The end of the year holidays are approaching.  What can you do to make the holidays particularly pleasant for your aging parents or loved ones?  Here are some thoughts:

1. Stroll down memory lane. Holidays provoke memories, which can be especially powerful in the later years of life. “Leading authorities have observed that memory and ‘life review’ are important parts of the aging process,” says Barry Lebowitz, Ph.D., deputy director of the University of California San Diego’s Stein Institute for Research on Aging. “Older people whose memories are impaired may have difficulty remembering recent events, but they are often able to share stories and observations from the past. These shared memories are important for the young as well—children enjoy hearing about how it was ‘when your parents were your age…’.” He suggests using picture albums, family videos and music, even theme songs from old radio or TV programs to help stimulate memories and encourage older seniors to share their stories and experiences.
2. Plan ahead. If older family members tire easily or are vulnerable to over-stimulation, limit the number of activities they are involved in or the length of time they are included. The noise and confusion of a large family gathering can lead to irritability or exhaustion, so schedule time for a nap, if necessary, and consider designating a “quiet room” where an older person can take a break. “Assign someone to be the day’s companion to the older person, to make sure the individual is comfortable,” says Daniel Sewell, M.D., director of the Senior Behavior Health Unit at the UCSD Medical Center, who adds that these guidelines work well for young children as well as adults with mental, emotional and physical health issues.
3. Eliminate obstacles. If a holiday get-together is held in the home of an older person with memory impairment or behavioral problems, don’t rearrange the furniture. This could be a source of confusion and anxiety. If the gathering is in a place unfamiliar to an older person, remove slippery throw rugs and other items that could present barriers to someone with balance problems or who has difficulty walking.
4. Avoid embarrassing moments. Try to avoid making comments that could inadvertently embarrass an older friend or family member who may be experiencing short-term memory problems. If an older person forgets a recent conversation, for example, don’t make it worse by saying, “Don’t you remember?”
5. Create new memories. In addition to memories, seniors need new things to anticipate. Add something new to the holiday celebration, or volunteer for your family to help others. Enjoy activities that are free, such as taking a drive to look at holiday decorations, or window-shopping at the mall or along a festive downtown street.
6. Be inclusive. Involve everyone in holiday meal preparation, breaking down tasks to include the youngest and oldest family members. “Older adults with physical limitations can still be included in kitchen activities by asking them to do a simple, helpful task, like greasing cooking pans, peeling vegetables, folding napkins or arranging flowers,” Sewell says.
7. Reach out. Social connectedness is especially important at holiday times. “Reaching out to older relatives and friends who are alone is something all of us should do,” Lebowitz says. “Loneliness is a difficult emotion for anyone. Recent research with older people has documented that loneliness is associated with major depression and with suicidal thoughts and impulses.”
8. Beat the blues. “Holiday blues” are feelings of profound sadness that can be provoked by all the activities of the holiday season. Seasonal blues can have a particular impact in the lives of older people, according to Lebowitz. “In some people, the ‘holiday blues’ represent the exacerbation of an ongoing depressive illness,” he says. “Depression is a dangerous and life-threatening illness in older people. Tragically, suicide rates increase with age, specifically for older men. Depression is not a normal part of aging and should never be ignored or written off.”
9. Stay on the sunny side. Seasonal affective disorder (SAD) or winter depression is an illness that can be provoked by reductions in sunlight during the short days of winter. It is important for people confined indoors, especially those at risk for winter depression, to make time for activities that will increase exposure to daylight.
10. Monitor medications and alcohol. If you have senior family members, be sure to help them adhere to their regular schedule of medications during the frenzy of the holidays. Also, pay attention to their alcohol consumption during holiday parties and family gatherings. Alcohol can provoke inappropriate behavior or interfere with medications.

Posted by: Frank Esposito, Vice President of Expert Home Care.  New Jersey’s Expert Home Care provides professional and reliable home health care and companion care for NJ elderly, helping them with their daily living activities since 1984. Please call us toll free at 800-848-2336 when you have home care related questions or need assistance for a loved one. Get a Free Home Care Assessment (a $375 value!) when you mention this post.

