When Our Senior Loved One Says NO – Family Caregiver Quick Tip

Appointment time for the doctor or hair dresser is fast approaching but your senior loved one is refusing to get out of their pajamas.

You need to go grocery shopping but can’t leave them home alone and they won’t get in the car.

It is time for a much needed shower but they won’t enter the bathroom, no matter how many times they are asked.

These scenarios and many more are encountered all too frequently by family caregivers.

In fact, research has shown that 77% of adult children think their parents are stubborn.

Unfortunately, their stubborn refusals impact the well-being of family caregivers. Anger and frustration at their behavior can quickly turn into resentment, which could change the way you care for them.

What is a frazzled family caregiver to do?

Strategies To Use When They Say NO

Finding coping strategies to help you deal with your senior loved one when they get stubborn and refuse, not only your advice about handling a caregiving situation, but refusal of care that you know is necessary, is important to their safety and your mental health.

Here are a few ideas to help you cope and perhaps even cajole them into doing what you think is important from A Place for Mom.

  1. Accept the situation. This is very difficult, but the reality is that your senior is an adult and should be able to make their own decisions when they have the information they need even when you don’t agree with them. The caveat here is if they are putting themselves in an unsafe situation. Sometimes you have to intervene.
  2. Decide how important the choice is. This is when you have to step back and decide if their decision is safe or if it will put them at risk. One example is them refusing to take all their medications. Are some medications essential and need to be given somehow or are there some like vitamins that they can live without? Would a liquid be easier for them or a patch that slowly delivers medication through their skin without the need to swallow — what are the options for medication administration without arguments? In other words, pick your battles and find workarounds.
  3. Don’t beat yourself up. Sometimes things are truly out of your control and all you can do is sit back and hope for the best, but be ready to take over when needed.
  4. Find an outside outlet for your feelings. Having a friend or family member with whom you can unleash your feelings, talk it out, and vent your emotions will help you maintain your calm, caring attitude toward your senior loved one and help you keep your sanity. Perhaps an online chat or Facebook group who are experiencing what you are can give you support.
  5. Try to understand the motivation behind their behavior. Try to determine the root cause of their behavior. Are they trying to make you upset or worry, is this response a way to hide their inability to do what is asked, is the behavior a habit, do they understand what is being asked or are they confused, are they depressed and acting out, or are they trying to be independent and make their own decisions (good or bad)? Understanding the why of it might help you create a plan of action for the how of it to help you overcome the behavior.

Every day is different when caring for older adults. Some days will be good and others will be a struggle.

Being a family caregiver is an important role that many of us are called upon to fulfill.

Staying healthy physically and mentally as a family caregiver should not be overlooked or pushed to the bottom of the list. Therefore, finding ways to cope with your daily challenges will help them and you!

Additional Resources

Here are a few more resources that will help you handle challenging behaviors.


Telehealth Guidelines from CMS May Bring it to a Senior Near You

Older adults who are receiving benefits under Medicare for their healthcare needs visit the physician at least six times per year while most people visit four times a year. That number increases when blood draws, specialists, and procedures are added.

People over 65 also visit the emergency room 19.6 million times in one year (15% of the total visits) according to the Centers for Disease Control and Prevention (CDC) data.

Even with chronic disease management efforts such as medications, diet, and lifestyle factors, our senior loved ones will spend a lot of time in the hospital. They represent 40% of the total number of people hospitalized, according to Agency for Healthcare Research and Quality (AHRQ).

What can family caregivers do to reduce the frequency of doctor office visits and crisis care for senior loved ones?

Have you tried telemedicine or encouraged your senior to use this technology?

Using Telemedicine

Senior Care Corner has long been an advocate for the beneficial use of technology for seniors and their family caregivers.

The list of available and affordable technology can fill gaps for aging in place seniors and the caregivers who provide ongoing care and support.

One way seniors can use technology to improve their health and well-being is to begin using telemedicine services.

Telemedicine is healthcare using a technology that links people to all types of healthcare providers remotely (that is, not in the same location). It is defined as the remote diagnosis and treatment of a person using telecommunications technology.

CMS Changes for 2019

The Centers for Medicare and Medicaid Services (CMS) is the government agency that administers the Medicare Program.

Each year they determine how much and for what services they will reimburse healthcare providers across the spectrum. They also determine which benefits seniors will receive, such as for wellness visits or Part D prescriptions.

In 2019 the Fee Schedule for Physicians and Quality Payment Program is supposed to help boost support for telemedicine, which could help seniors wishing to participate.

