The Golden Touch
well-known speakers on the issue of eldercare, my partner and I are involved in
many vital and meaningful discussions around aging population. What we’ve
discovered is that sometimes the issues around our elderly are vast and complicated
(like Medicare and the Healthcare Reform Act) – and sometimes the issues that
touch the aging most intimately are the simplest things. One of those simple
issues is TOUCH. We hear about touch as a medium for healing in so many arenas
of life – in premature infants, seriously ill and even terminally ill patients.
advocates of for healthy, wonderful resources in eldercare, eCareDiary hopes to
move this conversation to the top of the list for the aging population. As a
society, we may be powerless over many issues facing our aging parents and
grandparents, but this is ONE thing that we can simply and easily bring back
into their lives. It is only a question
Why? The reasons our aging population
grow physically more and more isolated are vast. To begin with, it’s common
that they will have lost those who were closest to them – their spouses, best
friends, siblings – in some cases, even their children. It’s also possible that
we, as care providers, are so conscious of being aware of their frailty, that
we go too far – hardly touching them at all. Even hugging them from an
invisible half-inch boundary becomes our norm.
What to do. There are so many simple ways to
reengage ourselves with the elderly population. For daughters, granddaughters and
female care providers, sometimes the simple act of providing a manicure or
pedicure is a restorative physical connection. For myself, the opportunity to shave
my dad was always a fond intimacy between us – and a way for him to feel good
What are the benefits. According to the Touch Research
Institute, elderly massage is one of the most useful treatments for all levels
of Alzheimer's patients. It’s been shown to facilitate relaxation and even communication. Touch
can also greatly assist in pain management and can also create an increase in
strength and muscle awareness. (And all things being connected, this can help
the elderly population to avoid falls and other injuries, simply because their
bodies grow weaker or less self-aware over time.)
touch can also have a profoundly calming effect – which can help the patient to
deal with medical and lifestyle interventions much more easily and in a way
that is more deeply connected to their loved ones and care providers. In short,
touch can be a bridge that breaks their isolation. This is even more true when
the patient may have lost their verbal abilities for one or more reasons.
patients and loved ones move into their golden – and even their platinum years,
bringing the intimacy and caring of touch back into their lives – and even into
OUR lives – is a strong and powerful connection that we should definitely not
overlook. After all, even the powerful healing of a simple hug can make all the
difference in a person’s day.
Mills, Co-Founder of eCareDiary
eCareDiary.com to save YOUR family and care providing tribe a world of
confusion and difficulty regarding patient care, information and wellness
PS: If you are care provider, please feel free to
reach out to us to get your organization and your patients set up – eCareDiary
is a powerful tool, and we’re here to support you, your patients and their
Journaling to Storytelling: Writing with Significance
Caregivers report that journaling is one of those activities that reduces stress by providing quiet time. Also mentioned is the sense of getting back in touch with oneself as insights are created on the page. Writing does have a way of informing and illuminating what can seem to be a blur of experience for all of us, in whatever role we find ourselves.
One of the questions I get is “How can I take my story and help others with it?” “How can my story have meaning and resonance for others?” It is a classic question and one that professional writers grapple with constantly.
Here is a way to consider those heady questions. Journaling encourages us to be free thinking and to allow thoughts to fall on the page in whatever way they fall. It is an outpouring of our souls, our thoughts, along with observations and feelings of the moment. By its very nature, journaling moves this way and that without the “shape” of a story. Storytelling has a shape intended to provide others with some sort of roadmap; it has a more conscious plan to it with events laid out to provide interest, intrigue, and sometimes advice. Helping others by sharing your thoughts/insights means that your journaling needs to take more the shape of a story.
Here’s how I shape my random thoughts into something that others might reflect on and use. My “stories” are often not very long but events are altered to capture interest and encourage others to reflect on them.
First, I draw a time line of some event, incident, or issue. I physically draw a line on a piece of paper and then along that line list in CHRONOLOGICAL ORDER the sequence of events--a “this happened, then this happened, etc.” approach.
Second, I review the sequence and try to pinpoint a key idea or event in the sequence, something that I or someone else did THAT MADE ALL THE DIFFERENCE to the outcome of the situation. For example, when I was caregiver to my Mother, the sequence of events (in some abbreviated form) were the following:
-Mom is weak and feeling bad.
-Mom is diagnosed with bone cancer.
-Mom is treated with chemo and radiation.
-There is little to no improvement.
-The family and Mom realize that keeping her as comfortable as possible with palliative care is the next step.
-Mom is eager to talk about her life and to reconnect with friends and family, particularly people she hasn’t seen in awhile.
-Dad is averse to having visitors at the house.
-My brother, Jim, and I strategize ways to honor both our parents’ wishes.
-Jim and I develop a strategy to get Dad out of the house before visitors arrive.
-The plan works for the most part.
