What Caring for My Mother Teaches My Children (and Vise Versa)

I’m part of the “Sandwich Generation,” a term that is used to describe those of us who care for their children as well as their aging parents. According to the Pew Research Center, 47% of American adults in their 40s and 50s are raising a young child or children (or financially supporting a child over 18) and have a living parent age 65 or older. Longer life expectancies and delayed childbearing means we baby-boomers experience the emotional, physical, and financial challenges of family caregiving across generations.

Since there’s just no getting around my double-whammy caregiving situation, I (uncharacteristically) try to keep an optimistic attitude and a little sense of humor when I feel pulled in so many directions at once. Caring for children is not all that different from caring for seniors and as care-recipients, they have a lot to learn from each other.

Patience, patience, patience
Are you trying to get out of the house on time? Start an hour early. Trying to decide on which cereal to buy? Be prepared to look at every box. Whatever time you think you need to complete a task, double it. That’s just the way it is. If you as the caregiver begin to show signs of stress and impatience, those in your care will respond with agitation and frustration. Those tasks that seem to take an interminably long time will take even longer. There have been times when I’ve been pushed to my limit, and here’s something interesting — if I raise my voice to my mother, she gets the same look on her face as my children do when I yell at them — and it’s not a good look. I’ve learned to breathe deeply, count to 10 (or 100), smile, and go scream into a pillow.

You can be active without being at a full-run
There’s nothing wrong with watching television or (more in the case of kids than of mom) playing video games. Sometimes we need that passive entertainment. But it’s important to balance those things with mind-engaging activities. Puzzles and games help with logic, thinking, and memory. Meandering strolls in the park not only help with your large motor skills (and I’m there to make sure you don’t fall!), but it gives us the opportunity to get away from all of life’s distractions, look at the world around us, and maybe have some great conversations.

Sometimes you need a little help
There’s no shame in asking for help now and then. It doesn’t mean you are weak or needy, it means that with someone’s help, you can do essential tasks quicker and safer.  Both children and the elderly need help with Activities of Daily Living (ADLs) like bathing, dressing, and personal hygiene (I swear if he doesn’t do it more often, I’m going to floss my son’s teeth for him.) I stoop to tie shoes and a climb to reach things that are too high. My children feel no loss of dignity when they realize they need my help, neither should my mother.

There’s nothing that a hug won’t help
Hugs can’t fix everything, but many studies show that there’s a physiological change that occurs when someone gets a supportive touch. Hugs and hand-holding have been shown to help release a person’s oxytocin, dopamine, and serotonin, known as the “feel good hormones.” Touch has been known to lower blood pressure, lower the risk of heart disease, and alleviate anxieties and fears. And remember, as you are giving, so are you getting. Hugs work both ways.

I don’t know how much longer I will have to care for my mother, and my children will grow up and away from me before I’m ready. Yes, multi-generational caregiving can be exhausting and stressful, but it doesn’t last forever and I need to remind myself of that every day. I’ve chosen the child-rearing, parent-caregiving path (or it chose me) and strength of character is often determined by how one handles challenging situations. And when my “strength of character” threatens to bail (as it does for everyone), babysitters and professional senior caregivers are there to provide respite and help me keep sane.

Sundowner's Syndrome: Sundowning and Daylight Saving Time

Daylight Saving Time — every year I hear more and louder voices insisting we do away with springing ahead, when we are forced to lose that precious hour of sleep. I don’t hear quite so many voices in the fall, when we “gain” an hour, except for many of my friends in the senior caregiving community.

Sundown Syndrome occurs in approximately 25 percent of persons with Alzheimer’s disease or other types of dementia, according to the Alzheimer’s Association. When someone is “sundowning”, they can become hostile and agitated, angry and confused. Experts speculate that Sundowner’s can be triggered by end-of-day exhaustion, when all the stimulus from the day overwhelms the senses. In institutional settings, like nursing homes, Sundown Syndrome can occur during evening shift change, when there is a lot of commotion.  Although the causes of sundowning are largely unknown, it seems to happen to many late in the day, when afternoon turns to dusk. In the evening, shadows can be confusing, and people can become upset when they can’t see in the dark.

Spring Daylight Saving Time means there’s an extra hour of light at the end of our day. I wonder if this is helpful to caregivers working with those who experience Sundowner's. Even though I couldn’t find any data to suggest that Sundowners experience fewer symptoms when we “spring ahead,” I found plenty of anecdotal evidence that those with Sundown Syndrome experience it more acutely during the fall time change, when it gets dark much earlier. 

In any case, Daylight Saving Time messes with the natural rhythm of sleep, which can also trigger or exacerbate Sundowner’s symptoms and the stress they cause in elderly and caregivers alike.