Recent surveys among NJ elderly, find that their biggest concerns are:

1. Remaining independent in the home without intervention from others;

2. Maintaining good health and receiving adequate health care;

3. Having enough money for everyday needs and not outliving assets and income.

Pre-planning can help address these issues.  No other life event can be as devastating to an elderly person’s lifestyle, finances and security as needing long term care. It can drastically alter or eliminates the three principal lifestyle concerns above.  The majority of the American public does not plan for this crisis of needing elder care. The lack of planning also has an adverse effect on the older person’s family, with sacrifices made in time, money, and family lifestyles.  Due to changing demographics and potential changes in government funding, the current generation needs to plan for long term care before the elder years are upon them.

Here are some facts.

• The population of the “very old,” – older than age 85 – is the fastest growing group in America. This population is at highest risk for needing care. (Statistical abstract of the United States,
  2008, population)
• Medical science is preventing early sudden deaths, which means living longer with impaired health and greater risk of needing long term care.
• The Alzheimer’s Association estimates the risk of Alzheimer’s or dementia beyond age 85 to be about 46% of
  that population.
• It is estimated that 6 out of 10 people will need long-term care sometime during their lifetime.
• Children moving far away from parents or parents moving away during retirement makes long distance care giving difficult or impossible.
• Government programs— already stretched thin for long term care services— will experience even greater stress on
  available funds in the future.

One of the important things for planning is how to maintain your lifestyle as you age. You may be healthy enough to stay in your own home with help provided for the following activities of daily living:

• maintaining a home
• providing meals
• supervision
• companionship
• transportation
• shopping services

This type of care at home is non-medical and must be provided free of charge by family, friends, or volunteers or the care must be paid for out-of-pocket by the family. Government programs, in most cases, will not pay for this kind of care. It is estimated that 80% of all long term care is non-medical, with 90% of that care provided in the home.

Plan now how you will pay for care when it is needed. In evaluating your future income you may find it necessary to add some resources such as long term care insurance to pay for assisted living or nursing home costs. Long term care insurance must be purchased while you are younger and healthy. Failing health, stroke or other aging issues will not allow you to qualify for this insurance.  A reverse mortgage will also help pay for home care if staying in your home is an option.

Consider where you may want to live in your elder years. Many assisted living facilities offer complete care alternatives with a nursing home wing if needed. Senior retirement communities also offer many amenities with some including home care options.  Now is the time to do estate planning. A professional estate planner will give you direction on how best to protect your assets for future needs and for Medicaid planning.  Now is the time to create your trusts, will, medical directives in a living will and any other documents you want noted for future use. Gather insurance policies and bank records where they can be found by family members in case you are not able to get them yourself.

The process of long term care planning involves the following four
principles:

1. Knowledge and preparation are the keys to success.
2. Having funds to pay for care expands the choices for care
settings and providers.
3. Using professional help relieves stress, reduces conflict, and
saves time and money.
4. Success is assured through a written plan accepted by all
parties involved.

(The above excerpt is quoted from “The 4 Steps of Long Term Care Planning,” National Care Planning Council)

The National Care Planning Council’ s website — www.longtermcarelink.net — provides over 700 pages of information for long term care planning and lists services of professional care providers in estate planning, long term care insurance, reverse mortgage, home care and many other important long term care services.

The National Care Planning Council’ s book, “The 4 Steps of Long Term Care Planning,” provides information on what Medicaid and Medicare will cover as well as an overview of professional long term care service providers and how their services can help you create and execute your long term care plan. A check list of what to do to create a plan and forms for creating necessary paperwork are also included in the book.

Posted by: Frank Esposito, Vice President of Expert Home Care.  New Jersey’s Expert Home Care provides professional and reliable home health care and companion care for NJ elderly, helping them with their daily living activities since 1984. Please call us toll free at 800-848-2336 when you have home care related questions or need assistance for a loved one. Get a Free Home Care Assessment (a $375 value!) when you mention this post.

Moving is physically and emotionally difficult for anyone, particularly the elderly.  Here are some things to consider when helping an elderly person move:

1. Be kind. When helping to sort and pack your elderly loved one’s possessions, keep in mind that their eyesight and an inability to do everything they used to do can result in poor housekeeping habits. Offer to clean as you pack and try not to criticize.

