Continuing care at home: Pricey but intriguing elder care option

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Photo: Pixabay

I’m always on the lookout for nontraditional elder care options. As we face a growing elder population, we are going to need some out of the box thinking and smart innovation to meet the high demand for elder care and elder-friendly housing.

A recent New York Times article highlighted one such option: continuing care at-home, an offshoot of the more well-known continuing care retirement communities. The NYT refers to the at-home option as a CCRC without walls. The goal is to keep people living comfortably and safely in their homes for as long as possible and for as long as the person desires, but with the option to move into assisted living if needed.

Instead of moving into an independent living apartment on a CCRC campus, people remain at home. Members are assigned a “care navigator” who monitors their health daily living needs. This hybrid aging at home with the option for supportive home care services and residential care could be attractive to baby boomers.

However, there are some downsides. The main one is cost. While the at-home version of the CCRC is cheaper than the traditional format, it’s still requires a hefty entrance fee (typically tens of thousands of dollars) plus monthly fees. In many cases, elders sell their home and move into more affordable housing in order to cover the costs. This is not a financial option for everyone.

There are also medical requirements to enter such programs, with a dementia or Parkinson’s diagnosis, among others being disqualifiers.

So it’s not for everyone, but it could be a good compromise for those who can afford it and want to remain in their homes as long as possible.

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Looting the elderly via CRAIN’S COMMENTS

In my line of work I read about so many cases involving criminals preying upon the elder population. Those with dementia are particularly vulnerable. As family caregivers, be vigilant upon checking bills, bank statements, etc. There’s a fine line between allowing your elder loved one to maintain their independence and protecting them from criminals, but it’s important to be aware.


IN 2017, financial institutions filed 63,500 inquiries regarding suspected fraudulent activities involving senior clients. That’s up 400% over 2013, and may still represent 2% or less of actual crimes. Traditionally, the elderly have been victims of their own family and care-givers. Now there are concerns that they are being victimized by financial professionals they trust, […]

via Looting the elderly — CRAIN’S COMMENTS

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November 9, 2019 · 10:15 am

‘Home is still a hard place to die’

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I was interviewed for a series running on Nashville Public Radio called, “The Cost of Dying.” My interview is featured in the segment, “Home is Still a Hard Place to Die.”

I am grateful to Blake Farmer for reporting on the cost and challenges of end-of-life care. It’s a topic that is not discussed enough, until one finds themselves dealing with death in their own family.

Farmer took note of my essay, “Dying at home is not all it’s cracked up to be,” which appeared in my essay collection, The Reluctant Caregiver. That essay sparked a lot of debate on social media, because it revealed that there is another side to the aging-dying at home trend, and it’s not pretty. It’s one that family members often silently suffer through, because they feel guilty if they complain.

As it’s made clear in the Nashville Public Radio report, I am not anti-hospice by any means, and I know there are wonderful people who work in the industry. It is not a job I could imagine doing, and I think it takes a special kind of person to care for the dying and their families on a daily basis. But especially in rural areas, there are simply not enough hospice and home hospice providers available. That means the care falls upon family members, which is what I experienced with my mother. It was one of the most difficult things I’ve ever done, and while I don’t regret caring for my dying mother, I wish I had been better supported.

Farmer’s series places a spotlight on the challenges of dying at home, from interviews with family caregivers to an examination of the growing hospice industry. I encourage you to listen to the series and read the accompanying reports.

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What I Wished I Knew When Dementia Was Diagnosed: Anosognosia(#1) — Dealing with Dementia

I learned a new word (anosognosia) and one that is so important for families who may suspect their loved one has Alzheimer’s or another form of dementia. It can be one of the most frustrating aspects for family members dealing with this disease.

Your loved one with dementia may not be able to recognize that anything has changed with their thinking and behavior.

Read Kay’s blog post for details.

via What I Wished I Knew When Dementia Was Diagnosed: Anosognosia(#1) — Dealing with Dementia

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October 24, 2019 · 6:02 pm

Study: Women may be underdiagnosed, men overdiagnosed for MCI

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Families who have dealt with Alzheimer’s are likely familiar with the battery of tests that loved ones go through. One of the most well-known is the clock test, where one is asked to draw a clock with a specific time. While my father never was subjected to such tests that I know of, I witnessed my mother do the clock test when she became ill. She didn’t have Alzheimer’s. The tumor in her colon had made her unable to eat, and her sodium levels were out of whack, which can induce temporary delirium. The symptoms closely mimic dementia, and it was frightening to witness in my mother, just months after my father died from Alzheimer’s complications.

My mother struggled mightily to complete the test, as I wrote about previously. If you look at examples online, some people have trouble getting the hour numbers positioned correctly, while others struggle with drawing the lines to the hour and minute. It is a surprisingly simple, but informative exercise. (I’m not sure what they will do for younger generations who only know how to tell time in digital format.)

In addition to visual tasks like the clock test, testing for dementia also involves asking a person to remember a set of simple words. The person is then asked to recall those words at various time intervals.

