Friday, October 31, 2008

Helping address loneliness in the elderly

Today's blog is based on an article I just read on the BBC (and was picked up by our AP).
It talks about the million people in the UK who are suffering with loneliness. A research study found that "half a million only leave their houses one a week, and a further 300,000 are entirely housebound." Of course, the tough economic times are only increasing their despair and loneliness.

The UK charity, Help the Aged, is launching a campaign to provide 25,000 people, with a Christmas dinner with friends.

As I finished reading the article, I realized there are likely many elderly in our local communities who find themselves in a similar state; people who can't afford or endure travel to their families or who are just isolated due to life situations.

So, I put out this challenge to each person reading this blog. Reach out to an elderly person in your church, neighborhood, or through your local Aging agency. (Note: to find your area's agency, enter your zip code at this link http://www.eldercare.gov/Eldercare/Public/Home.asp

Invite one or two such persons to your family Thanksgiving dinner. Yes, it will take a few calls and arranging, but think of what this will mean to someone who would otherwise sit alone at home at Thanksgiving. It will likely end up being one of your most special Thanksgivings.

Here is the BBC article: http://ukpress.google.com/article/ALeqM5gGJsVbVjA44ALUdw5LpNqAQ0nrrQ

Tuesday, October 28, 2008

Getting low cost prescription help for the elderly

We hear stories every day about the elderly having to choose between buying groceries and their prescriptions. But, there is help out there!

This morning the Today Show (NBC) had a great segment with tips for saving on prescriptions. Here are 4 key tips:

  1. Shop around. One survey found a 300-400% difference in purchase price of a drug in a given area. Compare costs at all pharmacies in your area.
  2. Shop on-line. In another survey, buying from an online pharmacy instead of the brick and mortar store yields a big cost savings. (i.e., walmart.com, cvs.com)
  3. Consider alternative drug classes. Doctors sometimes prescribe the latest type of treatment (which often is the most expensive). Tell your doctor about your financial situation and ask your doctor to consider alternative classes of drugs
  4. Contact an assistance program for a single point of assistance
    1. Partnership for Assistance Program. https://www.pparx.org/Intro.php or call 1-888-477-2669. This program brings together pharmaceutical companies, doctors and patient advocacy groups to those who lack prescription coverage to get the medicines they need through public/private programs. This link explains how the program works, https://www.pparx.org/about.php
    2. For those with the greatest need and least financial resources, contact Free Medicine Program. http://freemedicine.com/ or call 1-573-996-3333. This link explains how the program works, http://www.freemedicinefoundation.com/how_it_works.html

Sunday, October 26, 2008

Sorting through a home of 30 years - what to keep, what to give away, what to trash


In today's entry, I'll share some of our strategies for sorting through Mom’s entire household. The How, What and Why of our decisions around all the “stuff”. As I said in previous entries, it is incredibly important to involve your parent in all these decisions.


1. Steps we followed:
a. We went to Kmart and bought big plastic tubs (with lids); about $4 each. These were essential for our sorting process

b. We categorized what we had to sort through by item and/or room:
i. Paperwork
ii. Kitchen stuff
iii. Clothing
iv. Furniture

c. Paperwork (mail, statements, bills, etc): This was stuffed in desks, dresser drawers, bags, etc. We set up a spot in the living room to stage all this stuff. My husband’s main job (during the last week before move out) was to go through all of it. He acted upon any bill that looked unpaid, trashed all the ads, etc. (SPECIAL NOTE: There was a huge amount of old paper with full credit card number and social security number on that. He put all this stuff in a huge bin; we brought it home and paid for it to be shredded.)

d. Kitchen stuff: There were many, many mis-matched sets of dishes and old cookware. Mom wanted to keep most of it. So, my husband set a table with 8 place settings of her favorite dishes and cookware for her new apartment kitchen. When she saw how this would meet her needs, she agreed and we gave the rest away.
e. Clothing: My mother had been a shopaholic. There was a lot still with tags on it that didn’t fit her. She agreed to give all that away to a Mission Store (this was important to her to know someone in need would be wearing her clothes). To her surprise, we found things like 40 black skirts in the same color, style and make. She usually would decide just to keep just a couple. (NOTE: this is a very emotionally draining process ...so do this in short time segments.)

f. Furniture: This took a lot of time. We ended color coding each item; green: for keep and move; red: for give-away; yellow: for trash. Our biggest challenge was finding a place that would come into the house and haul her furniture away for donation. I did not find this place until the day before moving. As with every other challenge…..you must keep pursuing a solution. Never give up!

g. What to buy new for her retirement apartment: Her living room couch and chair were soiled and also broken. Her mattress set was 30 years old. So, she agreed she wanted a new couch and lazy-boy chair. We found these pieces at her favorite department store on sale, plus they gave her one year interest-free to pay these off. We went to a mattress store, and found an excellent set (with a low box springs), and again got her one-year interest free. On of her favorite new purchases was a new comforter.