2. Help sort. Seniors tend to keep things they don’t necessarily need or will ever use. Be gentle when suggesting to get rid of possessions. Ask them if they use the item and if they would mind if you donate it. If it’s a treasure or something they would like to keep but the new space can’t accommodate it, suggest keeping it in the family by giving it to a child or grandchild.

3. Take pictures of the inside of their home. As close as possible, try to place objects in a similar way so that their new home will feel very much like the old one. Be as detailed as you can from arranging the bedroom furniture to placing the family pictures on the bureau. This will help make the new place feel like home.

4. Obtain a room layout of their new place. Find out before you move how much space the new place has. If your senior is moving from a three bedroom house to a one bedroom condo, then together you will need to decide what will fit and how much can be kept.

5. Start small. Take a day to spend with your senior to talk about the move and what to expect. Give them small tasks to do such as going through a desk drawer or a box from the attic. Ask them to spend only 15 to 20 minutes a day on one task. Let them decide what they would like to do and what they might find hard to do. Taking small steps will help your senior get used to the idea of moving.

6. Pick a room that has less sentimental attachment. Have your elderly loved one start sorting through the bathroom or kitchen drawers; pick a place in the house that doesn’t hold the same emotional attachment as the bedroom or living room or a photo box kept in the attic.

7. Plan the move. Allow enough time that your senior doesn’t feel rushed. Sorting through years of stuff is difficult and sometimes emotionally painful. Give them time to absorb the change.

8. Hire outside help. Sometimes it’s easier for your senior to work with an outside party rather than with members of their family. There are many companies that specialize in moving seniors.

9. Be patient. Allow your senior time to say goodbye. If they take longer to clean out the desk drawer because of a stack of pictures they found, let them take the time to remember. This is a very important part of the process. Be patient. Listen to their stories.

10. Get them involved. Take your senior to their new home ahead of the move on their own time and when they are ready. Let them tell you how they would like it to look and make a plan to prepare the space accordingly.

Posted by: Frank Esposito, Vice President of Expert Home Care.  New Jersey’s Expert Home Care provides professional and reliable home health care and companion care for NJ elderly, helping them with their daily living activities since 1984. Please call us toll free at 800-848-2336 when you have home care related questions or need assistance for a loved one. Get a Free Home Care Assessment (a $375 value!) when you mention this post.

Making the necessary changes in your home or elderly loved one’s home

Is your senior citizen moving in with you or are they finding it hard to get around their own house? Here are some tips to help reduce the likelihood of accidents and give you some piece of mind:

Outside the house:

• Add a ramp to replace steps. Maximum slope should be 1 inch for every 20 inches of length with a bolt in place for stability.
• Add rails on both sides of steps.
• Add non-slip, contrasting color strips on exterior stairs to help your senior with reduced vision to easily identify steps.
• Add lighting along walkways and pathways, plus motion detectors.

Inside the house:

• Replace door knobs with flip handles.
• Replace swinging doors with pocket doors.
• Visual-signaling smoke detectors have a light that flashes when smoke is detected to alert a person who is hard of hearing.
• Increase the size of door openings.
• Fasten rugs and mats to floors to reduce tripping with double-sided tape.
• Add handles on both sides of stairwells.
• Consider installing a chair lift on stairway.

In the bathroom:

• Though it can be expensive, consider installing a roll-in shower or low-rise step-in tub.
• Add handles and grab-bars in tub and toilets. Add hand-held shower heads.
• If your senior is in a wheelchair, install roll-up cabinets.
• Make sure faucets have anti-scald temperature controls.

In the kitchen:

• Again, if your senior is in a wheelchair, install roll-up cabinets.
• Install pull-out shelves for low or deep shelves.
• Lower the light switches.
• A side-by-side refrigerator/freezer will allow for easier access.
• Install a wall-mounted oven for easier access.

General tips:

• Be sure furniture is stable, and has no sharp corners.
• Remove scatter rugs and clutter.

Posted by: Frank Esposito, Vice President of Expert Home Care.  New Jersey’s Expert Home Care provides professional and reliable home health care and companion care for NJ elderly, helping them with their daily living activities since 1984. Please call us toll free at 800-848-2336 when you have home care related questions or need assistance for a loved one. Get a Free Home Care Assessment (a $375 value!) when you mention this post.