A new study suggests that because women generally have better verbal skills compared to men, they may be underdiagnosed when it comes to mild cognitive impairment (MCI) while men may be overdiagnosed. A misdiagnosis can have a detrimental impact, either delaying potential treatments or subjecting someone to treatments with side effects. MCI can raise the risk of developing dementia.

Additional studies are needed to confirm the findings, but for those families going through diagnostic testing for dementia, gender differences are something to keep in mind. A person’s education also can help them perform better on tests, even though their brains may show significant changes associated with dementia.

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Caregiving 101: Maintain Your Life While Maintaining Theirs — The Diary of An Alzheimer’s Caregiver

This is an excellent, detailed post for first-time caregivers. Please share with those who are embarking on a family caregiving experience.

Giving your time and resources to loved ones brings feelings of delight and satisfaction while also attracting emotions of a heavy burden. Becoming a caregiver can be an extraordinarily taxing responsibility for many individuals, and therefore should not be taken lightly …

Read full post via Caregiving 101: Maintain Your Life While Maintaining Theirs — The Diary of An Alzheimer’s Caregiver

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October 10, 2019 · 12:17 pm

Investigative series on Georgia’s senior care industry a worthwhile read

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My local newspaper (and former employer, I must disclose) has unveiled an investigative reporting project that is putting a much-needed spotlight on the rampant deficiencies in Georgia’s senior care communities. The Atlanta Journal-Constitution’s Unprotected series recounts heartbreaking stories of abuse and neglect, how potential crimes were never reported to law enforcement and how residents are at risk no matter how upscale a community markets itself to be.

If you’ve ever had a loved one in a senior care facility, you likely will be able to relate to the reports included in this series. Families know all too well that such facilities are chronically understaffed and offer such poor pay that those with questionable backgrounds who lack professional experience are often hired. While family members struggle to pay the several thousand dollars a month that these facilities charge, their loved ones may be suffering and unable to defend themselves.

My parents spent time in care facilities in New Mexico, and I saw first-hand the deficiencies. My father suffered multiple falls and an altercation with a fellow resident at his memory care center. The center used an off-label medication to help keep the patients with severe dementia “more manageable.” It’s a common tactic used at such facilities, though of course none would admit it on record.

My mother’s facility was woefully understaffed, leading to my mother not being cleaned after soiling herself, and almost getting the wrong medication or treatment multiple times. It was only because I could be there daily as her patient advocate that further harm to her was avoided. When the laundry facilities broke down for a week, my mother had to used soiled towels and linens, putting her compromised immune system at risk of infection.

I hope you get a chance to read the Unprotected series and share with others. Encourage your local newspaper to conduct similar investigations if they haven’t already. The more that these criminal acts can be exposed, the greater chance we have in forcing changes in a corrupt system that is putting our elder loved ones at risk.

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Planning for the Future With Elders Facing Alzheimer’s or Dementia

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Alzheimer’s and other dementias can creep into a family’s life until loved ones find themselves overwhelmed and unprepared for the severity of the disease. That’s why having a care plan is so crucial. The guest post from Mile High Estate Planning offers key areas that need to be addressed.

It can be difficult to face conversations with your loved ones after a diagnosis of Alzheimer’s or dementia. However, interaction with others is important for helping them retain important social and cognitive skills. And, there are some conversations that will help you care for elders facing a dementia diagnosis.

To get you started, we have put together a few questions that can help get important conversations started. We have also included some tips for effectively communicating with people living with dementia or Alzheimer’s disease.

Planning for the Future

No matter how bleak that future may look, you still must plan for it. Consulting an attorney who specializes in Elder Law can help you decide what questions are most relevant to your family’s situation. Here are some general guidelines.

Have they completed all of the important and necessary legal documents? Talk to your loved ones about updating and finalizing wills, estates, and trusts.

Make sure that their finances are in order. This might be a good time to find out who should make financial decisions once the elder is no longer able to do it themselves. Talk to a financial planner about the best way to ensure your loved one’s wishes for their accounts are honored.

Ask what type and level of care the person wants to have as their disease progresses. Do they want to go into a nursing facility or stay at home? Is there anything that would signal whether treatments should continue or end?

Is there someone they would like to make decisions on their behalf if or when they are unable to? Be open to the idea that this person may not be you, and don’t belittle or second guess their decision.

Remembering A Life Well Lived

Now is the time to start a conversation about your loved one’s life. Ask questions to stimulate memories of special events, accomplishments, favorite places, anything they remember as important or special.

Fortunately, your conversations don’t have to focus only on the end of their life. The beginning and middle are important parts too, and should be remembered, discussed, and cherished as long as possible.

If your loved one keeps bringing up a particular hobby or interest from their past, make sure that is part of their future too. Keeping plants in the room can satisfy a love of gardening and a birdfeeder outside their window can attract wildlife for an animal or nature lover.

