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Reducing the risk of falling

Has your mother fallen recently? She’s not alone! One out of four adults 65 and over experiences a fall each year. That makes falls the leading cause of injury for older adults.

Falls are serious business
A few statistics: In the U.S. an older adult dies once every 20 minutes as a result of a fall. Disabilities from a fall include injuries that can be life changing: a traumatic brain injury or broken hip. Especially for seniors, falls pose a danger to an independent lifestyle. They often usher in a permanent need for daily assistance.

Who is at risk for falling?
Has Mom or Dad fallen twice in the past year? Have you noticed balance or gait problems? Has there recently been a severe fall? These are signs of “high risk.” Other signs involve poor vision, or taking medicines that list dizziness as a side effect.

A fall risk assessment
To be safe, ask your relative’s doctor to do a fall risk assessment. This includes a review of

  • underlying medical conditions. Many chronic diseases affect and the ability to get around.
  • the home environment. The doctor can write an order for an occupational therapist or other trained professional to do a home assessment. They can identify simple ways to remove hazards and make the home safer.
  • medication use. Some types of drugs, or daily use of four or more prescription drugs, increase the risk for falling.

 

Preventing falls
A recent review of numerous studies show that some strategies are better than others. The most effective measures for preventing a fall include:

  • Exercise, especially activities that promote balance.
  • Getting regular eye exams and following through with corrective procedures.
  • Removing hazards around the house.
  • Wearing sturdy shoes and slippers. A firm sole is better than a soft cushy one because it’s easier to feel the ground below.

 

Are you worried about a fall?
As the Northern Virginia expert in family caregiving, we at Senior Care Management Services understand the difficulty of your situation. You can’t be too forceful about changes. And at the same time, the consequences can be pretty serious. Put our experience to work for you. Give us a call at 703-329-0900.

“I don’t need help” – Part 3

It’s not easy to lose abilities and admit you need help. The reluctant elder in your life is more likely to ease into acceptance if you provide good listening, compassion, and a commitment to working together. In this third installment of our series, we look at elders’ concerns around privacy and pride.

Privacy
Having someone underfoot can feel intrusive, especially if your relative is used to living alone. Perhaps he or she fears being judged, or that word of unhealthy food choices or alcohol use may get back to the family. Maybe your relative tends toward hoarding and is embarrassed. Or has worries about safety with a stranger or the risk of theft. All of these are reasonable concerns for any adult who values their independence. You can address privacy concerns by

  • starting with part-time help;
  • hiring a friend;
  • working with an agency that does background checks and drug testing.

 

Pride
“Do you think I need a babysitter?!” Our culture values self-reliance. Anything that implies a need for help suggests weakness or incompetence. When you approach your relative,

  • shift from “we think you need help” to “we want to help you stay in charge of your life.” As noted in Part 1 of this series, working with your relative toward a common goal is a welcome and respectful approach;
  • clarify what type of care is needed. For instance, a nurse to dress a wound is different from someone who cooks and cleans;
  • start with a short-term arrangement, framed as “while you recover” or “just to see how it goes.” Then consider a more permanent arrangement;
  • talk about getting help as a way to liberate your loved one’s energy to do other activities he or she really enjoys;
  • emphasize your relative’s other abilities. If Mom can no longer do housekeeping, make sure to praise her often about her cooking talents.

 

Would a little coaching help?
At Senior Care Management Services we understand what a delicate line you have to walk— respecting a relative’s concern while at the same time addressing real issues of health and safety. As the Northern Virginia experts in family caregiving, we can help you grapple with your own frustrations and find the balance you need to take the next step with your loved one. Give us a call at 703-329-0900.

When you need an energy boost

When caregiver fatigue strikes, many of us reach for caffeine. Whether it’s coffee, cola, chocolate, or an “energy shot” drink, the effects are immediate. Like a reliable friend, caffeine seems to help us keep going.

 

Pros and cons
Studies have shown many benefits from caffeine. It can enhance performance. It increases productivity and elevates mood. It may even reduce or delay Alzheimer’s and Parkinson’s diseases.

On the other hand, caffeine can be hard on the heart. It’s like giving your heart a stress test on a regular basis. It’s known to cause a rapid or irregular heartbeat and can contribute to high blood pressure. Insomnia and anxiety are also common side effects.

 

Too much of a good thing?
High-caffeine energy shot drinks are increasing in popularity, especially among older adults. Take caution. In a four-year time span, the number of adults going to the ER because of energy drink intake doubled. Among adults age 40 and older, the rate quadrupled! Although the numbers are small, clearly there is a trend. Symptoms ranged from palpitations and anxiety to actual heart attacks.

