WHAT ARE YOU AFRAID OF? : Making Caregiving Changes in the New Year

Margery Pabst — Mon, 30 Jan 2012 12:37:58 GMT

The New Year looms large, and if you’re like me, making some needed changes can feel scary, particularly if those changes involve the relationship with our patient/loved one. For caregivers, changing day to day routines can feel risky even if the possibility for attaining some degree of balance for ourselves is possible.

So let’s take stock of that rut we were in called 2011. I know my personal ruts, my habits and routines of the past year need rethinking. So, let’s just jump into 2012 by facing our fears about our caregiving routines.

So what are you afraid of changing? Pick a caregiving task or activity. Ask yourself, “Why am I afraid of changing ________?” Is it because.....

-no one else can do it but me?
-my loved one only wants me to assist?
-I am fearful that someone else can do it better me?
-I am afraid something bad will happen?
-I don’t know how to ask others to help me?

Do you have other excuses not stated here for keeping your caregiving routine the same? Consider those and place them on this list of excuses.

Let’s examine each of these excuses for not changing our caregiving routine.

-NO ONE ELSE CAN DO IT BUT ME.

I’ve been known to say this too, but examined in the light of day, it’s just not true. Others can complete tasks; the issue is that they will probably do them differently. Different can be better! After allowing others to help, I’ve actually learned some new options for caregiving tasks.

-MY LOVED ONE ONLY WANTS ME TO ASSIST.

Of all the excuses on this list, this one is and was the most different for me to confront. Often your loved one will say something like, “You are the best at _____” or “I really want only you to do ______.” My suggestion is to sort out those tasks that really need doing by you, perhaps something that is very personal for your loved one. Try to delegate those things that are not personal.

-I AM FEARFUL THAT SOMEONE ELSE CAN DO IT BETTER THAN ME.

Yes, there are probably some tasks that others can do better than you. This is true in all of life. You excel at some tasks and for some, you don’t. Again, sort out what you really do best and delegate those things that you don’t like or are not good at.

-I AM AFRAID SOMETHING BAD WILL HAPPEN.

When I feel this way, I find that planning for my absence and anticipating all the possible problems is a good way to assure myself that everything will be all right. For example, asking the doctor the impact of not taking one dose of medication is a useful question that will put you at ease or will emphasize the importance of taking some necessary precaution. Writing instructions for the temporary carer is a good way to increase your confidence.

-I DON’T KNOW HOW TO ASK OTHERS TO HELP ME.

The three key rules for delegating and asking others for help are: pick a person you trust, be specific on what needs to be done, and begin small to increase your confidence. So the first time you leave your loved one with another person, be sure you trust that person, write down your instructions and the patient’s needs, and leave for only an hour or two. Once successful on a small scale, you’ll be able to apply these rules to longer periods of time and more complicated tasks.

I wish you a Happy New Year and new ways of making caregiving a personal triumph for you and your family!

Click here to listen to Caregiver and Physician Conversations Radio Shows hosted by Margery Pabst.

Margery Pabst is eCareDiary’s caregiving expert and the co-author of Enrich Your Caregiving Journey. Margery is the host of eCareDiary’s BlogTalkRadio show, “Caregiver and Physician Conversations” and answers your questions on the “Expert Q/A” section of the site. You can access Margery Pabst’s information on www.pivotalcrossings.com.

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Accepting the Truth About Our Parents

Chris Cooper — Mon, 23 Jan 2012 10:59:54 GMT

We don’t always know - or want to know - the truth about our parents. Take the story I heard recently about an elderly gentleman who had passed away. The man had worked for the state government for many years and had seen both the good and bad side of life. After his wife died, his son moved him into an assisted living facility. While this man was having difficulty living on his own, he didn’t really want to move.

This gentleman, who was in his eighties, was a bit lonely in his new home, and as a result he became friends with several of his caregivers. Two of those caregivers?a housekeeper and a nurse’s aide?ended up becoming “special friends,” which his family didn’t realize until after his death.

After he passed away, the family discovered that the man, who was of modest means, had titled two of his accounts in such a way that he left the money to the housekeeper and the nurse’s aide. Upon his death, the accounts passed directly to those women, outside of probate and away from the rest of his assets. When his oldest son found out about what his father had done, he was angry. The younger son was a bit more supportive and loving, perhaps to the point where he was denying that anything had happened. Neither son had known anything about their father’s relationship with these two women.

Why are we telling this story? Often, children don’t learn about their parents until after they pass away. That can be a sad thing, because the children never really got to know their parents as adults. At the same time, parents often fail to get to know their children as adults. In any case, sometimes we have to understand that parents are just ordinary people with frailties and weaknesses, including loneliness. They have a desire and a need to be with people and around people. Sometimes it’s people of the same sex and sometimes people of the opposite sex. Sometimes it’s for sex, and sometimes it’s not. But whatever it is, we have to learn to accept these things because it’s just part of who people are.