2. Lessons Learned:


a. Plan and think ahead. Given the timeframe for the move, map out the major steps you’ll need to accomplish. I listed all this in an Excel spreadsheet.

b. Track all the vendors, contacts and important names and numbers, and ‘next steps’. Again, I captured all this in an Excel spreadsheet and printed for my mother. When I had to return home, she kept the list on her frig, for easy reference.

c. Keep a pulse on how your parent is doing (physically and emotionally during all this). You may need to slow down but you can’t stop the process. You have to remind them why they are doing this and what it will mean to them in the end.

d. When your parent gets hung up looking through photos and memories, ensure them that you are saving all this. Again, we used a big bin to put all this in. Later, in the midst of winter, she could sort through these.

e. Consider things that are important to your parent. My mother wanted to take her piano with her. We made a place for it to fit in her apartment. Also, color (such as her new purple comforter) was important to her.

f. As early as possible, reserve the moving van company and other vendors (we used one just for senior moves and they book up fast).

g. Know that you will go through times where you are exhausted, dirty from cleaning, frustrated from delays, not finding resources when you need them. Often I would go outside late at night and just de-compress.

h. Always have a vision (and share it) for what your parent’s new life will be like.

Tuesday, October 21, 2008

Finding the right retirement community for an aging parent

Today, I’ll describe the selection process of a retirement community for Mom.

  1. First of all, I had an open-ended conversation with Mom. I felt it was important to understand Mom’s thoughts and perspectives. Know that even if a parent is 100% set on moving out of their home and into a retirement community, when the reality of leaving their home sets in, all kinds of strong emotions will emerge. As I’ve said in previous blogging, my mother and I kept reminding each other of the end goal she wanted. She no longer wanted to care for a large home; she wanted to live in a caring and vibrant community with excellent healthcare and services available.
  2. So, our criteria for selection of a community came down to these factors
    1. Location
    2. Size
    3. Inclusion of services
    4. Cost
    5. How she felt she would fit in
    6. Availability
  3. Location: She definitely wanted to remain within an hour drive of her current home, so she could stay in touch with her friends, church, and doctors. We came up with a list of 3 retirement communities, all highly recommended.
  4. Size: The 3 communities were different in number of residents which ultimately impacted the variety of activities, services offered, and something we had not thought about, diversity of the residents. Mom decided early on to exclude one of the communities because it was too large; it reminded her of a little city. She wanted something a bit more personal.
  5. Inclusion of services: Mom’s remaining 2 choices were Continuing Care Retirement Communities (CCRC). This was very important to us. Even though she would start out in independent living, if she had to move to assisted living or nursing care, that move would be possible at no additional charge. The place Mom eventually chose also had a highly rated Alzheimer’s / memory impairment facility. Again, if she ever needed this level of care, it would be available to her at no additional charge.
  6. Cost: At this point, we had made an initial visit, had very positive feelings about the community and …..we started to consider costs. Mom knew she preferred this place, but could she afford it? Her place of choice was “all inclusive”, unlike the other option. We compared initial cost, long-term cost and the overall quality and felt the costs were reasonable. Mom’s place of choice had a spreadsheet program that they could plug all her income into (including estimated proceeds of sale of her house). We found, that yes, Mom could afford this. And, Mom’s initial fear (of having to turn all her money over to a retirement center) was totally unfounded. She remained in total control of her money. This was a wonderful turning point. We decided to put down the deposit at that time and get on their wait list.
  7. How she would fit in: Now that Mom knew she could afford her place of choice, we had to try to find every way possible to see if Mom would be happy here. Here are some of the things we did:
    1. We made trips often back to the community; sometimes just driving around the grounds, walking through the halls, or having lunch/dinner in the dining rooms. The Marketing Staff was wonderful. My advice is to find a key point of contact; they absolutely want to help in the decision-making but they can’t read minds. I would often email our contact with questions. (Also, it was interesting…every staff member we met told us how much they loved working at this place. We could sense that in their interactions with us.)
    2. Mom enjoyed walking through the buildings. We could tell a lot by the people we saw, their demeanor, the noise level, even the light and the smells. Some of the things I remember from my first visit: everyone had a book with them; people would be sitting and quietly chatting or reading. They had a wonderful wall where they showed paintings of local artists. They had a community garden. And, probably key for my mother, she loved the food, and the way she was personally greeted on every visit.
    3. We read and re-read all the literature provided, all the calendars, activities. We even spent time looking through the biographies of the residents. What an incredible diverse group of people! We learned about the Wellness Center and that her primary care physician came there every week (as well as many of her other doctors).
    4. When she finally made the choice and was given an apartment number, she made several trips back to take measurements, to try and visualize how much she could bring and where to place it. (I’ll devote another blog to how she decided what to bring, another key decision in the transition. Don’t minimize how important each item is. For my mother, it was her piano.)
    5. All these visits were so important. With each visit, she began to consider this her new home. As she went through her daily routine back at home, she could now begin to think, how will I do this in my new apartment? What will my new life be like? We took every opportunity to keep our focus on making this a smooth and positive transition.
  8. Availability: This was so very important. One place Mom was considering had a wait list of 2 years. Fortunately, her first choice had an apartment open up and she moved in just 2 months after we had begun the search.
  9. So, what’s the rest of the story? As I end this blog, I’ll include some of the unexpected delights for my mother as she transitioned to her “new home”.
    1. She told me she loves the ecumenical service held at the retirement community, even more than her own church of 30 years.
    2. She loves the way she and her friends are greeted by name, as they enter the dining rooms each day. She looks forward to the Friday night social hours, a time to meet all the new residents…. and also, the many special events, such as the Crab Feast, the 4th of July cookout.
    3. Mom loves to tell me each week about the lectures and performances she has attended on site. She saw her first opera the other night!
    4. Her good friend down the hall has been bringing her fresh tomatoes from her spot in the community garden. They truly all look out for each other.
    5. The same friend called the other day to say she was making reservations for the New Year’s Eve party for the whole floor. My mother, who never went to college, says she feels like she’s living in a dorm. The dear gentleman living next to her volunteers at a local school. A priest down the hall is still active in his parish. These are people with vibrant lives and what a difference Mom’s choice has made in her life. In just 4 months, we have seen my mother blossom (and her health improve immensely) in her new surroundings.


