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Quality of Life

Joan Garbow, MSW, LCSW, CCM is a licensed clinical social worker, a certified case manager and a member of the National Association of Geriatric Care Managers. Currently in private practice, Joan works with clients throughout Fairfield County, CT, by assisting families with eldercare issues.
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  • My 84 year old dad and his 86 year old companion live 45 minutes away. In the past 6 months, he has experienced some memory loss and other health issues, the latest resulting in 2 trips to the ER within a week for dehydration. My brother and I have been traveling back and forth at all hours, requiring us to, at times, leave work and family. We discussed the possibility of assisted living, but as of now, my dad is opposed. Can you recommend a service that would come in 2-3 times per week to help with organizing meds, shopping and doctor appointments? I've spent hours searching, and your site was recommended by a friend in a similar situation. 

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  • I am struggling with the care of my mother. She was diagnosed with lung cancer six months ago. She got radiation and chemo, but it has spread to her lymph nodes, kidney and groin. She is 63, recently divorced, just claimed bankruptcy and is living in a house that is under foreclosure.
    She is refusing to give up her independence and wants to stay in her home until she can't do things for herself. In my opinion, she can’t do the things she thinks she can now. She also has a labrador retriever that weighs 150 lbs that she will not give up. I live two hours away from her and my brother is about 30 minutes away, but he is on the road working. My brother and I have sat down with her and she said she will come live with me “at the end,” but the end seems pretty close. My brother is the executor of her medical decisions and he basically says "Whatever you want, Mom." I, on the other hand, am frustrated with her actions. My mother did not raise me; my great-grandmother did. My mother was very reckless when I was a child—she could not afford to take care of my brother and me, too. So she gave me a better life with my great-grandmother. Now I am trying to give her a peaceful end, but she claims that she doesn't want to lose her independence. She has been a school bus driver for the last 15 years and now she is about to retire because she is unable to drive the bus any more. She has been out on temporary disability for a month now. The doctors have given her less than six months. What do I do?
     

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  • My mother is 93 years old and lives alone. Her driver’s license was just taken away and she refuses to have an aide live or stay with her during the day. Her house is dirty and none of her children want to go there. She is very stubborn and insists that she is going to get her license back. She has more than enough money to live at a luxury retirement community that would include meals, cleaning, etc., but she refuses to move. She was very active until her license was taken away. Now my sister has been taking her to her exercise class and food shopping, but my sister does not want to be her caregiver. I work full time and don't have time to be her caregiver. What can we do? 

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  • My parents are living in an assisted living apartment, getting help with one meal a day and aid for my father with morning and evening dressing. However, I believe that he needs more care as my Mother is having to help him move from chair to bed to walker, etc., and help him with toileting many times a day as well as basic hygiene such as oral care and shaving. He is aggressive, anti-social, and easily agitated. Could be possibly with mild dementia. She has become sleep deprived, anxious, and depressed. Is it ever good to move them to separate housing? She is 85 and he is 90. The situation does not seem to be doing either one of them any good. 

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  • My mom passed away a year ago. After being married for 45 years, my dad is now living without my mom and it has been very difficult. My dad moved in with my husband and I and he is very bored with life. He doesn't really have any hobbies he can still do. He says he is bored, but doesn't want to do anything about it. I can occasionally get him out of the house to play a game of pool or get something to eat, but that is the extent of his activities outside the house. He likes to do puzzles, but has an eyesight problem. Any suggestions would be greatly appreciated. 

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  • Looking for a good resource on how to write care plans. I work for hospice and so I work with a variety of patients from dementia to MS, to regular joes. I am trying to better myself, but not finding the resources I need. I would appreciate any help you can give to me. Thank you. 

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  • My 99 year old mom has limited vision, hearing and mobility issues. She's in an assisted living facility, and my 88 year old dad is nearby in independent living apartment. He was picking her up every day and bringing her to his apartment for 6-7 hours, but it has become too stressful. Most of the day, she just sits, lost in her thoughts or asleep. She'll carry on a short conversation or try to do a word puzzle now and then, but it's very difficult. My question is, will a visit or two a day at the assisted living residence from Dad and me be sufficient, or will this likely result in a downward spiral to depression? 

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  • My 91 year old Grandmother recently moved in with my parents after my 94 year old Grandfather had a stroke and passed away. She has moderate dementia, anxiety/depression and a host of other health conditions. My mom thinks she can take care of her on her own while juggling a full time job and being a wife and grandmother as well. She does have an un-trained “sitter” come in for 4 hours during the day while she is at work to do activities with my Grandmother. In my opinion my mom needs help and should look into homecare for her mom as well as seeking out a geriatric specialist to make a plan of care. Where should I even start in trying to convince her to look into these services? She also is always concerned about the cost as well. 