The hard part, however, is that sometimes older adults may establish relationships with people who don’t have their best interests at heart. These individuals who get involved with an older adult may have ulterior motives, such as financial gain. Sometimes it’s an honest exchange, and sometimes it may not be. We don’t know the exact situation in the story I just told you. We don’t know if there was undue influence or if the gentleman left the money to the women simply because he cared for them. And his sons will never know because they can’t ask him.

However, the rest of us do need to ask questions. We need to have frank conversations with our family members about their lifestyles, goals and intentions. Sometimes, it may help to have those conversations with our family member in the presence of an attorney, minister or doctor. The important thing to realize is that these are things could affect our loved ones later in life, with consequences ranging from sexually transmitted diseases to exploitation and elder abuse.

Coming to terms with the fact that our parents are not perfect, but rather normal, flawed human beings, can be difficult. But accepting this while they are still alive lessens the likelihood of unpleasant surprises after they are gone.

Click here to listen to Chris Cooper’s radio show on Long Term Care and Financial Planning.

Chris Cooper, CFP®, is the owner of ElderCare Advocates, Inc. a geriatric care management and long-term-care consulting firm. He is also the owner and founder of Chris Cooper & Company, Inc., a fee-only financial planning firm that works with small business owner, persons preparing to retire, and the very elderly. Chris is a regular contributor to eCareDiary.com and was recently interviewed by eCareDiary’s co-founder, Susan Baida, regarding Empowering Family Caregivers. Chris has also on has appeared on CBS's Early Show, NBC's Today Show, and is a regularly featured guest on CNBC's Power Lunch. He is frequently quoted in The Wall Street Journal, USA Today, The New York Times, Kiplinger's Personal Finance, Money, and SmartMoney.

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Do You Have a Life Care Plan?

Wendie Howland — Wed, 18 Jan 2012 11:33:55 GMT

A Life Care Plan is a road map for care, describing anticipated medical and non-medical needs, with associated costs, of a person with a catastrophic injury or chronic illness over an estimated life span. It is based on published standards of practice, comprehensive professional assessment, collaboration, and analysis.

A Life Care Plan may include medical and therapy treatment, future projections, architectural modifications, anticipated change in level of care, equipment/transportation/furnishings, vocational assessment, and anything else that will incur costs related to the related injury or illness. Many clients are unaware of the extent of these needs, particularly in complex cases, so I make it a point to describe complications of the injury, underlying conditions, and medication and treatment side effects to clarify my Life Care Plan rationales.

Life Care Planning may be comprehensive or modified, depending on specific client needs. Many Life Care Plans involve plaintiff or defense worker’s compensation or liability claims with people suffering such catastrophic conditions as traumatic brain injury, spinal cord injury, major trauma, burns, chronic pain, or a combination of conditions. I may also see children with birth injury or other developmental condition, like cerebral palsy or mental disability, or elders whose care needs fall to family or a trust fund and may not involve litigation.

I am a Certified Nurse Life Care Planner, a professional registered nurse with education and expertise in preparing and reviewing Life Care Plans, including medical record review, research, legal aspects, and particular course content on catastrophic or chronic conditions. I hold two national certifications in Nurse Life Care Planning; I also hold national certification in rehabilitation nursing and two national certifications in case management. As a registered nurse, I base my independent practice on nursing process and nursing diagnosis. My professional licensure, certification, experience, education, standards of practice, and ethics are backed by the nurse practice act. As a Certified Nurse Life Care Planner, therefore, I am within my scope of practice to prescribe the evaluations, equipment, consultations, and other interventions of my Life Care Plans.

Whether your case involves litigation or not, a Life Care Plan can help you travel the road regarding long-term conditions. Let us meet your Life Care Planning needs to help you reach your destination.

You will find a referral list for Certified Nurse Life Care Planners at www.aanlcp.org

Click here to listen to Wendie Howland’s radio show on Life Care Planning.

Wendie Howland, MN RN-BC CRRN CCM CNLCP LNCP-C, is owner and principal of Howland Health Consulting, offering life care planning, case management, and legal nurse consulting services nationwide, primarily for persons with catastrophic or chronic injury or illness. Contact information: 508-564-9556 or 866-604-9055 toll-free.

