Tips for Planning a Family Caregiving Meeting

Note: This post originally appeared at AlexisAbramson.com. If you’re interested in providing articles for SeniorHousingMove.com, please see our submission guidelines.

Alexis Abramson, PhD

Dr. Alexis

If your family is like most, you don’t all live in the same city – or maybe not even within a day’s drive of one another!  You’re here and there, with jobs, families and responsibilities.  Regardless of your whereabouts many of the decisions and tasks of caring for an elderly parent must sometimes be handled as a family.  A good way to do that is with a family meeting.

The time to plan a family meeting is before your parent(s) has a crisis that requires immediate attention.  Be proactive.  Clues from your parent – such as increasing forgetfulness, missed medications or difficulties managing money, keeping house or getting to appointments – are all signs that a family meeting may be in order.  The following ten tips will help make your family meeting more efficient and productive.

Meet ASAP.  If a crisis has happened and you’re the primary caregiver, the sooner you hold the meeting, the sooner you can get help and the less time your family members have to get stuck in the comfortable rut of letting you do all the work.

Set the agenda.  This meeting is serious business.  Make up an agenda just as you would if you were holding a business meeting.  Carefully consider which decisions need to be made and which tasks need to be completed.  Write them all down in advance.  If possible, mail, e-mail or fax a copy to all family members before meeting.  This will give them ample time to consider how they can best help before they meet with the entire group.

Establish meeting rules.  One person should lead the meeting.  Often, this is the person who is closest (either geographically and/or emotionally) to the parent and who will most likely be the primary caregiver.  In some cases, people have a family friend or less involved third party lead the meeting.  Make it clear that each person should treat the others with respect.  No shouting.  No interrupting.  No name-calling.  You get the idea.

Give everyone time to talk.  Everyone should have the opportunity to provide input and have your full attention while they speak.  To ensure that even quiet family members get a chance to talk, give each one an allotted time.  You might want to call on them in alphabetical order or in order of age.

Ask for volunteers.  Give everyone the opportunity to volunteer for particular tasks (such as locating legal documents, picking up your parent’s prescriptions, or hiring a home health care aide).  Before the meeting, decide whom you would choose for each job and make a list.  Consider your family members’ talents and interests – which jobs would they do well?  Which jobs would they most likely enjoy?  If no one volunteers for tasks, start recruiting based on your list.

Be specific.  If you need help with certain caregiving tasks, be specific with your requests.  For example, “Mom gets a senior discount at the grocery store on Wednesdays.  Would one of you be able to take her to the grocery store each Wednesday morning?” or “I have to be out of town for business March 10 through 14.  Could one of you plan to check on her daily and be on call for her on those particular days?”

Focus on the issue at hand.  Your sister was rude to you last Thanksgiving.  Your brother’s rowdy kids practically wrecked your home.  Sure, you have grievances with your siblings, but now is not the time to bring them up or let them influence your decisions.  The family meeting is to discuss your parent’s – nothing more.  Stick to the task.

Look to the future.  As you arrange your parent’s care for the here and now, don’t forget that health and abilities change – sometimes quickly.  Come up with a contingency plan – or at least the agreement to hold another family meeting if your parent’s condition changes and you need to make new arrangements or assign new responsibilities.

Establish a spokesperson.  If your parent needs someone to communicate with his or her doctor and other health professionals, it’s much better to assign one person to the task.  Pick someone who is reliable, has good communication skills and is willing to keep other family members up to date regarding your parent’s health information.  Often this will be the primary caregiver, because this person has the main responsibility for their parent’s care and probably has the closest relationship with the medical team.

Request a break.  If family members live far from your parent and have difficulty participating in day-to-day care, request that they devote one week of their vacation time each year to give you a break.  If that’s not possible, at least ask for an occasional weekend.  Get them to commit to specific dates in writing.  Depending on your parent’s health, he or she may be able to travel to them or they may need to come to the parent.  The important thing is that you get time off to relax and rejuvenate away from your parent.

ALEXIS ABRAMSON, Ph.D. is cited as America’s leading, impassioned champion for the dignity and independence of those over 50. Abramson is the author of two
highly acclaimed books – The Caregivers 
Survival Handbook and Home Safety for Seniors.  For more information go to www.alexisabramson.com.