Their own remarks show how valuable they now believe telemedicine can be for seniors:

“We now recognize that advances in communication technology have changed patients’ and practitioners’ expectations regarding the quantity and quality of information that can be conveyed via communication technology. From the ubiquity of synchronous, audio/video applications to the increased use of patient-facing health portals, a broader range of services can be furnished by health care professionals via communication technology as compared to 20 years ago.”

By increasing the reimbursement rate for physicians, the theory is that more doctors will join in delivering telemedicine. The greater the participation by doctors, the greater the opportunity for seniors to access telemedicine.

Many doctors have been reluctant to offer telemedicine services to their patients because of several factors, including lack of tech knowledge, potential cost versus benefit of their time spent in electronic medicine, crossing state boundaries with licensure and credentialing issues, privacy concerns, and the inability to receive adequate reimbursement.

What Doctors Do Via Telemedicine

Doctors and healthcare providers of all types, including general medicine, mental health providers, nurse practitioners, specialists, and emergency providers can use telemedicine technology and many already are.

  1. Receiving vital signs via text message or smartphone apps, including blood pressure readings, daily weights, blood glucose levels, and respiratory oxygenation data, as well as other vital statistics that will help them manage chronic disease, adjust medication, and avert a crisis requiring emergency care.
  2. Communicating via text message to discuss concerns, symptoms, schedule appointments, pay bills, and refill prescriptions without needing an office visit.
  3. Reviewing records in the electronic medical record, especially test results or consultations (store-and-forward medical care).
  4. Completing virtual exams where symptoms or physical signs, such as rash or swelling, can be viewed electronically.
  5. Diagnosing and prescribing treatments, especially in emergency first aid situations, avoiding the need for ER visits. Many of these ‘virtual practices’ have been operational using smartphone apps for a number of years already.
  6. Providing education and health coaching to better manage chronic disease states.

What Are the 2019 Changes That Could be Game-Changers?

The new guidelines coming in 2019 which could signal more availability of telemedicine include:

  • Reducing the amount of time required to complete a “visit” remotely. In the past, healthcare providers had a minimum time that they must spend with each patient to qualify for reimbursement under Medicare. The current guideline of 30 minutes/month is reduced to 20 minutes/month. This time could be spent reviewing remote data, communicating with the patient or caregiver, or completing a virtual visit.
  • Reimbursing the provider for time spent setting up the equipment or teaching the patient or caregiver how to use it. The new guidelines establish payment for three individual steps — setting up equipment, on-boarding a new patient into their system, and then training the user on the technology. This is a big step forward in making telemedicine more accessible as it removes obstacles to initiation of the new technology for seniors and caregivers.
  • Clinical staff, not just the doctor and other qualified staff, will now be able to receive reimbursement for using telemedicine through the physician’s office. For example, if the receptionist uses telemedicine technology to schedule and bill, theoretically, this time could be added to the 20 minutes allotted per month to be billed. The medical assistant or nurse can review the vital signs sent daily and report critical values to the doctor for order changes without the doctor spending time reviewing data. This will free the doctor’s time for office visits while providing care and oversight for remote patients who won’t need to physically enter the office for routine monitoring. Even better, under the new guidelines, the doctor doesn’t have to be in the room (or building) where this monitoring occurs. Currently any billing for services provided using a qualified staff member under the supervision of a physician must have a doctor present in the same building at the time of services. This is a huge change and will likely encourage a new form of healthcare provision that will certainly benefit seniors.

The real time benefit for seniors and family caregivers could be game-changers.

Many experts believe that these new guidelines will encourage healthcare providers to get into the game and begin offering telemedicine. Some also believe this will signal new companies and start-ups who can leverage clinical staff to provide telehealth services under Medicare but have been unable to do so in the past.

Multitude of Benefits for Seniors and Caregivers

Just think about the many benefits that both seniors and caregivers can gain if they begin taking advantage of more telemedicine services.

Family caregivers won’t need to spend hours getting to and from routine appointments, making appointments, or getting seniors ready to go out, often for hours for a 15-minute appointment.

It may all but eliminate the need for fragile seniors to be transported to the doctor office for routine visits.

It can reduce the incidence of healthy seniors getting exposed to communicable diseases while they sit in the waiting room, not to mention a sick person spreading their illness to others. Imagine not needing a visit to be treated for flu symptoms.

This can mean less waiting time for those who need to physically visit the physician or healthcare provider if some things can be done remotely, such as blood pressure monitoring for medication adjustments and then prescription changes.