If I were to tell the story in this chronological sequence, it might be somewhat interesting, but if I select either “Mom is eager to talk abut her life” or “ways to honor both our parents” as a beginning for the story, I have a better chance of making this meaningful to others. I can focus on the “life review and legacy” aspect or “the need to honor your parents’ values” as the central theme of my story.
I encourage you to try this right now. If you are already journaling, then turn to a few pages in the journal, list a sequence of events on a timeline, and then select a key piece and focus your story around it. If you are not keeping a journal, write a series of events like my example and then decide what key piece in the sequence gave you meaning and enrichment.
As caregivers, helping others by telling your stories can be tremendously rewarding, because your words will not only help the one person hearing it, but will also have the high potential of being shared with others. I have shared my Mom’s story of her desire to review her life and legacy; it has struck a chord many times.
The sheer act of storytelling will also empower you! What do I mean by that? Explaining “how” you made it through, “how” you or your care partner succeeded provides your caregiving relationship with more strength and insight for the next situation you may face. Storytelling can truly become your ‘fuel for transformation’.
Margery Pabst is the co-author of “Enrich Your Caregiving Journey”, a book of over 130 tips for caregivers to take care of themselves while caring for others. Margery will be speaking on the topic “Storytelling: The Fuel for Transformation” at the Eden International Conference to be held in Denver June 13-15. You may find out more about Margery and her book by going to www.pivotalcrossings.com.
What the CLASS Act Means For You
Editor’s Note: This article was originally posted on Caring for Our Parents.
The new health law creates, for the first time, a national, voluntary long-term care insurance system called the Community Living Assistance Services and Supports (CLASS) Act. Participation will be optional, but if you enroll, you'll get a basic cash benefit for life to help pay for personal assistance if you are disabled or very frail and unable to care for yourself. Here is how CLASS will work:
How Will I Enroll?
The insurance probably won't be available until at least 2012. Once policies are on the market, you may be able to sign up through your work. If your employer agrees to offer CLASS, you'll be automatically enrolled starting at age 18 unless you choose to decline coverage. If you do opt-out, you'll still be able to buy in later, although your premiums will be higher.
The Truth about Aging Successfully
Rita Dichele holds Masters’ degrees in Counseling and Healthcare Administration. Currently, she is an advanced doctoral learner at Capella University where she is writing her dissertation on successful aging. Rita resides in Shrewsbury, Massachusetts and serves as a board member on the Council on Aging. She is a town appointee for the Shrewsbury Cultural Council, facilitates two groups at the Shrewsbury Senior Center, and is a certified SHINE Medicare/Medicaid counselor. Rita is also a past presenter at the 2009 American Society on Aging Conference.
Aging is the process of growth and movement as we progress through each stage of life. The interesting concept of aging is that each of us ages chronically, but emotionally and physically we age in our own unique ways. For instance, one person may suffer physical hardship related to illness and disease because of an immune system that has been predisposed by genetic makeup, lifestyle habits, and environmental conditions.
Unfortunately, many older persons are subjected to myths about aging that often create detours to age successfully.
In 1975 Pulitzer Prize winner Dr. Robert N. Butler authored the book titled, Why Survive? Being Old in America in which he describes the negative attitude regarding the aging process. Dr. Butler referred to any negative attitude toward the aged as “ageism” which he considered was consistent with other types of discriminating and stereotyping of people such as “sexism” and “racism”. Dr. Butler suggested that ageism is perpetuated from one generation to the next because of aphorisms such as “You can’t teach an old dog new tricks.”
Subsequent to Dr. Butler’s research, stereotyping of the elderly has evolved to a level of erroneous stereotyping that has been heightened, for example, by the mass media, especially by television and movies made in the 1970’s and 1980’s. Moreover, literary accounts of the elderly have portrayed ageist attitudes that preempt elderly capabilities to be productive individuals who are able to age successfully.
Notwithstanding previous portrayals of the elderly, a new image of the older individual has emerged. Because many of the famous actors are aging such as Jack Nicholson, Robert Redford, Sally Fields, Diane Keaton, characters in the movies are now being depicted as characters that are aging successfully. Thus, as a result new stereotyping is being generated that focuses less on ageist attitudes.
But nevertheless, there does exist today many myths about aging that are often perceived by the public at large as absolute truths, thus causing many to believe that aging invariably can lead to a future in which one disengages from the mainstream community. Perhaps individual acceptance of certain myths may take the mystery out of why so many older persons experience depression, substance abuse, and isolation.
Furthermore, in many instances later life can be less stressful. Unfortunately, members of our society perceive the elderly through stereotype lenses that suggest that as we age, we decline and live out our lives vulnerable to the vicissitudes of time. The problems of the widowed, those living alone, and certain minorities are often exaggerated inferring that older persons are troubled by later life stresses. This concept can often add to the typical stereotype of the older individual who is at risk of living the rest of his/her life to the fullest.
