No matter how you cut it, helping a senior transition from one home to another will take a lot of your time. If you’re working, you’ll need to take vacation time during and after the move. If you can enlist other family members to help in a tag-team approach, it’ll take stress off of a single individual.

Before the Move

If you can help remember all of the things that need to be done in advance of the move, you’ll minimize the stress that comes from discovering the forgotten detail. Make sure all of the “turn offs” and “turn ons” are scheduled. File a change-of-address form with the post office. They should notify everyone they have an account with, utility, including credit cards, insurance, and so on, as the statements come in the month before. The post office has a “Movers Guide” here. Check out our seniors moving post here for ways to notify Medicare, the IRS and more. The more things that you can have go like clockwork, the better. After that, don’t sweat the small stuff.

During the Move

Of course you and the movers, be they professional or family, will want to be as efficient as possible. But, if you’re all business, you’ll be missing an opportunity to attend to needs of the person moving. Take time for conversation. Reminisce about family events. Talk about friends and family, or what’s going on in the world. Good breaks for food and conversation will be good breaks from the uncertainty that goes along with moving to a new location.

Moving In

It would be easy to be all business while moving it. It’s a lot of work. Moving-in time is an opportunity to help your senior to get to know their neighbors. There’s a lot of time spent in public places–in the halls and in front of the building–that gives you the opportunity to introduce your senior to their new neighbors. This is where you have to be a little more gregarious than normal. Get their name. Ask them about the neighborhood. Ask them a question that your senior genuinely wants to know, because they’ve been in the same situation before and most people will recognize how disorienting things can be at first and will want to help. Get the lowdown on how things work, or what we like at SHF are some good tips to make life a little better.

After the Move

Now that you’ve showered them with attention before and during the move, you have to go back to work. Suddenly there’s a big void. Assuming that they’ve moved to a location near you, consider setting aside certain evenings and weekend days for the next few months where you can run errands, stop by to help out, or just go out to eat. Don’t focus all of your time on the chores.

If there are other family members in the area, enlist their aid. Assisted living communities have activities coordinator. Talk to her and see what she suggests that your parent may like to do to get involve in their new neighborhood. But don’t push it. It takes time to become comfortable in the new surroundings.

After all this advice, the final tip is to keep an eye on your own mental health. Clearly removing the stress from a loved one can put it on your own shoulders. You may be better prepared to take it than a senior, but you have your limits too. Don’t be afraid to ask for help and find some time for yourself.

Courtesy a4gpa via Flickr

We’re always looking for the best resources on the Web that can help the busy, perhaps harried, caregiver do what they need to do with confidence and compassion, while maintaining a balance in life. Sometimes it’s not easy. One thing working in our favor is that we do have the Internet and its abundance of resources. We also have the networks of caring people with which to share information and ideas. But sorting through the huge volume of information can be challenging and time consuming.

While surely not a definitive list, we thought we’d provide our picks of some of the best caregiver resources among the embarrassment of riches. Our picks were chosen to get someone a little more thoroughly grounded in role of caregiver. If we’ve missed a great resource, let us know in the comment section below.

Family Caregiver Alliance

While there’s much to be had on the Family Caregiver Alliance site, we honed in on the “Caregiving Issues and Strategies” section of the site. This page provides links to printable pages on a good number of topics, including:

• Caregiver’s Guide to Understanding Dementia Behaviors – Includes Ten Tips for Communicating with a Person with Dementia
• Caregivers’ Guide to Medications and Aging – “Any symptom in an elderly patient should be considered a drug side effect until proved otherwise.”
• Caring for Adults with Cognitive and Memory Impairments – A very thorough over of the topic, from tips on getting started to more resources.
• Caregiving and Ambiguous Loss – Addressing the stress caused by unpredictable memory loss that, “comes and goes—one moment here, the next moment gone”.
• Dementia, Caregiving and Controlling Frustration – A great guide to dealing with the personal challenges that we have to deal with.