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  • My husband has MS, diabetes and some dementia. As of a month ago he could take about six or seven assisted steps. He had a slight stroke, which left him unable to stand up or take steps. He stayed in the community living center at the Veterans hospital in San Francisco while I took a vacation. Just got back and his social worker says he needs 24/7 care. I have done this for many years (I'm 62) and have been wrestling with the decision to bring him home or placed in a care home. VA will give me four hours a day help if he comes home. We live in a remote area—he is five hours away now—and they can place him in a home four hours away. I know this is a personal thing to think through, but I need some advice on how one comes to a conclusion. Maybe you can give me some hints? Thank you. 

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  • My parents, both in their 80s, have issues that make it time, in the opinion of my sister and I, for them to move to assisted living. Our Mom has limited mobility due to a stroke 5 years ago and our Dad suffers from depression (exasperated by caring for our Mom) and has digressed to staying in bed all day, providing a poor diet for both of them, allowing the house to become unhealthy and unclean, and is totally against any agency help (meals on wheels, Medicare Home Care, etc). My sister and I don't want to force them into an assisted living facility, but it would be the best thing for them! Due to our Mom's mobility issues neither of them get out, with the exception of our Dad getting their medications and minimal groceries. Dad is simply overwhelmed with her care and with all aspects of life and Mom is frequently in tears because she feels she's not being cared for appropriately but is at his mercy. After reading the comments on this page, I feel that we're approaching it correctly by bringing up the issue of assisted living and having him warm to the idea, but it would seem that the next step is going to be a health emergency. That might take the decision out of his hands.
     

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  • I have taken care of my mom at my home for 9 years. I know her very well. She is at a nursing home currently, soon to run out of her Medicare days since she lost 5 weeks not being able to weight bear due to leg surgery. I was wondering how to get an extension. Therapy is slow since she now has a painful spine fracture. Her therapist made a comment at the meeting for her care plan that she did not believe that she had much back pain and was making it up not to do her therapy. How do you handle rude therapists and doctors?
     

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  • My 92 year old mother always complains of being tired and wants to sleep all day. When she gets up she reports that she is dizzy and doesn't feel good and wants to sleep. Where do I begin? 

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  • Dear Joan, My Dad lives in Michigan and I'm in Texas. He will be 97 in August. My younger (66 years old) brother lives with him. He has macular degeneration and sees poorly. He has recently stopped bowling and all other activities. He now just sits in front of the TV and listens to Fox News. Is there anything I can do from afar? Or should I go up there and try to get things rolling? My brother isn't much help in that area unless I give him specific requests. Thank you! 

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  • Is it okay for a doctor's care manager to visit and advise me when in the hospital setting? 

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  • My sister and I are looking for a local support group. Our Dad has recently begun to show signs of dementia. At this point we do NOT want to put him in a facility. We need to get some advice, information and ideas about what we will need for home care for him. 

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  • What articles would you suggest for me to study elderly boredom? For two years now, I agreed to help my dad help my mother, which helps him help her better. Meanwhile, I let them row the boat their way, while I row my boat my way. I have had early childhood teaching experiences along with special education, that I use for my strategic planning as I care for them. My mother is 83, dad 85. He is very active and mentally stimulated while my mother seems to have a temper tantrum. She gets the attention she craves this way. Getting out of the house is a challenge…She is a child of the Great Depression. I think she sat on the front porch bored out of her mind until the US Air Force flew her off the porch 50 years ago! She is on the porch again bored. I'm looking for articles about boredom.
     

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  • I work in a nursing facility and would like some suggestions for improving the quality of life for our residents, both cognitive and non-cognitive. I would be open to any suggestions.  

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  • I'm exhausted all the time and don't have the energy to help my husband who has severe rheumatoid arthritis. What's happening to me? I can't afford to be sick. 

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  • Are walkers with wheels safe? I have concerns about the walker rolling too fast (our house is mostly carpeted). View

  • My parents fight day and night since my mom decided she wants to move from El Paso to Dallas to be close to me. I checked out several places I thought they would like, sent the information to them so they could go over the brochures or not. My dad is 90, healthy, still drives, totally against moving; they live in an apartment complex surrounded by young couples who are never home, all of their friends have either died or moved close to their families. My dad tells my mom to go ahead and move to Dallas, but he's staying in El Paso. Mom hates not having any friends around, sitting and watching TV all day while dad does his paperwork. This has been going on for 2 years—I'm getting to the point I can't take it anymore. Do you have any suggestions? View

  • What is the educational background of a certified senior advisor? View

  • My Aunt, who lives in another state, is wheel chair bound, is hard of hearing and doesn't see well. She is 97 years old. Still has a sharp mind but she tells me she is bored. Doesn't care for TV that much. My nephew is her caregiver (she is in Assisted Living), but this is new to him and I am sure he is bewildered on what to do to help her. The thought of listening to taped books is a good one. Any other suggestions? I would like to help her as best as I can, though we are in different states. View

  • My mother needs constant attention and entertainment. It's exhausting just meeting her health needs. What kind of activities can she do by herself? View

  • My parents are resisting a move from their home. What can I do? View

  • How can I help my parent choose the best housing arrangement? View

  • Q:

    I need some help with caring for my parents. Two years ago they moved to be near me and my sister due to health issues, mom's dementia, etc. The first year was spent in and out of hospitals. They were in independent living, which was my dad's idea since my mom no longer cooked and it seemed the ideal situation. That lasted about 6 months and he hated living there. He is not at all a social person and does not want to dine with strangers. Mom rarely went to meals or got out of bed. My sister and I were there 3-5 days a week to put out meds in boxes, do laundry, doctor appointments—Dad would not use their transportation. He said, what if they move out to a regular apartment and then I can "help them out." It turned out to be far more than a little help. In August of 2012 mom broke her hip and was in rehab for 2 months. This happened while they were with me at our cottage in northern Michigan. I was there as well for two months. I could not leave because my dad does not drive. When we got them back to their new apartment in Fall 2012 there were many followup doctor appointments, PT, more appointments. Also, while mom was at rehab, dad ended up in the hospital for a week. I have missed special events with my college age children, have not been able to get away and when I do it is a week of planning meals, meds, and then my sister who works full time has to fill in for me. My dad calls every day about mom not getting out of bed and not taking meds. He is very demanding and needy and seems oblivious of how he is consuming my life. This is my "empty nest" time and I have become resentful of having to do everything for them. We have caregivers three days a week, 5-7 Tues and Thurs and 3-5 Fri. That is it ! He does not want to pay for more help. My sister and I know we need help—we just have no family time at all. Weekends are consumed by our parents. I just do not know how my dad cannot see all of our time is with them. When they were our age and empty nest they traveled, mom went with dad on business trips. Neither one had to care for a parent. I do not know what to do and feel guilty when I want out or when people tell me I am such a good daughter. I want to be that daughter not a caregiver. My husband and children have been angry and upset because they take all of my time and also because they see what it is doing to me. Help ! 


    Kathy from MI
    A:

    This sounds like a "tough love" situation. I suggest you and your sister unite and have an intervention with your father. Explain how this is affecting your lives, relationships and stress levels, which will lead to health issues for yourselves. Be honest and factual in your presentation. Use "I" statements such as "I need to spend more time with my family, they are upset I am not there for them" and "I am struggling with the stress this is causing me and am worried about my health. Therefore we need to come up with another solution to your care needs. Here are some options…"

    Then I would lay out some options for them, such as hire a professional geriatric care manager to oversee and coordinate all the things you are doing. Explain they need to pay a professional to do this since you are not going to continue, it is overwhelming and consuming your life. In addition, caregivers can do some of the tasks you are doing, and a driver could also do some of the things you are doing. The other alternative is assisted living, which has already failed.

    I do not think much will change unless you and your sister find a way to pull back and stop doing all that you are doing. There might be some short-term family strife over this, but hopefully your father will accept it eventually. You need to decide to make the change in order for this to shift. I always recommend to adult children to be careful not to damage their own family relationships with partners and children over the care for elderly parents. If this is happening, it is a red flag to get some professional help.
     

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    Q:

    I would like your opinion on how to handle an upcoming event. We have a big birthday—99 years young—in a couple of months for my Mom. The family wants to throw a party at a hall and have all the relatives and friends that she has not seen for years and years to attend. This is nice, but I have my concerns about the stress and confusion this may give to Mom. She has moderate dementia and sometimes she does not recognize the family that is taking care of her daily. It also seems that when there are more than a couple people talking around the dining room table she gets confused and remote. If there is such a big celebration in her honor, is this the right thing to do for her? I suggested that we contact the relatives/friends and let them know about the birthday and they can send her cards/messages of their wishes and keep a small family celebration for Mom. Some days are good, some are not. I would appreciate your insight or suggestions on how to handle this, especially with the family members. It is definitely something to celebrate, but how we should do it is my concern. Thank you for any information you can send. 


    Beth from IL
    A:

    I think you are very much on target with your gut instincts here. A large family event would probably not be the best way to celebrate this birthday if it would at all be confusing and distressing for your mother. Given her level of functioning now, I would keep it small and simple. Follow her lead during the gathering, and if she is getting confused, then that's your cue to end the party.

    Your idea of having family members send her cards is lovely. You can share some with her during the party, and make a scrapbook perhaps that she can look at, at other times with you. It's important to explain to family members that this decision is based on what is best for her. If everyone wants to gather since you have not seen each other for a long time, then maybe a Family Reunion is a better venue for this than a party for your mother.
     

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    Q:

    What's with these Medicare "Observation days"? My 90 year old dad was in the hospital after a bad fall at his assisted living. Apparently he got confused because he had a urinary tract infection and lost his balance. Nothing broken, but the physical therapist recommended sub-acute rehab. The discharge planner told us that although had been in hospital getting care, he could not qualify for his Medicare rehab days. Apparently he was not in an acute level bed, but in an observation bed after he was admitted from the ER to his floor. He was in the hospital 2 nights. During that time they had to figure out if he had a stroke. He got intravenous antibiotics on his first day plus some IV hydration. After the first day, they changed my dad to an antibiotic that he took by mouth. We ended up paying for his care at a local nursing home. It wasn't cheap, considering the costs of paying for his rehab bed while maintaining his assisted living apartment. The hospital discharge planner wasn't the problem. It seems as if Medicare's criteria for hospital level of care was rather difficult to meet. Any thoughts about trying to impact Medicare and their ageist regulations? This was a very stressful time for my dad and me. Also, I think it will only get worse with all the talk and plans regarding trimming and containing health care costs. Feeling hopeless in Boston. 