The idea of Daylight Saving Time has roots in ancient civilizations, where the sun’s schedule set daily routines. Benjamin Franklin in 1784, proposed the notion jokingly to the editor of The Journal of Paris in “An Economical Project for Diminishing the Cost of Light,” pointing out that Parisians could save money on candles by extending the hours of natural daylight. The U.S. implemented DST on and off since 1918, when President Woodrow Wilson signed it into law. But it wasn’t until Congress established the Uniform Time Act of 1966 that America reached a DST standard. Today, over 70 countries have adopted DST, including the United States (except for Hawaii and most of Arizona.)

According to the Alzheimer’s Association, there are some coping strategies you can employ if you care for someone with Sundowner’s:

  • Keep the home well lit in the evening.
  • Keep the sleep environment comfortable and safe. The temperature should be comfortable and nightlights provided for safety when a person gets up in the middle of the night.
  • Maintain a consistent schedule of waking, bedtime and meals.
  • Avoid big dinners, nicotine, alcohol, and restrict sweets and caffeine so as not to interfere with restful sleep.   
  • Plan more active days and discourage afternoon naps..
  • As a caregiver, if you are feeling stressed late in the day, the person may pick up on it. Make sure you get respite help.
  • Share your experience with others.

For those of you who care for Sundown seniors, do you find that extra hour of sunlight helpful? Have you found  any sundowning therapies particularly useful? Share your caregiving strategies for coping with Sundown Syndrome in Caregiverlist’s Caregiver Stories or in the Comments section below.

Age is Beauty

Youth is beauty. It’s what our society tells us and shows us, from 14-year-old model Roos Abels on Prada’s catwalk to the goofy twenty-year-olds on America’s Next Top Model. It’s fairly common to hear that a model’s career is mostly over by the time they’re 25.

But not always.

Carmen Dell’Orefice, 83, is commonly known as the world’s oldest working model. Although she began her modeling career at the age of 13 (when she posed for Salvador Dali!),  she admits that  to New You magazine that she’s “had more magazine covers in the last 25 years than I have had in my whole elongated career." Over the last few years, she’s made her mark on catwalks around the world, and closed this year’s max.tan show at Digital Fashion Week Singapore.

Céline has made iconic writer Joan Didion, 80, the star of their Spring 2015 campaign. Of course, the decision propelled the fashion house into the limelight, but I applaud anyone who recognizes the beauty of “mature models.” And besides, Joan Didion has always been one of the coolest of the cool girls and that doesn’t change just because you age.

Joan Didion for Céline. Photograph: Céline

Dame Helen Mirren is a relative whippersnapper at 69-years-old. She stars in her first commercial for the L'Oreal Paris' Age Perfect campaign. And yes, the product is designed to target older women, but still, it’s awfully nice to see that beauty is appreciated, even in older women.

Is this a temporary trend? Will older women continue to be celebrated in fashion and beauty? I hope so. As the population ages, the buying public will be an older one. With just about 26 million women over 65 in the U.S. alone, it’s just smart to sell to the demographic.

We at Caregiverlist are great believers in aging well. While exercise and proper nutrition won't give you outstanding cheekbones or a 5'9" frame, you can certainly be your best you at any age.

You Are What You Eat: Senior Nutrition

March is National Nutrition Month and an ideal opportunity for senior caregivers to make sure seniors are getting all the proper nutrition they need. It’s easier said than done. As we age, our bodies have a more difficult time absorbing key nutrients. Certain foods can lose their appeal — medications especially can affect appetite or change the way food tastes.

A nutrient-rich diet is more than essential for health maintenance, its a form of preventative medicine. A good diet can help keep common ailments such as high blood pressure, diabetes, heart problems, and high cholesterol at bay. Key nutrients are essential to keep physically and mentally fit.

Unfortunately, according to a report released by AARP, more than 10 million seniors go hungry every day, and it’s likely that “proper nutrient intake suffers when individuals are food insecure.”  What money is available for food should go to the most nutritious foods available — whole, unprocessed foods that are nutrient-dense (and generally low in calories)  are key to senior health.

You can follow the Food Pyramid for Older Adults (Tufts University) or any balanced diet in order to get the proper nutrition. I think it’s key to get your nutrients from whole foods as opposed to relying on supplements. The elderly usually already take so much medication, who wants to take more pills?

