Caring for an elderly Mom or Dad can be daunting. Talk to them about their wishes.

If you have an aging parent, you probably have received advice from friends and experts to start talking with your parent now about issues such as finances, health and safety concerns. 

You know you shouldn’t delay any longer, and you definitely should not wait until a crisis occurs. 

However, it is tough to know how to get started.  You respect your parent’s privacy.  You have had no experience or training for this.  It is downright uncomfortable.

You may be thinking,

How do I find out what my parent really wants and what he/she expects from me?

How do I broach sensitive subjects?

What if they get upset with me?

What if they refuse to talk with me?

It’s important to realize it takes just one event to change your parent’s world and yours.  My mother’s health deteriorated rapidly in a 3-month period due to a viral infection.  A seemingly simple fall can result in a broken hip or brain injury.  An aneurysm can result in a coma. 

None of us can predict the future.  But, we certainly can start the conversations with our parent now.  Let me share some tips.

1. Start with an understanding of how your motivation and your parent’s motivation differ.  David Solie in his book, How to Say It To Seniors, tells us that the primary driver in the elderly is to “maintain control.”  That makes sense when you think about the losses they are experiencing; the loss of strength, health, and friends.  As adult children, our primary driver is “safety”!  We have to learn to assist, not insist.
2. Plan a special visit of 2 or 3 days with your parent.  During this time, just plan to be present, listen and walk beside your parent in their daily routines.  This means putting your laptop, blackberry and phone away.   The first time I did this, I was amazed.  I gained insight into my mother’s world, and the experience also helped me transition from my fast-paced world to hers.  A natural result of the visit was a deepened trust and openness between my mother and me.
3. Broach sensitive discussions with thoughtful wording, such as using the phrase, “What If”.  “What if your arthritis gets worse and you need help in your home” or “What if one day you need full-time care?” If your parent doesn’t want to talk about it at that time, know that you’ve planted a seed.  It also helps to share these conversations with your other siblings (who may live states away from you and your parent). Try to get family members on the same page.  

So, start with a sincere desire to understand your parent, their fears, needs and wishes.  Put yourself in their shoes, and listen, non-judgmentally.  Build a foundation of trust and sharing.  That foundation is what will help guide you through the conversations you need to have with your parent now and in the future. 

Want to learn more about communicating with an aging parent and siblings?

Obtain Dale Carter’s entire Ecourse, “Five Essential Strategies to Help Your Aging Parent Face Change” at http://www.transitionagingparents.com/

About Dale Carter

The above article was written by Dale Carter and published with permission.  Dale Carter is the founder of Transition Aging Parents, providing information and insight for adult children of aging parents so they can “thrive and find joy” in every stage of life.  Besides her blog, articles, and newsletter, she hosts a weekly radio show, interviewing authors and experts.  Her book, “The 6 Steps to Guide an Aging Parent through Change & Crisis” will be published later in 2010.

At Home Instead Senior Care

Home Instead Senior Care has many additional resources to help you with having those often difficult conversations with your aging parent.  There is a 40-70 Rule booklet which you can download at this link:  The 40-70 Rule.  You can also reference the website and book, The Stages of Senior Care.  And, lastly, you can preview our Richmond digital brochure here:  Home Instead Senior Care of Richmond.

And, remember, we’re here to help.  Just call our Richmond senior care offices at 804.527.1100 — we’re here for you anytime, day or night, whenever you need assistance.

If you’re not familiar with it, The New York Times has a well-written blog column in the health section called The New Old Age.  The column often features topics of caring and coping with stories of people who are being full-time family caregivers either for a spouse, a parent of other loved one.  There are often senior health related topics as well.

Home Instead CEO Paul Hogan quoted in The New York Times's New Old Age Blog

Last week, writer Paula Span featured a caregiver column entitled, “Will Boomers be any Different?”  In the column, she says that “…the the No. 1 question I encounter when I speak to family caregivers is how to cajole old people into adapting to increasing disability when they are, to be a tad euphemistic, “fiercely independent.”

“In 20 or so years, when we baby boomers enter the ranks of the “old-old” ourselves, will we be any different?,” she asks.

She interviewed our very own Home Instead CEO, Paul Hogan, who was in Richmond last week meeting with the Boomer Project, a market research firm specializing in marketing to Boomers.  

“We’ll see more seniors coming directly to us for help in the next 10 years, versus the past 10 when it was a daughter or son calling us and tearing their hair out,” says Hogan.