Current research conducted by gerontologists, individuals who study the elderly, suggests that aging is something to look forward to, dispelling common myths about aging. In fact much is being written about how older individuals are more resilient than their younger counterparts. Also, older individuals are more able to sustain lifestyles that are consistent with their previous days such as active sexual relations, living independently in their own homes, continued capabilities to make informed decisions, and cognitively able to process information and learn “new tricks”.
Furthermore, most older persons no longer live in poverty despite living on a fixed income. For instance, the creation of Social Security, Medicare, Medicaid, Food Stamps, and Supplemental Security Income can remove economic hardships once a widespread problem with older individuals.
And finally, old age is a period of greater adaptation because older individuals are able to assimilate into their lifestyles more changes than younger individuals. For instance, older individuals are able to reconcile change because earlier life experiences have prepared them for the uncertainties of life. Decisions made early on will affect the lifestyle choices in later life.
In conclusion, statements made to the contrary places older individuals at risk to living out a life in a compromised manner and in many instances causing some individuals to have to adjust to a lifestyle that just does not have to occur. Future predictions of the baby boomers monopolizing the older generation should provide hope to older people that those misguided myths about aging will dissipate. Thus, ageist attitudes will no longer be present and will yield to stereotyping that has replaced old stereotyping which historically has contributed to myths of aging successfully. Therefore, the real truth regarding aging successfully can be appropriately validated.
Getting From Here to There and Everywhere in Between
Priya Vin has worked in the aging and developmental disabilities field for 5 years and is based in northern New Jersey. Her experience has been in program management. She received her Master's in Social Service Administration from the University of Chicago, where she specialized in health care policy. She is excited to be contributing to eCareDiary. Priya's contact information is firstname.lastname@example.org.
You recently found yourself looking for ways to help your parents or the older adult in your life get themselves to important appointments or social activities. This could be a hard task. It starts with a conversation with them. Then thinking about the possible solutions. Luckily, there are a lot of resources out there. When you begin the conversation with them, you will want to ask them a few questions.
How were they running their errands or getting to their favorite spots before?
What was the cost like?
Where do they routinely go?
While talking to them, try to understand if they are comfortable with changing from their old routine to a new routine. Often, people want to stick with what they know because it is familiar and gives them a sense of independence.
Caregiver News Roundup Sunday April 25, 2010
The Elder Care Squeeze Play
Laurel Kennedy is a nationally-recognized expert on Boomer issues. Founder of the multi-generational consulting firm Age Lessons, she has worked as a senior executive with Edelman Worldwide and Ketchum for clients like Kraft, Kellogg, Pepsi and Sara Lee. Kennedy has appeared on national and syndicated television including CNBC and Comcast TV, testified as an expert witness in Superior Court, and keynoted numerous industry and professional groups. She has won dozens of awards for her work, including several National Tellys, Addys and Silver Anvils. For more information on elder care, visit www.daughtertrap.com.
Bet you wish there was more of you, and your day, to go around. That’s how most Boomer women feel these days, sandwiched between the constant and conflicting demands of a meaningful career, raising young children still in school, supporting adult children who can’t find a job, struggling to maintain a relationship with their significant other, and suddenly, taking on the responsibility for aging parents.
Note that in the scenario above, there is no time budgeted for “me time”, those brief breaks in routine and small indulgences like a good workout, a facial, or a mani-pedi that can keep us sane and help us recharge. It’s easy to fall into the trap of sacrificing yourself to care for others. But remember, if you lose your sanity or your savings, you’ll be no good to anyone.
Criteria for Choosing a Home Health Aide – Honoring What Won’t Be on a Resume.
As any family with a loved one who is “aging in home” probably knows, finding home health aides who are not only qualified, but also passionate about their work is not easy. There are many, many variables that come into play – after all, this person has access to your home, your family, and your precious parent or grandparent.
To make matters more difficult, your loved one has quite possibly lost their ability to advocate for themselves. So the home health aide you choose MUST be well above board.
I faced these issues over and over again, as we chose – and UNchose – almost a dozen home health aides while caring for my father. Although we finally found a wonderful person to help us, trodding through agencies and aides not only affected our careers and schedules every day – it made it almost impossible to do the basics of life. Even going to work or getting out to buy groceries became a measure in frustration when the home health aide didn’t show up or wasn’t the person we’d planned on.
And that’s not even touching on how confusing it is to the patient themselves. This issue filled our whole family with stress and worry – after all, this was our precious dad. the one who had been there every day of my husband’s life. How could we entrust his care, at the most vulnerable time in his life, to the wrong person?
There are some important criteria to keep in mind when you’re looking for a home health aide and agency. There are certifications and professional trainings that you should be aware of. We have attached a list of 10 criteria and questions to keep in mind at the end of this article.