The National Institute on Aging has recommendations for eating well as you age. They suggest you plan meals and snacks to include:

  • fruits and vegetables
  • whole grains
  • dairy products, especially low-fat or fat-free
  • protein in the form of lean meats and poultry, seafood, eggs, beans, and unsalted nuts
  • limited amounts of solid fats. Keep trans fats to a minimum
  • limited amounts of cholesterol, salt (sodium), and added sugars

Don’t forget to keep hydrated with water or water-rich food such as melons, cucumbers, radishes (!), even if you don’t feel thirsty.

The NIA also suggests any seniors with high blood pressure or hypertension consider the DASH diet, which I previously wrote about here.

Caregiverlist knows senior caregivers are integral to helping the elderly to eat right and age well. You can learn basic caregiving skills by taking our 8-hour online Caregiver Certification training course provided by Caregiverlist Training University.

Assisted Living Costs Ranked Nationally

Did you know that the term “assisted living” is the most popular Google search term for senior housing? Certainly more so than “nursing homes” and “senior living”, according to a new senior care analysis.

It’s no wonder. Studies show that in 2013, 45% of those who needed long term care and could not age in place chose an Assisted Living Facility (ALF), compared with 20% in 1996. ALFs provide a safe and secure social environment for an aging population.

But what is the cost? A recent Genworth 2014 Cost of Care Survey showed that, while the national median average for one Bedroom–single occupancy apartment in an assisted living community is $42,000 per year, that cost can can be much higher (or lower). What drives the difference in cost? Location, location, location.

The ten most expensive states for assisted living are:

$82,674 — Washington, D.C.           
$66,000 — Alaska
$66,000 — Delaware
$65,160 — New Jersey
$63,468 — Connecticut
$59,400 — Maine
$58,740 — Rhode Island
$57,000 — Hawaii
$52,470 — New Hampshire
$51,000 — Washington

The average cost increase over 2013 is 1.45% and the survey estimates a 5-year cost increase of 4.29%, based on the compound annual growth rate for surveys conducted from 2009 to 2014.

Assisted living is for seniors who cannot live independently. ALFs don’t provide the level of medical services found in nursing homes, but, generally speaking, most assisted living facilities may provide:

  • Assistance with activities of daily living
  • Central dining programs that include two or three meals a day
  • Lectures and educational activities
  • Emergency call systems
  • Exercise activities
  • Wellness programs
  • Health services, medication administration
  • Housekeeping and maintenance
  • Laundry services
  • Organized recreational activities and “field trips”
  • Social services and religious activities
  • Transportation arrangements
  • 24-hour security

Keep in mind that costs vary within state regions, so be sure to look closely at the costs of assisted living in your specific area.

Is assisted living in your future? Tell us what you look for in a facility and if the higher cost is worth the location.

Cruise Ship Retirement: Assisted Living on the High Seas?

Last month I read the USA Today story about Lee Wachtstetter, an 86-year-old Florida widow who sold her Fort Lauderdale home (and acreage) and to live a “stress-free, fairy-tale life” aboard Crystal Cruise Line's 11-year-old ship, Crystal Serenity.

Retiring as a permanent resident on a luxury cruise ship isn’t cheap. “Mama Lee” estimates she pays $164,000 per year, or about $450 per day, for her lifestyle. That cost includes her single occupancy stateroom, all meals (and the ubiquitous buffets,) beverages, gratuities, housekeeping, cocktail parties, movies, lectures, Broadway-type shows, and her favorite, nightly ballroom dancing — not to mention travelling to every city around the world that has a port. As long as Ms. Lee doesn’t become acutely ill or need special medical attention, which can get pricey on-board, cruise ship retirement seems like a pretty glamorous and exotic way to live out one’s golden years.

Or is it?

The Straight Dope’s Cecil Adams tackled this topic in a June 2012 article and compares cruise ship retirement with luxury hotel retirement, except the retiree gets to travel the world instead of being stuck in one place. Temperate climates and nightly sunsets on a vast horizon make cruise ship retirement sound like a better alternative to staid assisted living, but only if the senior is in the best of health and doesn’t mind traveling light. Ship staterooms can be cramped, especially when one is on a budget. Sleeping quarters aside, the entire ship and all its amenities are at your service.

While the employee-to-guest ratio is generally higher on a ship than the staff-to-resident ratio in most assisted living communities, those employees aren’t as likely to be trained for the special needs presented by older adults. And sure, the amenities are great, but if the ship breaks out in norovirus, as happened twice recently on Royal Caribbean's cruise line, those with compromised immune systems, such as the elderly, would be hardest hit. And there’s nowhere to run (no pun intended.)

While a long-term passenger might miss family and friends, how many receive sporadic visits, at best, when they reside in assisted living facilities? As seniors become more comfortable with technology, they can keep in touch through Facebook and email. Right now, video bandwidth is limited; most ships block or limit Skype. For face-to-face visits, onshore connections using free Wi-Fi in port with a smartphone may be the best route.