With the Depression generation…agreeing to home care “takes a doctor’s ultimatum: ‘You’re not going home from the hospital unless you get help, because you’ll break that other hip.’” But Mr. Hogan’s own mother, a businesswoman in her 70s, has long paid financial advisers, child care workers and housekeepers. “She sees getting help when she’s older as just another in the long line of services she’s taken advantage of throughout her career,” Mr. Hogan reported.

For boomers, though,“the concept of reaching a certain age, leaving work, and disengaging from our lives and social networks is anathema,” said Matt Thornhill, president of the Boomer Project. “We get a lot of our self-fulfillment from work – and we’re going to need the income,” Mr. Thornhill said.  So we may not be so amenable to leaving our homes, either — or giving up our cars.

Whether Boomers will really be any different than our parents in the next 20 years is yet to be seen.  But we certainly are more willing to outsource and pay for services that are parents didn’t.  And, as Ms. Span points out, 

“In fact, we’ll probably have to accept hired help. As a generation, we’ve had far fewer children than our parents, and we’re less likely to be married. Even if we prefer to rely on unpaid care when we’re sick or frail, our smaller families may be stretched too thin to provide it.”

“The reputation of older people is that they get stuck in their ways,” Mr. Thornhill mused. But that may not pertain to boomers. “We’ve always been so adaptive. Life for us has been change.”

If you’d like to read the full blog post and the comments, you can simply click on this link:  NYTimes New Old Age Blog – Will Boomers Be Any Different?

If you would like more information about Home Instead Senior Care, please call our Richmond home care office at 804.527.1100.

Though the economy is in decline, 133 franchise companies inspired strong franchisee satisfaction in results released recently by Franchise Business Review. This is the organization’s fifth consecutive year of conducting this study, researching more than 500 of today’s leading franchise brands representing 100,000-plus franchisees.

The top five winners in the large class (systems with 200 units or more) were Heaven’s Best, Home Instead Senior Care, Sotheby’s International Realty, Weed Man and Aaron’s Sales & Lease Ownership.

Home Instead Senior Care ranked best in the senior care category as well as second in large class!

Top winners say that franchisee satisfaction correlates with business success. “Our owners’ satisfaction is one of the most critical factors we consider to analyze our business to further invest in our network,” said Yoshino Nakajima, Chief Development Officer of Home Instead Senior Care, among the nation’s top non-medical home care and companionship companies, ranked first in this year’s senior care category as well as second in large class. “The survey provides us so much information on franchise support, training, initial visits, marketing and communication, and serves as a health index of our network,” she added.

For instance, Home Instead Senior Care received among its highest rankings – 4.5 of 5 – in the area of franchisee relationships. “Relationships are such an important part of our success and that carries over to our customers as well,” Nakajima added. “To us, it’s personal.”

Here at Home Instead Senior Care of Richmond and Northern Neck, we couldn’t be more satisfied.  And we are very proud of this prestigious recognition as we’ve been a franchise owner since 1997.  For more information about our CAREGiving services, simply call our Richmond home care office at 804.527.1100.  We’d be glad to talk to you about your in home care and senior home care needs.

There are advantages and disadvantages for Seniors to age in place in their own homes,

Aging in place enables seniors to live safely and comfortably in their own Richmond or Northern Neck homes or other primary residences, including independent living facilities. 

This is just one of many senior living options that are covered in detail in Lori and Paul Hogan’s new book:  Stages of Senior Care: Your Step-by-Step Guide to Making the Best Decisions.

Aging in place is an option that utilizes some or all of the following:  special housing design for seniors, the installation of safety and convenience equipment, and in home care service that enables the senior to remain at home while ensuring needs are met. 

The advantages of aging in place are many but we’ll list just a few here: 

• Aging in Place maintains a familiar environment for the senior or elderly person so that they can continue to live in their own surroundings without making a drastic change
• It fosters community continuity, which means the senior can continue to frequent their usual grocery store, drugstore or other places in which they are comfortable shopping and asking for help
• It maintains valuable social networks,  often keeping contact with neighbors and friends that live nearby
• It has a way of strengthening family and family ties
• It promotes physical and mental well-being, just be continuing to keep the senior in a home where they often have raised their family

Aging in place can also mean that a senior or a senior couple can move into an independent living facility or other retirement community, such as retirement villages or even a government-funded NORC (naturally occuring retirement community).  

Some of the disadvantages of having an elderly loved one continue to live at home or an independent living facility are as follows: 

• There would likely be a low to moderate investment in home equipment and home modifications.  Depending on the home and the ability for the senior(s) to easily navigate in the home, the cost of these modifications an be high depending on the extent and nature of the modifications required, particularly if ADA-compliant renovations are required.
• The lead time for renovations may be lengthy (weeks) for determining the need, finding a contractor, and completing these home modifications, especially if the home is outside of a pre-planned senior independent living facility or village environment.
• Without home modifications, structural barriers in the home may present challenges and contribute to falls and injuries.  Even something as simple as having too much furniture and rugs in the home can make it difficult for the senior to manage easily as they get older.
• Seniors may be resistant to home modifications and the installation of helpful technology.  Often a senior who has lived in their home for a long time may not want to see any modifications in their home that would signify that they’re getting older and need additional help.

Aging in place is an option that is best suited for seniors who are functional on all activities of daily living (this is often abbreviated as ADL) which includes eating, bathing, toileting, dressing, maintaining continence, and transferring (getting out of a bed or chair).  So for those who require limited or no assistance in getting around their home, the prospect is good for sustained independent living and home modifications can be a rather easy and often less-expensive solution depending on their needs and whether they’re living alone or as a couple. 

When is it time to move on? 

With a few home modifications, many seniors can live in their existing homes for many years without further help.  But when it is no longer safe for them to move about easily or if they are forgetting to take medicine or go to doctors appointments, then the situation has to be re-evaluated again.  And especially if the need continual nursing or medical help. 

This transition time period is often when Home Instead Senior Care can provide senior home care and companionship services that allow the senior to live in their homes or more independent living facilities longer, before having to consider assisted living.  When a senior simply needs medication reminders, transportation, light housekeeping, checkbook balancing – or just simply needs someone to be there to play a card game or engage in conversation to prevent loneliness — then that’s a perfect situation for our CAREGivers to lend a helping hand.  

Home Instead Senior Care serves seniors across Greater Richmond, including Midlothian, Mechanicsville, Short Pump, Glen Allen, Chester and many other towns.  Our West End offices are conveniently located off Broad Street and you can simply call us at 804.527.1100 for a free, no-obligation home care assessment.  Let’s work together to allow our Richmond seniors to remain safe and live independently in their own homes for as long as they are able.

P.S.  Does your elderly relative live in the Northern Neck?  We have an office in Tappahannock in which we serve the entire Northern Neck area.  That office number is 804.443.4885.

Home Instead CAREGivers can be there to help elderly loved ones when family can't

According to the American Association of Neurological Surgeons (AANS), simply falling at your own home is the leading fatal injury for people 65 and older. Nearly 50 percent of all fall-related fatalities are caused by traumatic brain injury. 

In 2008, nearly 8.6 million Americans of all ages suffered accidental falls. 

Gail L. Rosseau, M.D., AANS spokesperson and a Chicago neurosurgeon, states “Many head injuries occur at one’s residence – whether it is a home or a nursing home facility – and involve falling and bumping one’s head, resulting in mild concussions to severe and even fatal traumatic brain injuries.” 

Among people ages 55 and older, most head injuries were related to flooring, wheelchairs, canes, crutches and walkers. But falls can happen in so many ways — stumbling on stairs, slipping in bathtubs, falling off ladders and step stools, and tripping over garden hoses, dog leashes, and household appliance cord. It’s really easy to accidentally fall — at any age. 

And, you must be extra careful with any head injury. What seems like no big deal can turn out to be something much more. Consider actress Natasha Richardson, who fell during a skiing lesson in March 2009. Her fall was not “big” or unusual, and her head hit snow. Although she did not appear to be injured at the time, she died soon after from a fatal brain injury. 

Some easy changes around the home can help Seniors prevent falls and head injuries: 

• Secure loose electrical cords
• Remove articles on the floor that someone could trip on (rugs, footstools, grandchildren’s toys)
• Buy bath mats and rugs with slip-resistant backing
• Install grab bars and handrails for the frail and elderly
• Improve lighting in the home (this is so very important as vision worsens as we age)
• Check all stair railings and steps
• Wear proper shoes with slip-resistant soles
• Do not wear clothing that can interfere with your vision

Another way to help Seniors avoid falling is through fall prevention programs, which typically include a review of the person’s medications, reduces risk factors in their home and provides safety modifications, education, and an exercise program. Studies show fall prevention programs reduce falls by 30-50%. 