But the OTHER qualifications – the human side of someone… definitely take the time and be sure that your care provider has the qualities that are most important to you and your family. Sit with everyone in your household and ask them what those are. Remember that the extra time you put into this process at the beginning can save you countless hours of frustration and disappointment down the road.
10 Criteria for Choosing a Home Health Aide
Once you acquire the names of several providers, which you can do on our website under the CARE PROVIDER feature, you will want to learn more about their services and reputations. Here are 10 questions to consider as you make your decision:
The Little Details that Keep Someone’s Dignity
There were some things that came as a total surprise to me
as a care provider. It probably goes without saying that they shouldn’t have, but
the reality of being a caregiver is so far different than what we “think” or
envision. After he got sick, the reality of helping my Father-in-Law simply get
from one place to another wasn’t something anyone ever explained to me.
To support him gently, so that in public, it simply looked as though we were
arm in arm – to quietly stop every twenty feet or so just so he could catch his
breath – to take anything that needed to be carried into MY arms, so there was
never an embarrassing moment for him … those were the unspoken things between
us. THOSE moments probably did more to keep Ken’s dignity and to build intimacy
between us than the time I knew him before he got worse.
Those moments said so much more than a peck on his cheek or a new shirt for his
birthday. They were the gift of being present for someone right where they are in
life. For me, it wasn’t really a gift to HIM though – for me, this was always his
gift to me. To allow me into his heart – into the embarrassing, frightening
day-to-day experiences of entering advanced aging and becoming ill.
So today, I write this article for all of the care providers out there. For the
moments when we haven’t had a second to ourselves all day long. For the days
when our top priority is getting the taxi or ambulette to help us bring our
loved one to the doctor. When chores that we think will take an hour eat up an
entire afternoon. For THOSE days, I write this to encourage all of us to see
the privilege it is to love someone and care for them and honor them in a
thousand silent, secret ways. In ways that they cannot thank you for. When a
humble look of recognition is all there CAN be between you.
And for what it’s worth – I want to say that we’re a BIG village – and a
growing one. The aging process is complicated and full of questions and
difficulties. At eCareDiary, we are here to support you all in every way we can
embrace and invent. Our Care Diary is
cost free and exists as a secure, comprehensive tool to help you organize your
loved one’s medical appointments and activities AND to share those with
everyone you need to among your family and friends.
I celebrate you all today, and if our Dad can see my blog from heaven, hi Ken.
I miss you.
Susan Baida, Co-Founder of eCareDiary
PS: If you are involved in a care
facility, please feel free to reach out to us to get your organization and your
patients set up – eCareDiary is a powerful tool, and we’re here to support you,
your patients and their loved ones.
How Healthcare Reform Impacts Caregivers
Editors Note: This article was cross posted on Brightstar Healthcare's BrightInsights.
A few weeks ago President Obama signed into law a new healthcare reform bill which will expand health insurance coverage for 32 million people who are currently uninsured. This law will be phased in over the next decade but it offers a lot to help family caregivers both in the short term and the long term.
The benefits of the law fall into two categories – provisions which help the care recipient through Medicare and other public programs and those that help the caregiver through expanded health insurance coverage and better consumer protections. The biggest advantages to care recipients come through better coverage under the Medicare prescription drug program and through expanded health insurance options for pre-Medicare retirees.
Family caregivers will see their biggest benefits come from the fact that health insurance will begin to be de-coupled from employment starting in 2014. Many family caregivers face the difficult choice of whether to stay employed and hire professional caregivers to look after their loved ones or to leave their jobs and care for them full time. This decision is made more difficult by the fact that people who leave their jobs risk losing the health insurance benefits that go with them. By providing new health coverage options and subsidies to help pay for them, family caregivers will have one less thing to worry about when making these difficult choices.
Storytelling: A Credit to Your Emotions
Margery Pabst is the co-author of Enrich Your Caregiving Journey (Expert Publishing, February 2009) and is a national speaker and facilitator. She will be speaking at The Fifth Eden International Conference in Denver on June 15 on Storytelling: The Fuel For Transformation. Learn more about Margery and her book at www.pivotalcrossings.com.
Stories have a transforming effect on those who tell them and those who listen. As caregivers, your story and how it is told is important to your emotional health and lifelong learning. Rather than keeping your story to yourself, telling it and encouraging others to tell theirs are signs of well being. But how we tell our story and how we listen to others is a critical component for leading to personal transformation with yourself, your patient, and your family.
Stories come in all sizes from the small two sentence variety to the larger several page format. I like to think of stories this way: lots of little stories often make up the tapestry of a large story. When someone calls you to find out how you’re doing on any given day, the smaller story is the result. An example: "I’m doing better today. I decided to go for a long walk and get some fresh air. It really cleared my mind and helped me make the decision about Carl’s care at the Alzheimer’s Center. The change of scene helped me formulate some questions to ask." This example might become the turning point of a caregiver’s longer story. So the first principle is WE ARE CREATING OUR STORY EVERY DAY.
