How Being a Parent Paves the Way for Parent-Caring
By Paula Spencer, Caring.com

Child care and elder-parent care have a lot of parallels. I say this from the authority of having four of the former and two of the latter. It's risky to compare the two ends of the age spectrum, I'm well aware. Someone's sure to take me to task for implying that older adults are like children –- which, I agree, is as untrue as it is disrespectful.
However....
Time and again, my aging parents' needs have called up certain of my traits and skills in a distinctly deja-vu way. Been there, done that before. Turns out it's a silver lining –- pun intended –- to the hard work of being a parent. It was practice for my future of looking after my parents!

So, for example, here are six parenting traits that still are helping me now –- and why:

• My all-hands-on-deck approach to climbing the learning curve. There's been no end to new situations to grasp. (Vascular dementia. Macular degeneration. Pelvic ring. Transitional cell carcinoma. Ohmigosh.) On the other hand, I didn't go home with my firstborn knowing anything about jaundice, clogged milk ducts, or what the heck he was crying about all the time. Different crises, higher stakes now, but similar levels of abject ignorance.
  
  So I'm in repeat mode on my approach: a) Ask the doctor (geriatricians and internists have nurse-call-in lines, too); b) Read as much as I can on each problem, even the opposing opinions, til I can make up my own mind or at least talk to the doctor intelligently about it; and c) Rabidly compare notes with friends. Of course, with my babies I could also d) Endlessly quiz my mom. Since I can't do that now, I ask more friends. Or find new ones who can relate.
• My toughened hide. As a mom, I've learned the hard way to let a certain amount of toddler tantrums and teen angst roll off my back. It's good preparation when, say, dementia steals your genial dad. (Or worse, from what I hear from others.) I know there's a big picture. Besides, occasionally being treated with all the warmth of an ungrateful wretch makes the eventual thanks-I-love-yous all the sweeter.
• My ability to read body language. It speaks louder than words. I've always worried more about the child lying lethargically on the sofa than the one bellyaching about a bellyache on a school morning. Similarly, I know to discount my Dad's chipper "I'm fine!" and instead watch whether his hands are rubbing that sore spot on his side and log how much time he's dozing on the sofa.
• My now-strong stomach. I could never stand blood or guts or other bodily fluids (in movies or in real life) until faced with those of my own flesh and blood. Amazing how you snap out of weenieness in a crisis. True, I think, whether mopping up after your young or your old.
• My ability to lob a well-placed 'no.' Another cookie before dinner? An extravagant new pair of jeans? A bad word sprung during a bad mood? No, nope, not in this house. I've never had any trouble as a mother saying "no" when I felt I needed to. I'm not saying you can or should boss your parents around, but firmness in the right circumstances isn't bossiness. As with kids, it's having the other party's best interests at heart because you, at the moment, are responsible for them. So when my parents wanted me to go buy liquor while I was caring for them (as the only driver) and I knew the doctor had recommended against drinking, I refused. When Mom told me to leave the hospital and sleep but I felt she needed company (and an advocate), remembering I was justified fortified me to overrule.
• My capacity to endure boredom – I mean, my patience. I used to say that a full day with a 1-year-old seemed to drag like a week (although a year zipped by in the blink of an eye!). A mere hour with an 87-year-old who insists on reading the same patch of newspaper over and over can sometimes streeeeeeeeetch like that day with a toddler. Time warps. And don't get me started about how long too many successive evenings of "Wheel of Fortune" can feel! Or sorting through confusing financial paperwork. Coping demands recalibrating... Working harder to relax and savor the moment... Forgetting about the past, or what else I should be doing, or what's to come....

This list hasn’t even touched yet on the specific parenting skills that transfer well: first aid, reading aloud, cajoling a picky eater, biting your tongue so you're not saying "Be careful!" every 10 seconds. Perhaps that's another list. Meanwhile, I'm curious: What traits come in handy both in parenting and parent-caring for you?
For more expert information on caring for your aging parents and loved ones, visit Caring.com

How Medicare Works
By Stephanie Miles, Caring.com

Medicare is the government's contract to provide healthcare insurance coverage for Americans over the age of 65. But, as with all contracts, it's always smart to read the fine print.

Medicare pays for about half of all medical costs for older Americans, including hospitalization, doctors, some nursing care, some prescription drug costs, and medical equipment and supplies. But there's much that Medicare doesn't cover, as well as an alphabet soup of coverages, premiums, deductibles, and eligibility requirements that can be difficult to navigate -- especially for someone facing a health crisis.

Here are the basics everyone should know about Medicare, and where to look for more information if you need it:

What is Medicare?

Medicare consists of four categories: Part A covers hospitalization, some skilled nursing facility and home health care, and hospice. Part B covers doctors' services and outpatient care such as X-rays, laboratory work, some home health care, physical and occupational therapy, and some preventive screening. Then there's Part C, also known as Medicare Advantage, which is Medicare received through a private managed care system such as an HMO (health maintenance organization) or PPO (preferred provider organization). When someone enrolls in a Medicare Advantage plan, they receive all the benefits of Medicare Parts A and B, as well as some additional coverage provided by the private plan. As with other managed care, however, Medicare Advantage plans limit where and how their members may receive care. Finally, there's Medicare Part D, which consists of private insurance plans that partially cover prescription drug costs.

Who's eligible for Medicare?

Most people qualify for all Medicare programs if they're 65 or older and are citizens or permanent residents of the United States. However, eligibility rules and availability are different for each plan within Medicare.

• For Part A, people are automatically eligible without paying any premium if, in addition to the age and residency requirements, they worked and paid Social Security taxes for at least ten years. If not, they may still buy into Part A coverage for a yearly premium.
• For Part B, every citizen and legal resident over 65 is eligible. Even if someone is under age 65, he or she may qualify for both Part A and B if he or she has been receiving Social Security disability benefits for two years or has a chronic kidney disease.
• If they're eligible for Parts A and B, they can choose to receive that coverage through a Part C Medicare Advantage managed care plan, if a plan they like is available where they live.
• Anyone eligible for Medicare may purchase a Part D prescription drug plan offered by private insurance companies in the state where they live.