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Stay Hazard Free this Winter! : Safety Checklist for Seniors

Dr. Rein Tideiksaar — Mon, 16 Jan 2012 08:45:16 GMT

Ask any elder about the dangers of winter and they will tell you without hesitation that slips and falls on icy walkways are number one. They, of course, are correct but there are a host of other hazards placing elders at risk of falling during winter. Here are some potential health problems to be aware of:

Dehydration

• 68-year-old Martha has high blood pressure and is extremely careful about her diet and medication. But last week, Martha felt weak and collapsed while preparing to go out for an evening walk; doctors at the emergency room diagnosed severe dehydration. Martha didn't realize that she was not drinking enough water; her tea/coffee intake had gone up due to the drop in temperature (both tea/coffee have diuretic properties that can lead to dehydration). Martha’s health was restored with some fruit juice/lemon water.

Dehydration among elders goes up with the onset of winter because people generally drink less water in the cold weather. This can lead to dehydration, fluid imbalance and fall risk. In elders who are on medication for blood pressure and other long-term health problems, dehydration can even prove fatal. To avoid dehydration:

• Reduce or eliminate dehydrating beverages such as coffee/ tea and soft drinks.
• Drink between 6-8 glasses of water daily.
• Eat lots of fruits and vegetables; most have high water content.

Feeling Blue

• Albert (age 71) was brought to the emergency room by his daughter with the complaint of slurred/incoherent speech, impaired balance and a recent fall. Doctors found that Albert’s sodium level had dropped way down due to a decrease in salt intake; lately he had been lonely and was not eating regularly, skipping a lot of meals. Albert’s nutritional imbalance (low salt intake) was triggered by his depression (feeling lonely/not eating), which resulted in his health problems.

Feeling down and in the dumps peaks during the winter months is a common complaint; short, dark, cold days, less activity, restricted outings, etc. can negatively affect an elder’s outlook, especially if they’re living alone. Moreover, elders face the risk of feeling depressed due to life changes, medication, and illness. During winter, when stress levels and isolation increase, it’s important for caregivers to:

• Spend time with their loved ones and help them connect with others during the cold winter months.
• Watch for signs of depression, such as persistent sadness, reduced energy, sleep problems, change in eating patterns, etc. Many elders are unwilling to admit being depressed for fear of being seen as weak or unstable.

Hypothermia

• Lou Ann (age 84) enjoys going for her daily 5-mile walk, even in very cold and snowy winter mornings. After arriving home during a recent outing, Lou Ann’s son noticed that she was confused, drowsy, and weak and her balance was way off. He brought Lou Ann to the emergency room. The doctors said that she had hypothermia (low body temperature).
.

Hypothermia can happen from exposure to cold temperatures; elders are especially susceptible. Hypothermia may develop over hours or days if the body can’t regulate heat as it should. Diseases of the endocrine glands (such as hypothyroidism; a condition of the thyroid gland), which triggered Lou Ann’s problems, may also cause the body to have trouble producing heat.

Hypothermia can usually be prevented by:

• Dressing warmly, being careful to stay warm and dry, and recognizing the early symptoms (e.g., feeling tired, confused or weak and problems walking).
• If planning to be outdoors for long periods in cold weather, wear layers of insulated or moisture-wicking clothing, including a hat. If you start to shiver, go inside.
• Avoid overexertion, eat enough food, drink enough fluids, and avoid alcohol.
• Postpone early morning walks by 2 hours or until it gets warmer.

Another cold weather problem is:

• Seasonal flu and pneumonia; a loss of balance and/or falling can sometimes be the first sign of an underlying respiratory infection. Elders with weak lungs and suffering from respiratory conditions (asthma, chronic bronchitis or emphysema) are especially at risk and should get a pneumonia and flu vaccination. Any signs of coughing, yellow sputum, chest pain, chest discomfort, shortness of breath and fever should prompt a call to the doctor.

As for Avoiding Slips and Falls...

Winter is the time for snowy weather, freezing temperatures, and plenty of ice. For elders, this signifies an increased chance of slips and falls, which can cause serious injuries in just a matter of seconds. So what’s the best way to avoid being injured this winter? Prevention is the place to start:

• Simple exercise for joints can help relieve age-related arthritis or pain in the joints, which worsens during cold weather, making you prone for slips and falls. Exercise to strengthen your legs. Strong leg muscles can help you steady yourself if a slip and loss of balance happens. Moreover, if fall occurs, it will be a lot easier for you to get back up.

• Check your footwear. Walking on snow or ice is especially treacherous and wearing proper footwear is essential. A pair of well insulated boots with good rubber treads is a must for walking during or after a winter storm. Better traction can help keep you stable on icy surfaces.

• When walking on an icy or snow-covered walkway, take short steps and walk at a slower pace so you can react quickly to any changes in balance.

• Slow down. It is when you rush that you end up losing your balance. Keep in mind that being a bit late is better than falling.

• Listen for weather advisories on television and radio before going outdoors in snowy weather. Always take a cell phone when bad weather is expected.

• Keep a bag of sand, cat litter or rock salt to spread on icy walkway to avoid slipping.