The place my mother chose was Fairhaven (Sykesville, MD). I can’t imagine my mother being anywhere else, and neither can she. http://www.fairhavenccrc.org/subdomains/fairhavenccrc/


Stay tuned tomorrow as I talk about our process of dealing with everything in Mom’s house. My dear husband did a superb job of going through all the old paperwork, sorting, shredding, etc. I need to devote a whole entry to his efforts.

Thursday, October 16, 2008

Helping a parent in crisis - finding interim services and moving forward

The continuing saga of helping a parent in crisis. So here’s how my mother and I managed our week together. We had to focus on mom’s health as well as considering future changes for her. She wanted to explore area retirement communities and the possibility of selling her home. I wanted to ensure interim services were in place when I left at the end of that week.

So, here’s how the week went for us:
1. Mom’s health and medical appointments were our #1 priority. We scheduled all of her appointments as early in the week as possible. One thing I learned was to build a lot of extra time into getting to and from appointments. Mom needed to move slowly and use a walker for the first time.

2. We mapped out the first hour after breakfast each morning to handle financial calls, paperwork and business matters.

3. Mom picked out 3 retirement communities to visit. We prioritized them in order of which one she thought she would like most. This worked great because once we visited her first choice, she knew that was the place for her. (We laughed about this….because this is exactly what two of my sons told me when we visited their first choice in colleges!). I’ll follow up with future blogs that describe why she decided to sell/leave her home and also how she came to choose her retirement community.


4. Since Mom had to wait for an opening in the retirement community, we had to take some interim steps to help Mom live on her own after I left at the end of the week.
a. We called a wonderful place called “Visiting Angels” (offered services of light housekeeping, medication assistance, companionship). Mom decided she did not want a stranger coming in her house but we chose to accept their offer of Lifeline Alert. She was able to prepay for 3 months and it was installed on the spot. This gave Mom much peace of mind because she had a small number of steps to navigate in her home. http://www.visitingangels.com/
b. Meal preparation was a big concern. She could not drive to get groceries and didn’t know what to eat. Given her poor physical health and low immune system, eating the right food was important. I contacted Meals on Wheels and they started service as soon as I left. They have an income-based fee scale and provide a hot meal at noon and leave a cold meal for dinner. Although Mom sometimes complained about the food choices, she looked forward to the daily visits of the very kind people who delivered. http://www.mowaa.org/Page.aspx?pid=183
c. Mom’s closest friend agreed to stop by and visit once a week, Friday, check on her blood sugar, check the status of Mom’s home and Mom and let me know if things started to deteriorate.
d. I also arranged for a cleaning service to come in every other week and scrub down her kitchen, bathrooms, vacuum and do laundry.