Stories also come in both negative and positive varieties. Certainly, we are all going to have bad days when we give care, so we can’t always have positive stories or even put a positive spin on a story. However, when we can, it is important to tell the story in a way that demonstrates learning, that shows enlightenment can come from struggles. In the example above, the storyteller clearly was struggling with an issue, and her walk provided some perspective. She could easily have told it with a more negative tone: "I’m better but not great. I went for a long walk but the air wasn’t as fresh as I anticipated. I guess it was useful because I finally made a decision about Carl. I’ll probably have misgivings tomorrow."
What do you think? Which telling of the story is more useful to the caregiver? Which version credits the caregiver’s emotional bank account? My bias is that, in the second more negative telling, the caregiver is setting herself up for more failure than the first more positive telling. The second principle is HOW WE TELL THE STORY AND THE WORDS WE CHOOSE CAN DETERMINE OUR SUCCESS AS CAREGIVERS. Note the words "not", "wasn’t", "misgivings" are the words suggesting a half empty rather than a half full experience.
Storytellers need good listeners too, listeners who engage and ask questions that bring out even more details of the story. Both the storyteller and listener benefit from the questions because the story’s meaning is enhanced. A good listener who assists the storyteller might ask: "What questions did you come up with?", "Which one do you like best?", "What makes today better for you?" "What is your decision?" "Would you like to talk about it in more detail?" The third principle? A GOOD LISTENER HELPS ENLARGE THE POSSIBILITIES AND EXPAND THE UNDERSTANDING OF CAREGIVING.
Stories help us share meaning and understanding of ourselves. For the caregiver, this is crucial since caregiving can feel and be a lonely enterprise. As a caregiver, there were many times when I felt alone and unique as I struggled to care for my loved ones. At times, I felt that I was the only one in the world facing such daunting situations. Principle number four is STORYTELLING CREATES COMMUNITY AND CONFIRMS WE ARE NOT ALONE.
I encourage you to tell, to listen and finally to WRITE DOWN YOUR STORIES. Journaling as a fifth principle was and is an antidote to emotional stress, clarifying issues and showing meaning along the way. When I review my journals, I can literally see where I’ve been and what I’ve learned. I review the little and the big stories, the turning points and the humdrum activities. Through it all, I find perspective, knowledge, and a credited emotional account. I hope you find delight and meaning from storytelling.
Caregiver News Roundup Sunday March 28, 2010
Health Reform Includes a New Long Term Care Program – The new health reform law includes the CLASS Act, a new long term care insurance program administered by the federal government. The program would be available for working adults to purchase and would cover many traditional long term care services plus respite care, transportation, home remodeling and assistive technologies.
What Is in the Health Reform Bill – The new health reform law will make changes to our current system including expanding coverage to 32 million uninsured Americans, providing new consumer protections for the insured and closing the Medicare prescription drug "donut hole."
Memory Can Fade Quickly Even Before Alzheimer’s Disease – Patients with mild cognitive impairment, the stage before Alzheimer’s disease, lose their memory twice as fast as people not suffering any impairment. Once Alzheimer’s sets in, memory loss increases to four times as fast as people not suffering from the disease.
Study Identifies Which Diseases Are Most Likely to Put Seniors in Medicare "Donut Hole" – A new UCLA study has found that seniors suffering from chronic conditions like diabetes and dementia are the ones most likely to hit the Medicare Prescription Drug "Donut Hole."
Rheumatoid Arthritis Is on Rise in American Women – A new study published in the March issue of Arthritis and Rheumatism has found that rheumatoid arthritis is on the rise with American women, especially white women. The study found that the incidence of rheumatoid arthritis in men had leveled off but was continuing to rise by 2.5% per year with women.
Helping the Elderly Cope With Loss
As we age we become more frequently exposed to loss and grieving becomes more apparent. For the elderly population losses are more prevalent, forcing many of them to have to cope with disappointment, sadness, and uncertainty. Grieving can be complicated when the elder’s resilience is challenged by extraneous events that further compound the loss. Older people can become vulnerable to depression and many elderly consider suicide as a means to cope with their grieving.
There are many losses that the elderly may encounter: spousal/conjugal, siblings, friends, children, physical and cognitive functions, self esteem, roles, autonomy, home, job, finances, community status, intimacy, objects and pets.
There is a strong correlation between attachment and loss. The degree of attachment and the type of loss can affect how the elder copes.
For instance, loss of a pet can be a monumental experience. The attachment to the pet is intense for many elderly, particularly if they live alone. The elder may substitute the pet for the other losses that are often encountered later in life. The pet fills the void the elder experiences because of social isolation from family, friends, and even the community.
To further compound the problem, the elder may become depressed, anxious, and even suicidal. There is a high incidence of suicide among the elderly and many behavioral scientists are discovering that it is more common for the older person to commit suicide than the younger person.