Tai Chi, a martial art using slow movements, also helps Seniors lower the risk of falling. Tai Chi teaches people to relax, slow down, coordinate their mind and body, and improve posture. The strength and balance that Tai Chi and other exercises make seniors feel stronger and more confident as they move.  You can read more about how Tai Chi can help at this article:  Tai Chi May Combat Seniors’ Fear of Falling 

Home Instead Senior Care provides in-home care to Seniors in the Richmond and Northern Neck areas.    While we can’t always be there to prevent a fall, we can help Seniors live more independently by being there when they need a hand, by helping them with meal preparation or light housekeeping so they don’t have to, by driving them to a doctor’s appointment or shopping so that they don’t have to go alone.  

And we can be there when it’s just not possible for family members to be there and that can easily reduce stress on the family caregiver(s).  If you are caring for an elderly loved one — or if you perhaps are a Senior yourself — and you could use an extra pair of caring hands, simply call our Richmond senior care office at 804.527.1100.  We’ll be there when you can’t because…  to us, it’s personal.

What is hospice?  Probably no form of senior care is as little understood as hospice.  People often have misconceptions about it and almost always questions such as:

• Is it a building, like a hospital? 
• Who are the professionals who will take care of my mother in hospice care? 
• How much, or how little, will they do for her? 
• If nursing home costs have impoverished her how will she, or we, pay for hospice care? 
• What role does the family play in hospice care?

Hospice care is sometimes thought of as a synonym for palliative care.  That’s not too far wrong, but hospice care is really a particular kind of palliative care.  Palliative care is a form of treatment that does not attempt to cure the patient’s underlying disease.  Rather it focuses on alleviating the symptoms of the disease, especially reducing the pain.  People of any age can undergo palliative care, among them children suffering from cancer. 

Eliminating Pain

Palliative care does not preclude other medical care.  It is possible, for example, to have one team of doctors alleviating the pain of a child with leukemia, in other words, practicing palliative care, while other specialists focus on curing the child’s disease.

In contrast, hospice care is limited to those who are judged by medical professionals to be at the end of their lives, generally, but not exclusively, the elderly.  The purpose, as with other forms of palliative care, is to eliminate or at least control pain and suffering. 

The promise to the individual who is placed in hospice care is that she will be able to spend her final weeks and days with as much dignity and as little pain as possible.  Hospice care professionals assist the patient with the emotional and spiritual aspects of death as well.

SUMMARY:  Hospice Care and Palliative Care:  What’s the difference?

• Palliative care is designed to alleviate symptoms, especially reducing pain.
• People of any age can receive palliative care, including those who simultaneously receive healing care.
• Hospice is a particular kind of palliative care, limited to those who are judged by medical professionals to be at the end of life but are still in need of pain relief and comfort.

While in hospice or palliative care, your elderly loved one may need companionship care or personal care during this difficult time.  Home Instead Senior Care of Richmond can provide those services and more so that you can have a few less things to worry about.  Simply call our Richmond office at 804.527.1100.  We serve Greater Richmond and Northern Neck, too.

Excerpted from the book, Stages of Senior Care:  Your Step-by-Step Guide to Making the Best Decisions by Paul & Lori Hogan.  Also, credit to National Hospice and Palliative Care Organization.

Coronary heart disease is the No. 1 cause of death in the United States.*  Some heart attacks are sudden and intense, others start slowly, with mild pain or discomfort.

Here are signs that can mean a heart attack is happening:

• Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back.
• Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
• Shortness of breath with or without chest discomfort.
• Other signs may include breaking out in a cold sweat, nausea or lightheadedness. Even if you’re not sure it’s a heart attack, have it checked out. Minutes matter! Don’t wait more than five minutes to call 9-1-1.

A Home Instead CAREGiver can help Seniors transition home from the hospital if they’ve had a heart attack. Oftentimes the Senior’s doctor limits what activities they can do around the house – a CAREGiver can help with laundry and other light housekeeping. The Senior may also be weak, so it’s good to have someone around to help them get around the house.

And if the Senior hasn’t had a heart attack, Home Instead CAREGivers can help prevent one by assisting with a walk around the block, transporting them to an exercise class or trying a new activity. A CAREGiver can also remind them to take their cholesterol, blood pressure or other vital medication, or plan and prepare nutritious, heart-healthy meals.

Home Instead Senior Care is located right here in Richmond, Virginia, with a second office in Tappahannock.   To arrange a free, no-obligation in-home care appointment, simply call our office at 804.527.1100 anytime.  Help for those suffering from heart disease — or those wanting to prevent it — is just around the corner.

*Source: American Heart Association

Dear Savvy Senior,

What do I need to do to get Social Security disability? I’m 58 years old and have back problems that are keeping me from doing my job, but I’ve heard it’s very difficult to actually get disability benefits. What tips can you offer?

Disabled Dave

Jim Miller, creator of Savvy Senior column, answers your questions about senior life.

Dear Dave,

The process of getting Social Security disability benefits can be tricky and time-consuming, but you can help yourself by doing some homework and getting prepared.

Here’s what you should know.

Last year, around 3 million people applied for Social Security disability benefits, but two-thirds of them were denied. Why the high denial rate? Because most applicants fail to provide sufficient medical evidence that prove they’re disabled and can’t work. While there are no magic tips to getting Social Security disability, there are several steps you can take to give yourself a better chance for a favorable decision.

Get Informed

Your first step is to know if your disability meets Uncle Sam’s criteria. Social Security strictly requires that you must be physically or mentally unable to perform “any” substantial work and have a medical condition that’s lasted or is expected to last at least a year or result in death. You must also have worked five out of the last 10 years and be under full retirement age. For more details, see ssa.gov/dibplan/dqualify4.htm and go through the five questions Social Security uses to decide if you’re disabled.

If you think you qualify, your next step is to learn all you can about how the program works. Your best resource is http://SocialSecurity.gov – click on “Disability.”  Or, if you don’t have Internet access, Social Security offers lots of free publications that you can have mailed to you including “Disability Benefits” (publication No. 05-10029) which provides a good comprehensive overview. Call 800-772-1213 to order publications.

Get Prepared

After you bone up, your next step is to gather up your personal, financial and medical information so you can be prepared and organized for the application process. You’ll need your Social Security number; birth certificate; names, addresses and phone numbers of the doctors, hospitals and clinics that took care of you and dates of your visits; names and dosage of all the medicine you take; medical records from your doctors, therapists, hospitals and clinics; lab and test results; documents stating your physician’s objective view of your condition, restrictions and limitations; a summary of where you worked and the kind of work you did; and a copy of your most recent W-2 Form or, if you are self-employed, your federal tax return for the past year.

How to Apply

After you get all your information together, you can then apply either online at ssa.gov/applyfordisability, or call 800-772-1213 to make an appointment to apply at your local Social Security office or to set up an appointment for someone to take your claim over the phone. The whole process lasts about an hour. If you schedule an appointment, a “Disability Starter Kit” that will help you get ready for your interview will be mailed to you. If you apply online, the kit is available at ssa.gov/disability.

Be Patient

It takes three to five months from the initial application to receive either an award or initial denial of disability benefits. The only exception is if you have a chronic illness that qualifies you for a “compassionate allowance,” (see ssa.gov/compassionateallowances) which fast-tracks cases within 10 days.

Be Persistent

If Social Security denies your application for disability, you can request a hearing to appeal the decision, and you’ll be happy to know that roughly 55 percent of cases that go through a round or two of appeals end with benefits being awarded. But the bad news is, with backlog of over 700,000 people currently waiting for a hearing, it will take a year or two for you to get one.

Get Help

If you are having trouble getting your applications in order or need help with your appeal, consider getting an attorney or a Social Security disability claims services company to represent you. A representative can only charge you if they’re successful in getting you benefits. If they do succeed, typical fees are 25 percent of past-due benefits or $6,000, whichever is less.  

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit http://SavvySenior.org.

About Jim Miller

Jim Miller is the creator of Savvy Senior, a syndicated information column for older Americans and their families that is published in more than 400 newspapers and magazines nationwide. Jim is also a contributor on NBC’s “Today” show, and is the author of The Savvy Senior, The Ultimate Guide to Health, Family and Finances for Senior Citizens, (Hyperion, 2004).  

Jim is frequently quoted in articles about issues affecting senior citizens and has been featured in numerous high profile publications, including Time magazine, USA Today and The New York Times.  In addition, he has made multiple appearances on CNBC, CNN, Retirement Living Television and national public television. 

The Savvy Senior column is brought to you by Home Instead Senior Care of Richmond and Tappahannock

Home Instead Senior Care provides extraordinary senior care, personal care and companionship services to seniors in the Richmond area which includes the counties of Chesterfield, Goochland, Hanover, Henrico and Powhatan.  We also service all of the Northern Neck out of our Tappahannock office.  For more information, please visit our digital brochure or call our office at 804.527.1100 anytime.