There’s plenty more from Family Caregiver Alliance

Alzheimer’s Association CareFinder

This area of the Alzheimer’s Association website focuses on help for a person with Alzheimer’s, or their caregiver. This part of the site is well organized and serves as a good, high-level guide to addressing needs of someone with Alzheimer’s. The major sections of this site include:

• Planning Ahead
• Care Options
• Coordinating Care
• Support and Resources

The site also include an interactive tool called, “Your Personal CareFinder” that asks a number of questions about the patient so it can then recommended care options and questions to ask when screening a caregiver or facility.

Particularly helpful are the “Topic Sheets & Forms“. Included are a number of pages and PDF files categorized as, Forms, Daily Living, Financial, Legal and Insurance Issues and Home and Residential Care. Some, of particular note, are Individual Needs Assessment, Wandering: Preparing for and Preventing, Caregiver Stress and a couple of real thorough documents on taxes and Alzheimer’s.

AARP, Navigating the World of Caregiving

As you might expect, AARP has a good area on their site that helps caregivers find the kinds of information that they’ll need while helping a senior. The major, and best, parts of this site include:

• Planning Ahead
• Providing Care at Home
• Preparing Your Home
• Housing Options
• Legal and Insurance
• End of Life

There’s a lot of good detail here. While none of them are really deep, they’re helpful in that they give a good overview of each topic area.

The site has a couple of “interactive features” that are rather unimpressive. One is a quiz to see how stressed you are. You rate yourself on a number of factors and then it scores you on how stressed you are. I like that it has a button below your score that says, “Try Again”. Will me stress go down if I keep doing the quiz? There’s also a video section on the site with a lot of short videos on a variety of topics related to caregiving. Dr. Bill Thomas stars in many of them. The AARP also has a Caregiving area that has more timely articles.

Some Quick Hits

We also have a couple of quick hits for caregivers:
10 Tips for Family Caregivers (PDF) – Good tips from the National Family Caregivers Association
Stages of Caregiving – Also from National Family Caregivers Association on their Family Caregiving 101

Did we miss your favorites, or an obvious one?

If you can, don’t jump in with the news first thing. This may be difficult if your presence at their home, or on the phone, is out of the ordinary. Ask them how things are going and/or how they’re feeling. A few open-ended questions is a good way to start the conversation. Be sure to listen, and don’t be quick to fill the silence. Let them talk if you can.

When you feel their side of the conversation begin to dwindle, it’s your turn to talk. “Mom/Dad, I came here to tell you that…” If we’re talking about a death of a family member, or friend, don’t worry about being particularly eloquent. You can say, “I came to tell you that Tom died.” Or you can use, “passed away”. If you want, you can preface it by saying that you have ‘sad news’, or that ‘there’s no easy way to say this’. Don’t beat around the bush, but don’t rush through it either.

From here on in, your job is to convey the relevant facts, be a good listener and to provide comfort. Let them talk. Answer their questions as well as you can. Let them lead the conversation. Try to just listen and be open to a range of feelings. Let your parents express all their feelings, even if they’re hard to listen to. Talk about your own grief, feelings, and memories, and let your parent know that he’s loved and that you’ll do your best to support him throughout the process.

Keep in mind that everyone reacts differently to bad news. Some people are more emotional than others. Make sure that you’re prepared to break the news by being as in control of your emotions as possible. If they yell, remain calm and try to calm them. If they cry, comfort them. They may just remain silent, letting the news sink in. If they do that, put your arm around their shoulders and show sympathy.

On the other hand, if you don’t think you’re up to it and just can’t do it, consider asking another family member, or a minister, to do it.

You can see how doctors are taught to break bad news using Robert Buckman’s Six Step Protocol for Breaking Bad News.

If you’re a doctor, you probably already know his book: How to Break Bad News: A Guide for Health Care Professionals

Coach Broyles’ Playbook for Alzheimer’s Caregivers

Coach Frank Broyles, Athletic Director for the University of Arkansas, wanted to share what he had learned about Alzheimer’s caregiving because it had been difficult to find good information when he needed it. It’s the same sentiment that gave momentum to Senior Help Forum.

