Seniors Especially Prone To Holiday Blues

With the holiday season coming quickly upon us, many of us see changes in a loved one’s mood as the holidays approach. Relatives who live a distance away may notice these changes even more.

The National Institutes of Health estimates that 20% of those 65 or over (about 7 million people) suffer from some form of depression, with up to 2 million suffering from full-blown depression.

Because symptoms are often confused with medical illnesses, dementia or malnutrition, depression in the elderly frequently goes untreated, and can be difficult to diagnose. Also, many seniors simply can’t accept the idea they are depressed, and thus refuse to seek treatment.

Identifying The Causes
Holidays often bring back memories of earlier, perhaps happier times for seniors, that may have included a lost spouse or close friend. Moves from home to assisted living, or changes in routine can also be contributing factors, as they look back at holidays past.

But depression can also signal medical problems. Complications of illness, memory loss, chronic pain, or improper nutrition can all contribute.

Symptoms to watch for can include:

• Depressed, irritable mood
• Expressions of helplessness
• Feelings of sadness or worthlessness
• Anxiety
• Diminished interest in daily activities
• Weight loss
• Loss of appetite
• Fatigue
• Lack of attention to hygiene and personal care
• Difficulty concentrating
• Obsessing about dying
• Discussion of suicide

Differences Between Depression & Dementia
While both depression and dementia share similar symptoms, there are significant differences:

Depression can cause rapid mental decline, but memory of times, dates, and environmental awareness continues. Motor skills may be slow, but normal. Those suffering from depression may also be concerned about concentrating, and worry about memory impairment.
By contrast, dementia causes a slow mental decline, combined with confusion and lack of recognition of familiar locations. Speaking, writing and motor skills become impaired, and the individual with dementia may deny having a problem with memory loss.

Whether dementia or depression, a visit to a physician and a physical exam can identify if there is a medical cause, and help develop a plan for prompt treatment.

Treatment of Depression in Seniors
After identifying the cause of depression, treatment may be as simple as relieving loneliness through companionship, activities and outings. Severe cases of depression can be treated effectively with antidepressant drugs and/or cognitive therapy.

Because a senior may deny problems or have a fear of being mentally ill, it’s important to get involved and make the difference in removing the Holiday Blues. Geriatric Care Management services and In-Home Care services can also help. You can contact ComForcare for both services, at 760-724-7273.

A Care Manager Helps You Navigate Through The Maze

Services from care managers should be something that every family takes advantage of, but in reality very few families use them. Care managers could go a long ways towards helping the family find better and more efficient ways of providing care for a loved one.

The concept is simple. The family hires a professional adviser to act as a guide through the maze of long term care services and providers. The care manager has been there many times. The family is experiencing it usually for the first time.

Hiring a care manager should be no different than hiring an attorney to help with legal problems or a CPA to help with tax problems. Most people don't attempt to solve legal problems on their own. And the use of professional tax advice can be an invaluable investment. The same is true of using a care manager.

Unfortunately there are too few care managers and the public is so poorly informed about the services of a care manager, that valuable resources that could be provided go lacking.

The irony of not using a care manager is that most families -- when given the opportunity to use the care manager -- think they can do it themselves and will not pay the money. Yet the services of a care manager most likely will save them considerably more money then do-it-yourself. The cost of the care manager might be only a fraction of the savings the care manager could produce. Care manager services can also greatly reduce family and caregiver stress and help eliminate family disputes and disagreements.

Even the Yellow Pages do not cooperate in helping the public find care managers. To find a care manager one must look in the Yellow Pages under "Senior Services". Who is going to know to look under that subject?