How does someone enroll in Medicare?

Enrollment is different for each part of Medicare. People who are receiving any type of Social Security benefits when they turn 65 will be automatically enrolled in Parts A and B. Medicare will send them enrollment cards and information about three months before their 65th birthdays. If they aren't automatically enrolled, they may sign up for Part A or Part B at any local Social Security office. They should enroll two or three months before they turn 65, to ensure prompt coverage.

If they delay enrolling in Part A past their 65th birthday, their coverage can date back to up to six months before the date they do apply. Delaying enrollment in Part B is more of a problem. If they wait more than three months after their 65th birthday to enroll in Part B, they may not enroll until January 1 of the following year, and the coverage won't start until July 1 of that year.

If they want to enroll in Part C or D of Medicare, they do so with the private managed care plan or insurance company that runs the particular plan or issues the policy they want. If they don't enroll in Part C or D when they turn 65, or if they want to switch coverage under Part C or D, they can do so during Medicare's annual enrollment period, which falls between November 15 and December 31. (Some managed care plans and insurance companies also allow enrollment throughout the year.)

Which healthcare providers can Medicare patients see?

They can go to any doctor, hospital, clinic, outpatient provider, nursing facility, home care agency, or pharmacy that is approved by Medicare and that accepts Medicare patients. Before a visit, it's essential to verify that the doctor or other provider accepts Medicare.

What's covered by Medicare?

Medicare is intended primarily to provide coverage if when someone becomes ill or injured. This includes hospitalization, doctors' services, lab work, X-rays, hospice, and just about every kind of outpatient care, as well as some inpatient nursing facility and psychiatric care.

Over the years, however, Medicare has evolved to also cover a range of preventive and screening services through the Part B plan. Some of these services include cardiovascular screening; smoking cessation counseling; screening for breast, cervical, vaginal, colon, and prostate cancers; immunizations for flu, pneumococcal virus, and hepatitis B; diabetes screening and supplies; glaucoma tests; and a "Welcome to Medicare" physical exam. Most Medicare Part C managed care plans offer even more of these preventive and screening services.

For those who meet certain requirements for home health care, Medicare also pays for part-time nursing care; part-time health aides; speech, physical, and occupational therapy; and medical supplies and equipment such as bandages and wheelchairs.

Under Part D, the prescription drug benefit, Medicare covers part of the cost of approved generic and brand-name prescription drugs purchased at participating pharmacies.

One useful tool to check Medicare coverage for various services, procedures and devices is the Medicare Information Finder.

What's not covered by Medicare?

Medicare isn't intended or designed to provide long-term nursing home or in-home care, so there are significant gaps in these areas. Families can't rely on Medicare to pay for 24-hour at-home care, meals, delivery services, and many of the personal services provided by home health aides (except for some skilled nursing care for a short time if it's medically necessary ).

Although Medicare has added many preventive services to its coverage in recent years, many such routine care needs are not yet covered, including dental care, medical treatment outside the United States, routine foot care, glasses, and hearing aids. Medicare coverage for mental health treatment -- including depression, which is a growing issue among people over 65 -- is also significantly limited. And Medicare doesn't cover elective procedures, including cosmetic surgery.

Most important, make sure the doctors you have in mind accept Medicare, or the program won't pay for even covered costs. This is also true for outpatient care and home care, and for prescription drugs, which Medicare patients must buy from a pharmacy that participates in their particular Part D insurance plan.

How much does Medicare cost?

Each part of Medicare has a different payment system. And within each part, patients' out-of-pocket costs will depend on the particular way they receive their benefits. However, the following basic information about premiums and copayments holds true in most cases. The figures given are for 2009.

• Part A: Most people pay no premium for Medicare Part A. People who aren't automatically eligible for Part A pay a monthly premium of up to $443. Everyone with Part A pays a deductible of $1,068 for each period of hospitalization, and copayments for each day past the first 60 days of a particular hospital stay.
• Part B: Every individual pays a premium of at least $96.40 a month for Part B coverage, deducted from monthly Social Security checks; this figure goes up for people with high incomes. A person must also meet an annual deductible of $135. After the deductible, Medicare pays 80 percent of the approved amount for covered doctor services, and 80 to 100 percent of the approved amount for outpatient services and medical equipment. Those who don't enroll in Part B when they turn 65 can enroll later -- but each year they put it off, the premium increases by 10 percent.
• Part C: Part C Medicare Advantage private managed care health plans lump Part A and B together, offering one monthly premium and the plan's own set of copayments and deductibles. It's important to check not only premiums but also out-of-pocket costs when considering one of these plans.
• Part D: Every prescription drug plan under Part D has different premiums, copayments, and coverages. In choosing a plan, be sure not to focus solely on the lowest monthly premium but also on coverage of the specific drugs needed and any copayments that might apply.

Where can I find more information about Medicare? More detailed information about each part of Medicare is offered on Caring.com. You can also look at the federal website for Medicare and Medicaid, as well as at Benefits Checkup, an online service run by the National Council on Aging that can help you identify which government benefits your seniors qualify for and how to enroll.
For more expert information on caring for your aging parents and loved ones, visit Caring.com

5 Legal Documents You Need for Your Parents
By Susan Kostal, Caring.com
 
These documents will ensure that you can assist your parents in a medical or financial emergency and, at their deaths, ease the distribution of their estate.

• A medical directive. Also known as a living will or advance health care directive, this document sets out what kind of care your parents want to receive if and when they become ill or incapacitated.
• A durable power of attorney for healthcare and HIPAA release. A durable power of attorney for healthcare allows you to make healthcare decisions for your parents. A HIPAA release gives you access to your parents' health records and physicians.
• A durable power of attorney for finances. A durable power of attorney for finances allows you to manage your parents' financial affairs, pay bills, sell property, and so on.
• A revocable living trust. It allows your parents to retain control over their estate while making transfers of assets to beneficiaries. Your parents designate what property (home, investments, jewelry, and so on) goes into the trust and to whom it will be granted. During their lifetimes, your parents act as executors of their own living trust. A revocable living trust has an important advantage: it allows their estate to avoid probate at the time of their deaths.
• A will. A will makes clear who will receive your parents' assets and personal property. A properly written will helps to avoid disagreements over your parents' estate after their deaths.
  