For example, the 1995 Merck Manual for Geriatrics reported that suicide was 70% more common in white males aged 75 to 84 than the white males aged 18 and 24. The U.S. Suicide Statistics reported in 2005 that the 65+ population represented 14.7% of the total deaths attributed to suicide. On the other hand in that same year the 15-24 population represented 10% of the total suicides in the United States. Given that the older population is comparatively smaller to other populations, the rate of suicide in the elderly is a cause for concern.
Moreover, many elderly resort to substance abuse to cope with loss. In fact, substance abuse is becoming more problematic in the elder community.
Consequently, experiencing a loss for the elderly can be very stressful. If the elder is unable to resolve the sadness around the loss, he/she may experience what is known as complicated patterns of grieving. Complicated grief can lead to years of emotional suffering and turmoil. Therefore, it is important for the caregiver to recognize the grief surrounding the elder’s experience with a loss.
There are many steps a caregiver can take to help the elder through the grieving process. The caregiver should never minimize the loss no matter how trivial he/she perceives it to be.
It is important to help the elder embrace the loss by giving him/her the opportunity to verbalize the feelings associated with the loss. Encourage the elder to give meaning to the loss.
In other words by asking the elder how his/her life has changed because of the loss will validate what the elder is experiencing. In essence, validating the loss shows the elder that the caregiver understands the value of the loss. Allowing the elder to talk about the loss provides a forum for the elder to respond to the loss in a healthy manner. How the elder responds to the loss is at the core of allowing the elder to take control.
The elder’s attitude is also critical. A healthy outlook will help the elder seek other methods to compensate for the loss. Perhaps, the elder who has lost a pet might replace it with taking up an activity that will help alleviate some of the loneliness, yearning, and pining for the pet. The elder who is no longer able to work may take up volunteer work. The elder who has loss of income may want to take a course on how to live on a fixed income by using a budget.
There are three proactive steps the caregiver can take to help the elder gain insight to understanding the loss: awareness, acceptance, and action.
Awareness grants permission to acknowledge that indeed a loss has occurred.
Acceptance of the loss provides a feeling of gratification, eliminating conflicting feelings that clash because the elder is unsure how to come to terms with the problem.
Action allows the elder to move beyond the loss and replace it by putting something back into his/her life. For instance, many compensatory behaviors often can provide a sense of empowerment, increase self-esteem, strengthen resiliency, and promote optimism. By replacing the loss with something different can also help the elder reach a feeling of successful aging. For instance, the grieving widow may find solace by getting involved in a community program such as the senior center, engaging in activities that can enhance her life.
In summary, understanding that grief and bereavement for the elderly is different from other populations is essential so as to avoid illness and premature death. As caregivers, we need to be able to identify elderly losses, look for unresolved grief, and complicated patterns of grief. Furthermore, the ability of the caregiver to acknowledge the loss that the elderly is experiencing provides a caring and supportive environment.
It is also important for the elder to ultimately achieve closure around the loss. The caregiver needs to be empathetic towards the elder in order for the elder to move beyond the loss.
Finally, the caregiver and the elder can enter into a bonding relationship which will bring them closer together; thus, the elder knows that he/she does not have to go it alone.
The New Healthcare Law: What It Really Means
Editors Note: This article was originally posted on Women’s Voices for Change.
On Sunday, March 21, 2010, the House of Representatives passed major healthcare reform legislation, passing a bill that will be signed within days by President Obama. This is an historic moment that has eluded numerous Presidents, including Harry Truman, Richard Nixon and Bill Clinton. The legislation will provide health care coverage for an additional 32 million Americans who are currently uninsured, and provide important consumer protections for all Americans.
The struggle to pass healthcare reform has been difficult, at times nasty, and filled with misinformation. Now that it will be law, what exactly does it mean for the average person, and how will it affect our lives?
Women. This bill will help women both in terms of coverage and affordability of health insurance. Currently 19 percent of women are uninsured, for a variety of reasons. A smaller number of women receive health insurance coverage through their employers than men do, with 38 percent of women being insured through their jobs compared to 50 percent of men. Additionally, a larger number of women receive dependent coverage through their spouses’ employers, with 24 percent being covered this way compared to 13 percent of men. Another 6 percent of women receive coverage in the individual insurance market. By providing greatly expanding health care coverage, the number of women who are uninsured should drop dramatically.
Additionally, the bill will help lower the cost of insurance for many women, since insurers now can charge women of childbearing age higher premiums than men in many states. The bill eliminates this discriminatory practice by instituting community rating, a practice in which everyone is charged the same amount, including individuals and small businesses.
Children. Kids already benefit from the Children’s Health Insurance Program, but this bill provides additional benefits—the most important being the elimination of pre-existing condition restrictions for children, and allowing them to remain on their parents’ health insurance to age 26.