ComForcare provides Care Management Services through our Certified Geriatric Care Manager, Darcy Mulholland, M.S.W., C.C.M. (photo)

Darcy is certified by the Society of Geriatric Care Managers and holds a masters degree in Social Work from California State University. For over thirty years, she has assisted hundreds of older adults and their families with age-related issues. A list of care managers can also be found at http://www.longtermcarelink.net

Below is a partial list of what a care manager might do:

1. Assess the level and type of care needed and develop a care plan
2. Take steps to start the care plan and keep it functioning
3. Make sure care is received in a safe and disability friendly environment
4. Resolve family conflicts and other family issues relating to long term care
5. Become an advocate for the care recipient and the family caregiver
6. Manage care for a loved one for out-of-town families
7. Conduct ongoing assessments to monitor and implement changes in care
8. Oversee and direct care provided at home
9. Coordinate the efforts of key support systems
10. Provide personal counseling
11. Help with Medicaid qualification and application
12. Arrange for services of legal and financial advisors
13. Manage a conservatorship for a care recipient
14. Provide assistance with placement in assisted living facilities or nursing homes
15. Monitor the care of a family member in a nursing home or in assisted living
16. Assist with the monitoring of medications
17. Find appropriate solutions to avoid a crisis
18. Coordinate medical appointments and medical information
19. Provide transportation to medical appointments
20. Assist families in positive decision making
21. Develop long range plans for older loved ones not now needing care

Let's look at two hypothetical examples to see how a care manager could be used.

Here is the first example:

Mary is taking care of her aging husband at home. He has diabetes and is overweight. Because of the diabetes her husband has severe neuropathy in his legs and feet and it is difficult for him to walk. He also has diabetic retinopathy and cannot see very well. She has to be careful that he does not injure his feet since the last time that happened he was in the hospital for four weeks with a severe infection. She is having difficulty helping him out of bed and with dressing and using the bathroom. She relies heavily on her son who lives nearby to help her manage her husband's care.

On the advice of a friend Mary is told about a care manager, Susan Brown, who helped the friend's family cope with the care of a loved one. The cost of an initial assessment and care plan from the cervices available are provided for the family. Susan also calls a meeting with Mary's family and explains to them the care needs and how they need to commit to help with those needs. Susan makes arrangements to purchase medical equipment for lifting, moving and easier use of the bathroom facilities. Medicare will pay much of this cost.

Susan suggests using a geriatric care Physician she works closely with to help Mary in the care of her husband. The geriatrician meets with Mary and her husband and spends a great deal of time explaining the proper treatment and care of elderly with diabetes. He rearranges medications and puts Mary's husband on a new insulin regimen to better control his blood sugar. He starts a strict diet and insists on weight loss and exercise. The previous doctor seemed more interested in treating symptoms than in changing lifestyles. In contrast to this attitude, the geriatric Physician feels that Mary's husband has a chance of improving his health with proper treatment.

Susan also works closely with an elder law attorney and a financial planner who specializes in the elderly. The attorney prepares documents for the family including powers of attorney, a living will and advice on preserving Mary's remaining assets. The financial planner recommends a reverse mortgage specialist to help Mary and her husband tap unused assets in their home's equity. In addition, an income vehicle is put into place to convert assets into income in order to provide for Mary for her life when her husband is gone. And finally, with the help of the financial planner, an application for veterans benefits is made for Mary's husband who is a veteran. Depending on the monthly cost of care this additional income could provide up to $1,800 more a month in household income.

With the help of the care manager, Mary's life and future have been significantly improved. Her husband as well, if he adheres to the care plan, may end up having a better quality of life for his remaining years.

Here is another example of the value of the care manager.

Michelle is a single divorced mother with two teenage children. Her mother, Martha, has a stroke which apparently causes some memory loss as well as some disability in being able to fend for herself. Michelle decides to move in with her mother and take care of her. In return, Michelle who is temporarily out of work, has a place to live and share her mother's retirement income.

Martha is anything but easy to take care of. She has mood swings and often forgets what she is doing. She seems to display a lot of anger and takes it out on Michelle, calling her all kinds of horrible names. She is never happy and is constantly calling for attention. In trying to take care of her own children as well as her mother, Michelle is quickly being drained of her physical and emotional strength. In addition Michelle's brother and two sisters are happy she is taking care of her mother since they are now absolved of the responsibility, but they treat Michelle terribly. They also call her awful names and accuse her of being a "leech". On the other hand they have plenty of advice on how to deal with their mother but never offer any of their own time to help. After all, they reason, Michelle is receiving benefits from caring for her mother and logically she should be responsible for all the care.

On the advice of a friend, Michelle hires a care manager, Brent Smith, who comes highly recommended in solving family disputes. Brent is a certificated mediator. Brent first does a care assessment of Martha and comes away suspecting there is more to her personality disorder than a stroke. He makes arrangements to take Martha to a geriatric Physician who does a complete physical assessment and recognizes that Martha's mental state is due more to improper medications and severe depression. Martha's medications are reduced and changed and she is put on antidepressants. In addition her diet is upgraded, she is to receive more fluids, more healthy foods and especially receive vitamin supplements. Particularly important is a prescription for vitamin B12 shots.

The doctor insists on as much exercise as Martha can handle. Brent, the care manager, helps convince Martha of the need for her new care program and helps oversee her following through on the exercise program. Over the ensuing months Martha's lack of memory and abusive behavior become less severe. She is also better able to care for herself without Michelle's assistance.

In addition to the assessment, one of the first things Brent does is to contact Michelle's older brother who is the family leader. He has a long talk with her brother and gives the brother a different perspective on the issues. With a better understanding of the situation, the brother calls a family meeting and Brent mediates a successful resolution of the family mistreatment of Michelle and the ensuing bad feelings. Everyone including Michelle is called upon to do their part in managing the care of her mother and to work on better family relations. The issue of Michelle "sponging" off of her mother is addressed and an adequate solution is agreed to by all. Brent will follow up in a month to make sure everyone is following through on his or her commitment.

These two examples concentrate on care in the home but care managers are also actively involved in helping families with the selection of facilities and any appropriate care services. Finally, care managers are indispensable in helping coordinate and arrange for care for a loved one living far away from family membe

Call ComForcare 24 hours a day, 7 days a week for assistance with your home care needs or to speak to one of our Certified Care Managers a free one-hour initial consultation. Contact us today at 760-724-7273. Or visit our website at www.nccomforcare.com

How Do You Get Your Elderly Loved One To Stop Driving?

It's been awhile since I posted, but I'm resolved to try and keep posting regularly, especially when I find some useful content on the Web.

I often speak with families who are grappling with the difficult issue of an elder who's still driving, yet it's no longer safe for them to do so.

Here's a very detailed article on strategies to get them to stop. One thing I would add to this article is that an in-home caregiver can provide an important alternative in this situation, helping the individual retain their independence and mobility, by driving them to appointments, errands and other destinations....

from wikiHow - The How to Manual That You Can Edit
Just as getting one's driver's license is often viewed as a ticket to freedom or independence, losing the ability to drive can be a real loss of independence. It's best to work with the person to preserve as much independence as possible. If somebody's driving is too unsafe, it may fall to a family member or friend to help get them out of the car entirely.

Steps

1. Talk to the person whose driving concerns you. Be as gentle and understanding as you can, but also be clear and firm. Allow plenty of time to have the conversation. This process will be easiest if the person agrees voluntarily to let you help, and to reduce the amount of driving or, if necessary, to give up driving. Present your reasons for concern as a question of ability or condition rather than of age [1]. Be specific regarding what concerns you. Explain that you are concerned because you care about their safety and the safety of others.
2. Reduce the need for the person to drive. The transition from driving to not driving as much (or at all) will be easier the more of the person's lifestyle and independence you can help to preserve.
   • Many cities now have delivery available for groceries or take-out.
   • Stop by regularly with supplies, companionship and whatever else you can offer.
   • If you take over shopping for somebody, make sure to get their input and bring them what they want. You will only make a mess if you bring too much or too little, or choose all the wrong things.
   • Find out what other outings and activities are a regular part of their routine and work towards accommodating them.
   • Be aware that even simple trips to the store may provide the person with an opportunity to get out and be social. Keep in mind that your objective is to keep them as safe as possible, not to isolate them.
3. Find or create alternatives to driving. Transportation is required to get groceries, to visit the doctor, to attend social events, and to carry on the adult lives to which we all become accustomed.
   • Find out whether public transportation is available to the person and help them learn to use it. Many public transportation options offer discounts to senior citizens. Keep in mind though, that walking to a bus stop may be difficult now, too.
   • Help with cab fare if you don't live close by or can't be there each day.
   • Arrange transportation with neighbors who live nearby, offering to help pay for time and fuel. If the older person's finances are tight, he or she can offer neighbors other assistance, such as babysitting for children.
   • Find out if the town or city offers senior shuttles or other transportation assistance.
   • If you live close enough, help with transportation yourself.
   • Take advantage of transportation time to spend more time with the person. He or she may feel isolated or alone, especially with less driving.
4. Take steps to make sure that whatever driving a person is still doing is as safe as possible. Driving need not be an all or nothing proposition. A person may still be able to drive safely with certain extra precautions. [2]
   • Avoid driving at night, dawn, or dusk. Low light makes it even harder for someone with reduced vision to see well and react. Remember to time the trip so that both the trip out and the trip back will have plenty of daylight.
   • Avoid driving in bad weather. Besides reducing visibility, wet or icy roads are slippery and require an extra measure of caution and judgment.
   • Reduce the number, duration, and frequency of trips.
   • Avoid driving to places that are unfamiliar. Focusing on navigation or unfamiliar surroundings may mean not focusing as much on driving, itself.
   • Avoid driving alone.
   • Avoid freeways, rush hour, and other busy or difficult driving situations.
   • Avoid difficult intersections and left turns. It is safer to take a longer route.
   • Allow plenty of time for trips. A wrong turn is less likely to cause panic if there is plenty of time to correct.
   • Remove distractions while driving.
   • Arrange alternatives for longer trips, night trips, and trips to unfamiliar places.
   • Look for classes for senior drivers. Many insurance companies offer incentives to senior drivers who take a class in defensive driving or senior driving. The AARP also offers a program to help mature drivers stay safe. [3]
   • Make adaptations. Make sure that the eyeglasses prescription is up to date, for example.
   • Check that the vehicle is in good repair. Help the person to check tire inflation and fluids regularly and stay on top of oil changes and other regular maintenance.
   • Keep aware of the person's condition and abilities. You may have to revisit the question or make additional changes later on.
5. Recognize the hazards of age-related effects while driving, and ask the person to do the same. Older drivers may have difficulty with vision or hearing, increased reaction time, loss of strength or flexibility or loss of focus and concentration. Taken together, these factors can lead to injury and even fatal accidents. If the person can help to decide when to stop driving, it may be less of a shock and it will certainly be less of an argument. [4]
6. Evaluate the person's driving objectively. If you think that driving at all has become unsafe, ride along with the person and look for specific signs that his or her driving might no longer be safe. Also watch how they behave off the road. Tell the person what you have seen and why you are concerned, and ask that they stop driving or change their habits.[5] [6]:
   • Conditions or medications that may reduce reaction times, alter judgment, or induce drowsiness.
   • Driving at inappropriate speeds, either too fast or too slow. Ask specifically whether this practice creates a hazard, since driving at a moderate pace where it is appropriate to do so can be much safer than driving too fast.
   • Discomfort or nervousness about driving from the driver, concerns from passengers, or honking or anger from other drivers.
   • An increase in traffic citations or warnings.
   • Dents or scrapes on the vehicle or on curbs, garage doors, and other surroundings.
   • Accidents or "close calls".
   • Difficulty staying focused on the act of driving.
   • Difficulty staying within the lane; hitting curbs or crossing lane markers.
   • Failure to notice or inappropriate reactions to road signs, traffic signals, pedestrians, breaks in traffic, or other cues while driving.
   • Difficulty seeing to the sides or behind the vehicle or reliance on passengers to check whether a turn or other action will be safe.
   • Difficulty turning to look behind when backing up or changing lanes.
   • Getting lost, especially in areas that should be familiar.
7. Get the opinion of a doctor, optometrist, or other medical professional, and get it in writing. For some people, a letter from somebody who is an authority (and who is neutral or not a family member) may convince them not to drive. If the written opinion isn't enough to be convincing, it can give you grounds for taking stronger measures should you need to.
8. Ask for an evaluation from somebody who is an expert on driving, and agree in advance to follow their recommendation. Ask the person to retest with the agency that issues driver's licenses or contact driving schools and ask about getting a evaluation. Again, get the result in writing.
9. Approach the department of motor vehicles, or whatever agency issues driver's licenses. It may be illegal for the person to continue driving. Even if the official response is only a letter, it may help convince them to stop.
10. Force the issue. If other approaches have failed and driving is definitely no longer safe, it may be necessary to take away the keys or disable or take away the vehicle. Exhaust all other options first, and think ahead to what the person might do in this case.
    • Make sure your method is effective. Many people can reconnect a battery, dig out spare keys, or call roadside assistance. On the other hand, "losing" the keys may be an effective short term measure to keep someone from driving without it being "your fault". [7]
    • If you choose to take the car or the car keys, have grounds for doing so first. Be prepared to justify your actions if they call the police.

Tips

One size does not fit all. Make sure your approach is appropriate to the specific individual and situation you are dealing with.

Think in terms of minimizing the harm, including to the lifestyle and well-being of the person you wish to help. Try the most positive and least drastic approaches first. A little independence can go a long way.

If a person's driver's license is taken away, help them through the process of securing other legal identification.

Be sensitive and understanding, but be firm if you have to. Making someone angry for a little while is better than letting them get into an accident that could injure or kill somebody.

Don't blame the person for the lapse in their skills. They did not choose to grow older or to have their health fail.

If this person is a friend or family member, make it very clear that you want them to stop or cut down on driving because you care about them.

If you are someone who may need to stop or reduce your driving soon, be honest with yourself and others about your driving ability. Ask the opinions of others whom you trust if you are unsure of your skills. Also, ask for help making this transition and let those who care for you know how they can help you most. It can be very difficult to stop relying on your own driving, especially if public transportation is not available in your area, but it is better than creating a hazard.

Sources and Citations

1. ↑ http://www.youtube.com/watch?v=M5r35S-Ieyc&feature=dir
2. ↑ http://www.aging-parents-and-elder-care.com/Pages/Checklists/Elderly_Drivers.html
3. ↑ http://www.aarp.org/families/driver_safety/
4. ↑ http://www.drdriving.org/elderly/
5. ↑ http://www.aarp.org/families/driver_safety/driver_safetyissues/a2004-06-21-whentostop.html
6. ↑ http://www.aging-parents-and-elder-care.com/Pages/Checklists/Elderly_Drivers.html
7. ↑ http://www.mental-health-matters.com/articles/article.php?artID=424

Part Of The Family

Anyone who has ever visited with relatives in another part of the country or another part of the world has likely experienced the reassuring effect of being around family and friends in a different and less familiar place.

Before I moved to California, I spent my formative years in the Chicago area. I used to look forward to going back to Chicago to visit friends and family, but as I get older, there are fewer friends and family to visit, and the city feels less and less like my old home town. Most of my recent visits to the town have been for funerals.

So when ComForcare, the national home care company that I belong to, decided to hold this year's annual conference for its franchise owners in Chicago, I wasn't all that excited.