  For more expert information on caring for your aging parents and loved ones, visit Caring.com

20 Easy Ways to Boost Your Memory
by Paula Spencer, Caring.com

Worried about fading brain power? If you're older than 27, you have good reason. That's the age when cognitive skills start to decline, according to new University of Virginia research. But while some changes in thinking and memory are inevitable as we age, the good news is that lifestyle seems to be able to blunt those effects -- and keep many minds working sharply well into old age.

That's reassuring, given headlines from the Alzheimer's Association's new annual report showing that every 70 seconds, someone in the U.S. develops Alzheimer's (the most common form of dementia).

Debilitating memory loss doesn't happen to everyone, though. Learn what you can do to preserve yours.

1. Take the stairs

Exercise benefits your head as much as the rest of your body, a growing number of studies indicate. Overall cardiorespiratory fitness also lowers the risk of obesity, diabetes, and cardiovascular problems -- all known risk factors for Alzheimer's disease. Theories on why that's so range from improved blood flow to the brain to less brain shrinkage.

Experts recommend making regular aerobic workouts part of your routine. Failing that, it appears that even small efforts add up. So avoid elevators. Park at the far end of the parking lot. Start by walking around your block in the evenings, and add a few minutes more each day.

2. Change your wallpaper

When doing routine things, the brain runs on autopilot. Novelty, on the other hand, literally fires up the brain as new data creates and works new neural pathways.

So shake up what you see and do every day: If your computer screen background is "invisible" to you, run a program that mixes it up every day or every hour. Take a different route home from work. Brush your teeth with your nondominant hand. Buy, borrow, or download a book that makes you think about new ideas.

3. Steal some zzz's by daylight

It's while you're sleeping that your brain sorts, consolidates, and stores memories accumulated during the day -- that's why eight hours at night is so valuable. But a mere six-minute nap is as valuable as a full night's sleep to short-term recall, according to German research. And a 90-minute nap has been shown to speed up the process that helps the brain consolidate long-term memories.

4. Take a mental "photograph"

Memories aren't just stored in one spot in the brain; bits of data are processed and stored in different areas. To help make the memory of an incident last, take a "snapshot" of it while you're in the moment, using all your senses. Look around and think about what you see. Notice colors and textures. What do you smell? If you're eating or drinking (or kissing), what's the taste?

This "mental camera" trick can help you hang onto a happy memory longer. But it can also help you remember where you parked your car.

5. Eat less

After only 12 weeks, healthy volunteers (average age 60) who reduced their daily calories by 30 percent scored 20 percent better on memory tests, University of Munster (Germany) researchers reported in January. The possible reason: decreased levels of insulin, created when the body processes food, and of the inflammation-associated molecule C-reactive protein. Both factors are linked to improved memory function.

The people in the study were cautioned not to consume fewer than 1,200 calories a day. If cutting back on your diet by nearly a third seems too daunting, focus on eating less fat, meat, and dairy products. Earlier this year, Columbia University Medical Center researchers reported that in a long-term study of more than 1,300 participants, those with the highest adherence to a Mediterranean diet -- rich in vegetables, legumes, fish, and monounsaturated oils (like olive oil) but low in fat, beef, and dairy -- had the lowest risk of developing mild cognitive impairment and Alzheimer's disease.

6. Try a "brain-training" game -- or join a "brain gym"

The science is promising, if not conclusive, as to whether so-called brain-fitness software can actually improve memory. A study in the April 2009 *Journal of the American Geriatric Society* shows that people over 65 who used a computerized cognitive training program for an hour a day, over a period of eight weeks, improved memory and attention more than a control group.

7. Spend some time online

Neuroscientist Gary Small, director of the UCLA Memory & Aging Center and author of* iBrain*, says searching the Web is a bit like using a brain-training course. His researchers used MRI to measure brain activity in Web users ages 55 to 76; the net-savvy users showed twice as much brain activity, especially regarding decision making.

8. Stop and sip a cuppa

Green and black teas have a protective effect on memory, possibly by influencing enzymes in the brain. The caffeine sparks concentration, too. And people who drink moderate amounts of coffee at midlife -- as many as three to five cups -- have lower odds of developing dementia in late life, Finnish and French researchers say.

Another benefit: Taking a coffee or tea break in your day (or three times a day) is a good opportunity for destressing.

9. See a doctor if you feel depressed

Maybe it's "just a mood." But untreated depression is common and can impair memory. Talk therapy and/or antidepressant medication can resolve the problem. Two red flags worth mentioning to a physician: a loss of interest in things that once gave you pleasure and a persistent sense of hopelessness. People at higher risk for depression include caregivers of older people and those who have a family history of depression.

10. Take the "multi" out of your tasking

Especially when they're trying to learn something new, people remember less well later if they were multitasking while learning, UCLA researchers have shown. If, for example, you're studying while listening to the radio, your memory recall may be dependent on the music to help you later retrieve the information during the test -- except, of course, that you can't usually replicate the same circumstances (like music during a test). Try to learn something new -- reading a contract or directions, copying a skill -- when you can give it your full concentration. Cut out distractions like the TV in the background or pausing every few seconds when you hear the "ding" of your e-mail or text-message inbox.

11. Keep your blood sugar under control

If you're diabetes-free, work to maintain a normal weight and follow a balanced diet to reduce your odds of developing the disease. If you're a type 2 diabetic already, follow medical advice for managing blood sugar levels.

New research shows that brain functioning subtly slows as diabetics' blood sugar rises and the blood vessels that supply the brain are damaged. This process begins well before memory problems become obvious, or even before there's a diabetes diagnosis.