But what about the actual dollar cost? In 2004, geriatrics doctors Lee Lindquist and Robert Golub published an article in the Journal of the American Geriatrics Society which showed that cruises were priced similarly to assisted living centers could accommodate the needs of seniors and possibly provide a more desirable option to seniors for retirement. In their hypothetical, an 80-year old woman, for example would pay $228,075 in an assisted-living facility compared to $230,497 on a cruise ship over a 20-year time span.

More recently, however, Genworth’s 2014 Cost of Care Survey listed Washington, D.C. as the most costly spot for assisted living, with an annual median cost of about  $82,600 for a single-occupancy unit. Assisted living costs usually cover room and board, basic utilities (electricity, heat, water, and garbage), basic housekeeping (fresh linens) and some meals, significantly less than the price tag for Ms. Wachtstetter's cruise ship retirement lifestyle. It’s difficult to compare apples-to-apples, but it seems only like the least expensive cruise costs might be similar to a highest-end assisted living community.

Have you or a family member ever thought of cruise ship retirement as a viable option? I’d love to hear from assisted living community and cruise ship directors alike as to why theirs is the best retirement option. Or if you happen to read this while on an extended cruise, let us know what that's like. As for me, I think I’d like to summer on land and winter at sea, as long as I can have access to the helipad for quick escapes from either.

Short Films Highlight Ageism

Where will you be Sunday night? If you are like me and millions of viewers (43 million last year), you will be watching the 87th Academy Awards. Are you rooting for Birdman or Boyhood? Will Eddie Redmayne take Best Actor for channeling Stephen Hawking in The Theory of Everything? Who will win the Oscar for Best Actress? My money’s on Julianne Moore in Still Alice, in which she portrays a professor diagnosed with early-onset Alzheimer's.

Movies can be entertaining, informative, arresting. They have the ability to comment upon an aspect of society and, when done well, evoke great empathy.

Seniors experience ageism, discrimination, and prejudicial attitudes every day (I pity the fool who will condescends to call me “cute” when I hit 80.) Every year since 2011, the Assisted Living Federation of America (ALFA) sponsors a short film competition (under 9 minutes) about the challenges faced by older adults when they are marginalized by a society that values youth above all things.
ALFA’s goal in sponsoring this Short Films on Ageism competition is to:

  • Demonstrate the destructive forces of ageism in society and/or
  • Raise public awareness of how ageism is expressed in direct or subtle ways and/or
  • Demonstrate how individuals can change their attitudes and behavior towards older adults.

Keith Rivers, principal/creative director at Workhouse Creative! won the 2014 ALFA Short Film Competition on Ageism with his short story documentary, Salt & Pepper.

Second place winner was A Father to Dye For , directed by Lena Nozizwe and starring retired history professor, Hulme Thamsanqa Siwundhla, Ph.D.

ALFA is the largest national association dedicated to senior living communities and the seniors and families they serve. Since 1990, ALFA has championed choice, accessibility, independence, dignity, and quality of life for all seniors.

ALFA is now accepting entries for the 2015 Short Film Competition. The submission deadline is 5:00 p.m. EST on March 30, 2015.

Seniors and Online Dating

Seniors are using technology in all its aspects to improve their lives. Cell phones can also be medical alert devices. Email is a way to keep in touch with family and friends far away. Skype is the video phone promised in yesterday’s sci-fi movies.

It’s no wonder that seniors are now one of the fastest growing demographics in the online dating game. In the spirit of Valentine’s Day, US-based technology advisory company iTOK sent out a survey asking their members to discuss their online dating habits. Their findings? 1 in 5 seniors have tried online dating, with the largest group of respondents ( 36%) falling between 66 and 75 years old. And they’re not necessarily looking for lasting love, either. Seniors seeking companionship and casual relationships found their way primarily to Match.com, eHarmony, and OurTime (a dating site that caters to singles 50 and older). Fifty percent of iTOK responders were already married; 19% reported being widowed, 18% divorced, 11% single, and 2% currently dating.

Here’s their infographic:

AARP got into the game when they partnered with an online dating service and came up with HowAboutWe. As in, “How about we” take in a movie tonight? Take a baking class together? Although in my experience, most of the men seem to be under 40 years old. Not that there’s anything wrong with that. However, they are all so good looking according to their online profile photos, I have a hard time believing that a 32 year-old Javier Bardem-looking Jared would want to “hang out and hear bluegrass while drinking whiskey” with a 50-year-old woman. But perhaps I’m wrong. Certainly my Valentine’s-addled mind would love to think so.