Sleeping pills, assisted living cliques, advance directives, and organ donation

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Sleeping pills aren’t as safe as you might think; the FDA is changing guidelines on the most popular drugs.

As if being in assisted living wasn’t hard enough, there’s still the inevitable cliques to deal with!

If you’re having trouble figuring out your advance directives, there’s a new site out there to help.

How should hospitals handle organ donation to older patients?

Pills (white rabbit)” © 2006 erix!, Attribution 3.0 Generic http://creativecommons.org/licenses/by/3.0/

The Long Term Care Problem

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Long term care is a big deal right now in Congress.  Yet, most Americans don’t really understand it:

…a Thrivent Financial for Lutherans survey about long-term care planning conducted by Ipsos reveals that 51% of respondents think this kind of insurance is “too expensive,” while another 24% don’t even know what long-term care insurance is. (Source)

Is that even possible?  How can 75% of Americans not understand the importance of finding a way to fund long term care?  For those who suggest that long term care is too expensive, here’s something to think about:

  • Insurance reflects the cost of providing the care. How do you think insurance companies price their policies?  Here’s a simple formula: Anticipated cost of providing care + overhead (paying for administration of the policy, etc) – returns on invested premiums.  That’s basically the way that all insurance policies are priced.  Stock market returns aren’t expected to be spectacular in the coming years, and there’s only so much that companies can do to decrease their overhead.  Still, compared to other forms of insurance, most of the cost for long term care insurance comes from the cost of providing care.
  • Care isn’t cheap. Maybe people don’t spend a lot of time thinking about old age because it makes them uncomfortable, but it’s to their own detriment.  If there’s one immutable truth in senior housing, it’s that senior housing isn’t cheap.  Assisted living can run between $40,000 and $75,000 per year (depending on level of care and amenities).  Nursing homes can cost up to $100,000.  If you spend more than a few years needing higher levels of care (like assisted living or nursing), you’re looking at almost half a million dollars on care. Even if you plan to stay home, save a small fortune to pay for home health aides, housekeepers, and assistants.
  • Someone will be paying. Since most people aren’t saying for their long term care needs (either via insurance or their own personal savings accounts), the government or adult children will likely be picking up the tab for care.  This might mean multi-generational housing where granny lives with her adult daughter.  It might also mean that older Americans are forced to move into government-run assisted living facilities (which don’t really exist now, but may become more common as the population ages).  At the end of the day, those who save for their long term care needs will have more choice in who provides their care and in what setting.

Some scholars suggest that long term care is the biggest problem our country faces right now.  As Boomers age, more and more will have to rely on safety nets like Social Security and Medicaid to survive.  The viability of long term care insurance is a big wildcard in our future that, unfortunately, may turn out to haunt us.

G’ma’s hospital bed before she got there” © 2008 dreamingofariz, Attribution 3.0 Generic http://creativecommons.org/licenses/by/3.0/

Getting better at getting older, taxes & CCRCs, Medicare denials, and brain changes

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A new study shows that the older we get, the better we get at getting older. (More on this subject.)

There are tax implications of moving to a CCRC.  Here’s a primer on them (it’s sort of complicated, so I’d suggest taking it to your accountant.)

If you’ve had a claim denied by Medicare, don’t give up; here are some tips to help you win your appeal.

Brain changes in seniors might explain why scams are more common in the elderly. (Here’s more.)

“swim meet” © 2004 jonfeinstein, Attribution 3.0 Generic http://creativecommons.org/licenses/by/3.0/

 

Publish your thoughts on Senior Housing Move.com

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We’re growing our content and looking for your help.  If you’re an industry insider, consider contributing your advice to seniors!  We’re looking for content from the following sources:

  • Seniors: Did you recently move into a retirement community?  Have you remodeled your home so that you won’t have to move?  We want to hear your stories.  Offer advice to your fellow movers, and help them get the most out of their experience.
  • Retirement Communities: Do you see potential residents make the same mistakes over and over again when moving into your community?  Do you have advice to give?  What are some things that residents should consider before picking a community?  What’s the best way for new residents to become involved in the social life at their new community?
  • Retirement Professionals: If you are a financial advisor or estate planner for seniors looking for retirement communities, we’re looking for information about pitfalls associated with the financial aspects of moving.  What other financial issues must be considered prior to the move to senior housing?  What role do power of attorney and living will documents play in the move to senior housing?
  • Health Care Professionals: Are you a doctor or nurse that specializes in the care of seniors?  We’re especially interested in information regarding assisted living, home health, and nursing homes and how to get the best care for ailing loved ones.

The best length is between 400 and 600 words, and we’ll link to your site and/or include your corporate logo in the post.  Email submissions to Virginia@SeniorHousingMove.com.

*We reserve the right to edit articles for length and content and to not publish articles that are inappropriate for the site.

Age & creativity, getting the best care, and nursing home mistakes

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Your brain changes as you age; you might get more creative as a result!

How to get the best care from your physician.

An 87-year old nursing home resident got left in an elevator for over 24 hours during the Christmas holidays.

Not all Florida nursing homes are doing a great job for their patients.

Paintbrushes” © 2008 John-Morgan, Attribution 3.0 Generic http://creativecommons.org/licenses/by/3.0/

What is LifeCare?

In case you missed it the first time, here’s an overview of the popular CCRC product, LifeCare:

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LifeCare is a big selling point for communities that have it. Marketing representatives love to portray LifeCare as the choice for responsible seniors, and this is partially true. There is some reason to think that LifeCare is a responsible choice. But, first, what is LifeCare?

LifeCare is one of three types of health benefits that communities can offer as part of their resident agreement:

Type A (LifeCare): LifeCare guarantees that a resident’s monthly fee will never increase beyond their official independent living fee, no matter what level of care he or she receives. In other words, following a permanent transfer to skilled nursing or assisted living, the resident pays no more than the monthly fee he or she paid in independent living.

Type B (Modified LifeCare): Is a contract where residents are offered a discount on assisted living and nursing services. For example: 10% off of higher levels of care or 10 free annual days of nursing or assisted living.

Type C (Fee for Service): The resident receives no discount for assisted living or nursing services and pays the community’s market price for the service.

In my experience, LifeCare is generally calculated as a $30,000 premium above normal entrance fees. This means that, on average, the community expects residents to consume $30,000 in higher-level care over the years they live in the community. Obviously, some residents will consume more, spending more time in nursing or assisted living. Other residents will be relatively healthy and require only limited stays in higher levels of care.

Although some communities do not offer a choice between LifeCare and a modified or fee for service contract, some communities do allow residents to choose. Here are the main considerations when choosing whether or not to purchase LifeCare:

  1. Long term care insurance. Long term care insurance offers basically the same benefits as LifeCare. If you have a long term care insurance policy, check the benefits and compare them to the LifeCare benefits offered by the community. Some communities will negotiate with residents who hold long term care policies. Others will not negotiate.
  2. Age and health. Because LifeCare is a type of insurance, all LifeCare communities require residents to pass a medical exam. This is usually conducted by the community’s head nurse or certified by your doctor. Approval is based on the community’s opinion as to whether or not you will be healthy long enough for the community to make their money back. Thus, the longer you wait to move into senior housing, the more difficult it will be to pass this physical exam. However, the younger you are when you purchase LifeCare, the lower your return on investment. It is a catch 22. If you have health problems (beyond those that are considered normal for a senior), you might have trouble qualifying. Apply sooner rather than later.

A few additional notes:

  1. Some communities call themselves “LifeCare”, but do not have LifeCare in the traditional sense. It is sometimes used as a marketing technique to indicate the presence of multiple levels of care (independent living, assisted living, memory care, and/or nursing) on the same campus.
  2. LifeCare is a type of insurance, so communities offering it are often regulated by the state department of insurance. Check with your state to see what regulations CCRCs must follow and whether or not your community has filed all of their required documentation in a timely manner. Also, you can file an open records request with the department and receive copies of all of their filings.
  3. Some communities offer gradations on their contracts whereby older seniors pay more to live in the community. This is based on the actuarial estimation of cost to the community. As people continue living longer, more communities will likely switch to this type of contract in order to accurately account for resident longevity and its impact on the community’s bottom line.

Biking & Parkinson’s, fighting parents, long term care plans, and hiring the right movers

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Biking has been shown to improve symptoms of Parkinson’s.

When your elderly parents fight: Is it a sign of a normal marriage or that something is wrong?

More than half of Americans aged 45-54 don’t have any long term care plans

Hiring the right movers can make all the difference when downsizing to senior housing.

“Bike” © 2010 Sheffield Tiger, Attribution 3.0 Generic http://creativecommons.org/licenses/by/3.0/

 

What is an aging in place consultant? Should you hire one?

Note: This post originally appeared at AccessibleConstruction.com. If you’re interested in providing articles for SeniorHousingMove.com, please see our submission guidelines.

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An accident, stroke, or other debilitating disease can make a person a stranger in his or her own home. Stairways, bathrooms, and even bedrooms become obstacles in the daily routine. This makes living with a disability challenging and frustrating, and can lead to expensive stays in assisted living facilities.  It doesn’t necessarily have to be this way.  Proper home modifications can help seniors stay independent in their homes.

Although many home modifications can be as simple as installing grab bars in the shower or ramps at stairways, others require more complex installations like stair lifts or elevators. No matter how difficult the installation may be, an aging in place consultant can help in most situations.

Here are some things that you should know: 

  • It’s not that expensive.   A common misconception is that hiring an accessibility consultant is more costly than hiring a home remodeler or even a handyman for the simple stuff. The truth is, an experienced professional will perform a complete home assessment that considers all aspects of the disability and how it relates to home modifications that are needed now, as well as in the future, as the disability progresses. Planning for the future can save money in the long run as additional home modifications become necessary. 
  • You might avoid double modifications.  Installing a stair lift when an elevator will be needed in a year or two will result in two modifications instead of one. By installing the elevator in the beginning, it will not only save time and money; it will make the person with the disability AND the caregiver safer and more comfortable from the outset. 
  • You can avoiding common installation problems. Accessibility consultants know that installing a grab bar can be a simple procedure but if the backing behind the wall isn’t reinforced before installation, it could become a safety issue if the mounting fails. 
  • Consultants have special knowledge. Many accessibility consultants are familiar with the latest Home Medical Equipment products and can provide the best ramp and walker/wheelchair combination. They also know that a threshold ramp will be needed at doorways instead of just a ramp for stairways. Most construction remodelers don’t have the experience with the special needs of a person with a disability to understand all of the issues involved.

Finding the best person or company to perform a home modification for a senior or person with a disability has become easier in recent years with the advent of the CAPS Program. CAPS stands for “Certified Aging in Place Specialist.”

The Certified Aging-in-Place Specialist (CAPS) is a designation program by the National Association of Home Builders (NAHB) that teaches the technical skills essential for home modifications for “aging in place”. The NAHB Remodelers™ Council, in collaboration with the AARP, NAHB Research Center, and NAHB Senior Housing Council, developed the Certified Aging in Place Specialist program to provide comprehensive, practical, market-specific information about working with older and maturing adults to remodel their homes for aging-in-place. A Certified Aging in Place Specialist (CAPS) has been trained in:

  • the unique needs of the older adult population
  • aging-in-place home modifications
  • common remodeling projects
  • solutions to common barriers

The Certified Aging in Place Specialist (CAPS) designation is a reliable way to identify professionals to modify your home. Don’t let the “senior” label fool you, the CAPS designation is the standard most accessibility consultants follow for all home modifications that increase safety and accessibility in the home. To find a CAPS in your state, visit the NAHB web site at www.nahb.org.

Accessible Design & Consulting is California’s leading Barrier-Free Specialist; they provide legant residential and commercial barrier-free designs and accessories for seniors and people with disabilities. Contact Accessible for more information about your next renovation: (866) 902-9800 (Toll Free) or (310) 215-3332 (Local).

Getting more care for less, long-term care policies, colonoscopies, and hospice

Penny from Heaven

Advice for penny-pinchers: How to get the most medical care for your buck.

The cost of long term care insurance policies is going up!

A Boomer gets a colonoscopy.

Hospice is apparently very difficult to get into nowadays.

Penny from Heaven” © 2008 Caitlinator, Attribution 3.0 Generic http://creativecommons.org/licenses/by/3.0/