The Playbook is available for free as a PDF file from www.alzheimersplaybook.com, or you can call 800.272.3900 to request a copy. The book is 112 pages and extremely well laid out. It’s broken into four major, color-coded sections:

• Early Stage AD – may last 2-4 years
• Middle Stage AD – may last 2-10 years
• Late Stage AD – may last 1-3 years
• Resources Guide

Each of the first three sections are further broken into the following parts:

• Pre-Game Planning – Largely focused on knowing what you’re up against in this stage
• Coaches and Special Teams – Mostly addressing doctors and ‘special teams’ that might include anything from support groups to Hospice
• Playing Offense – Making sure that you have a plan in place, both daily and long-term, and being prepared to adjust the plans
• Playing Defense – Preparing for the likely behaviors that come with Alzheimer’s
• The Training Table – Special attention to nutrition for both the patient and the caregiver

What can we say? It’s the most thoughtfully presented guide to Alzheimer’s on the net.

Bonus: The Alzheimer’s Playbook site has a download page with the Playbook in numerous languages, a pocket tip sheet and Playbook audio book.

Mayo Clinic on Alzheimer’s

While the Mayo Clinic site has a few small quirks, it’s a nice site within the overall MC site. Quirks? It was a little off-putting that it started with the definition of Alzheimer’s. It gave the appearance that there wasn’t any depth to the site, which there is. There’s also a link to their “new blog” which links to the first post in 2006. Have no fear, they’ve posted as recently as March 19.

The site has a number of major areas for Alzheimer’s on tabs at the top of the page. The tabs include:

• Basics – Includes a number of subtopics like Definition, Symptoms, Causes, Risk factors, Complications, Preparing for your appointment
• In Depth – Is a deeper look at some of the topics in the Basics area
• Multimedia – Includes images, slide shows and podcasts
• Expert Answers – Coverage of AD related topics like, “Antipsychotic drugs: Can they help people with Alzheimer’s?”
• Expert Blog – With posts once, or twice, a month including topics like, “Should you tell someone about his or her Alzheimer’s diagnosis?”
• Resources – Links to a number of key Alzheimer’s sites
• What’s new – A page that points you to new content on the site

Alzheimer’s Association Publication Page

Finally, a single page from the Alzheimer’s Association site that is of particular merit is the publications page. Acrobat PDF files are often a place to find well crafted and focused reports on a particular topic. The Alzheimer’s association has pulled together a good number of documents and categorized them under the following groups:

• Basics
• Caregiving
• If You Have Dementia
• Quality Care
• Safety
• Financial/Legal
• Reports
• Alzheimer’s Association

There are 90+ files in this area, so we’ll only highlight a few.

• Alzheimer’s Disease: The Basics – A great 32-page introduction to Alzheimer’s.
• Respite Care Guide – A nice overview of getting a break if you’re a caregiver.
• Staying Safe – A brochure on safety at home, while traveling or in an emergency.
• Money Matters – A brochure on identifying the cost of care and how to pay for them.

From Halley via Flickr

There’s much said about caregivers’ need for support, but it’s often difficult to know how to help a caregiver when they need it. The tips here approach caregiver help from the perspective of the caregiver’s helper.

You may have already offered to help a caregiver, but not yet been asked. Often caregivers have many reasons for not asking for help. They may appreciate the offer, but think that it would be an imposition to ask. They may not know how to ask. Subconsciously they may feel that to ask would be to abdicate a responsibility. Or most plainly, they may think it too difficult for the person who made the offer.

One way to make it easier for a caregiver to accept your offer of help is to make it as specific as possible:

• “I made an extra big casserole so that you could have some.”
• “Do you need some laundry done? I can come over today and do it.”
• “I’m going to the store. May I pick up a few things for you?”
• “I’ve got the afternoon off tomorrow. May I fill in for you while you run some errands?”

If you’re able to bridge the acceptance gap, consider making an offer to do something on a routine basis:

• Assist with yard work, like mowing the lawn, or snow removal
• Do laundry
• Do some part of the routine housecleaning

Whatever you do, be sure not to add additional stress:

• Be on time and follow through on offers
• If you’re doing yard work, bring your own tools if you can
• Be careful not to be disruptive to the caregiving process
• If there is a group helping out, try designate one person to coordinate assistance

Caregivers can become socially isolated. Try to combine respite with a social occasion. If there is a group of friends/family that can help on a periodic basis, see if the caregiver is amenable to have everyone over for a morning of chores and a potluck lunch.