The Food and Drug Administration says that 400 mg of caffeine per day is likely safe. A 5 oz. cup of caffeinated coffee has about 100 mg. A can of cola about 50 mg. Energy drinks, by contrast, vary dramatically, having from 200 to 500 mg of caffeine.

 

If you want to quit
Caffeine can be addictive. Tapering off, or down, is easier than going cold turkey. One approach is to make your coffee or tea half decaf. Or switch to smaller servings or fewer drinks per day.

Another option is to respect your fatigue. Try to get enough sleep at night. And if life allows, consider a short nap midday. Listening to your body may be a wiser approach than reaching for a cup of joe or a high-impact energy shot.

 

Struggling to juggle it all?
If you are “self-medicating” with caffeine, perhaps it’s time to get some caregiving help. Too often, we at Senior Care Management Services see family members stealing from their sleep to find those extra hours needed in the day. Burning the candle at both ends is not a sustainable long-term strategy. At the same time, as the Northern Virginia expert in family caregiving, we understand! It’s hard to get it all done. Give us a call at 703-329-0900. We can help share the load so you can live a healthier rhythm and drink that cup of coffee only because you want to, not because you need it.

Safe traveling for older adults

If Mom or Dad has summer vacation plans, be aware that older bodies are more vulnerable to the stresses of travel.

Begin with a pretrip appointment with the doctor
Suggest a meeting with the physician 4–8 weeks ahead of the vacation. Ask the doctor to assess overall health for travel. Heart and lung issues are the primary culprits in terms of cutting a vacation short. Ask about precautions while traveling or things that can be done now to prepare.

 

Other medical issues

  • Plan to bring extra pills in case travel home is delayed. Check to see if a prescription renewal is needed.
  • Ask about the scheduling of doses when crossing time zones.
  • Pack prescriptions in the carry-on in case luggage gets lost.
  • Order oxygen for the flight. If your loved one has a lung condition, the airlines will require you to order oxygen from them. They need 1–2 weeks’ notice.
  • Ask the airlines for help with a wheelchair if your loved one has trouble getting around the airport.
  • Pack lightly and carry a wheeled suitcase to avoid back injuries.

 

Exercise during long seated trips
If drive time or flight time is more than four hours, your relative may be at risk of deep vein thrombosis. Although not common, this involves a clot that develops quite suddenly. It can result in a deadly embolism if it travels to the lungs. Cancer patients, overweight individuals, and people who have been recently injured or hospitalized are most at risk. Watch for painful pink or bluish hot areas in the thigh or abdomen.

Prevention involves seated exercises such as marching in place and “drawing circles” with the toes (while pointing and flexing to stretch the calf in all directions). Properly fitted medical compression socks may also help—just make sure they don’t bind at the knees. If possible, it is helpful to stand up and move about every hour or so.

 

Want help preparing?
Traveling is fun, but it can be physically challenging. As the Northern Virginia experts in aging well, we at Senior Care Management Services can help you or your loved one make needed preparations and set up support systems along the way. Give us a call at 703-329-0900.

Thrifty or hoarding?

We all accumulate belongings over the years. But when is it too much?

According to Michael Tompkins, PhD, author of Digging Out: Helping Your Loved One Manage Clutter, Hoarding and Compulsive Acquiring, your family member may be in the early stages of hoarding if he or she

  • keeps parts of the home off limits and the curtains drawn;
  • talks with you endlessly about the stuff. You’ve stated your concerns, offered help, even gotten angry, and yet there’s no action;
  • gets overwhelmed decluttering even a small area. It becomes a major job that can take more than a few hours or days;
  • often fails to pay bills. Not necessarily for lack of money, but because the bills can’t be located. Or the stamps. Or the checkbook;
  • is in debt because of compulsive shopping;
  • has trouble finding things and resists storing belongings out of sight;
  • puts off home repairs. He or she may not recognize the need. Or may not want to let a repairperson see the house;
  • insists on meeting you at your home. This avoids embarrassment or confrontation about the clutter;
  • rents one or more storage units. There is a seemingly unquenchable need for more storage space;
  • will not let you touch or borrow his or her possessions. Possessions are guarded fiercely and may be treated as if they are “friends.”

 

If these symptoms look familiar, your family member may well have a hoarding disorder. He or she literally lacks the ability to eliminate clutter. Suggestions for next steps:

  • Don’t rush to action. Force will only alienate your loved one. By maintaining your relationship, however, you may be able to help manage the problem.
  • Learn more. The most extensive studies on hoarding are done by scientists researching obsessive-compulsive disorder.
  • Consider professional help. Especially if there are safety risks. Consider a geriatric care manager or in extreme cases, Adult Protective Services.

 

Might it be more than clutter?
If you are worried, it may be time to call in professional help. We at Senior Care Management Services understand the full range, from an exuberant joy of shopping to extreme conditions that can even become a health hazard. As the Northern Virginia experts in family caregiving, give us a call at 703-329-0900. We can help you get perspective and take the next steps.

