Sustainable Aging in Place: Features to Make it a Reality in Your Community

Seniors and their family caregivers in growing numbers are finding the right solutions to make aging in place a reality.

More seniors are becoming healthier to face their aging head on. They’re managing to put realistic financial plans in place to allow them to maintain their lifestyle while paying for ever-rising healthcare costs. Many of them are early adopters to the latest technology and telehealth solutions that can keep them safely in the homes of their choice for longer periods of time.

Family caregivers are making great strides in meeting the needs of their aging loved ones. Some solutions, however, are not within their control. It is up to the community, city planners, governments and larger systems to catch up with the needs of the seniors in their locales.

Sustainable Aging in Place

According to a recent report prepared by MetLife Mature Market Institute, there are specific characteristics that a community will need to have in order for the seniors living there and successfully age in place.

  • Available accessible and affordable homes for seniors to live as they age, including homes in all price ranges, accessibility for disabled people and all types of living arrangements, such as personal homes, apartments, senior housing, assisted living and accessory dwelling units. It is also important to include the presence of home remodeling services and Certified Aging in Place Specialists (CAPS). Also, zoning for multi-family dwellings, more than one single family home per lot and mixed use neighborhoods should be flexible.
  • Contains specific features that allow access to the community at large, such as walkable neighborhoods with sidewalks, safe driving options such as easy-to-view signage and improved lighting, and neighborhoods that are safe for seniors to move about without fear. There should also be transportation that includes the five A’s – availability, accessibility, acceptability, affordability and adaptability to diverse needs is a priority.
  • Wide variety of services, such as healthcare, retail centers, food shopping and support services, in addition to community life including senior centers, peer events, libraries, beauty salons, banks, pharmacies, places of worship and clubs.
  • In-home services should be accessible through transportation or capable of being brought into the home, such as home health care, meals on wheels, support groups and respite care.
  • Emergency preparedness plans that take the needs of aging adults into account, such as identifying where seniors who need assistance are located, early warning methods, and help with supplying their needs during a disaster such as medications and documentation.
  • Volunteer opportunities that allow seniors to remain physically, mentally and socially active

Aging in Place Solutions Benefit Entire Community

Seniors aren’t the only ones who benefit when the community provides a sustainable aging in place environment, as there are dividends for the community as a whole.

  • Economic development for services and goods provided to aging population, including housing and healthcare
  • Fostering environmental health, not only that of the aging population but general population as well
  • Improved infrastructure of communities, such as walkable neighborhoods and transportation, provide opportunities for the entire community
  • Local governments that remove barriers to provide aging in place options improve business opportunities for all citizens
  • Obtaining a wealth of expertise and service from the seniors in volunteer opportunities lets the community share in and benefit from their experience

According to the MetLife report “a livable community is one in which residents of all ages are able to maintain independence and enjoy a high quality of life”.  A community that can allow for successful aging in place for all our seniors will also improve the community as a whole for all citizens.

As we advocate for our senior loved ones and help them age in place successfully more safely and longer, we will be helping to improve our communities and our own aging future.

Nursing Home Staffing Woes Increase Need for Family Caregivers of Seniors

Nursing home care is something many family caregivers see as part of the future, at least at some point, for their senior loved ones — and maybe even for themselves.

Looming staff shortages on the front line of resident care could make nursing home openings harder to find or more expensive (maybe both).

Even with the stated desire for aging in place by many current and future seniors, the growth in the number of older adults seeking nursing home placements is seen as challenging the already-strained recruiting efforts.

Nursing Home Direct-Care Staff

Some key points can aid in understanding what’s behind the difficulty nursing homes are already having in finding employees to fill positions that provide direct care.

  • The nature of some tasks that are part of the work, which can include tasks such as changing residents’ diapers (briefs) and worse, is found by many to be unpleasant and undesirable.
  • With hours that are often long and include lifting residents from their beds or chairs, many find the job exhausting.
  • Wages that are typically under $12 per hour are seen as too low by many for the work that is expected.
  • Occupational injury rates that rival those of professional athletes and are more than double those in manufacturing and construction industries feed a very high turnover rate.

Even though direct-care positions typically require little training and often not even a high school diploma, it’s easy to see why there is a turnover rate much higher than that seen across the healthcare industry.