Now, having just returned from the Conference, I have tell you I was very pleasantly surprised --- not so much by the locale and climate, but by the overall experience. This is the fourth ComForcare conference I've been to, and yet again, I was impressed by the great commitment of my fellow ComForcare franchise owners to delivering in-home care services in a manner that ensures clients, family members, and caregivers/employees are treated ethically, with dignity and respect. Though the conference is built around learning about the latest trends in home care management, and sharing tips and techniques that make for high-quality operations, the actual result of having all the owners together is so much more.

On the third night of this year's conference, just after the annual awards banquet, one of the newcomers, a husband of a franchisee, introduced himself and said "wow, what a great family ComForcare is." He was absolutely right.

My office serves the North County area of San Diego, and occasionally my clients move to other areas of the country, either permanently or for seasonal vacations. It truly creates a sense of family to know (as I do) that there are over 80 ComForcare offices around the country (and around the world -- there's new offices in Canada and Great Britain), that I can rely on when making out-of-area referrals. And over the past four years, there have been many times when I've called upon a fellow franchise owner's insight, experience and advice in dealing with problems I've faced -- much as anyone would with a good friend or family member.

An Insurance Agent That Went Above And Beyond

I was really impressed recently when a local insurance agent called me to obtain care for her longtime client. It's been my experience that many agents are not that involved with their clients years after they've sold the policy.

The insurance agent's client was seriously in need of help, and had been paying for a long term care policy for years. For some reason, the client was reluctant to use her long term care benefits. Had the agent not happened to check in on the client, it could have been a grim situation. Instead, we were able to provide care to the client right away, 7 days a week.

Nearly all long term care policies provide not only coverage for assisted living and skilled nursing home services, but also for services provided at home. But no long term care policy is worth anything unless you use it when you need care.

We often assist clients in accessing their long term care benefits and can help with determining coverage, answering questions, and interacting with the insurer.

A Development To Add To My Last Post

Last Friday, August 22nd, I wrote about the VA Aid and Attendance benefit, and mentioned that my uncle had been swindled by a financial advisor who said he would help my uncle apply for the benefit. Yesterday, I learned that the Illinois State's Attorney office will be pursuing my uncle's case and investigating this "financial advisor's" practices. Some oversight after the fact is much better than no oversight at all, but once again, if you're working with a third party organization to help you apply for this benefit, check them out carefully.

Veteran's Home Care and Assisted Living Benefits: Buyer Beware

The Veteran's Administration has a great little pension program known as VA Aid and Attendance that pays for up to $1400 or so in home care or assisted living for veterans of active duty who meet certain qualifications.  I recommend it to many of my clients.  

Problem is that it's quite complicated to pay for this benefit, and approval normally takes months.

That's why hundreds of companies and services have sprung up to help veterans access Aid and Attendance benefits.  And as you might suspect, while many of these firms are doing good work, helping vets to afford vital services, some are more like sharks that smell blood in the water.

One of these sharks found my uncle earlier this year.  My aunt had recently died, and my uncle was living alone in an apartment within an assisted living community in suburban Chicago.  The assisted living's management gave this "financial advisor" complete access to its residents. Within a matter of minutes, he had introduced himself to my uncle, who has slight dementia and was grieving the loss of his wife.   

It didn't take long for him to talk my uncle into signing up, and signing away not only $1500 -- the "advisor's" fee for processing the applications -- but also power of attorney on my uncle's investment accounts.  

Fortunately, my uncle mentioned this transaction to my father, who, after much threatening,  was able to retrieve from the "advisor" my uncle's original discharge papers from military service, as well as the signed power of attorney.  The $1500 is gone.

VA Aid &Attendance can be a valuable source of home care or assisted living funding.  But if you or someone you know is looking at quickly accessing this benefit through an assistance company, make sure you're dealing with a reputable, established organization (ask for references -- both clients and professional references). Many of these companies do require up-front fees ranging from $500 to $1500.  Others require no up-front fee, but charge an ongoing fee for managing the care provided under the benefit.  Or contact a local non-profit VA services organization in your area -- most have representatives who can help you fill out the paperwork if you're able to deal with the 4-6 month waiting period for approval from the Veterans Administration.