NJ Senior Care Planning

Talking to your elder parents about end of life care

No one looks forward to discussing end of life issues with aging parents, but this is something that needs to and should be done.

Having the conversation is necessary so that your senior’s preferences may be honored, if at all possible, and so that your contribution to the decision-making can be based on an understanding of those wishes.

The conversation should be ongoing, rather than just occurring one time, and hopefully each time the topic is revisited it will become more comfortable, as you and your elderly loved one become more used to discussing the range of future possibilities together.

Here are some tips to help you through the discussion:

How to begin a conversation about future wishes with your senior

One way to begin is by asking your senior what their biggest concerns are for the future. This topic may evoke thoughts on the past, regrets, or a life assessment. Listen uncritically, with empathy.  Having your senior share these thoughts with you can bring you closer.

Discuss your senior’s preferences regarding housing options

While most people prefer to remain in their current home, ask your senior what they would like to do if that were no longer possible. Sometimes this conversation will bring forth your senior’s expectations about moving in with one of their children, which can be helpful to know.

Ask your senior if they feel financially secure

It is important for you to have a record of your senior’s insurance policies, such as Medicare, Medigap, prescription coverage plan, and any long term care insurance.  If your senior doesn’t already have a will, durable power of attorney and health care proxy, now is a good time to see an elder care attorney so that they can have their wishes resolved as to asset distribution and care.

Discuss your senior’s feelings about their medical care and whether or not they are satisfied with their physicians

Does your senior have any concerns about their medical care? Do they have any concerns about their doctors? Do you need to help them find better ones? What are your senior’s wishes as to medical interventions and end-of-life care?

Discuss your senior’s wishes as to death, dying and funerals

Do your parents have any preferences as to funeral and burial? These conversations are difficult, but you need to resolve them sooner rather than later. Researching and selecting specific services isn’t morbid, and can help when the time comes.  Seniors to be assured their wishes will be followed even when their adult child is feeling sad and possibly overwhelmed when arranging a funeral.

Posted by: Frank Esposito, Vice President of Expert Home Care.  New Jersey’s Expert Home Care provides professional and reliable home health care and companion care for NJ elderly, helping them with their daily living activities since 1984. Please call us toll free at 800-848-2336 when you have home care related questions or need assistance for a loved one. Get a Free Home Care Assessment (a $375 value!) when you mention this post.

NJ Respite Care

What Is Respite Care?

Respite care is substitute care given so that the regular caregiver can take a break from the stress of caregiving. The respite care can be for a week, a long weekend, a day or an hour, on a regular basis or just once. It can be for an ill or fragile adult or a special needs child.

Who Gives Respite Care?

Sometimes respite care is given by family or friends, who want to relieve the regular caregiver. Or, it can be provided by paid caregivers who work for a home care agency.

How Will the Caregivers Know What to Do?

You will need to give them a check list of things to do and emergency numbers. List everything you do and check the references of the respite caregivers. For all respite caregivers, make sure they are comfortable and able to provide you with the assistance you need and that the person being cared for understands the temporary transition.

How Will I Find Respite Caregivers?

You can look for a licensed home care agency, many of who offer respite care services. Depending on the length of the respite, some nursing homes and assisted living facilities may also provide temporary respite care.

Who Pays for Respite Care?

Some local governments help pay for respite care. Check with your local Council on Aging or Social Services Department. The federal government is addressing the problem and may offer assistance. Call the eldercare locator at 1-800-677-1116, Monday through Friday, 9:00 a.m. to 8:00 p.m. Eastern Time, to see if help is available where you live.

Why is Respite Care Necessary?

Caregivers are often at increased risk of depression and other health problems as a result of the stress that accompanies being a caregiver. Having respite care refreshes the caregiver and protects them from burning out or becoming ill.

What Else Can I Do to Avoid Burn Out?

Join a support group, get adequate sleep, eat nutritious meals, and exercise daily. Take advantage of offers of help. Providing constant care is a demanding job. It’s crucial for caregivers to take a break periodically and this need is a normal part of the life-cycle of care. Support groups can help with guilt and frustration or just help caregivers keep morale high.