Uninsured. The bill provides much broader coverage by expanding health insurance to cover 32 million of the 46 million people who are currently uninsured. It achieves this through a combination of mandates to employers and individuals and expansion of government health insurance programs.
Who’s Left Out. It’s expected that approximately 14 million people will not qualify for coverage under the bill.
2010: What Goes Into Effect This Year
The bill is structured so that parts of the legislation will phase into law starting in 2010 and continue to phase in until 2020. There are many benefits that go into effect this year.
Elimination of Pre-existing Conditions for Children. The bill immediately eliminates the ability of insurers to deny coverage to children on the basis of a pre-existing condition. For adults, the ban on pre-existing conditions goes into effect in 2014. High-risk insurance pools (below) will be available to help them gain coverage in the meantime.
Temporary High-Risk Insurance Pools. The bill creates high-risk health insurance pools for people who have pre-existing conditions and have been denied coverage due to those conditions. To qualify, they have to have been uninsured for at least six months. Monthly costs will be based on those for general health insurance population. Perhaps most important: the monthly fees will not be able to vary more than 4-to-1 based on age. Out-of-pocket costs are capped at $5,950 for an individual and $11,900 for a family. The pools sunset in 2014, when the pre-existing condition ban goes into effect and Health Insurance Exchanges (see below) come online.
Changes to the Medicare Drug Benefit. The bill provides a $250 “bonus” to all who have enrolled in a Medicare Prescription drug program in 2010. It also begins closing the Medicare Prescription Drug “doughnut hole” in 2011.
Coverage of Adult Dependents Up to Age 26. The bill requires that insurers permit dependents to remain on health insurance policies up to age 26, regardless of whether or not they are full-time students. Most insurers currently cover dependents not in school only up to age 19 and those in school up to age 23.
Prohibition from Insurance Rescissions. Insurance rescission is a practice in which insurers retroactively cancel an insurance policy, usually due to an unreported pre-existing condition. The new bill makes this practice illegal.
Tax Credit for Small Businesses to Pay for Insurance. The bill includes $40 billion in tax credits to help small businesses pay for health insurance for their workers. The credits are available to employers with fewer than 50 workers and will cover 35 percent of health insurance premiums in 2010. This figure will rise to 50 percent of premiums in 2014.
Prohibiting Lifetime Benefit Caps. The bill will prohibit lifetime caps on health insurance benefits.
Years to Come: What Gets Phased-In
The bulk of the new benefits and subsidies for health insurance will begin in 2014. The lead time is necessary to accumulate funds to pay for the cost of the new coverage.
Health Insurance Exchanges. These state-based marketplaces start operation in 2014 and are based on the Massachusetts Health Connector system, in which individuals and small businesses are able to purchase health insurance. The goal is to provide individuals and small businesses with transparency in benefits and pricing so they can compare health insurance and purchase the coverage that best fits their needs.
Employer Mandate. Starting in 2014, businesses employing 50 or more people will be required to provide insurance coverage to their employees or pay a $2,000 per worker penalty.
Individual Mandate. Almost all Americans will be required to get insurance coverage or face fines—a system similar to the one that’s already in place in Massachusetts. The fines start small at $95 in 2014, but rise rapidly to $695 in 2016. Low-income individuals are exempted from the mandate but most of them will be eligible for coverage through Medicaid or other subsidies.
Health Insurance Subsidies. In order to help families afford the mandatory insurance premiums, starting in 2014 subsidies will be available on a sliding scale, up to a level of $88,000 per year for a family of four. The amount of the subsidies will also be on a sliding scale, meaning that people with lower incomes will receive larger benefits.
Long Term Care. The bill includes the CLASS Act, which provides a public, voluntary long term care program that working people can purchase. The program would cover home care, respite care, home modifications, transportation, and assistive technologies.
The Bottom Line: How’s It Paid For
The legislation is expected to cost $940 billion over ten years. It’s expected to reduce the federal deficit by approximately $143 billion during this time by slowing the rate of healthcare-cost inflation.
The new healthcare measures are paid for through cost savings in Medicare and other government health programs, estimated at approximately $500 billion over ten years. The cost savings in Medicare are achieved by bringing payments for Medicare Advantage plans in line with the cost of providing care, and by reducing the rate of estimated growth in the program.
Additionally, some new taxes are being instituted. Approximately $100 billion will be raised by fees on prescription drugs, health insurance premiums, and an excise tax on medical devices. The bill also raises the Medicare tax from 1.45% to 2.35% for individuals earning more than $200,000 and families earning more than $250,000 per year.
Finally, starting in 2018, an excise tax of 40% will be applied to “Cadillac” health plans: those costing more than $10,200 per year for an individual and $27,200 for a family. These are health plans for wealthier individuals, since the average cost for family coverage is about $12,000 per year.
While health insurance reform has passed and will be signed by the President within days, the Senate still needs to act on a bill to fix some of the problems in the bill enacted into law. That’s expected to take place this week.
