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.

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.

 

 

Seniors and Snow Removal

Winter Storm Linus dragged its blanket of snow across the North and Northeast portions of the United States earlier this week. Many spent long hours digging out and when, as we here in Chicago experienced, city snowplows couldn’t get to side streets, many of us were trapped in the middle of the road, tires spinning. It’s then that we had to rely on the kindness of strangers to help shovel us out of a mess.

Even for the hale and hearty, navigating treacherous sidewalks, getting from point A to point B, prove to be quite a challenge. Major municipalities like Boston, Chicago have city ordinances that make it a finable offense to neglect clearing snow and ice from property sidewalks.

Most city ordinances require snow removal within a certain period of time (usually within 3-4 hours of snowfall ending) and for a minimum path size in order to accommodate pedestrians, people in wheelchairs, strollers, students walking to and from school, individuals with assistive devices and, ironically, seniors.

These senior homeowners are the same who are compelled to clear their own sidewalk or face considerable fines. The snow that Linus dropped was wet and heavy and fell intermittently all day. Shoveling is hard work and can take a quick toll on the body at any age, but especially if that body is older.

According to a study that appeared in the January 2011 issue of the American Journal of Emergency Medicine, cardiac-related injuries accounted for only 7 percent of the total number of cases, but they were the most serious. More than half of the hospitalizations and 100 percent of the 1,647 fatalities occurred while shoveling snow  Patients 55 years of age and older were 4.25 times more likely than younger patients to experience heart attack symptoms while shoveling snow, and men were twice as likely as women to exhibit cardiac-related symptoms.

The City of Chicago provides a volunteer snow-shoveling service called the Snow Corps, which seniors and those with disabilities can contact by calling 311, filling out an online Service Request, or by contacting their Ward office.

Some programs like the Snow Sergeant program in Lansing, MI pair screened and pre-approved High School students needing community volunteer hours with local seniors who need snow removal services.

The Chore Corps Program in Madison, WI is operated by Independent Living, Inc., a local not-for-profit multi-service organization. Following snow storms, volunteers shovel sidewalks and driveways for seniors, allowing the seniors to safely enter and exit their homes.
The volunteers also provide a meals-on-wheels service for independent living seniors.

Caregivers are urged to discourage seniors from clearing their own sidewalks when it would be dangerous for them to do so. Instead, keep them safely inside, warm and well-fed, and contact local authorities for needed support in order to prevent incurring any fines. Living independently is preferred by most seniors, but there’s nothing wrong with getting a little assistance.

CDC Reports Record High Flu Hospitalizations of Elderly

It’s a well-known fact that people 65 years and older are at greater risk of serious complications from the flu than their younger counterparts. According to the Center for Disease Control and Prevention, it's estimated that between 50 and 60 percent of seasonal flu-related hospitalizations in the United States occur in seniors.

The CDC release the new flu numbers on Friday showing a record high amount of flu hospitalizations among the senior population. In fact, the numbers are the highest since the agency started tracking the numbers nine years ago.

About 198 out of every 100,000 people 65 and older have been hospitalized with flu-related illness this season. The next highest rate was for the 0-4 year old group with about 38 out of 100,000. Compare that to last year’s numbers, when, at the same time in the year, only about 40 out of every 100,000 elderly were hospitalized with flu-related illness.


Click on image for larger, interactive view

Because immune defenses weaken as we age, the flu can be a real danger; seniors comprise an estimated 90 percent of all seasonal flu-related deaths. On average, about 24,000 Americans die each flu season, according to the CDC. While flu vaccinations don’t guarantee a flu-free season, (the CDC reported that the flu vaccine is only 23 percent effective this winter,) Fluzone, a higher-dose flu shot developed specifically for older adults, is designed to give people a better immune response, thereby providing better protection against flu.

Those who are considered at high risk of developing serious flu complications are those with:

  • Asthma
  • Blood disorders (such as sickle cell disease)
  • Chronic lung disease
  • Endocrine disorders (such as diabetes)
  • Heart disease (such as congenital heart disease, congestive heart failure and coronary artery disease)
  • Kidney disorders
  • Liver disorders
  • Morbid obesity (body mass index [BMI] of 40 or higher)
  • Weakened immune system due to disease or medication (such as people with HIV or AIDS, cancer, or those on chronic steroids)

If you see your senior client or care recipient developing any flu symptoms, act fast and get them medical attention. Antiviral drugs can be used to manage and treat flu in the elderly before serious complications develop. Look out for fever, cough, sore throat, runny or stuffy nose, headache, body aches, chills, fatigue, and sometimes vomiting and diarrhea.

Caregivers should take extra precautions as well. The CDC especially recommends that anyone working with older adults get vaccinated to help prevent the spread of influenza, especially if they work in a long-term care facility.

Caregiverlist hopes that seniors and their caregivers stay safe and healthy all year, but especially during this dangerous flu season.

California Enacts Minimum Caregiver Training

Cases of elder abuse and elder neglect can be found everywhere. Abuse can be physical, psychological, and/or emotional. Seniors can be the victims of neglect when caregivers fail to fulfill their duties and obligations to provide even the most basic elder care. Seniors can be the victims of financial exploitation, especially when they entrust their caregiver with their funds and assets. If a caregiver is going to mistreat someone in their care, they’d be hard-pressed to find an easier victim than a vulnerable senior.

Senior care experts agree that there is a correlation between caregiver training and elder abuse. Regrettably, there is no federal mandate for caregiver training. It is up to each state to set its own guidelines for nursing assistant, home health aide, and personal care aide training and supervision. Most senior care agencies have minimum training requirements for their employees, but are not required by law to do so.

California has taken steps to rectify that situation with its Home Care Services Consumer Protection Act. Per Assembly Bill 1217, on and after January 1, 2015, home care agencies would be duty-bound to establish and continuously update a home care aide registry and would require criminal background check clearances for home care aides.

Caregiver training would include a minimum of five hours of entry-level training prior to working with a client. This includes:
(1) Two hours of orientation training outlining the role of a caregiver.
(2) Three hours of safety training, including basic safety precautions, emergency procedures, and infection control.
(3) An additional five hours of annual training. The annual training will include, but not be limited to:

  • Clients’ rights and safety.
  • How to assist a client’s activities of daily living.
  • How to prevent, detect, and report abuse and neglect.
  • How to assist a client with personal hygiene.
  • How to safely transport a client.

The training may be completed through an online training program, as long as that training can be verified.

While this is a great step and in keeping with the many states that require minimum caregiver training, it doesn’t necessarily cover the 400,000 caregivers in California’s $7.3 billion In-Home Supportive Services Program (IHSS) for low-income elderly and disabled residents. Those caregivers are hired, managed and trained by the care recipients themselves. Training requirements for the nation’s largest publicly-funded home care program have been met with resistance because clients want autonomy over their care and how it’s delivered. As a result, only about 12 percent of those caregivers have even basic caregiver training.

Finding official state reports of elder abuse and neglect is a daunting task. The most recent data I could find is from the 2004 Survey of State Adult Protective Services published in 2007. Titled Abuse of Vulnerable Adults 18 Years of Age and Older, a Report of the National Center on Elder Abuse (NCEA), it was prepared by the National Committee for the Prevention of Elder Abuse and the National Adult Protective Services Association. Unfortunately, many states differ in their definitions of what constitutes abuse. For the survey, because states collect very different types of information on the abuse of vulnerable adults, it’s hard to compare apples-to-apples. Thirty two states could provide abuse reports for vulnerable adults aged 18-59 as well as aged 60+; the balance of states don’t collect data by age group, so there’s no telling how many of their reports detailed elder abuse specifically.

The demand for direct-care workers like Personal Care Aides and Home Health Aides will soon outpace the supply. According to the Bureau of Labor Statistics at the U.S. Department of Labor, the projected growth in home health care services from 2012 to 2022 is 67 percent. As the pool of informal caregivers shrinks (family and friends), the demand will need to be filled by a more professional workforce. And in order to to help minimize instances of elder abuse, we believe that workforce should be adequately trained.

Caregiverlist applauds California for taking training initiatives, but is it enough? Should minimum caregiver training be federally mandated? What are the possible downfalls to requiring any senior caregiver to obtain even the most basic caregiver training?

Feel-Good Senior Care and Caregiver News

It’s an occupational hazard. Because I write about anything and everything connected with seniors and eldercare, I come across a lot of depressing stuff. From elder abuse to inequitable caregiver pay, the internet is not lacking in bad news.

In a bit of a departure, certainly for me, here are some stories from around the web about seniors and senior caregivers destined to make you feel good.

  • Two nurses thwart “grandparent scams,” as reported in a story by Steve Coulter of the Connecticut Ridgefield Press. One nurse prevented a senior from wiring $5000 for “bail money” and another stopped a couple from sending $2,800 to a scammer claiming to be their grandson needing money for surgery. Both instances involved bogus claims from grandchildren in trouble and both warned the seniors not to tell anyone about the financial need. Luckily, these two nurses were both highly observant and able to convince the seniors to contact other family members for verification. Of course, they found out their grandchildren were never in trouble.
  • Scotland’s oldest woman, Jessie Gallan, celebrated her 109th birthday and divulged her secrets of longevity to the Daily Mail. “My secret to a long life has been staying away from men. They're just more trouble than they're worth. “I also made sure that I got plenty of exercise, eat a nice warm bowl of porridge every morning.”
  • Men are in the house as well. Yoganonymous posted these life instructions as told by William Snell, 95:

  • In my FB feed: Random Acts of Flowers Chicago delivered 63 bouquets to Waterford Nursing Home and Rehab. RAF recycles and reuses every part of donated flower arrangements including ribbons, wire, foam, buckets, baskets, vases, moss, and stands (and flowers) as part of their “upcycled” floral arrangements.
  • Kitty Nicholson, 100, knits a baby cap a day for the last five years. Every baby born at Waccamaw Community Hospital and Georgetown Memorial Hospital leaves with one of her creations. “It keeps me out of trouble.”




So there’s good out there along with the not-so-good. Caregiverlist invites you to share your feel-good senior or caregiver story in the comments.

Medicare Pays Doctors for Integrated Senior Care

Eleanor is 85 years old and spends many of her days in various doctors’ offices. Her osteopath checks her progress after a recent hip replacement. Her rheumatologist helps manage her arthritis pain. She sees her cardiologist after a mild heart episode and her primary care physician treats her hypertension. No one has yet addressed her depression. With each visit, Eleanor receives prescriptions, instructions, and tests — so many that she feels overwhelmed and underinformed. 

Many seniors seeking medical care have multiple chronic conditions. In fact, it’s estimated that three in four older Americans live with MCC. That figure is only going to increase as baby boomers age. This challenges has been recognized by the U.S. Department of Health and Human Services. They are initiating federal programs to prevent and manage MCC.

As one of those programs, Medicare is now paying primary care doctors to coordinate care for their elderly patients. Typically, when seniors see so many different doctors, their care is quite fragmented. MRIs and x-rays can be duplicated (and costly) and results aren’t shared between the various specialists. Dangerous drug interactions can adversely affect patient, leading to more doctor visits and deteriorating health.

Primary care physicians are ideally situated to oversee their patients overall health. Services include non-face-to-face planning and management for patients with two or more chronic conditions. To collect the new fee, doctors would have to create a care plan for their MCC patients and spend time each month working with their various specialty physicians.

"We're hoping to spur change, getting physicians to be much more willing to spend time working on the needs of these patients without necessitating the patient to come into the office," Sean Cavanaugh, deputy administrator at the Centers for Medicare and Medicaid Services told The Associated Press.

Critics of the plan say the proposed $40 per qualified patient per month is not enough to entice doctors to take on the extra work involved. They suggest it opens the door for even more Medicare fraud. But many doctors, especially those in smaller communities, have for years coordinated care for their senior patients with no compensation. "Quite honestly, I just didn't get paid for it," said Dr. Robert Wergin, president of the American Academy of Family Physicians told the AP. Dr. Wergin spends about 2 hours a day calling on his older patients who can’t make it into his office.

Many times, caregivers also play the part of care coordinator, especially if they accompany their senior to many of their doctor visits. However, it is no doubt helpful if a professional oversees medication prescriptions, possible test duplications, and the coordination of specialists. It’s the hope of Medicare to not only increase the quality of life for patients by strengthening primary care but also, let’s face it, save money on hospital stays, emergency room visits, and post-acute care.

Do you as a caregiver coordinate any of the care for your senior? If so, how involved are you? Do doctors welcome your care coordination? Have you utilized the Caregiverlist Care Consierge to create your own Senior Care Plan?  We’d love to hear from you in the comments.

