times for a total of four breaths.

Note that you always inhale quietly through your nose and exhale audibly through your mouth. The tip of your tongue stays in position the whole time. Exhalation takes twice as long as inhalation. The absolute time you spend on each phase is not important; the ratio of 4:7:8 is important. If you have trouble holding your breath, speed the exercise up but keep to the ratio of 4:7:8 for the three phases. With practice you can slow it all down and get used to inhaling and exhaling more and more deeply.

This exercise is a natural tranquilizer for the nervous system. Unlike tranquilizing drugs, which are often effective when you first take them but then lose their power over time, this exercise is subtle when you first try it but gains in power with repetition and practice. Do it at least twice a day. You cannot do it too frequently. Do not do more than four breaths at one time for the first month of practice. Later, if you wish, you can extend it to eight breaths. If you feel a little lightheaded when you first breathe this way, do not be concerned; it will pass.

Once you develop this technique by practicing it every day, it will be a very useful tool that you will always have with you. Use it whenever anything upsetting happens - before you react. Use it whenever you are aware of internal tension. Use it to help you fall asleep. This exercise cannot be recommended too highly. Everyone can benefit from it.


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