Key Nursing Home Caregivers

Direct-care workers often define the nursing home experience for residents. These workers fill the most basic care needs and establish personal relationships with the those for whom they care, relationships that can have much to do with seniors’ satisfaction with their life in long term care.

Having good relationships with seniors may not be enough to ensure direct-care workers are safe on the job, let alone enjoy going to work each day. In addition to work that is simply unpleasant at times, front line caregivers can find themselves regularly verbally and even physically abused by those under their care.

The abuse on caregivers may be from dementia sufferers who aren’t aware of what they’re doing or the impact they have on others. It might also be an expression of frustration by nursing home residents who are unhappy with their health and functional loss, family members who don’t visit often enough or one of many other factors.

Regardless of the reasons behind the physical and emotional bruises direct-care workers receive, it’s understandable why it’s hard to fill open positions and those doing the work may choose to leave their jobs.

Meaning for Family Caregivers

Difficulty filling and keeping filled direct-care positions may mean open nursing home beds will be harder to find for many seniors or  that increasing costs to keep positions filled put this long term care option out of reach. Either way, family members may find their senior loved ones aging in place in their own homes even longer than expected — or forced to move into the homes of family members.

Seniors who are candidates for nursing home care but find it out of reach may be able to receive professional in-home care at least part time. Regardless, their needs may drive them to lean more on family caregivers than in earlier stages of their aging.

What can family caregivers, or future caregivers, do about this? We’re hoping one of you will offer up the solution. In the meantime, preparation, emotionally, financially and otherwise seems the best way to prepare to meet the needs of senior loved ones who would otherwise be living in a nursing home environment.

That and making sure those providing direct care to our senior loved ones currently know their efforts are appreciated!

Strategies for Family Caregivers on the Receiving End of Hurtful Words

Family caregivers give their time, attention and even finances to help make life better for a family member.

Many feel honored and proud to be able to provide love and nurturing, especially when it’s giving back by caring for parents who once gave them everything when they were children.

Unfortunately, there are times when it doesn’t feel like the time and sacrifices are appreciated, even when we know they are.

Family members, especially siblings and even the ones for whom you care, can offer their often unwanted opinions about how they think you are doing providing that special care. Usually this isn’t helpful criticism but instead hurtful to you as a caregiver.

Some of these hurtful comments serve to make us wonder why we keep giving of ourselves. We can feel guilty when someone suggests we aren’t doing enough or something right, even though we truly are doing all we can. We often try to take on even more to quiet their insults, only hurting our own physical and mental health in the process.

Strategies For Handling Hurtful Words

  1. Try not to listen. Redirect the topic of conversation to something that is helpful for your senior loved one instead of hurtful to you. If redirection isn’t working, simply walk away from the person making negative comments or politely disconnect from the phone call. Unfortunately, too often negative comments come from siblings or other family members who aren’t helping or who want it done their way, which may not always be in the best interest of the senior loved one.
  2. If the comments are coming from your senior, remember they may be frustrated or perhaps confused by their disease so don’t take it personally or get offended. They may be angry at their situation, their loss of independence or depressed. Their comments are being hurled at the closest person — you! They don’t mean to hurt you. Remember the old rhyme: sticks and stones will break my bones but words will never hurt me. Especially words that come from older adults who may not realize their words are hurtful.
  3. Accept that no matter what you do, what care choices you make, what food you prepare for a meal or any other day to day decision you make as the one in charge, you will not please everyone all the time. That is reality so just accept the comments, don’t take them to heart instead continue with your tasks. Practice makes perfect with this one.
  4. Don’t react with anger – you will just give the person making the insults the desired outcome. They are just trying to get under your skin or get you to do what they want even — if it isn’t the right thing to do. Smile and continue on with care or other duties. It will be difficult for the person throwing the insults to keep pushing when you are smiling.

Naturally these strategies might not be easy to implement and will require caregivers to practice them. It’s human nature to get hurt feelings when someone is telling you all the things you’re doing wrong. The insults and negativity are even harder to take when you are tired. Remind yourself about the importance of what you are doing — it is very important, priceless even!

If your siblings or other family members who are not impaired by a disease process, as may be the senior for whom you care, are only offering insults without any assistance to you for the care you are providing, you will have your answer to how important their opinion really is to the care of your senior loved one. If they can’t walk the talk, you have no choice but to ignore their comments as best you can.