The keys in helping a caregiver are to be patient in letting them choose the time and circumstances for accepting your assistance, be sure that you’re not adding stress with your offers, and be as consistent as possible in your follow through on your help.

Courtesy code poet via Flickr

We ran across The Caregiver’s Marketplace a while back and wondered if it was worth the effort. After looking into it, I think that depending upon your financial situation, it could very well be a help to the everyday household budget.

The Caregiver’s Marketplace is a rebate program for a good number of products that you may find yourself buying on a regular basis if you’re a senior, or a caregiver. Many of them are routinely purchased items like Benzodent, Citrucel, Comfort Bath, Depend, Ensure, Glucerna, Kaopectate, Oscal and Poise.

The way The Caregiver’s Marketplace works is that when you buy five, or more, products that are part of the program, you can send the receipts with the rebate form and get anywhere from 25 cents to $2.00 back per item you purchased. Most of the rebates look to be 75 cents and $1.00. The important thing to note here is that if you purchase fifty Ensure six packs in a year, that’s $50 back. There appears to be no limit to how many rebates you, as an individual, can get.

The obvious strategy here is to put the rebate form, that you can download from their site, and the weekly receipts (with the eligible items circled) in an envelope. Periodically send in for your rebates. You may decide to do it every time you have five plus items, or once a month/quarter, or whatever is most convenient for you.

Most of the products are for seniors, but there are a number of products for babies as well. So if you’re a caregiver for two generations, you may be able to save even more.

For more info on respite care, see our recent post on respite care for more information.

Many sources of funds for respite care require a level of financial need. If the senior can afford to pay for the care, some of the avenues that might pay for respite care will be closed to you. You should still investigate your options.

Find the right organization

There are a number of reasons why you may find yourself in a situation where respite care, and that’s the first tip for finding help. For instance, commonly seniors who are in need of continuous, or near continuous, care are suffering from chronic, debilitating, progressive diseases like Parkinson’s, or Alzheimer’s. Organizations like Alzheimer’s Association and National Parkinson Foundation have programs that may help pay for respite care. Other organizations like these may offer help with respite care.

If the senior is nearing the end of life and is in the care of Hospice, Medicare will cover inpatient respite care. You can stay in a Medicare-approved facility up to 5 days each time you get respite care. Medicare requires that the patient pays for 5% of the care associated with respite care. For more information on Medicare covered respite care, see their publication (PDF) called Medicare Hospice Benefits.

Go local

One of the best ways to find help with respite care and possible sources of funds are to talk to people locally. Both the Parkinson’s and Alzheimer’s sites have ways of finding local chapters and support groups. Ask them what they would recommend for respite care in your area.

The Eldercare Locator, a public service of the Administration on Aging, U.S. Department of Health and Human Services, can help you find care locally. They have a good page on respite care.

Check out Chapel Hill Training-Outreach Project. They have a respite locator to help you find a respite care provider in your area. They may be able to give you help in finding a way to pay. They also have links to state respite coalitions that may help.

Consider contacting a SHIP counselor who may be able to help guide you to help on respite care.

Catholic Social Services and other church-based programs often help with respite care.

Other considerations

Not all respite care is alike. In some cases, the need is for a day, or even a part of a day; time enough to get away and have time to relax for a few hours. In other cases, it’s truly time for a week’s vacation. Each type of respite care has different solutions. Investigate your options for both, because you’ll likely need both.

Let us know if you have any tips on paying for respite care.

Related Links

Alzheimer’s Association: Respite Care Guide (PDF)

The following is an email that periodically makes the rounds in email…that’s true.

This might be a lifesaver if you can remember the following advice, sent by a nurse, whose husband is a medical doctor.

Sometimes symptoms of a stroke are difficult to identify. A stroke victim may suffer permanent brain damage when people fail to recognize what’s happening. Now, doctors say any bystander can recognize a stroke, simply by asking three questions:

• Ask the individual to smile.
• Ask him or her to raise both arms.
• Ask the person to speak a simple sentence.

If he or she has trouble with any of these tasks, call 911 immediately, and describe the symptoms to the dispatcher. Researchers are urging the general public to learn to ask these three questions quickly, to someone they suspect of having a stroke. Widespread use of this test could result in prompt diagnosis and treatment of a stroke, and prevent permanent brain damage.