12. Waggle your eyes back and forth

To help you remember something important, scan your eyes from side to side for 30 seconds. This little exercise helps unite the two hemispheres of the brain, say researchers at Manchester Metropolitan University in England. When the two hemispheres communicate well, you're better able to retrieve certain types of memories.

13. Eat your green vegetables

There's no such thing as an "anti-Alzheimer's diet." But people who are deficient in folate and vitamin B12 have an increased risk of developing dementia. (The research is iffy, in comparison, on the benefits of taking so-called memory enhancers: vitamin C supplements, ginkgo biloba, and vitamin E.)

Great vegetable sources of folate include romaine lettuce, spinach, asparagus, turnip greens, mustard greens, parsley, collards, broccoli, cauliflower, and beets. For you vegetable haters, the nutrient is also abundant in lentils, calf's liver, pinto beans, and black beans.

14. Don't ignore sleep apnea

People with sleep apnea -- a condition involving blocked airways that causes people to briefly stop breathing during sleep -- show declines in brain tissue that stores memory, researchers at UCLA reported last year.

More than 12 million Americans have obstructive sleep apnea. If your doctor has suggested you have the condition, be vigilant about trying treatment, which can include wearing oral appliances and "masks," losing weight, and surgery.

15. Learn something new that's a real departure for you

If you're a sudoku fan, you might think a good way to stretch your mind would be to take up a different Japanese numbers game, like kenken or kakuro. But an even better strategy for a nimble brain is to pursue a new kind of activity using skills far different from those you're accustomed to using.

If you ordinarily like numbers, try learning a language. If you're an ace gardener, try painting flowers instead.

16. Quit smoking

The relationship between smoking and Alzheimer's disease is hazy. But smokers do develop the disease six to seven years earlier than nonsmokers.

In case you were looking for another good reason to quit.

17. Eat some chocolate!

Every year some study extols the virtue of dark chocolate, and the effects of this wonder-food (or, at least, wonderful food) on memory have not gone ignored by researchers. In 2007, a *Journal of Neuroscience *study reported on the memory-boosting effects in rats of a plant compound called epicatechin, possibly because it fueled blood vessel growth.

In addition to cocoa, epicatechin is found in blueberries, grapes, and tea.

18. Put everything in its place

While novelty is like growth hormone to the brain, your memory needs a certain amount of familiarity to keep your life functioning smoothly. Place your keys and glasses in the same place all the time. Write notes to yourself as reminders (the very act of writing will help your recall). If you want to remember your umbrella tomorrow morning, place it right at the door, so you won't miss it.

19. Don't retire

Good news for those who can no longer afford to quit: Provided you like your work, you're helping your brain by sticking with it as long as you can. A satisfying work life offers social stimulation and decision-making opportunities -- and exercises problem-solving skills.

Next best: Volunteering, such as at a school or museum, where your training involves learning new material and the task involves interacting with others.

20. Throw a party

Being around other people lowers one's risk of developing dementia. The catch: They should be people you enjoy who make you feel engaged and stimulated. People who are physically isolated (not around people) or emotionally isolated (around people but feeling lonely nevertheless) are at higher risk for depression.

Just go easy on the alcohol at those parties. Studies on its effect on memory are mixed. Long-term, excessive drinking is clearly linked with dementia. Binge drinking also impairs short-term memory. On the other hand, for people who drink moderately (one drink a day), alcohol may have a protective effect. One study found that in people with mild cognitive impairment (mild memory loss that doesn't necessarily advance to dementia), those who drink less than one drink a day progressed to dementia at a rate 85 percent slower than teetotalers who didn't drink at all.

For more expert information on caring for your aging parents and loved ones, visit Caring.com

12 Signs You Probably DON'T Have Alzheimer's
by Paula Spencer, Caring.com

Are you worried that you might have Alzheimer's or another form of dementia? Many a stressed-out caregiver is a bit over-worried. Watching a family member with dementia decline is enough to make anyone secretly fear his or her own occasional memory lapses or confused moments.

Which is why I want to offer a little gentle reassurance this week as the Alzheimer's Association kicks off a renewed emphasis on early detection with a big campaign about its 10 warning signs of Alzheimer's.

I'm all for this campaign. But it's also worth emphasizing the flip side to overloaded caregivers, who are often also in midlife and coping with work and sandwich-generation demands: The statistical odds indicate that you're probably okay. I don't say that to make light of Alzheimer's disease or the horrible fact that early-onset Alzheimer's cases are on the rise. And I would urge anybody nagged by suspicions to get them checked out pronto.

But when you're under a lot of strain, other factors can also play with your mind, such as moving too fast, not getting enough sleep, depression, or plain old worry. The majority of people over age 50 – even over 60, 70, or 80 – don't have dementia.

So if it makes you feel any better, here are 12 signs that generally don't indicate Alzheimer's:

1. Forgetting a new acquaintance's name. Everybody does it.

2. Forgetting an old acquaintance's name. It's more embarrassing, but everybody does this, too.

3. Remembering in the middle of the night that you forgot to put out tomorrow's trash for pick-up. The fact that you eventually remembered is positive.

4. You caught another mistake when balancing your checkbook. Balancing a checkbook is a complicated task; that you can do most of it flawlessly is a good sign. And slipshod math is common.

5. You can't remember where you parked the car. Unless you always park in the same spot and then forget, occasionally blanking is no big deal, especially in vast lots at a shopping center, hospital, or mall. Possible problem: If you have to write down where you park each and every time.

6. Feeling too blah to attend book group, an activity you usually love. Losing interest in hobbies or a social life is a hallmark of the disease. But wanting to chill alone every so often is, well, human. Take care not to make it a habit; isolating yourself socially is also a red flag for depression, something caregivers are definitely at risk for.

7. Losing your sunglasses – again. To misplace is human. To finally find the sunglasses in the refrigerator or the trash, on the other hand, is possible Alzheimer's.