    Ellie from MA
    A:

    I agree, the Medicare Observation status is problematic for people who need sub-acute rehab and do not have the 3-day qualifying stay. There is currently a push by various advocacy groups to make changes to this to allow for sub-acute rehab coverage when needed. We will have to wait and see what happens though. Meeting criteria for acute hospitalization under Medicare is more and more stringent. 

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    Q:

    My 84 year old dad and his 86 year old companion live 45 minutes away. In the past 6 months, he has experienced some memory loss and other health issues, the latest resulting in 2 trips to the ER within a week for dehydration. My brother and I have been traveling back and forth at all hours, requiring us to, at times, leave work and family. We discussed the possibility of assisted living, but as of now, my dad is opposed. Can you recommend a service that would come in 2-3 times per week to help with organizing meds, shopping and doctor appointments? I've spent hours searching, and your site was recommended by a friend in a similar situation. 


    Karen from CT
    A:

    You can contact a homecare agency to help you with this. There are many agencies now that service clients with these needs. Just make sure they are licensed agency, and insure their caregivers and cover worker's compensation. You might want to ask the social worker at the local senior center or department of social services for names of agencies in your father's town that are known and reputable. Or contact a Visiting Nurse Agency. Home Health Aides or Certified Nurses Aides cannot handle medications by putting them in a medication box, but they can remind the client to take their medication at the right time. The VNA could have an RN come to organize and pour the medications for a fee. 

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    Q:

    I am struggling with the care of my mother. She was diagnosed with lung cancer six months ago. She got radiation and chemo, but it has spread to her lymph nodes, kidney and groin. She is 63, recently divorced, just claimed bankruptcy and is living in a house that is under foreclosure.
    She is refusing to give up her independence and wants to stay in her home until she can't do things for herself. In my opinion, she can’t do the things she thinks she can now. She also has a labrador retriever that weighs 150 lbs that she will not give up. I live two hours away from her and my brother is about 30 minutes away, but he is on the road working. My brother and I have sat down with her and she said she will come live with me “at the end,” but the end seems pretty close. My brother is the executor of her medical decisions and he basically says "Whatever you want, Mom." I, on the other hand, am frustrated with her actions. My mother did not raise me; my great-grandmother did. My mother was very reckless when I was a child—she could not afford to take care of my brother and me, too. So she gave me a better life with my great-grandmother. Now I am trying to give her a peaceful end, but she claims that she doesn't want to lose her independence. She has been a school bus driver for the last 15 years and now she is about to retire because she is unable to drive the bus any more. She has been out on temporary disability for a month now. The doctors have given her less than six months. What do I do?
     


    Angela
    A:

    Cancer treatment centers have social workers who might be able to help with this situation. She should be eligible for hospice services if she has a 6-month prognosis, depending on her insurance coverage. This is a complex story with a troubled family history that can’t be solved in this type of forum. Please seek help from the hospital where she is being treated. 

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    Q:

    My mother is 93 years old and lives alone. Her driver’s license was just taken away and she refuses to have an aide live or stay with her during the day. Her house is dirty and none of her children want to go there. She is very stubborn and insists that she is going to get her license back. She has more than enough money to live at a luxury retirement community that would include meals, cleaning, etc., but she refuses to move. She was very active until her license was taken away. Now my sister has been taking her to her exercise class and food shopping, but my sister does not want to be her caregiver. I work full time and don't have time to be her caregiver. What can we do? 


    Doree from FL
    A:

    Perhaps your mother should be evaluated by a neurologist to determine her competence to live in this way. If you can afford to hire a geriatric care manager, he or she could help you work with your mother on a solution to live in a healthier environment, and even help your mother consider assisted living. You and your sister might need to stop doing these things so that a hired caregiver can step in instead, once your mother realizes you won't be continuing in that role—if she is cognitively capable, that is. If she is not cognitively capable, as determined by a physician, you might then involve the town social worker to advise you or an attorney about needing to explore conservatorship. 

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    Q:

    My parents are living in an assisted living apartment, getting help with one meal a day and aid for my father with morning and evening dressing. However, I believe that he needs more care as my Mother is having to help him move from chair to bed to walker, etc., and help him with toileting many times a day as well as basic hygiene such as oral care and shaving. He is aggressive, anti-social, and easily agitated. Could be possibly with mild dementia. She has become sleep deprived, anxious, and depressed. Is it ever good to move them to separate housing? She is 85 and he is 90. The situation does not seem to be doing either one of them any good. 


    Jan from MN
    A:

    Sometimes couples do need to live separately as their needs become divergent. Often this is when one has dementia and the other does not. I have worked with several families with this issue. The best solution is usually if the assisted living facility has a Memory Care area for one and the other can remain in independent or assisted living. They can visit, go to activities or eat meals together, and be under one “roof.” The cost can be an issue, since then you are paying for two apartments, but if it is affordable it can be the best for both, especially the spouse who is the caregiver and has become tired, worn down and stressed, since this can adversely affect one's health. 