The ability to react quickly and get care remotely when a crisis is looming may prevent many emergency room visits and avoidable hospitalizations.

All of these benefits can help not only manage the health of our senior loved ones more effectively, but also reduce the cost of healthcare.

Telemedicine will not replace the need for seniors to visit a doctor in person at some point. In fact, the guidelines for telemedicine reimbursement often require that the senior be a current patient so that the initial visit will be made in person.

As the technology improves and the trust in the system increases, asynchronous healthcare via technology may not involve a face-to-face visit.

One thing is for sure, using telehealth will help seniors and caregivers when used now and in the future.


Care Plans – Ensuring Caregiving Addresses Wants and Needs

Have you or your senior loved one done an advance care plan?

You may have urged your senior loved one to execute legal documents that spell out their wishes at the end of life. You may have also completed documents such as a DNR (do not resuscitate) order to dictate how you wish to receive medical interventions. But has your senior (or you as a caregiver) set forth your personal desires for caring?

Making wishes known, not just about who gets the desk or car, but how you want to be cared for when you can no longer express your wishes is important for family caregivers and seniors to document no matter their age.

These decisions are very personal and should be guided by your values, preferences, and life beliefs.

Caring for older adults, as well as considering our own needs as caregivers, should involve creating plans for care.

Common Desires to Include in a Care Plan

One in four households currently includes at least one person who is serving as a caregiver.

As we all age, the prevalence of chronic disease increases, affecting our need for care.

About one-fourth of people with chronic conditions are limited in their capacity to live independently and to do everything for themselves that needs to be done, such as personal care, housekeeping, or medication management. We may need help accomplishing these daily activities.

We usually have a specific way we like things done, too. Those should be spelled out in your care plan.

Here are some of the most common desires we all have as we age that should be included in our care plan:

  • Controlling our pain
  • Honoring our wishes
  • Be treated as a whole person
  • Receiving care in a homelike location instead of a facility
  • Being surrounded with people we love (or restrict those we don’t want to care for us)
  • Having enough money to cover our costs without leaving family to pay the bills
  • Living with dignity as we age up until death
  • Communicating effectively between person, family and healthcare providers

There are other things we can include in our personal care plan such as:

  • Arranging for your pet when you can no longer do it
  • Stating your desire for fresh flowers in your room
  • Wanting to keep certain family or friends involved or refusing them to be involved, depending on your relationship
  • Specifying the type of music to play when you are confined to your bed
  • Listing any other type of special consideration that is important to you or your senior loved one and could be easily overlooked when you can’t tell them what you like

Keeping Your Care Plan Updated

Your wishes expressed in your care plan can change as circumstances in your life change. They are not written in stone.

As a matter of fact, they should be reviewed regularly (at least annually) and updated as often as things or people change.

Perhaps the person you anticipate will give you care becomes incapacitated or moves to the other side of the country. You should change your wishes so that those needs be fulfilled by someone you designate.

Did you know that Medicare has a provision to pay your doctor or other healthcare provider to help your senior complete any advance care planning, either as part of their annual wellness visit or as a separate Part B service? It can be billed as many times as needed with no limits set on frequency by the Centers for Medicare Medicaid Services (CMS). Take advantage of this time to discuss future medical changes or potential long-term needs so that the care plan can reflect these issues.

Communicating the Plan to Everyone

Just as you would with legal documents for the end of life, once you and your senior loved one have created a personal advance care plan, it should be shared with significant family members, the established healthcare proxy, and the healthcare team.

As many as one third of us do not want to have CPR or other heroic measures but most of us do not share our wishes with our healthcare provider.

Older adults in the early stages of dementia are able to make decisions about future care on their own. However, the majority eventually will be unable to articulate their wishes for advance care planning and must rely on someone else to do so.

It is important to create an advanced care plan while cognition allows them to make decisions and make those decisions known. Once cognitive loss progresses, the ability to communicate decisions about their desired care will be lost.

Care Planning for Caregivers

Advance care planning is not just for those who are aging. An accident can happen to us at any age.

We should all have a plan, regardless of our age or health status. A life changing event can mean that we will be unable to express our own desires and need someone to speak for us using our personal care plan.

Important questions that should be addressed by family caregivers, but are often overlooked, include;

  • Who will care for your senior loved one when you are unable to do so?
  • Who will manage their care?
  • Where will they live?
  • Who will help pay the bills?
  • Who will be their advocate?

Enlisting the aid of the entire family will be an important part of seeing that not only your senior’s care is defined, but also yours as a family caregiver.

You may feel that taking time from your daily duties to consider and create an advance care plan is selfish. In reality, other family members will be thankful that you were thoughtful enough to guide them in providing care when the time comes.

Decisions about care made in advance are easier to follow than trying to think of what you (or your senior) might want family members to do.

It actually relieves their burden.


Person Centered Diabetes Care Means Better Control for Seniors

The risk of developing diabetes, especially type 2 diabetes, increases when we are over 40.

There are many risk factors, such as weight management, physical activity, and high blood pressure or cholesterol, that can be controlled.

Lifestyle factors are actionable so seniors and their family caregivers can take steps to improve their health with the support of their healthcare team.

Unfortunately, not all seniors are benefitting from diabetes education for proper self-management.

Family caregivers are well positioned to help their senior loved ones improve their ability to manage their diabetes by connecting them with education and appropriate, easy to follow, individualized treatment plans.

Latest Report of Treatment Guidelines from the American Diabetes Association

Every year the American Diabetes Association (ADA) prepares a report with input from researchers, experts in the field, medical doctors, and others to guide practitioners, caregivers, patients, and payers to appropriate care and treatment.

Recently they published their latest report for 2018.

The goals for the care of diabetes expressed in this report:

  • Timely treatment decisions based on evidence in collaboration with patient based on their needs, preferences, and other comorbidities (diseases). Improved self-management support is vital.
  • Care systems should facilitate team-based care, patient registries, decision support tools, and community involvement to meet patient needs
  • Creating quality diabetes treatment programs and evaluating their effectiveness to promote improved processes.
  • The ADA encourages patient centered care which is respectful and responsive to the needs of the person with diabetes because one size does not fit all people diagnosed.
  • Evaluate social factors such as food insecurity, financial barriers, and housing when creating a treatment plan and refer to community resources as needed

Despite all efforts to educate and manage diabetes in the population, the ADA reports that “33–49% of patients still do not meet targets for glycemic, blood pressure, or cholesterol control, and only 14% meet targets for all three measures while also avoiding smoking”.

Innovations for Improved Diabetes Care

This report details specific innovations and changes in the care of people with diabetes that can help seniors and everyone with diabetes (29 million currently diagnosed and 8 million more unaware that they have diabetes) manage their disease for health and prevention of complications.

Increasing the percentage of people who are managing diabetes will lower healthcare costs and side effects from uncontrolled abnormal blood sugar levels.


Using the latest technology can help lower the cost of care, reduce the likelihood of unscheduled medical interventions, help control medication adjustments and reduce complications due to better blood glucose control.

Here are some of the technology advancements available to seniors that can benefit their self-management:

  • Apps provide improved blood sugar monitoring, communicating results in real time with the health team and caregivers so that emergencies can be avoided.
  • Telemedicine, especially for those with limited access or transportation obstacles, when more frequent follow-up and monitoring occurs, blood sugar control, and medication adherence is improved.
  • Electronic medical record (patient portal), which allow caregivers and seniors can view and track their lab work, have more individual contact with physicians and other health professionals, make appointments easier, and refill prescriptions, among other tasks.
  • Text an educator or health professional using text either as part of the electronic health record or using smartphones, being in touch with an experienced person who can guide you and your senior if trouble or questions occur.
  • Tracking medication adherence using electronic pill dispensers that will alert both caregivers and the medical team when medication is skipped or administered inappropriately

Reducing Cost of Care

Improved diabetes management will occur when the cost of care, supplies, medications, and a reduction in out-of-pocket expenses are controlled. This will improve treatment plan adherence.

The cost and availability of education and eye exams is an area needing improvement as well.

Continuous Glucose Monitors

Managing blood sugars without frequent finger sticks using a continuous blood glucose monitor will improve adherence to treatment plans. If a person with diabetes can keep blood sugar in better control without having to use strips or hurt themselves multiple times a day via fingerstick, they may be more apt to monitor as directed and administer medication accordingly.

Improved A1C Testing Procedure

Laboratory tests for A1C have in the past not been as accurate for certain groups of people. Advancements in testing procedures means that, especially for these people, a lab can be aware to use specific testing to overcome inaccurate results yielding more appropriate action based on the data. Ultimately meaning that more people will be able to manage blood sugars more effectively.

Heart Health

More emphasis has been placed on the connection between heart disease and diabetes. It is important to incorporate not only heart healthy lifestyle factors such as eating and activity but also be sure that medications do not contribute to heart attack and stoke for people with diabetes.

Some heart medications have been shown to potentially reduce the risk of heart disease and those should be used for people with diabetes.

Hypoglycemia in Older Adults

Low blood sugar has become a real concern for older adults managing their diabetes. The ADA recommends more education and close monitoring be done for older adults to prevent episodes of low blood sugar or hypoglycemia. Some older adults may be struggling with medication management and overtreating their diabetes. Using a drug regimen that is as easy to follow as possible is important for aging adults.

Putting Education Into Practice

All these advances can help our senior loved ones manage their diabetes and prevent adverse events from low blood sugar (or high blood sugar) as long as we advocate for them to get the individualized treatment plan and education they deserve.

Learning more about what foods to eat, heart health, weight management, physical activity, sick day care, and medication administration is key to a successful treatment plan.

Medicare pays for diabetes education as an annual benefit. One-on-one sessions with the diabetes educator and dietitian are a great way to create an individual care plan. Classes are available in most healthcare systems or wellness centers.

Family caregivers are able to attend diabetes self-management education sessions to help their senior manage their diabetes at home. If you haven’t taken a class or seen a diabetes educator, it is a good step in the right direction to control diabetes.


9 Wheelchair Tips for Seniors’ Safety — Family Caregiver Quick Tip

Family caregivers are responsible for many things requiring skills that they may never have had to use before and may be wondering what is the best way to accomplish certain tasks.

Caring for a wheelchair may be one of those things.

Often we are learning about wheelchairs at the same time as our senior loved one, so they are unable to direct us based on their experience.

That does not, of course, reduce our desire to care for them and their well-being as we care for their wheelchairs.

Tips for Safe Wheelchair Use

It isn’t enough just to push your senior loved one here and there, out in the community, or just inside the house from room to room.

Caregivers want to be sure that the wheelchair their senior loved ones use is safe and in good working condition.

There are many ways for wheelchairs to wear out or be used in such a way that harm could occur. In fact, in 2016, almost 18% of all wheelchair users were injured in a wheelchair-related accident and 44-57% reported a wheelchair breakdown. Worse yet, 20-30% of those with a breakdown were stranded at or away from home.

Here are a few tips for wheelchair safety:

  1. Check the wheels regularly – ensure the wheels aren’t loose or have flat tires, which may impact its braking ability. Don’t forget the spokes, as broken spokes can keep the chair from moving freely. In addition, keep the spokes clear of obstructions, such as lap blankets.
  2. Keep the wheels well-oiled for proper functioning.
  3. Check the brakes often to be sure they still lock tightly to prevent accidents. Always lock brakes before transferring your senior in and out of chair!
  4. Don’t overload the chair with heavy bags, especially on the back, which could cause it to tip over.
  5. If the wheelchair is battery powered, inspect the system for safety and keep it out of the rain. Check the speed and reprogram it to a lower rate for safety if needed.
  6. Don’t allow children to play on wheelchairs.
  7. Keep the chair clean, including chair seat, arms, and wheels, to prevent the spread of germs and prolong its life.
  8. Pay close attention to the surface on which your senior is riding to prevent tipping over due to cracks or holes in pavement or any change in grade, including carpeting.
  9. Be aware of people nearby (not to mention small pets) so that they don’t get run over, causing injury to them or the senior in the wheelchair.

You may want to keep the owner’s manual handy in case service or warranty information is required.

Using a wheelchair can be vital to seniors who have difficulty walking or have limited stamina so that they can stay engaged in the community and socialized with those they love.

Keeping the wheelchair in good working order will help you keep them safe and them a part of the action!

Additional Resources

Those tips are a quick snapshot about caring for a wheelchair but here are a few more articles you might find informative.



After a Natural Disaster Strikes — What Family Caregivers Can Do

Summer storm and hurricane season is upon us.

Now is the time for family caregivers to begin getting their plans in place to help their senior loved ones weather the storm and pick up after a disaster.

Natural disasters include events such as hurricanes, tornadoes, floods, or earthquakes that can cause great damage and even loss of life. We are also seeing widespread wildfires and even volcano eruptions that are causing homelessness. Falling trees, heat stroke, freezing, belongings being washed away or worse are some of the consequences of a natural disaster.

All natural disasters cause some type of loss. For older adults, much can be lost after a natural disaster that is currently allowing a senior to live independently, such as the help of a nearby family caregiver, access to medical care, adequate nutrition, safe housing, and getting medications.

When these lifelines are lost, even temporarily, a senior can be in real trouble physically, financially, and emotionally.

Seniors Struggle After a Disaster

Senior’s are affected more drastically than younger people following a disaster because, according to the National Center on Law and Elder Rights (NCLER), they have fewer private resources to recover after a natural disaster.

Almost 80% of older adults own their own home. After a disaster, they must rebuild or repair their home. Sometimes they must find another place to live if the home is unlivable and until it can be made whole again.

Oftentimes, disabilities of age can inhibit seniors from participating in both the clean-up and the repair of their own homes.

Financially, the cost of this recovery could be out of their reach.

Another obstacle for seniors is the need to use technology to get the help they need from recovery programs. Their access to technology, hearing loss, and cognitive impairment are all obstacles.

Family caregivers can and may have to help older adults in the aftermath of a natural disaster so we want to share some tips to help you in the recovery process.

Resources for Recovery

There are a variety of sources that can help family caregivers and senior loved ones access the help they need after a natural disaster to help them recover, hopefully without losing even more, including their homes.

Caregivers may have to facilitate many of these interventions, so having the proper documentation will be essential for you to act on their behalf. You may want to collect it now and keep a copy safe in an emergency.

  1. Private insurance (medical, flood, auto, and homeowners); be sure to follow directions for filing and meet the expressed deadline dates; this can be done over the phone or online
  2. Federal, state, and local assistance (FEMA if the Governor and President have declared the disaster)
  3. Non-profit organizations or governmental aid agencies (HUD, homeowners assistance programs, faith-based relief)
  4. Mortgage relief because, while your senior is still responsible for payment of the loan, there may be adjusted payment plans or grace periods granted which reduce or suspend payments for up to six months after talking with a loan servicer
  5. Debt relief
  6. Personal resources

Tips for Getting the Help You Both Need

First, ensure your senior made it through the disaster uninjured!

Before your senior’s home suffers more damage, secure any property that might be impacted in the aftermath of the disaster, such as boarding broken windows or tarping a damaged roof against more rain.

Have a list of possessions cataloged before a disaster. Using a smartphone to take pictures or even video of each room is recommended. After a disaster, this can help generate a list of missing or damaged items for loss recovery.

Keep a list of any expenses incurred, such as rental car or hotel fees for claims. Ensure all receipts are retained.

If the disaster is a FEMA covered event, generally you and your senior will have 60 days to apply for assistance. This can be done at disasterassistance.gov or by calling 1-800-621- FEMA (3362).

Caregivers may want to photograph important information, including all insurance cards, and upload to a cloud server so that the information can be obtained after the disaster.

There can be a 90-day moratorium placed on any foreclosure activities by the mortgage holder after a natural disaster. This could protect seniors from foreclosure or eviction if the mortgage isn’t paid on time.

If your senior needs legal help after a natural disaster, caregivers can contact the National Disaster Legal Aid Resource Center.

If flood insurance is needed to protect your senior’s home from the next disaster, you can contact floodsmart.gov for more information or to purchase flood insurance. FEMA will only cover costs of home repair for one flood event.

Have a first aid kit and disaster plan ready to go before disaster strikes. Check out
Disasters Can Strike Anytime – Ensure Senior Loved Ones are Prepared and First Aid Kit Essentials for the Homes of Senior Loved Ones to learn more about preparation to keep your senior safe.

Advance planning and preparedness won’t stop the next disaster from occurring but it will help caregivers manage a successful recovery and improve the likelihood that seniors can continue to age in place.

Elder Orphans — Raising Family Caregiver Awareness on the Senior Care Corner® Podcast

Millions of older adults receive care and support from loved ones. For many, it’s those family caregivers who enable them to age in place successfully.

But more than 20% of current seniors — and even higher percentages of future seniors — don’t have spouses, partners, or children to care for or about them.

In addition, many other seniors have family members who live a long distance away or are estranged. Either way, they aren’t around to provide the caregiving many of older loved ones need.

In an unfortunate irony, many who will face this situation in the future are — or will be — family caregivers themselves, providing for the needs of their parents or other senior loved ones.

What are these “elder orphans” to do when they need help with those things, big and small, they can no longer do effectively for themselves?

In this episode of the Senior Care Corner® Podcast, we want to help raise awareness and let current and future elder orphans know there are many others facing challenges similar to theirs.

Click on the ▷ below to play the podcast (note: you can continue reading while you listen if you want)


Raising Awareness

Raising awareness of elder orphans is important, first, because many of us may know one who could use some help and not realize it. Understanding their situation is a step toward connecting them with what they need.

Promoting awareness in family caregivers and others who be elder orphans in the future enables them to start planning to meet the needs family caregivers might otherwise provide, things they might not otherwise consider in advance, such as these.

  • Determining who would care for them or where they would go if something happened to make them no longer able to care for themselves.
  • Establishing a network of people with whom they can communicate and socialize to help avoid isolation.
  • Arranging transportation for activities such as shopping, healthcare appointments, social activities, and more, should the elder orphan no longer have the ability or desire to drive.
  • Naming a healthcare proxy, someone to make medical decisions should the elder orphan become unable to do so.
  • Setting up emergency procedures, such as someone who will check in to ensure the elder orphan is okay, such as after a storm, during a heatwave, or simply after time has past without any interaction.

There are many more things current and future elder orphans should consider doing in advance to help them age successfully.

Conversation with Carol Marak

Carol Marak

When we decided to focus a podcast episode on elder orphans, we knew a conversation with Carol Marak was the only way to do it.

It is through social media interactions with Carol that we first learned of this hidden minority among our growing senior population. Finally, we got a chance to meet her at Aging in America this year, where she shared her insights as part of a panel.

After being a family caregiver to her own parents, Carol realized “there is no one who will do that for me.” Since then, she has researched, written, and spoken on the topic of elder orphans.

Carol also created a Facebook group for elder orphans, a place where members can interact and share experiences with others who understand what they are facing.

Links from This Episode


We look forward to sharing more about elder orphans in the future and hope you will check back with Senior Care Corner often for future podcasts and other articles.


Celebrating Seniors’ Independence & Helping Them Maintain It

Independence is a goal held dear by many seniors and their loved ones, not just on the 4th of July but year-round.

Families celebrate Independence Day in the US with picnics, parades, baseball games, concerts, and fireworks!

While the nation celebrates Independence Day, many family caregivers continue to provide daily care for their senior loved ones.

We hope to spend time with extended family, reminiscing about the fun times the family shared on past July 4 holidays.

It is also a good time for caregivers and other family members to think about what types of things we can do to help senior loved ones maintain their own independence in the years to come.

Aging with Independence

Successful aging is often expressed in terms of a person’s functional independence.

Functional independence is the level at which we can be mobile and perform our own activities of daily living (ADL). Someone who is successfully aging will have a minimal decline in physical function.

A person who is aging successfully will be actively engaged in life, have a high level of cognitive function, and have avoided chronic disease or risk factors for disease. Also, if there is an impairment the person has made the most of their limitations through adaptation.

Many believe our measurement of aging is a matter of perception. When asked about successful aging, 50% of adults say they are aging successfully when in fact only 19% of them were doing so, as determined by clinicians.

Both self and clinical assessment are important.

There is a tool that can be used to measure the level of functional independence your senior now has and help you decide what care may be needed to keep them independent. The Functional Independence Measure (FIM) scale assesses physical and cognitive status. The Functional Assessment Measure (FAM) adds twelve items to the FIM, including community integration, emotional status, attention, orientation, and reading/writing skills.

Both of these measures are completed by a healthcare professional. These tools could help family caregivers understand where there may be gaps in functional status and plan a course of action for improving our senior loved ones’ independence.

Mobility is Key to Senior Independence

Mobility is a major factor in being independent. Their ability to age in place will depend on how well seniors can move their bodies, whether it is for walking, standing up, reaching, turning over in bed, or climbing stairs.

This physical motion is essential for independence in activities of daily living such as dressing, eating, and toileting.

Walking involves many physical abilities, including muscle strength, sensory function such as vision, cognition, and motor control. How capable seniors are when walking is predictive of their future independence.

Seniors who walk at speeds faster than 1.0 meter/second have greater independence when performing activities of daily living. They have reduced hospitalizations as well. In contrast, walking speeds of less than 0.6 meters/second are associated with dependence for ADLs and more hospitalizations for seniors.

Being mobile means that your senior can leave their home and participate in activities in the community without help. Without mobility, their independence is threatened.

Social Engagement and Independence

Successfully aging seniors are able to maintain their social engagement within the family and among their communities. Those who are no longer able or desirous of being socially active will have more difficulty maintaining their independence as they age.

Even when a senior is physically well, able to be mobile, and perform their own ADLs, they may still have difficulty with socialization and independence due to one or more factors limiting their engagement.

Perhaps a physically functional senior has no access to transportation or finances that would allow socialization and community engagement. Maybe their community is unsafe for them to walk alone due to either predators or infrastructure, such as poorly maintained sidewalks, no nearby retail outlets, or unsafe traffic patterns that put pedestrians at risk.