8. Your partner elbows you at a party and says, "Oh please, don't tell that story again." Over the years, couples often build up a trove of anecdotes (how we met, the time we sat next to a movie star on a plane, how we bought our house for a song, the day we learned our son was a genius). Such tales and jokes are often ignited by certain social cues. Knowing you're doing this is different from hearing, "But you just told that story five minutes ago" – and not remembering doing so.

9. Not recognizing your own reflection for a second after a new haircut or new glasses. Your brain's still absorbing the new look. More worrisome: Still thinking, after a moment's pause, that the person staring back at you in the mirror is someone else.

10. Forgetting an appointment, or arriving on the wrong day. Big goof, but still. Blame stress, multi-tasking, or maybe needing a better planner system. Don't worry unless this is happening routinely, instead of once in a full blue moon.

11. Feeling old and baffled because you can't figure out how to text message, set up wireless access in your house, or stream video to your TV set (though the 10-year-old kid next door can). I write from experience: Technology moves faster than many a middle-aged mind. And instructions often seem written by non-Englishspeaking tech-heads. Keeping up with progress is different from losing ground --- e.g. no longer being able to follow a recipe or tell a cell phone from a TV remote.

12. Saying stuff like, "that thingamabob" or "you know, that actress who was in that movie…". Sounds like typical over-40 conversation to me. Proper words for things do tend to elude people with Alzheimer's but they improvise strangely ("ice on a stick" for popsicle, "hair fork" for comb). But as for peppering your talk with "thingys" and "that’s," well for that you're still on pretty solid ground if you can still manage to Google.

Still not sure, whether about yourself or someone you love? Okay. Learn more about what to watch for if you suspect Alzheimer's. Go find out for sure. Early detection puts people on a better coping path.

Or maybe now you have one fewer thing to worry about.

For more expert information on caring for your aging parents and loved ones, visit Caring.com

8 Steps to Make Independent Living Work
How to help older adults age in place
By Nell Bernstein, Caring.com

The great majority of older adults say they'd prefer to live out their days in their own home. The likelihood of making independent living work is much greater, though, if everyone involved does some conscious planning -- the earlier the better. These eight steps will set you on your way.

1. Have a group or family meeting.

This is the first step toward building what Ann Cason, author of Circles of Care: How to Set Up Quality Home Care for Our Elders, calls a "circle of care." This network may include paid caregivers, health care providers, friends, and neighbors as well as family members. With planning, you can all work together to provide a web of support for older adults as they continue to age.

Such a meeting is also a good opportunity get clear early on about what care-giving duties the older adults in your care may -- perhaps unconsciously -- expect you to assume as they get older, and what you and other caregivers or siblings are (and aren't) willing or able to take on. A frank conversation about this upfront can help avert potential resentment or disappointment down the line.

2. "Future-fit" their home for independent living

Take a tour of their home, perhaps with them, and think about how to make it safer and more navigable. Everything from a grab bar in the bathroom to a variety of new high-tech gadgets aimed at helping elders live independently at home safely are worth a look.

Your local Area Agency on Aging or a private geriatric care manager can refer you to an occupational therapist who can help identify hidden hazards and ways to make their home easier to navigate as they get older. The occupational therapist may also be able to recommend companies or tradespeople who can make necessary renovations.

This is also the time to think about downsizing -- helping them get rid of decades of accumulated belongings that can make their home harder to maintain as they age.

Create an independent living care plan

3. Observe and then put together a plan

A family member or caregiver should start by spending a day with them, suggests Cason, writing down their daily routine. This will let you know when they are most alert and active, and also when they're most likely to be tired, depressed, or anxious. Then you can help plan activities for when they're at their best, and perhaps extra care during the low points of the day, when they may be more vulnerable to accidents or just feeling blue.

Practical needs to consider might include:

• Transportation Do they plan to continue driving? What are the options in their area if they need to stop driving at some point?
• Finances Do they have the income to cover their needs, including in-home care if they could use it? If not, what public or private resources can they or their family draw on to help? Do they plan to manage their own finances, or do they need or want help? If they do, how do they find that help?
• Health care Do they live near their doctors and a hospital? What do they plan to do if they have a medical problem on the weekend or on a holiday?
• Household maintenance Which tasks can they still handle, and which do they need help with? Who is available -- volunteer or professional -- to help out?

4. Explore all the options

Options for independent living have changed just as much in recent years as those for out-of-home care. As you plan, consider some of the less-obvious solutions, such as a home share, putting in a specially designed backyard cottage called an ECHO, or helping them turn their neighborhood into a naturally occurring retirement community, in which older neighbors organize, sometimes with the help of a community agency, to provide collective services.

5. Learn about in-home care resources for independent living

Independent living doesn't have to mean going it alone. In-home care options run the gamut from basic services such as housekeeping and meal delivery all the way to live-in nurse's aides.

Examine independent living alternatives

6. Make a contingency plan

Don't get caught unprepared by an illness or sudden change in health in those you're caring for. Get to know local senior communities and skilled nursing facilities. Ask the older adults in your care where they'd prefer to go should the need arise. If possible, visit those communities and keep a file with information about eligibility requirements, costs, and application processes.

7. Re-assess regularly

Age -- and the decline in ability that often comes with it -- happens gradually, so those closest to an older person can sometimes miss signs of deterioration. Jot down some baseline notes about how they're doing -- physical mobility, capacity to take care of themselves and their home -- and then reevaluate every six months or so to make sure you aren't missing a new need or issue.

8. Build in joy

Sometimes, says Ann Cason, we spend so much time worrying about protecting older adults' health and keeping them safe that we forget to help them plan their lives around the things they enjoy. They chose to live independently for a reason. Find out what pastimes and pleasures are most important to them -- whether it's a meal with the grandchildren, a drive in the country, or a weekly card game with friends -- and try to find ways to help them continue to pursue those things they enjoy.