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    Q:

    My mom passed away a year ago. After being married for 45 years, my dad is now living without my mom and it has been very difficult. My dad moved in with my husband and I and he is very bored with life. He doesn't really have any hobbies he can still do. He says he is bored, but doesn't want to do anything about it. I can occasionally get him out of the house to play a game of pool or get something to eat, but that is the extent of his activities outside the house. He likes to do puzzles, but has an eyesight problem. Any suggestions would be greatly appreciated. 


    Robin from NC
    A:

    I would have him evaluated for depression either through his primary care MD or a geriatric psychiatrist. He might need medication to help improve his mood. It has also been found that socialization and stimulation help to decrease depression in the elderly. I would look into activities at a senior center or adult day care. You might need to go with him at first and start with just one activity, then gradually add on. 

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    Q:

    Looking for a good resource on how to write care plans. I work for hospice and so I work with a variety of patients from dementia to MS, to regular joes. I am trying to better myself, but not finding the resources I need. I would appreciate any help you can give to me. Thank you. 


    Tammy from WI
    A:

    In my experience, the type of care plan you create depends on the agency you work for, their goals, and the documentation requirements and guidelines you are following. A clinical supervisor should be able to assist with this. A strong knowledge base is needed to understand each client and their medical condition in order to write a comprehensive care plan. The patient or client's goals should also be included in the care plan. 

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    Q:

    My 99 year old mom has limited vision, hearing and mobility issues. She's in an assisted living facility, and my 88 year old dad is nearby in independent living apartment. He was picking her up every day and bringing her to his apartment for 6-7 hours, but it has become too stressful. Most of the day, she just sits, lost in her thoughts or asleep. She'll carry on a short conversation or try to do a word puzzle now and then, but it's very difficult. My question is, will a visit or two a day at the assisted living residence from Dad and me be sufficient, or will this likely result in a downward spiral to depression? 


    Pam from CA
    A:

    A daily visit sounds like a very appropriate thing to do with your mother at this point. If she was not engaging with your father during this long period, then I would certainly try having him see her at the assisted living for shorter visits. Perhaps he can plan his visit during a meal to keep her company then and socialize, or during an activity they can do together. This might enhance their interactions and actually improve her mood. 

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    Q:

    My 91 year old Grandmother recently moved in with my parents after my 94 year old Grandfather had a stroke and passed away. She has moderate dementia, anxiety/depression and a host of other health conditions. My mom thinks she can take care of her on her own while juggling a full time job and being a wife and grandmother as well. She does have an un-trained “sitter” come in for 4 hours during the day while she is at work to do activities with my Grandmother. In my opinion my mom needs help and should look into homecare for her mom as well as seeking out a geriatric specialist to make a plan of care. Where should I even start in trying to convince her to look into these services? She also is always concerned about the cost as well. 


    A:

    Caring for a person with dementia in the home can be rewarding, but can also be a challenge and stressful. It's important to have a support system for the caregiver to call upon when new or different services are needed. I would suggest you provide your mother with information about a local support group of caregivers through the Alzheimer's Association and literature about caring for a person with dementia. You might also do some research on home care agencies in your area if she wants to hire someone. At some point your grandmother might need constant supervision and 4 hours will not be enough. Talk to your mother about having a plan for this. It is important to understand how the disease progresses and what to be prepared for so that you are not solving problems while in a crisis. Watch for signs that your mother is stressed, and perhaps then you can introduce some of these supports and services to her to consider. 

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    Q:

    My husband has MS, diabetes and some dementia. As of a month ago he could take about six or seven assisted steps. He had a slight stroke, which left him unable to stand up or take steps. He stayed in the community living center at the Veterans hospital in San Francisco while I took a vacation. Just got back and his social worker says he needs 24/7 care. I have done this for many years (I'm 62) and have been wrestling with the decision to bring him home or placed in a care home. VA will give me four hours a day help if he comes home. We live in a remote area—he is five hours away now—and they can place him in a home four hours away. I know this is a personal thing to think through, but I need some advice on how one comes to a conclusion. Maybe you can give me some hints? Thank you. 


    Ellie from CA
    A:

    Making the decision to place a loved one in a nursing facility is quite personal, emotional and difficult. It usually comes when care in the home becomes unmanageable physically, emotionally or financially. You must also take into consideration your own health and age and how long you think you can be the primary care provider. Ask yourself if 4 hours a day of help is enough, or if it's too much of a struggle the rest of the time for you alone. Do you have a support system to help when he needs more care in the future? What if he needs more "skilled" care from a nurse or care during the night for incontinence and to prevent skin breakdown? Are you able to get the rest you need? These are some reasons why people choose to enter a nursing facility. There is no easy answer, but follow your instincts and plan ahead for increasing care needs as his conditions progress. 