Bonus: The American Stroke Association has a fun and educational email application that you lets you send a message to a friend on recognizing the symptoms of a stroke.

Amanda M Hatfield via Flickr

When I was a kid, flushing things down the toilet was good sport. Of course I was five at the time. Today it seems as though just about nothing, save the obvious, can be flushed. The concern over flushing prescription meds down the drain was amplified last year when the drinking water in 24 major cities was found to contain, “A vast array of pharmaceuticals — including antibiotics, anti-convulsants, mood stabilizers and sex hormones”.

Seniors of course take significantly more prescription medications that the average adult. And while you should follow your doctors orders and finish the medicine, it’s not uncommon for a physician to change your prescription midstream leaving you with unwanted pills.

So what to do with the excess meds? The FDA says that there are a few drugs that should be flushed, many should not.

Specifically, the FDA recommends:
Follow any specific disposal instructions on the drug label or patient information that accompanies the medication. Do not flush prescription drugs down the toilet unless this information specifically instructs you to do so.

• If no instructions are given, throw the drugs in the household trash, but first:
  • Take them out of their original containers and mix them with an undesirable substance, such as used coffee grounds or kitty litter. The medication will be less appealing to children and pets, and unrecognizable to people who may intentionally go through your trash.
  • Put them in a sealable bag, empty can, or other container to prevent the medication from leaking or breaking out of a garbage bag.
• Take advantage of community drug take-back programs that allow the public to bring unused drugs to a central location for proper disposal. Call your city or county government’s household trash and recycling service (see blue pages in phone book) to see if a take-back program is available in your community.

FDA’s Director of Pharmacy Affairs, Ilisa Bernstein, Pharm.D., J.D., offers some additional tips:

• Before throwing out a medicine container, scratch out all identifying information on the prescription label to make it unreadable. This will help protect your identity and the privacy of your personal health information.
• Do not give medications to friends. Doctors prescribe drugs based on a person’s specific symptoms and medical history. A drug that works for you could be dangerous for someone else.
• When in doubt about proper disposal, talk to your pharmacist.

Bernstein says the same disposal methods for prescription drugs could apply to over-the-counter drugs as well.

Despite the FDA’s flushing policy, we recommend investigating local disposal options. Check with your doctor and pharmacist whenever you get a new prescription to see if they can dispose of them, or if can recommend an alternative. Policies are likely to change over time given the publicity over medicines in the drinking water, so keep asking. Check with your local recycling center. Our county has a program to take them and dispose of them.

What can I do? If you have a Longs Drugs, Rite Aid, or Walgreens in your area. Print this page and ask them to take your unused prescription medicines.

Additional Links

• SMARxT Disposal
• Prescription drugs that ARE recommended for flushing
• FDA Page on drug disposal

Update 9/21/09: The Environment Report – Cement Pollution & Drug Disposal

Flickr by Random McRandomhead

In an earlier post (“Fall Prevention” posted by lmcgowan on January 14, 2009), I provided readers with an overview of the many risk factors associated with falls in the elderly and a list of things they can do to prevent such falls.  As we learned in that post, clutter can be a real concern.  According to ReadersDigest.com, clutter “places hoarders and their families, especially the elderly, at high risk for injuring themselves in a fall.”  

The Reader’s Digest online article also stresses that  ”dust, mildew, mold and rodent droppings commonly found in extreme clutter can irritate allergies or lead to headaches or respiratory problems like asthma for hoarders and their families. In some cases, home maintenance suffers, so individuals may endure freezing winters without heat and sweltering summers with no air conditioning.”  There have even been extreme situations in which “hoarding endangers not only the residents but also neighbors and firefighters, who face greater risk of injury and death when battling clutter-fed flames.  It can become a financial threat to communities as well.  Making a hoarder’s home safe and habitable can be staggeringly expensive, and hoards can’t always pick up that tab.”

A recent article on Martha Stewart’s website explains that:

• - “1.4 million Americans suffer from chronic hoarding & clutter.”
• - “People burn 55 minutes a day looking for things.” and
• - “80 percent of what we own we never use.”

She provides her site visitors with some excellent ways to eliminate and handle clutter in their homes.