For more expert information on caring for your aging parents and loved ones, visit Caring.com

How to Help an Older Adult Age in Place
By Nell Bernstein, Caring.com

The great majority of older adults say they'd prefer to live out their days in their own home. For many, this desire is so strong that they’ll insist on staying in the face of what seems to be an impossible situation.

But even as a friend or relative begins to decline and need more support, "aging in place" can usually continue to work.

The good news is that there’s a wide and growing array of supports available to help older adults age in place safely and in comfort, from high-tech home-monitoring systems to skilled in-home caregivers. The key to successful aging in place is learning about these supports -- and how to "future-proof" her home -- before a health crisis or other emergency strikes.

Practical needs to consider include:

• Transportation. Driving -- which many older adults perceive as the key to their independence -- is a touchy subject, but talking about it is crucial, as is assessing an older adult's ability to continue to drive safely. If she does lose the ability to drive, there are a number of available alternatives, from paratransit and door-to-door vans to enlisting family, friends, and church members to help out with rides on a rotating basis.
• In-home safety. You'll want to do a top-to-bottom review of her home for comfort and potential safety hazards. Put yourself in her shoes and look for (and be prepared to install) things like bright lighting throughout the house, light switches at the top and bottom of stairs, and grab bars in the bathroom, for starters. A certified aging-in-place specialist can make suggestions and help figure out how to implement needed changes.
• Finances. Like driving, money is a touchy subject, but it's important for aging-in-place older adults to have a clear sense of their financial resources and how long they will last, especially if their need for in-home care increases.
  
  Assuming that your friend or relative is comfortable discussing finances with you, sit down with her and go over whether she has the income to cover her needs over time, including in-home care should it become necessary. A financial planner who specializes in eldercare can help. If it looks like there's going to be a lack of funds, become familiar with financial options, from reverse mortgages to Medicaid's Cash and Counseling program, which pays for in-home care in some states, for those eligible.
• Healthcare. Again, planning is key. If she's willing, review her healthcare coverage with her and make a list of her doctors and nearby hospitals. Make sure everyone caring for her knows what the plan is if a medical problem arises on the weekend or on a holiday. The more information you have at hand before something happens, the better prepared you'll be to help when it does.
• Household maintenance. One of the main reasons older adults wind up moving to retirement communities is because they have trouble "keeping up with the house." But if you make a list of household tasks -- both routine and intermittent (mowing the lawn, cleaning the rain gutters, taking the trash cans to the curb) -- and figure out together which tasks she can still handle and which she needs help with, an unwanted move can often be avoided.
  
  The next step is figuring out who’s available -- volunteers or professionals -- to help. A neighbor may be more than happy to take out the trash cans each week, and more time-consuming maintenance tasks can be delegated to a handyman or gardener. If you live nearby and are willing help with something as minor as changing a light bulb that requires climbing a ladder, let her know -- it will bring her and you peace of mind, and will help keep her safe.

For more expert information on caring for your aging parents and loved ones, visit Caring.com

Caring for Elderly Relatives: How to Handle Family Conflicts
By Connie Matthiessen, Caring.com

Common causes of family tensions and disagreements

It shouldn't surprise anyone that sensitive family dynamics can be one of the most challenging aspects of caregiving for an elder, given the tremendous financial, physical, and emotional demands involved. This doesn't mean that family squabbles are inevitable. In fact, if managed well, the experience of caring for an older family member has the potential to bring relatives closer as you help this person through this final stage of life. Here's how to avoid conflicts with family members and work through them when they occur.? Typically, disagreements arise because of:

• Roles and rivalries dating back to childhood. Mature adults often find that they're back in the sandbox when their family gets together. This tendency can grow even more pronounced under the strain of caregiving.
  
  If your sister was the favored child, for example, you may find that -- no matter how successful and capable you are now -- in your parents' or relatives' home you become a jealous, powerless little girl again.
• Disagreements over an elder's condition and capabilities. It's common for family members to have very different ideas about what's wrong with a loved one and what should be done about it. You may be convinced that your family member is no longer capable of driving, while your brothers argue that he needs to maintain his independence.
• Disagreements over financial matters and other practical issues. How to pay for a family member's care is often a huge cause of tension. Financial concerns can influence decisions about where the person should live, whether or not a particular medical intervention is needed, and whether he can afford a housekeeper. These conflicts are often fueled by ongoing resentment over income disparities and perceived inequities in the distribution of the family estate.
• Burden of care. Experts say the most common source of discord among family members occurs when the burden of caring for an elder isn't distributed equally. "Usually one of the adult children in the family takes on most of the care-giving tasks," says Donna Schempp, program director at the Family Caregivers Alliance, a national nonprofit organization that provides information and support to caregivers.

The primary caregiver might assume this role because he lives near the family member, is perceived to have the fewest obligations, or has the closest relationship with the person. Whatever the reasons, the situation is likely to make him resentful.

How to avoid family blowups

The following steps can help you recognize and avoid some of these common land mines, so you can keep the focus where it belongs -- on your family member's care.

• Hold regular family meetings. As soon as the person begins to have health problems, initiate regular family meetings with your siblings and other family members who will be involved in her care. The goal is to share information and make decisions as a group; the meetings can also be a source of support and provide a forum for resolving disagreements.
  
  If all or some of you live in different parts of the country, the meetings can be held by conference call. There are now many free conference call services available (you can search online with the term free conference calls). Set a regular time for the family meetings that's convenient for everyone involved -- it could be once a month, or whatever suits your family -- and if you can, do so before a crisis occurs, so this tool will be in place when you really need it. If possible, reserve a little time at the end of the meeting or conference call to chat and catch up.
• Divide the labor. Rather than insist that all of the care-giving tasks be divided equally, consider a division of labor that takes into account each family member's interests and skills, as well as their availability. Your sister may find it difficult to get away during the day to take your family member to his doctor's appointments, but perhaps she can handle his finances or take the lead in finding an appropriate long-term care situation. A far-flung sibling won't be able to help with day-to-day care but may be able to come for a visit every few months to give you a break. A fair division of labor can mitigate resentment and make caregiving more efficient. The family meeting is an excellent venue for setting up a caregiving schedule and dividing up tasks.