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    Q:

    My parents, both in their 80s, have issues that make it time, in the opinion of my sister and I, for them to move to assisted living. Our Mom has limited mobility due to a stroke 5 years ago and our Dad suffers from depression (exasperated by caring for our Mom) and has digressed to staying in bed all day, providing a poor diet for both of them, allowing the house to become unhealthy and unclean, and is totally against any agency help (meals on wheels, Medicare Home Care, etc). My sister and I don't want to force them into an assisted living facility, but it would be the best thing for them! Due to our Mom's mobility issues neither of them get out, with the exception of our Dad getting their medications and minimal groceries. Dad is simply overwhelmed with her care and with all aspects of life and Mom is frequently in tears because she feels she's not being cared for appropriately but is at his mercy. After reading the comments on this page, I feel that we're approaching it correctly by bringing up the issue of assisted living and having him warm to the idea, but it would seem that the next step is going to be a health emergency. That might take the decision out of his hands.
     


    Alan from RI
    A:

    Waiting for an emergency to make a move is never the best way to make it happen, but sometimes is the only way. My advice is to be prepared by visiting facilities and even trying to arrange for a visit for lunch with one or both of your parents. Start the process of paperwork if you can and talk to the doctor about what you are trying to accomplish since they will also need to fill out admission paperwork. Depending on the finances, sometimes one half of a couple chooses to enter assisted living even if the other is too resistant. If the home environment really becomes unsafe and unhealthy, you might need the assistance of a social worker from elderly protective services or a social worker from your town department of social services. You can also try to explain to your parents that they have a choice...to accept some help in the home or to move to a place where there is staff available. The choice could be taken away from them if they don't work with you in this process.
     

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    Q:

    I have taken care of my mom at my home for 9 years. I know her very well. She is at a nursing home currently, soon to run out of her Medicare days since she lost 5 weeks not being able to weight bear due to leg surgery. I was wondering how to get an extension. Therapy is slow since she now has a painful spine fracture. Her therapist made a comment at the meeting for her care plan that she did not believe that she had much back pain and was making it up not to do her therapy. How do you handle rude therapists and doctors?
     


    Julie from PA
    A:

    The only way to address running out of Medicare days is to file an appeal with Medicare. The social worker at the nursing home should provide you with this option in writing, and inform you about the process of how to proceed. I would ask the therapist who made this comment to explain why he/she thinks your mother is not in pain and to give you examples to back up this assertion. Sometimes, patients are observed by staff doing certain things that do not produce pain, while they cannot do the same things in therapy without pain. This can lead to this type of comment.

    If you feel this therapist is negatively biased in working with your mother, I would request another therapist work with her or ask for the therapy supervisor to do an assessment.
     

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    Q:

    My 92 year old mother always complains of being tired and wants to sleep all day. When she gets up she reports that she is dizzy and doesn't feel good and wants to sleep. Where do I begin? 


    Carlin from IA
    A:

    There are many reasons why she might be tired all the time and dizzy, so it's best to have a full medical work-up through her primary care doctor or perhaps a geriatrician, if you have one in your area. A review of her medications, blood work, nutrition, mood, and social activities should be reviewed and discussed. 

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    Q:

    Dear Joan, My Dad lives in Michigan and I'm in Texas. He will be 97 in August. My younger (66 years old) brother lives with him. He has macular degeneration and sees poorly. He has recently stopped bowling and all other activities. He now just sits in front of the TV and listens to Fox News. Is there anything I can do from afar? Or should I go up there and try to get things rolling? My brother isn't much help in that area unless I give him specific requests. Thank you! 


    Duane from TX
    A:

    Long-distance caregiving can be a challenge. You will likely need to go in person to make any changes in this situation, or enlist a local geriatric care manager to help facilitate some change. The things I would look into are Adult Day Care or a Senior Center to increase socialization and stimulation. Some places provide transportation, lunch and skilled nursing if medications need to be given. Isolation and withdrawal from activities can often be a symptom of depression in the elderly, so you should have him evaluated for this by his primary care doctor.
     

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    Q:

    Is it okay for a doctor's care manager to visit and advise me when in the hospital setting? 


    Ruth from OH
    A:

    While in the hospital, an outside care manager can be very helpful in being an advocate for the patient, and also communicating with the staff, getting information, participate in discharge planning and helping you cope with a stressful situation. The patient, or the patient’s legal representative, must consent to having an outside person receive information from the hospital staff, and often must sign a release of information form, per the HIPPA protocols, which protect patient information and privacy. There are also hospital case managers who will help with discharge planning, and it is important for an outside care manger to communicate with this person on your behalf.

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    Q:

    My sister and I are looking for a local support group. Our Dad has recently begun to show signs of dementia. At this point we do NOT want to put him in a facility. We need to get some advice, information and ideas about what we will need for home care for him. 


    Patty from CT
    A:

    I would recommend you contact the local Alzheimer’s Association office for a support group in the area. You can search on alz.org. You might also want to consider a consultation with a geriatric care manager. You can look at caremanager.org for information about what a GCM can offer. Keep in mind that every patient is different and will have different needs as their condition progresses—that timetable is also very variable and you will need support and information every step of the way as your dad’s situation changes.

     

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    Q:

    What articles would you suggest for me to study elderly boredom? For two years now, I agreed to help my dad help my mother, which helps him help her better. Meanwhile, I let them row the boat their way, while I row my boat my way. I have had early childhood teaching experiences along with special education, that I use for my strategic planning as I care for them. My mother is 83, dad 85. He is very active and mentally stimulated while my mother seems to have a temper tantrum. She gets the attention she craves this way. Getting out of the house is a challenge…She is a child of the Great Depression. I think she sat on the front porch bored out of her mind until the US Air Force flew her off the porch 50 years ago! She is on the porch again bored. I'm looking for articles about boredom.
     


    Anna from TX
    A:

    Here are 2 articles that address your question about boredom:
    http://www.parentgiving.com/elder-care/senior-engagement-fighting-boredom-is-essential-for-quality-of-life/

    www.care2.com/greenliving/10-boredom-busters-for-frail-seniors.html#

    In my experience boredom can lead to depression and loneliness so it is important to introduce some of these activities into a daily routine. In addition, I have seen that sometimes an outside person can be more
    effective than family in doing activities with an elder. Perhaps you might consider a companion for your mother a few days a week to also give your father a break.

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    Q:

    I work in a nursing facility and would like some suggestions for improving the quality of life for our residents, both cognitive and non-cognitive. I would be open to any suggestions.  


    Anne from KS
    A:

    Activities in nursing facilities need to be designed to meet the needs of the population you are working with. This can change depending on the current residents and the group you are trying to reach. Here is a website that will help you: http://www.nursinghomeactivitiesresource.com/share.shtml

     

    Keep in mind the cognitive and physical problems your residents have and modify the activity for this. I am in favor of smaller group activities in nursing homes where you can try to group people with similar interests or strengths. This can be a challenge though due to the structure of the setting. From my experience visiting clients in nursing homes, I can tell you that one thing I do not recommend is TV as an activity. Too often I observe residents sitting in a common area with a TV on, nobody watching or inappropriate programming playing. Consider utilizing more music when there is no structured activity going on rather than TV. Studies have shown that playing music helps to decrease agitation and difficult behaviors with dementia patients. This is something to consider as well.

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    Q:

    I'm exhausted all the time and don't have the energy to help my husband who has severe rheumatoid arthritis. What's happening to me? I can't afford to be sick. 


    Alexandra from CT
    A:

    One of the most important aspects of caregiving is knowing when you need help. Most people cannot do it all alone, so it¹s important to build a support system for yourself. If you are feeling very stressed, anxious,
    depressed, not sleeping well, or losing weight, you probably need to look for and accept help in your role as caregiver. It is important to take care of yourself as a caregiver so that you can continue in this role. Many people can become ill themselves if they do not accept outside assistance. Identify who you have in your life who can be a support to you. This can be family, friends, neighbors, clergy, or medical professionals. If you are feeling alone without these supports, you might need to reach out to professionals in your community. Call your town hall or senior center and speak with a social worker who can help connect you with senior service providers in your area, a support group, or resources that can help with respite care funding to give you a break. 

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    Q: Are walkers with wheels safe? I have concerns about the walker rolling too fast (our house is mostly carpeted).
    Sharon from AZ
    A:

    An evaluation of the proper type of walker or assistive mobility device, is best left to a trained physical therapist. There are many factors to consider when choosing the safest type of device, including the surface it is used on in the home. I suggest you contact your (or your loved one's) doctor for a referral for physical therapy, either outpatient, or in the home, if  homebound, through a VNA (visiting nurse association). 

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    Q: My parents fight day and night since my mom decided she wants to move from El Paso to Dallas to be close to me. I checked out several places I thought they would like, sent the information to them so they could go over the brochures or not. My dad is 90, healthy, still drives, totally against moving; they live in an apartment complex surrounded by young couples who are never home, all of their friends have either died or moved close to their families. My dad tells my mom to go ahead and move to Dallas, but he's staying in El Paso. Mom hates not having any friends around, sitting and watching TV all day while dad does his paperwork. This has been going on for 2 years—I'm getting to the point I can't take it anymore. Do you have any suggestions?
    Gina from TX
    A:

    Dear Gina,
    There are some professionals that can help you with this situation since it cannot be solved over the phone or long distance. I suggest you contact a professional geriatric care manager (GCM) in their area who can meet with your parents and help sort out a solution that you all can live with. The best way to find a qualified GCM is to search on caremanager.org, the website for the National Association for Professional Geriatric Care Managers. If you enter their zip code, you will get names of local GCMs. There are also suggestions on this website about how to choose a GCM. I suggest you choose someone who has a social work background since there will need to be a fair amount of counseling. Although this will be a private pay consultant, the cost my be well worth it to help all of you come to some resolution of this situation.