At the risk of sounding alarmist, I might even run a background check on someone before I committed to a relationship. I know, I’m a hopeless romantic. There are a lot of scammers out there. I strongly advise to take care in all things — especially matters of the heart, where the head tends to lose.

Will Wisconsin Seniors Pay More for Drugs?

For the second time during his tenure, Wisconsin State Governor Scott Walker is proposing to cut the state’s popular SeniorCare prescription drug program by requiring Wisconsin's seniors to first enroll in the federal government’s Medicare Part D prescription coverage.

The majority of elderly in Wisconsin like the system the way it is. Some 85,000 SeniorCare members across Wisconsin pay a yearly $30 enrollment fee as well as co-pays of $5 for generic drugs and $15 for name-brand drugs, with no gaps in coverage. Medicare Part D can cost $30-$40 monthly and many plans include deductibles.

Governor Walker’s office disagrees. "In some cases, SeniorCare deductibles are higher than Medicare Part D," Laurel Patrick, a spokesperson for Gov. Walker, wrote in a statement to 27 News, Madison, WI.  "Also there is a provision under SeniorCare that requires some individuals to spend down their income, which means they need to pay for prescription drugs out-of-pocket in order to reach eligibility levels, that makes it less beneficial for many seniors."

The governor’s plan calls for seniors to first enroll in a Medicare Part D plan and SeniorCare would supplement coverage for any drugs not covered by the federal plan. His office estimates a $15 million, or 40 percent savings over the next two years in the state’s budget for the prescription drug program for low-income seniors.

Gov. Walker first proposed a similar plan in 2011. At that time, the proposal was dropped when it faced opposition from both Democrats and Republicans.

It’s interesting that when so many want less federal intervention and more statewide control, a state program with so much local support, especially when, during fall campaigns, elected lawmakers voiced their "commitment(ment) to fully fund SeniorCare."

Currently, Democrats Sen. Dave Hansen and Rep. Eric Genrich are launching a petition to drop the proposal.  They suggest the Republican governor is "putting the interests of big pharma above Wisconsin's seniors." AARP also denounces the plan, urging Wisconsin members to contact state legislators to encourage them to remove the provisions from the governor’s proposed budget.

Bracing for the Elder Boom in America

The image of a typical nursing home, right or wrong, inspires fear in the hearts of many seniors. They picture dark, dank living spaces, rife with an uncaring, or worse, malicious staff, and, perhaps most of all, they fear becoming isolated and forgotten. It’s no wonder, then, that the idea of aging in place, at home, is a popular option for elders in America. And as the baby boom gives way to the elder boom, we realize that whatever viable options are put in place for seniors today will become our aging options in the not-too-distant future.

In her book, The Age of Dignity: Preparing for the Elder Boom in a Changing America, 2014 MacArthur Fellow Ai-jen Poo discusses the need to provide an environment whereby the increasingly aging population can stay in their own homes if they choose. But finding a competent careforce will be the primary challenge. Tackling that imminent problem is Ms. Poo’s primary focus.

Living longer is a good thing, as long as there are systems in place to care for the aged. By 2035 there will be 11.5 million Americans over the age of 85, more than double today's five million. Right now, those who need long-term care, nearly 79%, live at home or in community settings, not in institutions, and 90% would prefer to age at home. Currently, the lion’s share of home care is provided free of charge by informal or family caregivers.

This dynamic is unsustainable according to demographics and to a changing society, as Ms. Poo points out in the book. Whereas the women in the family were traditionally expected to provide care for aging parents, dual-income American family households means there is no one at home full-time to absorb those duties. Households with fewer children and more elderly begins to look a little like something from Roald Dahl’s imagination.

The answer, clearly, is a vital, supported profession senior care workforce. Ms. Poo fights for the rights of domestic workers across the nation. Fair wages along with comprehensive senior care training would go a long way to help stem the high caregiver turnover rate and provide consistency for seniors, their families, and for the workers themselves. But paying for in-home care is already a challenge for most seniors and their families. Ms. Poo proposes that this nation needs to face and tackle these challenges now, so that all seniors and their families have access to the care they deserve.

Ms. Poo recently worked with the Department of Labor to include senior caregivers in federal minimum wage and overtime protections (which has since been delayed.). She is a vital part of Caring Across Generations who believe that this country has “an unprecedented opportunity to bring care back home—where we feel most safe and secure, and surrounded by love – and to create much needed jobs in the process.”

The Age of Dignity provides a positive roadmap to becoming a more caring nation while addressing our fraying safety net and the limited opportunities for women and immigrants in the workforce.



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