Keeping Lines of Communication Open

Unfortunately, dementia can make even basic communication difficult as it progresses. Your loved one may find it hard to come up with the right words or names for objects and people. Their logic may seem off, and conversations can start to flow in an unpredictable manner. Some people may revert to a native language from their younger days.

These are all normal effects of dementia and are nothing to be ashamed of. Since it is so important to keep people living with dementia and Alzheimer’s disease engaged, do not let these challenges dissuade you. Isolation can quickly lead to depression. Instead, follow these tips for successful communication.

Don’t assume you know what the person is capable of. Everyone will be affected by dementia in a different way. Instead, ask them what style or methods of communication are most comfortable for them. Maybe they prefer talking in person to phone calls.

Dementia slows response time, so don’t rush or force a conversation. Give the other person plenty of time to think about what you said and come up with a response on their own. This gives them the opportunity to share their thoughts, feelings, and ideas without interference.

As dementia progresses, your loved one will have more trouble coming up with words. Try asking simple questions that can be answered with a yes or no response. Visual cues or written notes can be very helpful in getting ideas across.

Since they will likely have trouble concentrating, try to eliminate background noise. Also, don’t overwhelm them; ask one question at a time so they can focus on what you are saying.

Unfortunately, as the disease progresses communication will become more and more difficult. By the later stages of dementia or Alzheimer’s disease, it may be reduced to sounds or movements. Consider the feelings behind those gestures.

Focusing on What’s Important

Communication is a tool. Use it to understand what is important to your loved one as they face their diagnosis and adjust to living with the disease. Remember that there is no shame in having dementia and to always treat your loved ones with the dignity and respect they deserve.

 

Author Info

blake harris

Blake Harris is the Managing Attorney at Mile High Estate Planning where he assists clients with Wills and Trusts, Asset Protection, and Probate. Blake has extensive knowledge and experience helping families plan for and manage the transfer of their assets.

 

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A trip of a lifetime

 

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In Belfast, Northern Ireland

What an amazing trip. Ireland was everything I imagined it to be and more. The people were wonderful, the weather was surprisingly good (mainly dry with plenty of sun!) and the sights were breathtaking.

If you want to see all of my Ireland trip photos, I created a public Google Photos album.

I started in the southern part of the country in Blarney and Cork. Blarney Castle was fascinating to tour. I air kissed the stone (couldn’t quite lean back far enough due to my vertigo) but also enjoyed walking the beautiful grounds. Spent the next day in Cork, a charming city. Then I made my way to Westport, where I took a break from being a tourist and enjoyed a stay at a writer’s cabin at a retreat. There were country roads that offered picturesque, serene walks and I loved how the owner’s pets came to visit me during my stay.

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Blarney Castle

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It was in Westport while I was at the grocery store that I happened to see the Alzheimer’s fundraiser. It truly is a global movement and I was happy to support it.

Dublin was a lively, bustling city full of history. Seeing The Long Room at Trinity College was one of the highlights of the trip for me.

I saved my father’s hometown of Belfast for my last stop. I had so much anticipation as the train neared town. Of course Dad would not recognize modern-day Belfast, but there were markers of the past everywhere.

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I’m not a big fan of group tours but I did take a walking tour on The Troubles in Belfast. The guide provided an excellent historic overview of the origins of division and unrest, how The Troubles unfolded in the 1970s and what the future may hold in store for Belfast. From taxi drivers to shop owners, everyone I talked to in Northern Ireland and the republic were concerned about the upcoming Brexit actions that could trigger increased violence along the border.

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The above mural was taken in the working class neighborhood near where my father’s family members lived. I was able to locate the street that was on my father’s birth certificate and the street where my grandparents lived until their deaths.

While Belfast is known for its politically-charged murals, a new crop of murals have also emerged, offering a fresh perspective and are quite artistic.

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I visited my aunt’s grave at a sprawling ceremony just outside of Belfast. She lived to age 95, and while she was plagued by physical ailments in her later years, her mind remained sharp as far as I know, while three of her siblings (including my father) ended up with dementia.  She was a resilient woman, raising three children on her own after her husband died while working overseas.

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Giant’s Causeway was one of my favorite destinations. What a breathtaking site.

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I ate really well while maintaining my gluten-free diet. The awareness of celiac disease and the gluten-free diet is quite high in Ireland, and I ate as well and in some ways even better there than I do here in the U.S. The highlight food-wise was gluten-free fish and chips in Dublin.

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The modified Irish breakfast that was gluten-free came a close second. (I had a few variations of it during my travels.)

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I am grateful I was finally able to complete this trip of a lifetime, and I can’t wait to return.

 

 

 

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Taking a blog break for a bucket list trip

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Blarney Castle

Soon I will be departing for a two-week trip to Ireland. This is a trip of a lifetime for me, as it will allow me to appreciate my father’s homeland in person. I only wish we could have made the trip together. I know he will be with me in spirit.

I will share an account of my adventures upon my return.

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