    A GCM will come up with a plan with them and you to solve this problem. If it involves a move for one or both of your parents, a GCM will also help you to plan and coordinate the move, which is a daunting task for a long-distance daughter and an elderly couple. There are also Senior Moving specialists, that a GCM will know about to help with the whole moving process, from cleaning out, sorting, donating, selling and the actual packing and moving. Sadly, some couples do separate during their elderly years since needs can change and the ability to cope with long-standing marital issues seem to no longer be possible. You might need to consider this for your mother’s well-being, and have a plan to monitor your father if he stays in El Paso alone. A GCM would be a valuable resource in this scenario. 

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    Q: What is the educational background of a certified senior advisor?
    Debbie from FL
    A:

    A Certified Senior Advisor is a person who has completed a training program and exam through the Society of Certified Senior Advisors. The educational background of certified senior advisors may vary greatly. They can be accountants, financial planners, realtors, reverse mortgage specialists, insurance agencies, homecare providers and more. There is no prior educational requirement for this designation, but usually these are people in a field that deals with seniors in some way. Visit http://www.society-csa.com for more information.

    This is quite different from a geriatric care manager, who must have training, education, experience and certification in the field of geriatrics in order to be a member of the National Association of Professional Geriatric Care Managers. Visit www. caremanager.org for further information.

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    Q: My Aunt, who lives in another state, is wheel chair bound, is hard of hearing and doesn't see well. She is 97 years old. Still has a sharp mind but she tells me she is bored. Doesn't care for TV that much. My nephew is her caregiver (she is in Assisted Living), but this is new to him and I am sure he is bewildered on what to do to help her. The thought of listening to taped books is a good one. Any other suggestions? I would like to help her as best as I can, though we are in different states.
    Diane from AZ
    A:

    When there is a loss of multiple senses—hearing and vision in this case, then there is certainly more of a challenge to stay engaged in activities. First, I would have her hearing assessed and determine if there is anything that can help her hear better. Many older people resist this, but it¹s important to keep trying. There are many new devices available that might work better than in the past or be more comfortable and discrete. Second, since she is in assisted living, I would make sure that the staff are doing all they can do to engage her and bring her out to activities. Spending too much time alone and feeling isolated or bored can lead to depression, so it¹s important to encourage social interactions.

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    Q: My mother needs constant attention and entertainment. It's exhausting just meeting her health needs. What kind of activities can she do by herself?
    Peggy from IL
    A:

    Caring for a person who needs a lot of attention and is demanding of your time can be quite a challenge. Independent activities need to be specific to the individual¹s abilities and interests. You might want to think about things she enjoyed doing in the past like puzzles, crafts, reading or listening to books on tape, music, etc. Consulting with professionals like occupational therapists can guide you on how to modify activities to accommodate specific deficits. You might also consider adult day care, where she could participate in activities in a structured environment along with socialization, lunch, and staff trained to work with seniors. This would also give you a break as the caregiver.

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    Q: My parents are resisting a move from their home. What can I do?
    A:

    Resistance to moving is a real challenge. I have found that timing is very important when trying to orchestrate this transition. Sometimes you have to wait for a health crisis to make it happen. I am currently working with a couple in their late 80s who have resisted moving out of their home for years. They are now receptive because one has Alzheimer’s disease that has progressed to the point where the spouse is feeling overwhelmed and anxious. Now she can see the value of living closer to family, in a supportive environment with specially trained staff, and not having to manage the upkeep of a house. Also, a geriatric care manager has the specialized expertise to help you through situations where the resistance is great, safety is an issue and the process seems totally overwhelming. Consider hiring such a senior care expert.

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    Q: How can I help my parent choose the best housing arrangement?
    A:

    A very important part of planning for the aging process is a realistic evaluation of the current housing situation. When elderly or disabled people try to live in an unsuitable environment, inevitably a crisis or major safety issue can arise. It can also lead to an unnecessary nursing home admission if there is a sudden change in health or ability to function in that environment. This might include a home with a lot of stairs, laundry in the basement, doorways that are too narrow to fit a walker or wheelchair or with parking outdoors, which can be dangerous if you live in an area where there is snow or ice.

    I have worked with many people struggling to help their parents make a transition to a different housing arrangement. Often this is to an assisted living facility. It is very important to visit several facilities in your area so that you can have a basis of comparison. If there are any cognitive issues or dementia, it is very important to find a facility that has a memory care or cognitive program. Not all assisted living facilities have this and it will ensure that another move will not be needed. I am always trying to stay one step ahead by thinking about what will likely come next in the aging or disease process. So try to find a place that can handle the next stages your parents might need in terms of care. Assisted living is a great option for people who enjoy socializing and want to be in an environment where there are meals and the support of staff who can help with personal care and medical oversight.

    If assisted living is not affordable and there is a risk of outliving the financial assets, then even more planning is needed because you should be looking into affordable housing options for seniors. Most low-income HUD housing for seniors have wait lists of several years. If you contact your town or city social services department you should be able to obtain information about this option. But the key is to be able to recognize that this is where you are probably headed so you will have this option down the road. It cannot hurt to fill out an application to get on a wait list. Eligibility is based on income and assets, and the rent, if you do move into this type of housing, is based on a percentage of your income. Some senior housing complexes have social activities and meals, and others do not.

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