If you are caring for a loved one, you need to take care of yourself so that you can continue to provide that care. Finding quality respite care is an excellent means to an end.

Posted by: Frank Esposito, Vice President of Expert Home Care.  New Jersey’s Expert Home Care provides professional and reliable home health care and companion care for NJ elderly, helping them with their daily living activities since 1984. Please call us toll free at 800-848-2336 when you have home care related questions or need assistance for a loved one. Get a Free Home Care Assessment (a $375 value!) when you mention this post.

What is an elder law attorney and when is it time to contact one?  Here are some things to consider:

What is Elder Law?
Elder Law is the legal practice of counseling and representing older persons and their representatives about the legal aspects of health and long term care planning, public benefits, surrogate decision making, older persons’ legal capacity, the conservation, disposition and administration of older persons’ estates and the implementation of their decisions concerning such matters, giving due consideration to the applicable tax consequences of the action, or the need for more sophisticated tax expertise.

What is a Certified Elder Law Attorney (CELA)?
Any attorney can claim to have a specialty in elder law, but only Certified Elder Law Attorneys have met rigorous criteria and been reviewed favorably by five of their peers. These attorneys have been in practice for a minimum of five years, three of which have been focused on elder law. They have passed the regular bar exam, and a special one focused on elder legal issues. In addition, they must take continuing education courses to keep up with the latest changes in the law as it relates to elder issues.

Why should you consult a CELA?
For advice on estate planning, future planning, Medicare and Medicaid issues, end-of-life issues, choice-of-living-situation issues and planning for special-needs children.

What is an example of something a CELA could help a client with, that someone else might not be aware of?
In some states, if a grown child cared for a parent for at least two years, making institutionalization of that parent unnecessary, and lived in the same home as the parent, then that home may not be taken to pay for the adult’s nursing home costs. This is something of great significance to many families that a non-CELA may not be aware of.

Some tips for people dealing with elder issues:

• Become educated about the situation. Come up with a long-term plan. Educating yourself in the issues will prevent you from being taken advantage of by someone pretending to be an expert, who is not.

• Find an intelligent, qualified adviser, and don’t be afraid to pay him/her for their time.

• Create a health care proxy which designates someone to make health-care decisions for you in case you can’t. The health care proxy can include elements of a living will, dealing with what kind of treatments you do or do not want.

• Sign a durable power of attorney, which allows your spouse to protect your assets. This is the financial equivalent of a health care proxy. It’s better than putting your assets in a joint bank account, and you can specify what kinds of decisions the person can make for you. It is often used to protect the money of one spouse if the other goes to a nursing home.

Posted by: Frank Esposito, Vice President of Expert Home Care.  New Jersey’s Expert Home Care provides professional and reliable home health care and companion care for NJ seniors, helping them with their daily living activities since 1984. Please call us toll free at 800-848-2336 when you have elder care related questions or need assistance for a loved one. Get a Free Home Care Assessment (a $375 value!) when you mention this post.

According to a recent MetLife Mature Market Institute study, losses from elder financial abuse are estimated at $2.6 billion annually.

New Jersey seniors can protect themselves and their assets by educating themselves, planning ahead, and putting in place specific guidelines for those they trust with their financial affairs.

According to the National Committee for the Prevention of Elder Abuse (NCPEA), financial abuse can take many forms: outright theft of money or property; forging signatures; or using deception, coercion or undue influence to get seniors to sign deeds, wills or powers of attorney.  Other means of financial abuse include using deception to gain victims’ confidence and telemarketing scams such as those that prompt seniors to send money or provide a credit card account number.

Signs of elder financial abuse can include:

• Unpaid bills

• Eviction notices

• Large, unexplained withdrawals

• Frequent ATM withdrawals

• Seniors who find themselves with a new “best friend”

• Care that isn’t commensurate with the size of their estates

• Family members or caregivers who are overly interested in the amount of money seniors spend or that is spent on their behalf

Seniors may not suspect or may not want to suspect that they are being taken advantage of.  Those who are abused don’t seem to be aware of the abuse. For instance, seniors may know their children have sold their home, but they may think the children intend to use the money to pay for the senior’s needs.  The fact that family members are the most frequent perpetrators is the biggest stumbling block to resolving these crimes. Victims are reluctant to prosecute because they find the situation embarrassing, and it’s demeaning to admit that someone they trust, especially a son or daughter, is exploiting them.

Seniors can stop financial abuse by putting in writing what they want to have done with their property, money and belongings long before the need to invoke a power of attorney ever arises, or see an attorney to draw up specific directives rather than relying on a document from an office supply store or the Internet.
To get help, contact the U.S. Administration on Aging, which identifies Adult Protective Services in every state. Call 1-800-677-1116 or visit http://www.ncea.aoa.gov or the National Domestic Abuse Hotline at 1-800-799-7233.

Posted by: Frank Esposito, Vice President of Expert Home Care.  New Jersey’s Expert Home Care provides professional and reliable home health care and companion care for NJ seniors, helping them with their daily living activities since 1984. Please call us toll free at 800-848-2336 when you have elder care related questions or need assistance for a loved one. Get a Free Home Care Assessment (a $375 value!) when you mention this post.

For seniors, the bedroom can become a place for accidents.  Here are some things to consider:

• Lamps and light switches should be within reach of the bed. Lamps or switches located close to each bed will enable people getting up at night to see where they are going.

• Night lights should be used. This is especially important if your elderly loved one makes frequent trips to the bathroom at night.

• Ash trays, smoking materials, or other heat sources (heaters, hot plates, teapots, etc.) should be kept away from beds and bedding. Burns are a leading cause of accidental death among seniors. Smoking in bed is a major contributor to this problem. Among mattress and bedding fire-related deaths in a recent year, 42% were to persons 65 or older.  Remove sources of heat or flame from areas around beds.  Don’t smoke in bed.

• Check for proper use of electric blanket. Tucking in electric blankets, or placing additional coverings on top of them can cause excessive heat buildup which can start a fire. Use electric blankets according to the manufacturer’s instructions.  Don’t allow anything on top of the blanket while it is in use. This includes other blankets or comforters, even pets sleeping on top of the blanket.  Don’t set electric blankets so high that they could burn someone who falls asleep while they are on.

• A working flashlight should be kept close to the bed in case electrical power goes out.  Check the flashlight regularly to see if the batteries are still good.

• The telephone should be close to your elderly loved one’s bed. In case of an emergency, it is important to be able to reach the telephone without getting out of bed.

• Never go to sleep with a heating pad if it is turned on because it can cause serious burns even at relatively low settings.

With a little planning, you can prevent accidents that should never happen.

Posted by: Frank Esposito, Vice President of Expert Home Care.  New Jersey’s Expert Home Care provides professional and reliable home health care and companion care for NJ seniors, helping them with their daily living activities since 1984. Please call us toll free at 800-848-2336 when you have elder care related questions or need assistance for a loved one.

Are you prepared to deal with any emergencies that may arise with your elderly loved one?

Below is a list that you, as a caregiver, should keep in an easy-to-reach place should an emergency occur.  The list should be filled out and kept on a refrigerator and/or nightstand.  In times of panic and confusion, you or your senior may forget the most basic information.  Timing is critical and seconds can make a difference.

Fill out this list, review it with your senior citizen and keep multiple copies:

Children’s or Next of Kin’s Full Names, Addresses and phone numbers:

Name__________________  Address ____________________  Phone Number_____________

Name__________________  Address ____________________  Phone Number_____________

Name__________________  Address ____________________  Phone Number_____________

Special Health Concerns:

Medications Taken_____________________________________

Pre-Existing Conditions________________________________

Emergency Contact Information:

Doctor’s Name______________Address_____________Phone Number______________

Nearest Hospital              Address____________ Phone Number______________

Insurance Carrier___________________________Account Number_________________

Police Station Phone Number___________________________

Additional Instructions:

_______________________________________________________

_______________________________________________________

Posted by: Frank Esposito, Vice President of Expert Home Care.  New Jersey’s Expert Home Care provides professional and reliable home health care and companion care for NJ seniors, helping them with their daily living activities since 1984. Please call us toll free at 800-848-2336 when you have elder care related questions or need assistance for a loved one.