Opioid addiction and serious illness

Morphine, hydrocodone, fentanyl . . . with the opioid crisis in our country, it can be scary to hear that a frail or seriously ill relative needs this type of medicine. What are the risks of addiction?

Fortunately, addiction is rarely an issue for individuals dealing with cancer or a painful terminal condition.

Understanding addiction
People who are “addicted” have such an intense desire for a drug, they do whatever it takes to get more of it. Their craving overpowers their concerns about relationships and their ability to function in the world. People with a painful, serious illness rarely behave this way.

The need for more medication
Over time, the body develops a “tolerance.” This means that a higher dose of the drug is needed to achieve the same relief. This is just a biological truth. A legitimate need for more medication is a far cry from an addictive craving that sparks irrational behavior.

Breakthrough pain
It is also very common with cancer and other conditions to have pain spikes in between doses. A booster dose of the medication is then essential. It is not a sign of addiction. Simply part of the unpredictability of pain.

Possible signs of addiction

  • Going to multiple doctors for pain medicine
  • Going to multiple pharmacies to fill prescriptions
  • Using up a prescription early
  • Taking ALL the breakthrough doses

If you are worried
Ask your relative’s health provider if they are concerned. If your loved one has a history of substance abuse, let the doctor know early on. Ask about trying different types of pain medication. Perhaps the opioid can be used in rotation with others. Spiritual distress can also be a source of physical pain. If medication is not enough, ask if a visit with a chaplain—a member of the clergy—is possible.

Is pain a problem?
Pain profoundly impacts an individual’s quality of life. It dominates every experience. And it changes relationships. At Senior Care Management Services we know that a person in pain needs extra support, as do his or her family members. If pain is part of your picture, give us a call at 703-329-0900. We are the Northern Virginia experts in family caregiving and can help all of you get a healthy handle on pain.

“I don’t need help” – Part 2

When a loved one obviously needs help at home but refuses to allow it, it’s frustrating! Below are two common concerns, with suggestions for ways to problem solve together.

 

Cost is a very practical barrier
Many older adults feel particularly vulnerable where money is concerned. They don’t want to spend! But the cost of help depends on the type of help needed.

If licensed care providers are what your relative needs—for example, home visits with a physical therapist after a hip surgery—Medicare and supplemental insurance usually cover these costs.

If nonmedical help is needed (cooking, laundry, errands), there may be resources to assist. Maybe your relative has long-term care insurance. Perhaps he or she is eligible for VA benefits. Consulting with a care manager can bring those possibilities to light.

Or it may be that your loved one does not have an accurate picture of his or her financial resources. If you are the person your loved one trusts with money matters, ask if you can review the facts together to better understand his or her concerns.

 

Retaining control over their life
It’s common for accepting help to symbolize “the end of my independence.” That’s a scary thought. Realistically, though, all of us will need assistance at some point. You might try asking, “Under what circumstances would you see yourself accepting help at home?” This allows your loved one to explore his or her own red flags. Plus, it gives you insight about what life event might make home care acceptable and why.

When hiring help, look for ways your relative can retain as much control as possible:

  • Pick the caregiver.
  • Choose the days and times for help.
  • Decide on the care attendant’s tasks and participate in giving the instructions.
  • Clarify if this is a short-term or long-term arrangement.

 

Does this conversation feel like a battle?
At Senior Care Management Services we often notice that an older adult will be more resistant to their child’s suggestion regarding help than they are when they talk with a professional. With a professional, there is less face to save and no family baggage. As the Northern Virginia experts in aging well, we’d be happy to talk with you about options for introducing the subject. Give us a call at 703-329-0900. Let’s see what we can do.

Before you quit your job

It may be true: Your aging relative needs more and more care. You know you are the best person for the job. But it’s too much to do on top of your own work. Think twice before exiting the workforce, however. There are some stiff financial consequences.

For example, if you are midcareer, you are in your prime income-earning years. This is when you want to double down on retirement savings. If your employer offers retirement matching funds, you want to be in a position to grab them! And continue contributing to Social Security.

According to a Met Life study:

  • Men age 50 and over who left work to care for a parent lost an average of $89,107 in wages. The impact on their Social Security benefits was $144,609. Loss of pension income, $50,000. Altogether, early retirement cost male employees $283,716 over their lifetime.
  • Caregiving women age 50 and over got hit much harder. They tended to leave work sooner. Lost wages averaged $142,693. Women lost $131,351 in Social Security. Figuring lost pension at $50,000, early retirement cost female employees $324,044.

 

Consider these options:

  • Hiring help at home may be less expensive than losing your wages. Suggest sharing the cost with your siblings. (Show them this article!) Then no one among you bears the sole financial burden.
  • You might take advantage of an adult day center to provide care during your work hours.
  • Ask about flex-time options so you can work when others can care for mom or dad.
  • Investigate Family Medical Leave. If your company is big enough, you may be able to take weeks or months off. (It is unpaid.) That may get you through a crisis and buy you time to make other arrangements.

In your generous desire to help, be careful you don’t shortchange your own future.

Is it time to get your siblings more involved?
At Senior Care Management Services we’ve seen one sibling become the primary caregiver while others seem not to pitch in. It’s not necessarily a matter of laziness. Often it’s a matter of not understanding the needs. As the Northern Virginia expert in family caregiving, we can help you meet with your siblings and work out a plan that addresses everyone’s concerns. Give us a call at 703-329-0900.

 

Is it Alzheimer’s disease?

When your father struggles to remember a grandchild’s name, should you be concerned? Older adults typically have some memory loss. People with Alzheimer’s disease, however, experience very specific changes in their thinking that go beyond the normal forgetfulness of aging.

 

You might consider a dementia evaluation if your loved one has begun having difficulty with the following:

  • Remembering new things. Do you have to give the same information over and over again?
  • Dealing with numbers and logical thinking. Is Dad fumbling with the checkbook? Having trouble with a favorite card game?
  • Familiar activities. Is Mom leaving ingredients out of favorite recipes? Skipping steps?
  • Understanding the passage of time. Do you have to remind your loved one of the season or year?
  • Changes in vision. Does Dad have trouble judging distances? Does he get easily lost or disoriented, not recognizing familiar places?
  • Carrying on a conversation. Is Mom repeating herself or seeming to make up words? Do her answers in a conversation not make sense with the topic?
  • Losing things. Are you finding things put in odd places?
  • Poor decision making. Is Dad spending money on unusual purchases? Do you have to convince Mom to bathe?
  • Socializing or doing hobbies. Has Mom given up a favorite hobby or withdrawn from a group of friends?
  • Staying calm. Is your loved one suddenly moody? Perhaps anxious or irritable?

 

Any one of these changes in behavior could signal the beginning of a more serious memory problem, or not. That is why it’s important to have your loved one checked out by a physician.

  • It may not be Alzheimer’s. A number of reversible conditions look like Alzheimer’s. With proper diagnosis and treatment, these symptoms disappear.
  • If it is Alzheimer’s, there are benefits to detecting it as early as possible. Medications are available that slow the progression of Alzheimer’s symptoms. Other medications may help relieve moodiness.

 

For more information about what’s normal and what’s not, check out the Alzheimer’s Association’s in-depth description of the 10 signs of Alzheimer’s.

 

Are you worried?
As the Northern Virginia experts in aging well, we at Senior Care Management Services understand how troubling the thought of Alzheimer’s can be. We can help you get a proper evaluation. Give us a call at 703-329-0900.

“I don’t need help” – Part 1

It’s a common refrain and the bane of many family members: Your loved one is having trouble, yet he or she refuses outside help. This can put your relative at risk. But if the worst happens and things go south, it also ends up making more work for you. Doubly frustrating when you know it could have been prevented.

Rather than battling head on for acceptance, you might try a softer approach:

Build empathy
Ask your loved one what their concerns are. Just listen and try to identify the hot-button issue underneath the reaction:

  • Is it an issue of cost? – He or she may not know about Medicare coverage or the actual cost of the service. Your loved one may also underestimate his or her financial resources.
  • Is it an issue of control? – Fear that this is the beginning of the end in terms of living independently.
  • Is it an issue of privacy? – “My home is my refuge from others.” Or concern about being judged for lifestyle choices.
  • Is it an issue of pride? – “I don’t need a babysitter!”
  • Is it lack of knowledge (or denial) about their health? – Some people minimize the toll an operation or disease is likely to take.
  • Is it an issue of feeling loved? – “My family will take care of me.”

Validate feelings
All of these are valid reactions and worthy of exploration. You might start with, “I hadn’t thought of it that way. I see why you’re concerned….”

Explore thoroughly
Before problem solving, ask more questions. “Tell me more about that. It’s important that I understand.” The more your relative feels “heard” and the more you genuinely comprehend his or her issues, the easier it will be to work together to find a viable solution.

In subsequent articles, we’ll talk about ways to address these concerns with dignity and respect.

Is your relative resisting help?
At Senior Care Management Services we frequently get calls from family members who want our help but are sure their loved one will refuse. Actually, we have had great success arranging a meeting with the older adult. Sometimes it’s simply easier for them to talk with a professional than to reveal concerns or vulnerability to a family member. As the Northern Virginia expert in aging well, we can help. Give us a call at 703-329-0900.