5. The biggest physical problem we had with Mom’s house was the trash and clutter that was absolutely everywhere. I worked late into the night hours separating out what was obvious trash. I tried, as best I could, to have her look through stuff before it went in the trash pile. By the end of the week, I called the refuse guy in. They ( he had a crew of 4 very strong men) took away a “ton” of trash. This is not an exaggeration. The guy actually had to weigh the stuff at the dump to know how much to charge us. I didn’t do this all alone; twice my dear childhood friend over as we sorted through stuff. It was like stepping back in time. We found income tax returns from the 1950s!!! By the time the refuse guy left, the entire bottom of the house (family room and unfinished area) was emptied out. This was a big feat but it also made me realize how much we had left to go!

6. We knew early in the week that Mom wanted to sell her house. The realtor said she could sell “as is” and someone (a house flipper) would likely scoop it up for a good price. She said no; she wanted to fix it up and sell it to a nice family who would fit into her neighborhood. From that moment on, I became the only person that was allowed to speak to the realtor, general contractor and anyone else interested in anything. Everyone had my cell number and knew they had to go through me. This took a huge burden off my mother. Now that Mom decided she wanted to sell, we decided to move quickly,
a. She applied for an equity loan from her bank
b. She had a new roof and gutters put on
c. We met with the general contractor, got a fixed price contract to renovate the whole house; all new cabinets, paint, carpet, fixtures, bathroom sinks. The price was more reasonable than we had expected. I checked the contractor out thoroughly and our family friend checked the work frequently.

7. I’ll finish this blog now by sharing that the contractor finished 2 weeks ahead of schedule, the house looked brand new. This gave Mom such a sense of pride that she was providing something of quality to another family. The house went on the market and sold in ‘one day’.

The key to this success was to thoroughly check out everyone we worked with; to negotiate, clarify and understand all contracts and always keep the end goal in sight….to see Mom’s house the way she wanted it sold so that she could move, unhindered, into her new retirement community.

Stay tuned tomorrow to hear how we selected a retirement community.

Tuesday, October 14, 2008

Excellent website for finding transportation for your parent

If your parent has to stop driving and needs a way to get to the doctors and grocery store, check out the following website. Scroll down to the state you’re interested in and find the correct link. http://bulletin.aarp.org/yourworld/gettingaround/articles/state-by-state_guide.html

Helping an aging parent in crisis - four categories to consider

October 14, 2008


Helping a parent in crisis. Here are the four categories of care/aid that I considered while helping my mother through her medical and living situation crisis.


Health

Finances

Current living situation

Future living possibilities

Here are tips that helped me:

  1. Health
    1. Establish a relationship with your parent’s doctors
    2. I already had an email relationship with her specialist of 6 years at Johns Hopkins Hospital. I found his academic email address on the university website. He responded to my emails within 24 hours, often with a phone call.
    3. I had no relationship with her primary care doctor. But, when I arrived in Maryland, I went with her to her next appointment. My mother has a way of putting on a fa├žade that everything is ok. When the doctor left to get something, I followed him out into the hallway, pulled him aside and filled him in. I told him how I found stacks of unfilled prescriptions as well as numerous pills in her carpet. He immediately offered contacts at service agencies in the area to help.
    4. Ensure that your parent goes through the primary care doctor on everything. My mother was going to an ENT and dermatologist on her own. Sometimes their prognosis and new medications would negatively impact her overall health.
  2. Finances
    1. Establish your parent’s financial situation as soon as possible. Over the 20 years since my father’s death, my brother (who lives one state away) had accepted responsibility to keep an eye on her finances. I found out quickly all that meant was he ensured my mother received the same checks each month. He (and she) had no idea, long term, what the money flow would be.
    2. I looked at my mother’s last 1099s for her income tax and called every financial institution. I called each (with my mother present); she gave authorization for me to speak with the institution. I also made her listen and understand every conversation. I was willing to help her stabilize but I did not want to become a crutch. I found out what type of fund she had (annuity, IRA, pension…), the monthly disbursement, how long it would continue. We also put her on direct deposit for all funds. KEY: Knowing how much she money she had (long term) enabled my mother to consider all the alternatives of living situations. This was a very positive, freeing and turning point for her and me.
  3. Current living situation
    1. My mother had lived in her home alone for the past 20 years. She enjoyed visiting us so I rarely went back. I realized she had a shopaholic problem which I had tried to resolve previously with no success. But, since she had been confined to her home for 3 months (due to medication and being unable to drive), her house was in a horrible state (trash everywhere; dishes, mail, newspapers stuffed under furniture), refrigerator with much outdated food; kitchen piled high with dirty pots and pans, beds covered with feet of clothing she had nowhere for. When I arrived, I was overwhelmed by the condition.
    2. I hired a cleaning service to come in for 4 hours. They immediately told me they only did surfaces. So, I had them do the bathrooms and vacuum and dust as they could while I tackled the kitchen. I had to get the house in a liveable state to bring my mother home from the hospital.
    3. I had a friend of the family, a realtor, walk through and assess the house and tell me about the housing market. He also referred me to a refuse guy and a general contractor who could renovate the house if she decided to sell and move into a retirement community. She told me that she knew her living condition was bad. She just didn’t know what to do about it. She denied her friends and neighbors entry. The part that was difficult to understand was how my brother (who visited regularly) did not see there was a problem. There were bags throughout the house he had brought with cereal and canned goods. It was like trying to put a bandaid on a large wound.
    4. For the remainder of the week, I would get up at 5am, tackle paperwork until Mom awoke at 8. Then I tried to get her to learn to check her diabetes, learn to eat properly and clean up after herself.
    5. We began to map out her living options. She would need lots of interim help even if she did decide to sell her home and find a retirement community she liked.