Finding strategies to help you cope with the daily challenges of being a family caregiver will help you be a more successful and healthier caregiver.

If you have more suggestions for everyone on how you handle negative feedback, we would love for you to share them with us!

Seniors Staying Active While Having Fun Playing With Grandchildren

Regular visitors to Senior Care Corner know we’re strong proponents of physical activity at every age — but especially for our senior loved ones and their family caregivers.

We often encourage the caregivers of senior loved ones to stay fit so that they can continue to be healthy, both for themselves and those for whom they care. We also want to do everything we can to keep our seniors moving and physically well, too.

Too few people will jump up and get going, choosing instead sitting over their cup of coffee or watching their favorite TV show. We all need encouragement to get moving (even self-encouragement)!

What better motivation to stay physically active for your senior loved one than to keep up with their grandchildren (or even great grandchildren)! Also a great way to create memories for both.

Seniors Staying Active With Grandchildren

  1. Encourage your senior to keep up with younger grandchildren. Just pushing a stroller or going to the park and pushing a swing will help your senior stay active.
  2. Find games that both your senior and the grandchildren can play together to enjoy shared moments but also staying active. Rolling a ball, playing croquet or collecting rocks are some fun shared activities that seniors and children can participate.
  3. Blowing bubbles – one can blow the other can catch are fun memories and good belly laughs!
  4. Swim in the pool or run in the sprinklers on a warm day!
  5. Challenge your family members to some physical video games such as Wii bowling, tennis or a dance party! The competition and ensuing fun will definitely provide some physical fitness for all!
  6. Engage the whole family in fishing, a nature walk, bird watching, miniature golf, picnicking, badminton or other outdoor sport you all enjoy!
  7. Ask the younger family members and teens to help in the yard with some chores that may be too exhausting for seniors such as raking, gardening, weeding, etc. Remember that your senior needs a role too, maybe holding a trash bag while someone else fills it or planting the seeds while someone else digs the hole.
  8. Let children help the seniors with household chores, too, like dusting, sweeping and vacuuming including everyone in the work at hand. Play some old favorites on the radio or stereo so that everyone will keep the beat or sing along!

Together we can have some fun, stay physically active and mentally engaged and share family memories that will not soon be forgotten.

We would love to hear your stories about the activities your family enjoys!

Understanding Seniors’ Drug Labels and Why It’s Important to Read Them

Millions of seniors, more than likely your loved ones included, take prescription drugs every day.

According to the latest information available from the Centers for Disease Control, there are 2.6 billion prescription drugs ordered each year. 73% of adults over 60 years use tw0 or more prescription drugs while 37% use more than five.

The most often prescribed for adults are analgesics, antihyperlipidemic and antidepressant medications.

In seniors, the most often prescribed medications were lipid lowering drugs, beta blockers and diuretics.

Polypharmacy poses a great risk for seniors for adverse drug reactions, compliance failures and potential healthcare emergencies.

It is important to read any drug label whether it is an over-the-counter (OTC) remedy or a prescription drug. Most drugs come with patient package inserts that should be read to learn as much as a senior can about the medication. The print is often very small so you may need to help your senior with some inserts.

Not following the instructions can be harmful!

Reading the Drug Label

  1. Read the name of the person intended to use the drug. Be sure you are that person especially if there is more than one person using the medicine cabinet. Your senior should use only those medications specifically prescribed for them.
  2. Carefully read the instructions about how often and how much of the medication to take. Be sure your senior understands, if not, ask the pharmacist. Take only the amount and the number of pills needed – no more and no less. Take them at the specified time, too.
  3. Read the USE BEFORE DATE. Do not take medications after the use by date. If they become inactive, your senior could be at risk for health problems such as high blood pressure or blood sugar that could require medical treatment.
  4. Keep track of the name of drugs, strength and dosages that your senior loved one takes and update it as changes occur. This is to be given to the primary care doctor or healthcare facility in case of an emergency.
  5. Be alert to any special precautions on the bottle such as take with food, take before a meal, sit up 30 minutes after ingestion, don’t mix with alcohol, drink with 8 ounces of water, don’t drive or operate machinery when using, etc. These are placed there for a reason and could lead to trouble if not followed.
  6. Read any storage instructions to be sure the potency is properly maintained. Some drugs need refrigeration or others need to be out of direct sunlight for example.
  7. Be aware of potential side effects. If your senior is experiencing these, contact the prescribing physician listed on the label and continue to take the medication until the doctor is aware. Discontinuing a medication without approval of a doctor could lead to more trouble than the side effects give.
  8. Be careful you don’t run out of prescription medications by reading the refill information. If your senior is on the final refill, be sure to schedule a doctor’s appointment so that a new prescription can be given in time to prevent a lapse in medication.

Your senior may benefit from pill organizers, pill cutters/splitters, day-of-week pill dispensers, electronic pill dispensers that can alert you if they don’t take their pills or smartphone apps that alert them (and you) of missed dosing or low supply.

Prescription drug and OTC labels can be confusing for many seniors, but a little time and assistance to help them stay in control of their medications is time spent wisely.

Health Mobile Apps from US Agencies for Seniors’ Smartphones and Tablets

There’s an app for that — you might have heard that before! We know many family caregivers have actively used apps on their smartphones and tablets, both for their own needs and as part of providing care to loved ones.

Seniors are using apps more and more too!

It is estimated that more than half of American adults have apps on their phones. They also use apps on their tablets.

We know seniors are using their smartphones and tablets and finding apps that fit their needs.

The US government is trying to fill the gap in services to seniors and spreading information by using apps too. They hope that seniors will try them out and like them enough to keep using them.

Selected Health Apps from US Agencies

  • 52 Weeks for Women’s Health – this app gives weekly tips about health topics and allows you to track your own personal health information such as medications, allergies and other prevention items.
  • BMI Calculator from the National Institutes of Health – great way to keep track of your weight and risk associated with being overweight.
  • CDC Health e-cards – allows you to send free electronic cards with health messages to friends and family members.
  • CDC Health Information App – brings health information, updates, health articles and “disease of the week” to tablet users.
  • FluView – lets you track flu outbreaks, influenza statistics and health information related to the flu including your own location.
  • Health Hotlines – helps you locate health-related information and agencies including toll free contact numbers; a directory of 9,000 organizations across the country which include support groups, government agencies, professional societies, and voluntary associations.
  • HRSA Find a Health Center – locate a health center that treats anyone including those without health insurance. Locator by zip code.
  • My Dietary Supplements MyDS – store list of your personal supplements including dose amounts, this list can go with you to store to buy more or sent directly to healthcare provider for advice.
  • My MedList – stores list of current and past medications; information protected; list can be printed to share, mailed to anyone you choose, reminder for taking medications or provided to healthcare provider or hospital.
  • NCI Quit Pal – helps you stop smoking! Produced by the National Cancer Institute; sends personalized video messages from loved ones, tracks smoking habits, keeps you motivated by recognizing milestones, links to Facebook and twitter to keep your friends and family involved in your success and keeps track of the money you saved from not smoking.
  • Solve The Outbreak – be a disease detective by solving the outbreak through this game. It takes you through fictional outbreaks where you make decisions about quarantining the city, talk to the sick people and study epidemiology. Brain stimulating for those who enjoy solving mysteries.

These are a few apps that we thought your senior might find interesting and are free to try. We found all available in Apple’s App Store and most on Google Play.

Exercise Care in Choosing Apps

There are many kinds of apps available to keep your senior’s mind sharp, help stay healthy and connect with family. Apps that are free such as these from government health agencies can be tried without worry. They are secure and reputable.

A caution when looking for apps — as with products there are a number of look-alike and sound-alike apps that may not be as safe as those from the US government agencies or provide information that is reliable. In other words, buyer beware.

We hope you try some out and enjoy! If you have any questions or suggestions for apps that your senior enjoys, we look forward to hearing from you today.

Therapeutic Journaling Can Mean Inner Calm for Family Caregivers

Family caregivers have full days of doing things for others. They all too rarely take time for themselves.

They seldom stop to look in the mirror to see the effects of their caregiving on their own well-being.

One strategy family caregivers can use to take a deep breath and improve their own coping ability is therapeutic journaling.

What, you have never heard of that and wonder what it is?

Therapeutic Journaling – What It Is

Therapeutic journaling is a self-help tool to deal with emotions and life events. It is a written dialogue with yourself, for your eyes only. It will help you express your feelings to help you process them, release your daily tension and be able to set your emotions aside and move on to continue caregiving.

No, not a diary because therapeutic journal writing focuses on your perceptions, personal internal experiences, and reactions to a situation, occurrence or emotion.

Therapeutic journaling does require the family caregiver to take on a risk, when you begin writing your innermost thoughts and feelings onto paper that someone unknowingly could read. Here’s the flashback to high school when your teenage brother or sister laughed at your diary entries. But this shouldn’t be the case now since you are in control of your personal journal. The benefits you will gain will overshadow any fear of being exposed.

Therapeutic Journaling – Where Do You Start?

  1. Get a journal. Find one that expresses your own sense of style so that it can be a true representation of you.  Perhaps you want a leather bound journal or one that has a pink paisley cover. I might like to use one that resembles a scrapbook with a picture of my family on the front to remind me when I open it what I hold dear including myself.
  2. Write in it every day. Don’t add line items as if you were filling in your calendar but express your thoughts and perceptions freely.
  3. Remember there are no rules. No one will grade it, so if your sentences don’t agree or if they end with prepositions or run on for miles – that is OK.
  4. Ask your journal a question in a way you expect it to answer you…you will find over time that when you delve deeply enough into your feelings, you can answer your own questions more easily.
  5. Write down any thoughts that you found troubling or conflicts you experienced taking care of senior loved ones.
  6. Capture the good moments too. Be sure to write down events and days you want to remember. Add how it felt to be a caregiver, the joys and sorrows and proud moments.
  7. Listen to yourself through your journal.

Using therapeutic journaling can help you relax, improve your physical well-being and benefit your mental health.

By gaining a healthier outlook on your life as a caregiver, it will allow you to be a better caregiver.

Helping Senior Loved Ones Who are Veterans with PTSD

Service to the nation is a badge worn proudly by many of our senior loved ones and we honor their service.

These brave men and women have precious stories to share of heroes with whom they served, travels to foreign lands, battles hard fought, friends lost and memories of a lifetime.

Unfortunately, many also came back with Post Traumatic Stress Disorder (PTSD) from those life changing experiences that are now painful memories. Many of those affected are boomers who served in Vietnam.

Those particular service members witnessed many atrocities and lived in horrible conditions during their tour of duty. Several of these veterans are on disability, as they find dealing with PTSD makes many activities in their life hard to handle.

After they returned home, and now as they retire and look back on the past, many Vietnam vets found it difficult to keep a job, hard to discuss their experiences, hard to recover from nightmares, and troubling trying to overcome the reality that America wasn’t always understanding of their issues — or even their service.

Vietnam War

  • Both men and women served in Vietnam
  • According to a Harris poll most were happy they went:
    • 91% were glad they’d served their country
    • 74% enjoyed their time in the service
    • 89% agreed with the statement that “our troops were asked to fight in a war which our political leaders in Washington would not let them win.”
  • 9 million Americans served in the military during that era; 3 million served in the Vietnam theater
  • 2/3 of those were volunteers and 73 % of those who died were volunteers

Helping our Senior Vets with PTSD

  • Communicate with the family, especially children. Let them know the situation as much as they can understand depending on their age. Tell them about war, how living with trauma affects people, what type of behavior to expect with the senior in their life, and how to deal with the words they hear and the emotions they feel. You might want to check out these books for more: Why Are You So Scared?: A Child’s Book about Parents with PTSD by Beth Andrews and Katherine Kirkland and Daddy’s Home by Carolina Nadel.
  • Stay patient with the behaviors and mood swings your vet may exhibit.
  • Learn about the effects of PTSD so that you will understand better what to expect and how to deal with what might happen or is now happening.
  • Talk with your senior’s doctor about lingering medical consequences of their tour of duty, including physical disabilities and diabetes (thought to be caused by Agent Orange).
  • Openly discuss the events with your senior vet who needs closure, acceptance of the events of the past and a healing of their spirit as they move through retirement.
  • Contact the Vietnam Veterans of America (VVA) to gain access to educational, health, cultural and emotional adjustment services to help your senior vet.
  • Currently a lawsuit is in process arguing that Vietnam Veterans were wrongfully dishonorably discharged due to PTSD. If this litigation is effective, it could mean that these vets can reapply for benefits. Be aware of the outcome if this might benefit your senior vet.
  • Seek out with your senior the services of a trained mental health counselor (one who specializes in PTSD) to deal with the psychological effects of PTSD. Get family therapy, if needed, so that you can come together for treatment.
  • Join a support group for PTSD with your senior and other family members to learn from others and realize you are not alone.
  • Help your senior avoid alcohol and drugs or get into treatment if this is already a problem. Although it may seem like temporary relief, it can worsen symptoms of PTSD.
  • Practice relaxation techniques and meditation to help calm your senior vet.

When you face the trauma together and gather your support network, you can help your senior overcome PTSD. You all deserve a bright future!

We are grateful to your senior loved one for his or her service to our country and to you for your role in caring for them!

Advance Directives: When a Power of Attorney Holder Becomes Incompetent

Advance directives — including living wills and, if desired, Do-Not-Resuscitate (DNR) orders — for our senior loved ones and even family caregivers are very important, we believe.

Making end of life wishes clear is crucial, both for each individual and their family members. It’s also vital to designate who will look out for your interests and desires when the time comes to assure your wishes are honored.

It doesn’t end when you’ve done that, though…

Power of Attorney Holder

Your senior loved one has done what is needed and selected people trusted to honor their final wishes and assure they are carried out for your senior when she or he no longer can speak for themselves.

Fast forward five to ten years (or more) in the future and the holder of the power of attorney, the one charged with seeing that your senior loved one’s final wishes are followed, is now incompetent to carry out that role and may even be causing trouble due to their incompetence.

  • Who should be informed?
  • What steps need to be taken legally to have that person removed as holder of the power of attorney (agent) before they cause harm through their actions?
  • Who should be chosen as a replacement?
  • What do you do now?

Usually the power of attorney and any legal considerations of advance directives vary from state to state, so check with your own attorney to be sure that any changes are handled according to the laws in your state.

Incompetent to Serve – Options for Caregivers

When someone becomes incompetent to perform a duty it means that they, possibly due to an accident or medical condition, can no longer serve or make decisions for someone else, such as for your senior loved one. They are unable to make decisions for the principal, your senior loved one, and probably themselves. If your senior’s agent becomes incompetent, they could make decisions regarding healthcare or finances that are not in your senior’s interests or contrary to what was set forth as your senior’s wishes.

In many instances an alternate power of attorney or agent is named in the event that the primary person is unable to serve, whether from their own incompetence, because they choose to no longer be involved or if they are not available. Your senior loved one may have selected more than one person. In this case, the alternate person would be in charge.

Your senior can also designate more than one person and stipulate that these agents must act together, needing approval of each person to carry out any decisions. This will mean that one who becomes incompetent can’t make decisions against your stated wishes without the approval of those who are competent to act on your behalf.

If alternate agents are named but are now all unable or incompetent to serve as decision maker when the time comes, a guardian can be appointed to oversee the wishes of your senior loved one. The guardian will be appointed by a court. The court can hear testimony about the wishes of your senior loved one to be sure their choices are being followed.

Early Action Best When Possible

Before your senior becomes incapacitated, if they feel that their agent is incompetent they can revoke the power of attorney and designate another to take over the duties. The agent, who is thought to be incompetent, should be notified in writing of your senior’s desire to remove them from the advance directive. Please note that the process varies from state to state but most require this written notification.

It is important to inform anyone with whom your senior has done business – financially or medically – of the change in agent and provide copies of your senior’s revised advance directives so that their file can be updated with the changes.

If your senior loved one is not of sound mind in order to revoke an incompetent agent, family members can go to court and request that a judge put restrictions in place to limit the agent’s power over your senior’s affairs.  The court can force the agent to show how money was spent or decisions made. It can also appoint another agent or guardian to oversee your senior’s wishes.

Unfortunately this often isn’t considered until the power of attorney holder is needed. It can become more problematic when decisions need to be made and agents can’t make them as making changes to an existing power of attorney can take some time.

Being aware of potential pitfalls and planning ahead for them by setting up alternate agents or a group of agents may make things easier for family caregivers as the future unfolds.

Have you experienced this problem and how did you handle it? We would love for you to share your story.

(Note: This discussion is meant to inform family caregivers and start an important thought process but is not legal advice. Family caregivers should strongly consider engaging the services of an Elder Law Attorney to assure their rights – and especially those of their senior loved one – are adequately protected.)