These simple safety tips, when used together, could make the winter elements a bit less perilous.

Click here to read Dr. Rein Tideiksaar’s article about suitable safety gifts for seniors.

Rein Tideiksaar Ph.D., PA-C (or Dr Rein as he is commonly referred to) is the president of FallPrevent, LLC, Blackwood, NJ, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician's assistant. He has been active in the area of fall prevention for over 30 years, and has directed numerous research projects on falls and has developed fall prevention programs in the community, assisted living, home care, acute care hospital, and nursing facility setting. To learn more, check out the Doctor’s professional profile on LinkedIn: http://www.linkedin.com/pub/dr-rein/6/759/592. If you have any questions about preventing falls, please feel free to email Dr. Tideiksaar at drrein@verizon.net.

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Private Home Care Assisted Living

Lety Wakely — Mon, 09 Jan 2012 16:39:52 GMT

Can somebody give me some tips to promote my Private Home Care Assisted Living, I have it in my home and we are under the "3 and under" category; my website is: www.annsplace.webs.com

Thanks for your help

Norma Gomez-Wakely

Caring Too Much? : Watch Out for Compassion Fatigue!

Ann Catlin — Mon, 09 Jan 2012 13:00:16 GMT

Years ago, while sitting in a restaurant with a colleague, I learned something about myself. We each worked as massage therapists in eldercare facilities and it was really nice to talk to someone who "got it." Our conversation took an unexpected turn. We candidly admitted seemingly unhealthy responses to our work — and they were quite similar: distancing more than we thought we should and feeling irritated with other caregivers. There was one thing that stands out. We each were avoiding our work by putting off seeing clients and rushing through sessions. This caught our attention because we both love our work. So, why were we avoiding it? It just didn’t make sense. We had a good laugh at ourselves, got some relief and I’m grateful for it even years later (thanks, Jeff).

I now realize that we might each have experienced compassion fatigue. As it turns out, we aren’t alone. Anyone in a "helping profession" is vulnerable. Nurses, doctors, counselors, veterinarians, social workers, chaplains, emergency response workers and people caring for aging parents can also experience this. Massage therapists are on the list, too. I think those of us who specialize in working with frail elders and people living with terminal illness are especially vulnerable. Choosing to serve this special population means we are sensitive people to begin with — not a bad quality to have, but maybe it means we need to check in with ourselves from time to time to avoid the toll of compassion fatigue.

Compassion fatigue is a relatively new term. Dr. Charles Figley, an expert on the subject, describes it as, "a state experienced by those helping people in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper." He goes on to say that, "the capacity for compassion and empathy seems to be at the core of our ability to do the work and at the core of our ability to be wounded by the work."

Compassion fatigue results from the cumulative impact of taking care of people living with serious illness, trauma, abuse or severe conditions. It’s different than job burnout, which is dissatisfaction with our employment situation, not necessarily the work itself.

Wanting Others To Be Happy

Compassion is our feelings and thoughts when we witness the suffering of another and the unconditional desire to alleviate that suffering. The Dalai Lama describes compassion as the "wish for another being to be free from suffering and wanting them to be happy." He also tells us that sometimes we confuse compassion with attachment, which is our own personal investment in the outcome of the situation. In other words, when we think we are feeling compassion, we actually are wrapped up in our own emotional needs rather than simply being open to the needs of the other person. Perhaps it’s attachment that leads to compassion fatigue, not compassion itself. In my experience, when I truly feel compassion, I’m uplifted and it does my heart good. I feel love.

A perfect illustration of this happened just yesterday to a massage therapist named Jane in a workshop taking place in a long-term care facility. When Jane walked into the elder’s room, she was stunned when she took in what she saw — an extremely thin, emaciated woman with severe bruising and discoloration on her arms and legs sitting in her wheelchair, alone. Jane described her first reaction as fear, which turned to sadness for this woman’s condition and knowing that she really couldn’t do anything to change it. But she conjured up the courage to stay present and focused her attention on this woman rather than the outer condition. The fear softened. She gently massaged the woman’s shoulders and neck and she told Jane, "that feels good." Jane shared that following the session, instead of fear she felt good knowing she had made a difference by connecting with this woman. She was able to drop the attachment to the fear and sadness which allowed her to be present and both she and the elder were uplifted in the process.

Knowing the Signs

How can you recognize compassionate fatigue? Some of the symptoms might seem like "normal" stress responses and you might associate them with your work. After all, we live in a pretty stressful world these days. Some characteristics of compassion fatigue include:

Withdrawing from others.

Difficulty connecting with clients or detaching.

Feeling angry that other caregivers don’t understand the nature of your service.

Life feels too serious.

Turning to compulsive or addictive behaviors such as overeating, overspending, alcohol, smoking, etc.

Physical symptoms: headaches, gastrointestinal symptoms, muscle tension.

Fatigue and apathy.

Difficulty concentrating.

Avoiding clients. Calling in sick or postponing appointments.

Thinking that this work isn’t for you (when you know in your heart you really love it).

Recognizing our vulnerability to these symptoms is important. How can we avoid this reaction or ease them when they happen? The answer lies in holistic self-care. Advice about self care typically includes physical support like regular exercise, getting enough sleep and good nutrition. However, we shouldn’t stop there. Nancy Jo Bush, an oncology nurse, says that holistic self-care also includes setting empathetic boundaries; self awareness and self forgiveness; being in tune with one’s spirituality and finding hope. The experts agree that reaching out to others and developing a support system is critical. Who would you turn to if you needed the support of an understanding friend? I personally like the advice from a practitioner working in hospice who says, "lighten up and don’t forget to laugh." That reminds me of an old Joni Mitchell lyric, "laughing and crying, you know it’s the same release."

Thanks, Joni. We’ll all try to remember that!

Listen to Ann Catlin’s radio show on Focused Touch and Massage for Seniors in Eldercare, Hospice and Palliative Care.

Ann Catlin,a Licensed Massage Therapist is an expert in the field of massage in eldercare and hospice. A recognized author, she brings to her work thirty years of experience as an occupational therapist in long term care and rehabilitation. She founded the Center for Compassionate Touch LLC an organization that offers Compassionate Touch® training internationally. Compassionate Touch® is a hands-on complementary approach for those in eldercare, hospice and palliative care.

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You Can Stay at Home! : Modifications for Seniors to Age in Place

Michelle Seitzer — Tue, 03 Jan 2012 11:02:09 GMT

Granite countertops, stainless steel appliances, shiny wood floors, custom tiling: these are among the items frequently found on the modern home buyer’s checklist.

Decades ago, when seniors currently aging in place (AIP) were house-hunting, it’s unlikely that wide doorways and expanded halls, hand and chair rails, interior and exterior ramps, or streamlined one-level living quarters were on their checklists. But that’s what they need now, and that’s what their adult children, many of whom are boomers planning for their own present and future care needs, are struggling to provide.

Overwhelmed with keeping up on repairs and making needed upgrades to the family home, adult children often give up, encouraging Mom or Dad to ditch the aging abode in favor of something that’s safer to maneuver and easier to maintain. But moving out of a home after a lifetime of living within its walls is both emotionally difficult and economically impractical.

Thankfully, there are solutions.

Enter universal design, an emerging movement that is changing the way homes on the current and prospective market will look as America ages. Essentially, universal design considers the needs of everyone in the home – and for the long haul – instead of building and remodeling based on a perpetually young, unencumbered, and mobile tenant.

Industry experts are watching this trend unfold. In this MSN.com article. The National Association of Home Builders said that 75% of remodelers reported getting more requests for AIP projects from customers ages 45 and up. Of those requests, 75% were planning for future needs, and 53% were living with aging parents.

Whether you renovate an entire floor of your home, build an addition (i.e. the mother-in-law suite) or complete several home modifications in stages, it is possible to age in place without moving out. Consider these tips for adapting your home – and know that the benefits extend beyond the caree to the caregiver too:

1. Ramp it up: Installing ramps at the home’s most-used exits and entrances enhances independence and prevents home “imprisonment”. Additionally, stair lifts allow access to a 2nd floor bathroom or bedroom. Learn more about different styles and models of ramps, as well as the installation process, here.

2. Simplify, simplify, simplify: Overstuffed shelves, drawers and cabinets are not only unattractive, they’re a fall risk, a hazard, an obstacle to efficiency. Take time to do some much need cleaning and consolidating. And should you or a loved one eventually require a transition to a care facility, the work of downsizing from a multi-bedroom home to a single room or apartment will be easier.

3. Let there be light: Lighting can make a significant difference when it comes to preventing falls and easing mobility in the home. Installing additional lights (or windows to let in more natural light) in high-traffic areas and frequently-used rooms makes the home safer – and more attractive.

4. Lend a hand: Chair rails in hallways, grab bars in the bathroom, and other touch points for safe and supported maneuvering can dramatically reduce the risk of falls and promote independence within the home.

5. Keep things dry in the water closet: In the bathroom, where the majority of fall-related injuries occur, incorporate non-skid surfaces; when not in use, toilet seats, countertops, tubs, and shower floors should stay dry. For examples of other bath safety products, like transfer benches or walk-in showers, click here.

6. Watch where you step: Flooring in all rooms of the house can easily present a fall risk, as can rugs that are bulky, shift around easily, or have corners that catch on walkers, canes or wheelchairs. For optimal mobility, hard flooring is best.

After home modifications have been made to accommodate an aging resident, these features, if done well, can certainly be highlighted as a selling point for future homebuyers (i.e. those young adults who are already thinking about taking care of Mom, Grandpa, or another senior relative). Invest wisely; prepare your home now.

Get more information on AIP adaptations at 101Mobility.com.

Click here to read Michelle Seitzer’s article on Car Modifications and Safe Driving Tips for Seniors.

Michelle Seitzer is a freelance writer and editor who specializes in elder care content. Seitzer writes for a number of senior-related websites, including 101 Mobility.com, the nation’s leading sales, service and installation provider of a complete line of mobility and accessibility products and equipment that may be customized to suit each individuals’ home care needs. Learn more about the company at http://101mobility.com/ or email Michelle (mseitzer@101mobility.com).

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'Tis the Season of Safety Gifts for Seniors!

Dr. Rein Tideiksaar — Tue, 27 Dec 2011 12:07:47 GMT

$0With the holidays upon us, it’s that time of year, gift giving. As a fall prevention and mobility expert, I’m often asked by family caregivers about safety gifts for elders; especially for those with impaired balance. A typical line of questioning goes something like this:

‘My mother’s (or father’s) balance is so-so; you know one day it’s OK and the next it might not be OK.’ ‘What can I give her (or him) for the holidays to make their life a little bit more safer? ‘Can you help me?’

There are many elders living with ‘so-so’ balance, which can best be described as being somewhere between having good balance (and not needing any equipment to support balance) and poor balance (requiring balance support 24-7).

Typically, individuals get by without any balance support at all. But occasionally, their balance is off. Any number of things may trigger poor balance; exacerbation of an underlying chronic health problem (such as diabetes, arthritis, etc. going awry), the onset of a sudden illness, (flu, pneumonias, infection, etc.), sometimes even mood swings can upset balance. On those days when balance is less than good, individuals could benefit from some support. In future blogs, I’ll have more to say about the causes of balance problems and how to best maintain balance (including safety technology/specific exercises), but for now my holiday safety gift list includes the following:

Rollators: A 4-Wheeled Walker with Style

Walkers are often recommended to support elders with balance problems. A wheeled walker allows an individual to ambulate by pushing or rolling the walker forward and is easier to use than the standard “pick-up” walker (i.e., those without wheels). The advantage of having wheels is that the elder doesn’t have to lift the walker during ambulation; they simply roll the walker along the ground.

A rollator is a walker with four wheels, the front two wheels typically are on swivel casters for easy maneuverability. Rollators offer important advantages over standard walkers.

Rollators are equipped with hand braking systems (i.e., caliper brakes, much like a ten-speed bicycle) to prevent the walker from rolling away from the elder. The user squeezes the hand brakes to lock the wheels in place, or release them to continue walking. For those individuals with arthritis or other ailments that make hand brakes difficult to use, some rollators are equipped with automatic braking systems, which prevents the rollator from suddenly rolling away.

Most rollators have foldable, padded seats and back rests built into them. In this way, if an elder gets tired while walking, they can fold the seat down and rest on it. This feature is especially beneficial for those individuals with arthritis whose legs may give way after walking a distance, and in those individuals with underlying heart disease who tire easily and need to frequently stop and rest while walking.

Rollators offer balance stability and maneuverability on uneven ground surfaces (such as thick carpets, sidewalks, gravel walkways, etc.). The rollator’s wheels are designed to turn, pivot and maneuver in a way that standard walkers can't, which makes it much easier to get around. Rollators with smaller wheels are aimed at indoor use; while rollators with bigger wheels are ideal for outdoor use.

Lastly, and perhaps most importantly, rollators are aesthetically more appealing than conventional walking aids; thereby, improving the elder’s acceptance and compliance. Rollators come in various sizes, shapes, designs, and styles to meet individual needs.

Transfer Pole

Elders may not always experience balance problems when walking, but instead exhibit poor balance while attempting to get up from bed, chairs, toilets or in/out of bathtubs. A transfer pole (also known as a floor-to-ceiling pole) is designed to help elders with their balance and confidence while performing seated transfers (the elder grasps onto the pole when seated and pulls themselves up to a standing position when getting up).

How does it work?

The transfer pole extends from the floor to the ceiling and mounts using tension (it’s basically a vertical pole that is adjusted via a screw mechanism at the floor at the pole's base without the use of any tools. The pole’s height adjusts from 7' 8.25"-8'2.5"). The transfer pole is easy to remove or relocate for use in strategic locations where extra support is needed.

Silver Sneakers Program

Among the lifestyle behaviors that have negative effects on one’s balance, being sedentary is near the top of the list. The good news is that a regular program of exercise enables the body to keep good balance. To be effective, exercise programs need to be fun and tailored to each individual’s level.