Make an effort to communicate

Most families have taboo subjects that everyone avoids. Sometimes the topic is a sensitive one, like a drinking problem or a family tragedy, but often family members avoid speaking up because they are afraid of hurting feelings -- or simply because openness has never been part of the family culture.

• Talk about it. If you feel you're carrying too much of the burden, consider discussing it with siblings and other family members. They may not realize that you're feeling overwhelmed -- or even know how much you're doing. In a calm, quiet moment -- perhaps at the next family meeting -- explain how you feel in a matter-of-fact, nonconfrontational way. Try to be concrete and specific when you ask for help. For example, ask your sister if she can take over the grocery shopping, or find out if your niece can regularly drive your family member to doctor's appointments.
  
  It's also important to communicate with other family members if you're burned out and need a break. Likewise, if another sibling or family member is doing most of the caregiving, offer support and encourage her to express her frustrations and talk about what would make it easier for her.
• Offer help even if you live far away. If you live far from your family member and other relatives are responsible for most of the care, be sure to offer support. Check in often to see how things are going and to offer whatever assistance you can. Ask about how the caregiver is doing and be a sounding board for frustrations and concerns. Be patient if the caregiver needs to vent.
  
  The National Caregivers Alliance advises relatives who live far away to let the caregivers know how much you appreciate what they do and to make sure that primary caregivers get regular respite. Visit regularly and take over your family member's care if you can, and if you can't, find other ways to make sure primary caregivers get regular breaks. Perhaps you can pay for some additional care or offer to hire a housecleaner for the caregivers.
  
  Resolving conflicts when they occur
• Seek mediation -- especially if you hit trouble spots. A counselor or mediator can help you and your family resolve disagreements or manage particularly difficult care-giving dilemmas. Schempp, who regularly counsels siblings and other caregivers, says, "It helps families to have an outside facilitator who can offer advice and support."
  
  Even if your family doesn't have specific disagreements, you may want to see a counselor on an occasional basis, because experts like Schempp can help you tap into options and resources that you may not be aware of. Many problems facing caregivers have no easy answers. Take, for example, your argument with your brothers about whether your dad can still drive. In a sense you're both right: He might well be too infirm to drive, but he needs his independence. An experienced counselor can help you work through dilemmas like this one and determine what's best for your family member -- and for you. To find a counselor, contact your local senior center or area agency on aging.
• Be part of the solution. If you find yourself in conflict with another family member when caring for an elderly relative, take a step back and get some perspective. Consider your own role in the conflict, and ask yourself if you're acting out an old family role or resentment. It might help you to see a therapist for support and insight.

Make sure that you're taking care of yourself by getting regular sleep, nutritious meals, and exercise. If you're the primary caregiver, you also need to have regular breaks to avoid burnout. These steps won't make the conflict disappear, but chances are they will help you manage and resolve it in a more honest and clear-headed way.

For more expert information on caring for your aging parents and loved ones, visit Caring.com

How to Get Siblings to Help Pay for a Parent's Care
by Melanie Haiken, Caring.com

Okay, it's time to tackle an especially hot topic: How do you get your siblings to help share the costs and work of caring for your parents? Usually what seems to happen is that one sibling, sometimes two, is identified as having the time and flexibility to do the bulk of the care. Sometimes this is because she (yes, it's usually a she) lives closer, sometimes because she's not working in order to run her own home and take care of her own family.

But as we all know, when responsibilities, financial or otherwise, aren't shared fairly, resentment and bitterness are the natural result. Here are some suggestions from Caring.com users and others in the caregiving role for how they've dealt with this touchy topic.

1. Make a list of tasks that need to be done. This should include absolutely everything required to keep your parent living safely. In addition to day-to-day tasks, it should include home maintenance, transportation, and other big issues. In addition, make sure you list those organizational tasks that can be so ridiculously stressful and time consuming, such as dealing with health insurance coverage issues, pension administrators, and the IRS.

2. Convene a family meeting, or schedule a conference call or series of calls. Remember those PTA and Rotary meetings when they'd read out a list of tasks and call for volunteers? This is going to be a lot like that. Driving -- who's going to do it? Cleaning out the gutters -- who's up for that? Then list each day of the week that your parent needs care, and decide who's in charge of that day. (And yes, this means every week. If one sibling takes Tuesdays and then can't come, it's his responsibility to trade days or find a replacement.) Make sure everyone's agreeing to something they can commit to on a long-term basis. A brother who works five days a week could take Saturdays, for example, and make sure mom has an outing to look forward to each week.

3. Designate specialized tasks to those best suited. If there's a family member who's good with numbers, let him or her handle the health insurance, banking, and tax responsibilities. This is often a good area to give to a sibling who lives further away, as it can be done long-distance. If there's a sibling who has contacts in the construction industry, he or she can call in favors and get remodeling and other tasks taken care of.

4. Be sure you've tapped all your parent's resources. Your parent may not have money in his monthly budget for care, but there may be other assets--a reverse mortgage, for example--to tap. If your parent is looking at assisted care facilities, many have financial advisors who can help determine if there are assets available that can be used to pay for care.

5. List the gaps in care, the cost of paid care, and make a financial plan. This part is both the simplest and the hardest. If Tuesdays, Thursdays, and Fridays are still up for grabs, and dad can't be alone, then you need a paid caregiver three days a week. Add up the hours and you have the amount you need per week. How much of that can your parent's budget cover? If mom can afford $160 a week for one day of care, then you and your sibs need to come up with the rest. Or find a way to be there more often.

6. Share the pain. When paying for care, "fair" doesn't necessarily mean an even split. Chances are, a couple of family members with the most flexible schedules and the most free time are providing the bulk of the hands-on care. That leaves others who are getting off the hook time-wise, so it's reasonable to expect them to cough up the cash. And if one sibling is better off financially, it's reasonable to expect him to kick in more. Sadly, this may have to be spelled out clearly in a group discussion. Stories abound of siblings who are able to afford annual vacations to Hawaii yet sit in silence as other sibs try to figure out how to get mom the nursing care she needs.

7. Factor inheritance hopes into the decision process. Not to be crass, but it can help to be open about what you and your siblings are expecting in terms of future inheritance, and how your parent's financial choices today will affect what is likely to come to you. Formerly tight-fisted siblings have been known to suddenly discover they can contribute $200 a month when the alternative is selling the family home, so it won't be there to inherit.

8. Cast the family net widely. Several people told me that they've had more distant relatives such as uncles and aunts, nieces and nephews, even second cousins chip in to help out with paid care. I heard a lovely story about a niece with fond memories of her aunt teaching her to play the piano who offered a monthly contribution. Ditto for around-the-house help; there might be a church friend or neighbor who remembers your mom fondly and would love to sit with her one day a week. Spread the word that you need gifts of time and money; there may be folks out there who'd like a chance to give back, but they can only do so if they're aware of a need.

This list is only the beginning -- families all over the country are coming up with creative ways to help aging family members continue to live as independently as possible. If you have a strategy to add, please share it. We could all use your help.

For more expert information on caring for your aging parents and loved ones, visit Caring.com

How to Know If It's Time to Move an Older Relative Out of the Family Home
By Nell Bernstein, Caring.com

The decision to move aging adults out of the family home is a complex one -- both emotionally and practically. It requires a delicate balancing act between their safety and their emotional stake in staying put. Each of these is important, and helping them make the right decision (while remembering that as long as they are of sound mind, it's ultimately their decision) requires care and planning.

The basic questions to ask in considering a change in housing

Everyone is different, and the decision to move is an intensely personal one. But asking yourself, and those in your care, the following questions can help all of you navigate this difficult terrain.

• Have there been any accidents recently -- or close calls? Who responded, and how long did it take?
• Are activities of daily living getting harder? If the answer is yes, are you able to get in-home help with chores like shopping, cooking, or laundry?
• Are they becoming socially isolated? Lack of companionship can leave older adults more vulnerable to heart problems and other health conditions. If they no longer see friends or visit with neighbors, moving to a place where they would be around other people could actually be a lifesaver.
• Is the house clean and well cared for, and are basic home-maintenance tasks getting taken care of? If not, are they open to getting more in-home help, can they afford it, and do you know how to help them find it?
• Can someone check in on them on a regular basis? If a family member, friend, or neighbor isn't nearby and available to do this, are they willing to consider a home-safety alarm system or daily calling service?
• What's the plan for a worst-case scenario? If there's a fire, earthquake, flood, or other disaster, is someone nearby prepared to assist them?
• Are they clean and well-groomed? If, say, an older man has always been known for his crisply ironed shirts but starts looking disheveled, that may be a clue it's time for another level of support.
• What's in the refrigerator? Is the freezer full of TV dinners and the vegetable drawer empty? Has the milk gone sour? A quick look can tell you whether they're eating well or whether they'll do better someplace where trained staff could make sure they're getting balanced meals.
• How are the pets doing? What about the plants? Their ability to take care of other living things may offer clues to their ability to manage their own care.

Questions about health and well-being regarding a change in housing

• How did those you're caring for weather their most recent illness (for example, a flu or bad cold)? Are they able and willing to seek medical care when needed, or did last winter's cold develop into untreated bronchitis?
• What does the doctor think? With appropriate permission, talk to their doctor. The doctor may share your concerns about their safety at home but may also be able to alleviate them. Sometimes your closeness to the issue can exaggerate your worries, and a little professional distance (and expertise) is just what's needed to clarify the picture.
• How often do they get out -- especially in the winter? Are they spending days without leaving the house because they can no longer drive or are afraid to take the bus alone? While many older adults fear being "locked away" in a retirement home, many such facilities offer regular outings that may actually keep them more mobile and active, not less.
• How are they doing compared with this time last year? The holidays, when families get together after long periods apart, can be a good time to reflect on the previous year and take note of any significant changes. A marked decline from one year to the next may mean it's time to start looking -- and planning -- for a more supportive environment.
• How are you doing? While this decision is not primarily about you -- the caregiver -- your own exhaustion can be a good gauge of a decline in older adults' ability to care for themselves. If their need for care is just plain wearing you out, that may be a sign that it's time to start looking at other options.
• How old are they? Many continuing care facilities have age ceilings after which they won't admit older adults, no matter how healthy they are, so if you have your eye on a particular place, find out what its age cutoff is and plan accordingly.

Questions based on others' perceptions about a change in housing

• Are the older adults you're caring for happy? Safety is crucial, of course, but so is emotional well-being. If they're riddled with anxieties or increasingly lonely, then that may tip the scales toward a move that may not be 100 percent necessary at this point for health and safety reasons. On the other hand, if they have a full life, close neighborhood and community connections, or simply enjoy being at home, it's worth exhausting every option before pushing them to move out of the home they love.
• How do others think they're faring? Sometimes it helps to get a second opinion, either from a family friend or relative or from a professional geriatric care manager who visits older adults' home and does an informal evaluation. While they may initially resist the notion of a "total stranger" checking them out, this one may be worth insisting on (offer to have a family member pay for it as a holiday gift). You may be surprised to find they're willing to share doubts or vulnerabilities with a sympathetic, experienced stranger that they're loathe to admit to their own children or family, easing the family conversations that follow.
• What do they want? This may be the most important question of all -- and you may be surprised by the answer. While an initial response may be a knee-jerk "I'll cross that bridge when I come to it," many older adults harbor the same fears for their current and future safety and security that their caregivers do, even if pride keeps them from voicing them. Taking the time to sit down with them, draw out their concerns, and find out what they fear most about moving out and what they do want to change about their life -- rather than launching into your worries for them, or what you think they ought to do -- may give all of you the information needed to make the right decision for everyone concerned.

For more expert information on caring for your aging parents and loved ones, visit Caring.com