The initial hard part is confronting all the problems and trying to create order out of chaos. I tried hard not to point blame at anyone or anything. You really need to channel all your energy into finding solutions. I tried to segment out parts of the day to address the various categories of need. And, above all, you can’t rush your parent. I often had to make myself stop and sit down and spend time with my mother. So many lessons learned for both of us.


Stay tuned tomorrow to find out how we explored the various options that first week.

Sunday, October 12, 2008

Key first steps to take when parent is in crisis mode

Ok, you're 1,000 miles away and get the call your parent is in crisis and most likely will need assistance living in his/her home or will need to consider a change.

The key first steps I took were the following:
1. I called my mother's church office, made them aware of my mother's situation and asked what community services would be good for me to contact.
2. I called a childhood friend who worked for a local hospital. She was able to give me a list of comprehensive services recommended by colleagues. This was a huge help.
3. I called my mother's close friend with whom my mother had shared her wishes about changes she wanted to make in her lifestyle and living.

And, finally, I decided to take a week of vacation, drive back and help my mother get settled back in her home (after her hospitalization) and assess her living condition. I knew I had to use my time wisely and I began to carve a plan out in my mind. My next blog will explore those "categories" that I add to address: her health, her finances, her current living situation (staying in her home of 30 years) and possible new living situation. I also began to prepare myself mentally for what would be a stressful, physically and emotionally demanding week. I kept focused on what our end goal was....to help my mother live the rest of her life in dignity and good health.

Here is a fantastic web site that I wished I had known about.
Check it out; just put in your parent's zip code, city or country and you will get a tremendous array of resources so you don't spin your wheels. I recall how every second is precious plus you want to find trustworthy sources.
http://www.eldercare.gov/Eldercare/Public/Home.asp

This site is a wonderful resource from the Administration on Aging (of the US Department of Health and Human Services). Its goal is to enable the elderly to live independently. Here you will find local and state agencies to answer your questions about meals, home care, transportation. Check out the Resources link which covers everything from 'general health resources' to 'housing and living options' to 'end of life care'.

Information and planning were critical factors in helping my mother understand her situation, options and helping us to move forward and create a plan together.

Stay tuned tomorrow when I describe the four categories of consideration. I'll also cover the many key phone calls/appointments I made before I ever left home, ones that saved precious time as well as yielded additional resources.

Friday, October 10, 2008

You get the call that your aging parent is in crisis

Last March, I received a call from my mother's friend (halfway across the country) that I had to come immediately; Mom was being hospitalized and her home was in a terrible state. In a 3 month period and 2 visits, I was able to get her health stabilized, her home totally renovated and sold and helped Mom to find the retirement community of her dreams. She is now healthy, mentally active, surrounded by a vibrant community of friends about 5 miles from where her home was.

I've decided to start this blog to help anyone who gets that kind of call from out of the blue. Who do you call first? How do you find resources in your parents' community (across the country)? What are the crucial steps you must follow in order to consider your parent's health, finances, living needs and also their personal wishes? The transition is not easy. It takes a lot of work, planning, and strong emotions will emerge. But, I (and my mother) are here to say....we worked through the process and my mother is happy, healthy and engaged in a way she has never been before in her life.

I hope that others who find this site will also share their stories. Just one little tip can help someone so much. Stay tuned each day as I share my tips and research.

Thanks for reading and also for sharing. Dale