Silver Sneakers is a fun, energizing program that helps elders take greater control of their health (and balance) by encouraging physical activity. The Silver Sneakers Fitness Program is designed specifically for Medicare beneficiaries. The program concentrates on improving strength and flexibility so daily living activities become easier. Silver Sneakers has participating locations nationwide (visit www.silversneakers.com to find a Silver Sneakers location).

What does the Silver Sneakers Program offer?

Exercise options for elders at all levels of fitness.

Strength/ balance training.

One-on-one guidance from trainers qualified to work with elders.

Fitness equipment, treadmills and free weights; access to amenities like a swimming pool or indoor walking track.

Engages elders; helps keep them motivated to improve their health and well-being.

Offers a non-intimidating environment; elders can meet new people who share their health goals, participate in social activities and receive health education.

When it comes to picking the perfect presents for older loved ones, what truly makes the best gifts are those that enable them to maintain a great quality of life and to live as independently as possible.

Happy holidays!

Click here to read articles by Dr. Rein Tideiksaar on Fall Prevention.

Rein Tideiksaar Ph.D., PA-C (or Dr Rein as he is commonly referred to) is the president of FallPrevent, LLC, Blackwood, NJ, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician's assistant. He has been active in the area of fall prevention for over 30 years, and has directed numerous research projects on falls and has developed fall prevention programs in the community, assisted living, home care, acute care hospital, and nursing facility setting. To learn more, check out the Dr’s professional profile on LinkedIn: http://www.linkedin.com/pub/dr-rein/6/759/592 If you have any questions about preventing falls, please feel free to e-mail Dr. Tideiksaar at drrein@verizon.net

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Choosing the Right Caregiver for Your Elderly Loved One

Chris Cooper — Mon, 19 Dec 2011 10:25:08 GMT

Recently, I attended a national convention for financial planners. At the conference, I attended a session on Alzheimer’s disease led by a young financial planner. After the presentation ended, another financial planner in the audience stood up and asked a question. She explained that she had a client who had a caregiver. The caregiver lived in the client’s home and appeared to be a relatively well-to-do woman?she had nice jewelry and clothes, and her hair and nails were always done.

One day, the financial planner mentioned to the caregiver that she was supposed to be paying taxes on the money she received for caring for the client. The caregiver, perhaps not surprisingly, objected to that. To be specific, the caregiver did not want the elderly woman to issue her a 1099 for her services because she didn’t want to pay taxes on those earnings. However, according to the IRS, the elderly woman was required to issue the 1099. Nonetheless, the caregiver argued that she’d never paid these taxes before, so why should she start doing it now?

Now, the financial planner was somewhat befuddled by the caregiver’s response. She wasn’t a tax expert, and she wasn’t sure how to respond when the caregiver said things like, “Well, I don’t want it messing up my Social Security.”

Essentially, the caregiver was saying that she wanted to be paid under the table for her services. The financial planner then turned to this speaker at a national convention to ask if she should be concerned about the caregiver and whether there was anything she should do about her. The speaker was an intelligent young man, but this wasn’t his area of expertise, and he was caught off guard by the question. So I spoke up from the back of the room and said, “This caregiver is gross. She doesn’t want to pay her taxes. What else might she also be neglecting to do, including properly care for the client? You should get rid of her.”

Unfortunately, situations like the one above are all too common. People let caregivers into their lives and then don’t know when (or how) to get rid of them. In some situations, people become fearful of the caregiver. In other cases, a client might become attached to caregiver, even if he is dysfunctional or abusive. In those situations, a client could be afraid to let a caregiver go because of a fear of being left alone or of being unable to find someone to replace the caregiver. The client may even fear that another caregiver will be just like the first.

One way to avoid getting involved with a dishonest, exploitative or abusive caregiver is to check them out before a relationship begins. If there are signs (such as wanting to be paid under the table) that the caregiver just wants to line their pockets, walk away. In the story above, the client and the planner knew nothing about the caregiver. They hadn’t done any kind of background investigation on this woman, even though she was being allowed to live in the client’s home.

When choosing caregivers for your own loved ones, you must be vigilant. If a caregiver is failing to follow basic laws (such as paying taxes), there’s a good chance that there are other things that they are failing to do. Remember, don’t be afraid of the caregiver. Get rid of bad people, and get good people in there to care for your mother, father, or other loved one. There are plenty of good caregivers out there. The problem is, many people are willing to put up with unqualified or dishonest caregivers because they don’t realize there are other options. We need to expect?and demand?more from those who care for our loved ones.

Click here to listen to Chris Cooper’s radio show on Long Term Care and Financial Planning for Seniors.