It is unlikely that work on health reform is done. The lesson of other social insurance programs is that they always remain works-in-progress. Social Security and Medicare have been modified and expanded a great deal since they were first enacted. You can expect similar developments to occur with healthcare reform as it moves forward.
Caregiver News Roundup Sunday March 14, 2010
Some Older Patient’s Treated in Emergency Room’s Are Getting Wrong Medications – A new study has found that it is common for patients 65 and older treated in Emergency Rooms to receive incorrect medications.
New Alzheimer’s Test Offers Opportunity for Early Detection – The Computerize Self Test (CST) is a new and simple test for medical professionals to use in identifying Alzheimer’s disease. New research has found that early detection of Alzheimer’s is important in treating the disease so CST raises the possibility of more effective therapies.
Mediators Focus on Elder Issues – Mediators have been used for years to avoid court appearances in divorces and other disputes. Now they are becoming a popular way to deal with family disputes over eldercare.
Numbers of Years a Person Smokes Is Key Factor in Lowering the Risks of Parkinson’s – A number of studies have shown that smokers are less likely to contract Parkinson’s disease. A new study has found that the key factor in lower the risk of Parkinson’s disease is the number of years a person has smoked rather than how much they smoked. An important note – smoking does not eliminate your risk of getting Parkinson’s and has other serious health impacts.
Deciding on the Right Care for Elderly Parents – Finding the correct care solution for parents with declining health is difficult. Finances, the patient’s needs and the person’s personality will all come into play when deciding whether or not to care for the parent at home or move them to a facility.
Stress and Isolation Are Major Problems for Caregivers – A new article in the Atlantic Monthly highlights the stress and isolation people caring for family members/loved ones face and discusses the lack of a strong support infrastructure for caregivers.
Are You Prepared to Handle a Long-Term Care Situation?
A new and useful publication to help people plan for long term care was released this week. The Guide to Legal and Financial Planning Needs of Seniors by Homewatch CareGivers was produced to help educate a growing community of Americans needing long-term care, and more specifically the generation of baby boomers approaching retirement, who are running out of time to get their financial and legal issues in order before needing long-term care themselves.
The baby boomer generation, in many circles, has evolved into ‘the sandwich generation’ by having their income’s and savings accounts tugged at from each end thanks to elder parents needing expensive, long-term care, and college-aged, or adult children still feeding from the trough.
By 2020, baby boomers will swell the senior population from 39 million to 53 million, according to the Centers for Medicare and Medicaid Services (CMS), which means one in six Americans will be a senior!
The Guide to Legal and Financial Planning Needs of Seniors offers information on the following critical areas of focus for those concerned about the future:
Crediting Your Emotional Bank Account: How Words are Critical to Our Well Being
Margery Pabst is the co-author of Enrich Your Caregiving Journey (Expert Publishing, February 2009) and is a national speaker and facilitator. Learn more about Margery and her book at www.pivotalcrossings.com.
Our use of language has a critical effect on our emotional lives. We can credit our emotional bank accounts with positive words about ourselves and others, or we can think and talk in negatives that tarnish our present life and diminish our future. Roger Rosenblatt says, "Write with grace rather than pain". For those who aren’t writers, these words can easily be applied to how we speak and think. "Speak and think with grace rather than pain" is a mantra to consider when caregiving. ‘Grace’ suggests looking at ourselves and others through the prism of positive purpose and while ‘pain’ denotes wallowing in all the negatives life has thrown us and allowing ourselves to be victims of every circumstance.
How we speak and think about ourselves and others will create ‘grace’ or ‘pain’ in our lives. Furthermore, the words we choose are crucial to our emotional and physical health.
So how can we focus on positive, graceful words and shift from negative, painful ones?
FIRST, we must LISTEN TO OURSELVES. What is the nature of our thoughts? What exactly are we saying to others, particularly our children? Are there hints of negativity or blatant comments about hypothetical, tragic events to come? SELF-AWARENESS is especially critical for the CAREGIVER.
I’ve caught myself saying things like, "Well, Murphy’s Law will probably be true. If there’s a possibility of something going wrong, it will." Sound familiar? By saying these words, your negative expectation and intention is out there, and your behavior may be affected, so you will actually do things that make your negative statement come true.
For example, if the caregiver says, "Jim always has a hard time getting his pills down", Jim will always have a hard time with his pills. He will meet your expectations and your behavior will suggest through body language and speech that you are ready for the difficulty at hand. When Jim has difficulty and his emotions rise, yours will too and in the process, a DEBIT TO YOUR EMOTIONAL BANK ACCOUNT WILL OCCUR.
SECOND, we must make a shift in our thoughts and language. Creating a shift will bring more honor and respect to our caregiving. Let’s review some examples of making a shift from negative debits to positive credits in our thoughts, speech, and emotional bank accounts: