Florida Elder Law Blog - ElderLawAssociates.com

If you are a primary caregiver for a loved one, you are well aware of the daily stress and emotional and physical impact it can have on your health. As Florida elder law attorneys, we see this every day, as our clients come into our office.

Susan learned this first hand when she and her husband, Tom, brought his Mom home to live with them. Mom suffered from dementia and had to be watched constantly. Susan found that when you become a caregiver, you start by giving up a few things you usually do for yourself to make up for the time needed for caregiving. Even though your service is one of love and you are willing to do the sacrifice on behalf of your loved one, you find yourself giving up a lot more as time goes on.

“As a caregiver,” Susan laments, “You are often frustrated that you can’t do enough for your loved one and so guilt and feelings of inadequacy set in. Couple that with feelings of being unduly burdened, of resentment, of stress and then of more guilt at having those feelings."

She continues, "Now don’t get me wrong, I am very glad that I spent those years in caregiving. There were many cherished moments with Mom that only I experienced.”

In order to enjoy those moments and sustain your caregiving momentum, a little respite is essential.

An article posted on About.com by Carrie Hill, PhD states:

“Caregivers who use respite care often tell me that although caregiving is one of the hardest jobs they've ever had, they wouldn't trade the experience for anything. Helping a family member or close friend who has Alzheimer's disease can provide a sense of purpose and great satisfaction. Still, the emotional and physical demands of caregiving make it hard to be a caregiver 24 hours a day, 7 days a week. Without respite care -- a temporary break from the demands of caregiving -- you may be more susceptible to the effects of caregiver stress, such as depression, exhaustion and other health problems.

Carrie Hill, PhD, About.com “Why Caregivers Need Respite CareGiving Yourself a Break Helps You and Your Loved One” Updated: August 3, 2008

Be on the lookout for caregiver burnout. It can creep up on you without your noticing it. Caregiver burnout symptoms can include:

• depression
• anxiety, irritability, or anger
• feelings of exhaustion
• self-criticism
• Withdrawal from usual activities
• trouble with handling caregiving responsibilities
• substance abuse

The need for support for caregivers at home has received national recognition. State Human Resource Departments and Area Agency on Aging Services are offering more counseling and respite services for caregivers. The ARCH National Respite Services is also an organization that is reaching out to educate and support caregivers in many states. There is, however, one service that is highly valuable but very underused:

Adult Day Care to the Rescue!

Adult Day Care respite is two-fold. It gives the caregivers much needed time to themselves and gives their loved ones social and interactive therapy with their peers.

Many adult day services offer such things as:

• Social activities; music, movies, crafts, excursions
• Meals
• Fellowship support
• Assistance with daily living
• Nursing care
• Help with activities of daily living
• Medications
• Physical therapy
• Transportation

Finding an Adult Day Services provider takes a little investigating on your part. It is important to know what you are getting and that your loved one is comfortable with his or her new surroundings.

First: Ask for recommendations.

Check with your local Senior Center, Area Agency on Aging Services, Mental Health Centers, Doctor, Clinic, Family, Friends and neighbors. The best recommendation is by someone who has used the adult day services or is familiar with those who run it.

Second: Call and ask the facility to send you information.

Ask specifically to be sent the application, eligibility requirements and payment information.

Ask to see the calendar of activities, menus, hours and days of operation are needed to be sure to fit your schedule.

Ask about availability of transportation to and from the location and what is the cost.

Ask who runs the facility. Is it private, non-profit or a franchise or part of an assisted living facility or a nursing home?

Third: Visit the Adult Day Care facility.

Go visit the provider location along with the person you are caring for.

See if the staff is friendly.

Check that it is clean and odor free.

Ask about the experience of the staff.

Request a list of references.

Fourth: Find out the cost and payment requirements.

A survey from NCOA/NADSA provides the following information on fees:

“Fees for Adult Day Care providers range from $25 per day to $70 per day, with the average around $50 per day. Many facilities provide services with a sliding fee scale.”

One last word of advice. Don’t feel guilty about taking your loved one to adult day care.

Susan’s mother-in-law complained bitterly about leaving home and going to the adult day care facility, expounding on how Susan just didn’t want her around anymore. This only increased the guilt Susan was already feeling, but Susan was also determined that she needed the respite time the day care would provide and they pressed forward. That evening as Susan picked up Mom and helped her into the car, Mom -- who suffered from dementia -- exclaimed, “That was the nicest resort I have ever been to!”

To learn more about the AOA National Caregiver Support Program go to:

http://www.aoa.gov/prof/aoaprog/caregiver/caregiver.aspx

Labels: elder care, Florida Elder Law Attorney

Plan and consider before you jump.

Bringing a stranger into an elder's home is a big step and thought and consideration will go a long way in helping this big change be a success. First and foremost the elder needs to be involved as much as possible. How would you like having someone else arrange to bring a stranger into your home?

Start by making a list of which areas the elder needs help, such as cleaning and meal preparation, personal care like bathing and toileting or medical attention for medications, therapy, skin care, etc. A different type of aide is needed for the different levels of care. Will they need to drive and if so will the aide need to have her own car?

Next, how much help is needed, 4 hours twice a week, every day all day, or day and night? If someone needs to be on hand for 24 hours, will they be able to sleep through the night or must someone be alert at all times. This will determine whether you can have a live-in or if you will need shifts. A live-in is much less costly than shifts and helps to maintain a more stable situation.

Also critically important is the need to define a compatible personality that will interact well with your elder. Will the aide need to be able to keep control and be assertive, need to be tolerant of mood swings, need to play cards, or discuss current events, etc? With the needs defined you are now ready to start your search.

There are some community resources available for home care which may meet your needs. You can call the Eldercare Locator at (800) 677-1116 to learn what public agencies are in your area and how to contact them. However, most of these agencies are stretched to the breaking point and often will be unable to provide you with the level of care required, if they can provide any care at all.

Most areas have multiple private home health agencies available which you can find online, in the phone book and by asking for referrals. It is possible to save money by hiring someone directly, but if you have not had experience doing that, the choice can be fraught with obstacles such as medical screening, criminal background checks, payroll tax issues and more which you will have to handle yourself. You definitely do not want to have someone come into the house without the medical and background checks being made. If you do not have that experience, I strongly recommend you use an agency. Contact two or more different companies so that you will get more than one input about pricing, the amount of care needed, what type of aide, Home Health Aide (HHA), Certified Nursing Assistant (CNA), License Practical Nurse (LPN), etc. is required. Have them provide you a copy of their agency license, and referrals which you should call.

Determine whether the same person or persons will be providing the care. A revolving door of different aides is a prescription for problems. If it is a live-in will they really be there every day, or do they have obligations to a family and home. You may need two live-ins so they will they both be able to maintain a consistent schedule. If they will be driving get a copy of their driver's license and if they will be using the elder's car, make sure the insurance will cover them. Interviewing aides from more than one agency will give a wider choice of candidates. The first person you hire, or even the second or third person may not be the right one. Don't get discouraged, the right match is out there. Do not settle for someone that does not meet all your expectations.

It is also critical that you provide adequate supervision during the start of the process. If you do not live near by, you should get the help of a friend or relative. If there is no one, give serious consideration to getting a Geriatric Care Manager to help, at least in the beginning. Be sure to also ask your elder's opinion about the aide, but only when the aide is not present.

If you are not using a Platinum LifeLedger you will need to collect and make a copy available for the aide and the agency of all the many things they will need to know

Bringing help into the home is big project and you will need to be prepared for these new, added responsibilities. Do the best you can - perfect is not going to happen.

Labels: elder care

Elder care includes resolving family conflicts, a situation as Florida elder law attorneys, we're unfortunately very familiar with.

"My daughter is insisting I move in with her," complains Martha. "She just wants to control my life and take away my freedom," she continues.

Jenny, Martha’s daughter worries that her mother keeps falling, and fears one day she will break her hip or hit her head.

"I’ll take my sister to court before I will let her get control of mom and my inheritance," exclaims Jim about Jenny’s desire to move her mother in with her.

It is amazing how quickly formerly cordial relationships between family members will sour when the family has to deal with care of elderly parents or inheritance at their death. Sometimes the consequence of dealing with the final years of elderly parents can break families apart and create long-lasting animosity.

The National Care Planning Council has seen an increase in requests from caregiving children for help in solving disputes with siblings. In one case, the caregiver was being sued by her sister for abusing their parent and stealing the Social Security checks. In another, the caregiving child would not allow siblings to see their mother, claiming they would take advantage of her.

A lot of times it is a “she said,” “he said” situation with neither party really understanding what the elder person needs or wants.

Some families find it hard to communicate with each other when their parent is in need of care. Perhaps when they grew up together they were not accustomed to come together as parents and children to work out problems. And now those children are older and taking care of parents and they don't have this family council strategy to rely on. It may seem unnatural to them. But that is often exactly what is needed, especially in situations where perhaps one child is caring for the parents and the others are left out of the loop.

Children all have a common bond to their parents and as a result a common obligation or responsibility to each other. When disagreements arise, suspicions begin to grow. Suspicions or distrust often lead to anger and the anger often leads to severing the channels of communication between family members. This can occur between parent and child or between siblings or between all of them.

It is often at this point that a neutral third party can come in and repair the damage that has been done and help correct the problems that have come about because of the disagreement.

A practitioner experienced in elder mediation is a perfect choice for solving disagreements due to issues with the elderly.

WHAT IS ELDER MEDIATION?

Mediation is a non-adversarial approach to solving disputes. Mediation is a process of bringing two or more disputing parties together and having them mutually negotiate a solution to their disagreement. The mediator is not a judge and does not render a decision but is there to make sure that communication flows freely between the disputing parties. Elder Mediators are trained in the art of negotiating resolutions between elderly parents and family members.

Mediation can achieve results that the family by itself may not be capable of realizing or have the expertise of achieving. Here are some reasons that make Elder Mediation so valuable.

• A trained expert on communication gives the family a perspective it could not gain by meeting together on its own;
• All family members involved meet and prevent problems from arising by anticipating situations that may cause disputes;
• Allows for the mediator to invite experts such as care managers or other care providers into the meeting to educate the family and give them a new perspective;
• Allows parents to focus on their abilities rather than their limitations;
• Allows children to come up with and consider options not thought of previously;
• Encourages uninvolved family members to become involved;
• Allows parents to express wishes and desires that had previously gone unuttered;
• Allows for a neutral third party to challenge family members and make them take responsibility for their actions;
• Promotes consensus of all involved which in turn creates a much higher rate of compliance with the plan than with any other process; (the success rate for compliance with elder mediation is estimated to be about 80% to 85%)
• Requires a written plan with specific responsibilities which makes compliance feasible.

There are many organizations and companies throughout the country providing expertise in "Elder Mediation" to help seniors and their families. You will also find that mediators often have many coincident professional accreditations such as, Professional or Geriatric Care Manager, Elder Attorney, Clinical Social Worker or Certified Mediator.

In choosing a mediator, consider your needs. Is there a need for a medical assessment to determine the type of care? Are legal concerns with inheritance or family business or power of attorney, the main need? Perhaps, just bringing the family together to communicate on what needs to be done and who will do it is the agenda for now.

In one case, after months of dispute with her parents over their health and safety issues, Connie enlisted the service of a professional care manager mediator.

“Bringing a neutral person with a professional and compassionate attitude into our disputes was the best thing for all involved,” Connie recalled. “My parents shared their concerns and listened with acceptance to mine. All of a sudden we could communicate and work out a plan that they could live with and I could relax knowing they were safe.”

Seniors Use Mediators to help the family plan for long term care.

In the National Care Planning Council's book, “The 4 Steps of Long Term Care Planning,” the process of creating your own “Care Plan” before you need it is introduced. Quoting from the book:

“If the current or future caregiver wants the other persons attending the meeting to give support with respite care, transportation to doctors, etc., everyone needs to be aware of this and in total agreement to do it. All must also be willing to work with the member of the family, friend or professional who is designated as the Personal Care Coordinator.

If you feel the communication will be strained, consider having a professional mediator present. The mediator will be able to keep things calm and running smoothly
and help work out each person's concerns.”

“The 4 Steps of Long Term Care Planning” book can be found at http://www.longtermcarelink.net/a16four_steps_book.htm

Where to Find an Elder Mediator

• In your local phone book, on the internet or with your community senior services.
• References from friends and neighbors
• Contact the local area agency on aging
• Contact your state bar association
• Contact a local university or college and asked to speak to the department that provides mediation training and ask for a referral.
• On the internet look up mediation in your area
• Yellow pages in local phone books

Labels: elder care, Florida Elder Law Attorney

Eight Unselfish Ways to Put Yourself First

1. Eat a well-balanced diet
When you’re stressed out, you may tend to overeat. When you’re exhausted, it’s easy to resort to whatever is handy; quick snack foods, tea and toast, cheese doodles and soda. You need high quality food to perform well.

2. Get regular exercise
Exercise is the original “feel good” tonic. It helps you sleep better and wake up refreshed and ready to face another arduous day. Regular exercise improves both your mental and physical well-being, keeping your mind alert and body fine-tuned and energetic.

3. Get enough rest
This may be easier said than done, especially if you’re caring for someone who tends to wander at night. Still, most people need six to eight hours of sleep a night to maintain good health. Catch up with cat naps if necessary, early in the day.

4. Look after your own health
When you’re preoccupied with someone else’s health, it’s all too easy to neglect your own. Caregiving can be physically and emotionally exhausting, leaving you at risk for serious illness.

5. Get organized
It is very important to get an early diagnosis of your loved one’s illness, and then learn everything you can about it. That way you’ll know what to expect, and you can plan for it. (It also pays to have your legal plans well mapped out. Consult a Florida elder law attorney to do just that.)

6. Plan for emergencies
Who will take over if you do get sick? How will you cope if your loved one has a medical emergency? Be prepared. Keep a file or notebook with names and phone numbers of people you might need. In a crisis, you’ll be less likely to panic if you’re organized down to the last detail.

7. Take time out for yourself
Whether you’re caring for a parent, spouse, or other relative or friend, you need time for yourself. You need outside interests, other people, and a way to escape from the constant pressure of caregiving. You need to get away from time to time. Keep up your friendships. It’s easy to let friendships lag when you have “more important” things to do. But friends can get you through some tough times, just by being there.

8. Consider joining a support group
If you feel alone and isolated in your role as caregiver, talk to other caregivers. They’ll know what you’re up against; they’ll understand where you’re coming from. Think of it as therapeutic socializing — while you’re not actually escaping from your role as caregiver.

From the Saskatchewan Health Wellness and Health Promotion Promotions Branch
3475 Albert Street
Regina, Saskatchewan, S48 6X6

Labels: elder care, Florida Elder Law Attorney

A 2008 study by the Harvard School of Public Health found evidence that seniors in the United States with active social lives may have slower rates of memory decline and lower mortality rates. In fact, memory decline among the most integrated of the study subjects was less than half the rate among the least integrated (findings were independent of age, gender, race and health status).

Click here to read the entire article.

Of course, it's always prudent to make sure that elder care documents are in order. Please consult a Florida elder law attorney to make sure your loved ones are taken care of.

-- Ellen Morris, JD

Labels: elder care, Florida Elder Law Attorney