Chris Cooper, CFP®, is the owner of ElderCare Advocates, Inc. a geriatric care management and long-term-care consulting firm. He is also the owner and founder of Chris Cooper & Company, Inc., a fee-only financial planning firm that works with small business owner, persons preparing to retire, and the very elderly. Chris is a regular contributor to eCareDiary.com and was recently interviewed by eCareDiary’s co-founder, Susan Baida, regarding Empowering Family Caregivers. Chris has also on has appeared on CBS's Early Show, NBC's Today Show, and is a regularly featured guest on CNBC's Power Lunch. He is frequently quoted in The Wall Street Journal, USA Today, The New York Times, Kiplinger's Personal Finance, Money, and SmartMoney.

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Key Skills Every Caregiver Needs: Tips from Top Doctors!

Margery Pabst — Mon, 12 Dec 2011 10:40:43 GMT

Did this year go by as quickly for all of you as it did for me?

As we end 2011, I’d like to thank all of you who read my articles each month on the eCareDiary website and who tune into “Caregiver and Physician Conversations” on the last Tuesday of each month. Please note that December’s show is scheduled for Tuesday, December 6 at 2PM EDT. Dr. John Guarneri, Head of Healthcare and Spirituality at Florida Hospital, will be my guest as we discuss the topic of “Spirituality and its Role in Healing”. I invite you to check out the program archives for “Caregiver and Physician Conversations” either on eCareDiary.com or on my website www.pivotalcrossings.com. and click on “Newsroom”. Countless suggestions and skills are provided by those professionals we interviewed this year.

So what are the top five skills as identified by eminent physicians across the country? Five key skills were recommended with amazing consistency by our physicians over the past year on “Caregiver and Physician Conversations”. I thought that a review of key skills/practices would be helpful, particularly as we’re in the season when a caregiver’s skills can be stretched and tested even more than usual.

Physicians interviewed on “Caregiver and Physician Conversations” encourage the following practices when dealing with medical professionals:

Be an advocate but be tactful.

-Explain your concern for the patient rather than placing blame on the
medical professional or treatment.
-Use “I” messages like, “I need more of your time today”. or “Please explain the procedure again so that my loved one and I can fully understand it.”
-Do not ask your physician to cross the line ethically. (Asking for a diagnosis over the phone or requesting treatment via an email.)

Be specific.

-Explain details about your loved one by identifying specific behaviors for the doctor/medical professional.
-Keep a notebook of day to day events/issues so you can remember to share them during medical appointments. The notebook should also include questions as you think of them.
-Keep a historical log of the patient’s medications, dietary restrictions, etc. as this information will enhance the doctor’s understanding.

Come prepared and anticipate future issues.

-Keep a list of questions in your notebook so you’ll remember to ask them during medical visits both in the clinic and in the hospital or nursing facility.
-Do research on your loved one’s illness so you remain an informed consumer.
-Anticipate the possible next steps/events in your loved one’s care by reading, researching, and by requesting your doctor’s opinion on an ongoing basis.

Know who’s who in the healthcare hierarchy.

-Research how the medical team is organized. (i.e. What professionals assist your doctor?
-Identify what each professional on the medical team does and what information you can expect them to have.
-Advocate for your loved one by always ensuring that the person providing care has explained what specific treatment and care they are providing. (This rule applies to both out-patient and in-hospital situations.)

Keep the focus on the patient.

-When facing a difficult or ambiguous situation, always ask, “What is best for the patient”? and “What does the patient want?” Simply asking, “What would you like to do?” will clarify the situation.
-Keep your patient/loved one in the decision making loop if at all possible. Feeling and being in control goes a long way toward healing and well-being.

Physicians consistently pointed out that the benefits for using these skills not only ensure better patient care, but also confirm for the physician that the caregiver is an invaluable partner in the healing process.

We hope that the thoughts and suggestions presented this year have provided you with helpful, light filled ways for your caregiving journey. We want to thank the following physicians and contributors: Dr. John Guarneri, Lead Physician; Dr. Maria Gonzalez, Dr. Debi Hunt, Dr. Barry Jacobs, Edward Leigh, Dr. Rick Bommelje, Dr. Dennis McCullough, and Dr. Kesavan Kutty. Have a wonderful, memory filled holiday!

Click here listen to Margery Pabst’s radio shows with eminent physicians on various caregiving issues.

Margery Pabst is the co-author of Enrich Your Caregiving Journey , the winner of the 2010 “Caregiver Friendly Award”. As eCareDiary’s caregiving expert, Margery writes this monthly blog, answers your questions in the Expert Q/A, and hosts “Caregiver and Physician Conversations”, a monthly feature of eCareDiary’s “Empowering Family Caregivers.” Margery is also a national facilitator and speaker on topics of caregiving, health literacy, and storytelling. Find out more on her website, www.pivotalcrossings.com.

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