Senior Safety During Extreme Cold

Last year today, my blog post was about Senior Care during the Polar Vortex. Here we are once again in the grips of an extreme cold snap and it’s time, say senior care professionals, to revisit how best to keep seniors safe during frigid weather.

The first consideration in keeping the elderly safe is to keep warm. The CDC (Centers for Disease Control and Prevention) said people over the age of 65 make up nearly half of all hypothermia deaths. As we age, our metabolism slows. Couple that with decreased physical activity and seniors are especially susceptible to low body temperature that can drop to a dangerous degree.

Here are some signs of hypothermia in older adults: shivering, exhaustion, memory loss, slurred speech, confusion, drowsiness. If you notice any of these signs, check their body temperature. If it’s below 95°, seek medical attention immediately. Don't hesitate to call 911.

You can prevent hypothermia in seniors by keeping the home heated safely. Place an easy-to-read thermometer in a room where the most time is spent and make sure the temperature doesn’t get below 65°. Close off rooms that are not in use to conserve heat. Also, put a carbon monoxide detector near the sleep area.

Power outages during peak usage times are always a risk. Keep extra blankets on hand. Seniors should dress in several layers of loose clothing. And of course, the elderly should not go out unless it is absolutely necessary.

In order to keep trips outside in the cold to a minimum, the CDC suggests making sure seniors have these are on hand:
Food that needs no cooking or refrigeration, such as bread, crackers, cereal, and canned foods—canned soup is a great warmer-upper.
Water that is stored in clean containers, or purchased bottled water (5 gallons per person). Keep alcohol intake to a minimum.
Medicines that any family member may need.

Check on older family and neighbors who are at risk from cold weather hazards. As always, if you or a senior in your care needs special help, contact your state's Area Agency on Aging. Caregiverlist hopes all caregivers and their seniors stay warm and safe.

New Year's Resolutions for Senior Caregivers

It’s about that time of the year. The time when we look at our lives and think “How can I make next year better than this one? Am I leading the life I want to lead?” Some people absolutely hate New Year’s resolutions. What better way to heap more stress on yourself than setting unrealistic goals?

What if we don’t call them New Year’s Resolutions? What if we refer to these ideas as hopeful plans to achieve goals that will help both caregiver and care recipient? Start them in January if you’d like, but they’ll be just as relevant in July. Bookmark or print this page and use it as a reminder that life is a balancing act and just as you give (care), you must also take.

Take Care of Yourself
This is the biggest challenge facing both family and senior caregivers. Senior care is exhausting at best, so there is little time to look after your own well being. Don’t make that mistake. You know how in an airplane emergency, you must place the oxygen mask over your own face before you can help those around you? It works the same way with your health. You are an athlete and senior care is your event. Make sure your body is in its best condition by exercising, eating right, and taking some quiet meditative time to regroup.

Take a Respite Break
You just can’t do it all yourself. Nor should you. If you are a family caregiver, consider hiring a professional caregiver to provide a few hours (or days) break for you. If money is tight and you have a community of givers nearby, programs like Lotsa Helping Hands were created to provide friends, family, and colleagues a place to come together and coordinate needed support through a group calendar. Volunteers can provide a meal, furnish transportation, or plan a visit. But most of all, they can give you a break.

Take Some Training
Whether you are a family caregiver looking to learn how to maintain a clean, safe, and healthy environment specifically geared toward seniors, or a companion caregiver who wants to begin a path to professional senior care, formal training is a great place to start. Online training (like the kind Caregiverlist offers) allows you to learn at your own pace, on your own schedule. If you are a seasoned caregiving professional, maybe it’s time to take that next step and study to become a C.N.A. — and very much in demand.

Take Advantage of Technology   
There are a host of programs and applications that can help with self- or elder-care. From exercise and nutrition, to crafting, to ideas for caregiver stress relief, every Friday, Caregiverlist’s own Paige Krzysko reviews all things Tech to help with your senior caregiving. Be sure to give her a read.

Well, that’s my last post for the year 2014 — thanks for reading. From everyone at Caregiverlist, have a happy, healthy, safe New Year and I’ll be back with senior care news, advice, opinions (and sometimes just some general nonsense) in 2015.

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