Another scenario limiting seniors is one of a spousal caregiver who can’t leave his or her loved one alone at home, leading to isolation.

Being homebound due to external environmental factors can lead to isolated seniors who are now unable to be functionally independent. This, in turn, could lead to a decline in functional status and a loss of independence.

Prevent and Cope with Loss of Independence

Aging is bound to catch up to every one of us. Hopefully it takes a long time to negatively affect us and our senior loved ones. Maintaining physical abilities and independence is a goal most seniors strive to achieve and family caregivers can encourage and support.

Here are some things we can encourage and help senior loved ones to do in order to manage their own aging .

  1. Stay physically active — every day! It will be necessary to keep moving and strengthening muscles to prevent functional decline, loss of mobility, falls and possible loss of independence. Help your senior loved one find activities they enjoy and get them going! Walk, dance, golf, garden, swim, play active video games, or just move doing something fun each day.
  2. Engage socially — Participate in events and activities outside of the home. Go shopping, go to a movie, go to church, go to a festival, go to a class, volunteer in the community, talk with family members, enter a support group, and take every opportunity to be social. Find a buddy and do things together.
  3. Observe what they can and can’t do — Take a close look at what your senior is and isn’t capable of doing. Is it something your senior can improve or do they need to find an accommodation to continued independence? Focus on the positive and maintain all aspects of good health.
  4. Learn to accept help — If a senior’s family members want to help, if you can afford home care, or if you qualify for community benefits, say yes and schedule the help. Knowing support is needed and accepting the additional help will prolong the time your senior can remain independent. But, your senior should be encouraged to do everything they can to help her or himself. Doing for them things they can do themselves puts their independence at risk.
  5. Join the digital world — If your senior wants to be independent, some technology innovations can help them stay at home. There are medical monitors that will help them stay well and out of the hospital. There are tech solutions that will help them stay safe at home. There are internet connections and social media platforms that, when used with computers or mobile devices, will help them stay socially engaged. There are cognitive games that will help keep their minds sharp so that they can function optimally as they age. Using a smartphone or tablet with a variety of apps will give them opportunities for learning something new, engaging with others, keeping their brain sharp, and preventing isolation and depression.
  6. Make home improvements — Make modifications, including small and big renovations, to their living space that will help your senior be safe but also live independently. Install cabinets that can pull down for ease in reaching their contents. Install adequate lighting to prevent trips and falls. Make access into and around the house easier with wider doorways, fewer steps, handrails and safe flooring. Add internet access so that all the latest technology gadgets can be connected. If retrofitting is too costly or not practical, your senior may need to consider a new location that will provide them with universal design that allows them to live independently now and in the future.
  7. Manage finances — Senior loved ones have hopefully planned for their future and have funds available to meet their basic needs. Family caregivers may need to assist them with staying on a budget, getting access to all the benefits for which they are entitled, and putting practices into place that will reduce their susceptibility to financial scams so their money remains secure.

Celebrating our nation’s independence reminds us to celebrate the independence of our senior loved ones too — and help them plan to stay independent!

As George Burns put so well,

“You can’t help getting older, but you don’t have to get old.”



Importance of Respite for Family Caregivers and How To Find It

Family caregivers often spend long hours caring for senior loved ones and their immediate family members but take little time to care for themselves.

Telling someone “care for yourself so you can care for others” is so much easier said than done for family caregivers, who struggle to find the time they need to finish everything that needs to be done each day.

It is all too easy, however, to put your own personal needs on the back burner or on the ‘I’ll get to it later’ list.

When was the last time you went to the doctor for yourself?

How about the beauty shop for a haircut, manicure, or pedicure?

When was the last time you went to a movie, ate in a restaurant, or had a date with your partner?

I hear you laughing – too long??

Family caregivers need the gift of time to not only complete essential household tasks but to care for their own needs.

How can you get back time?

Respite for Caregivers

Respite is a great way to get back time for family caregivers.

What is respite? Respite is planned or emergency temporary care provided for caregivers.

Respite programs provide planned short-term and time-limited breaks for families as well as a positive experience for the older adult.

Getting a break to care for yourself while caregiving is essential. You will need a hand with daily tasks or personal care needs for your senior loved one so that you can go to the doctor, get a haircut, take a nap, visit friends, or getaway on vacation.

There is no failure in seeking out respite care. Caring for yourself will help you be a better caregiver.

Where to Find Respite

There are many avenues to find a respite solution that fits both your senior’s needs and yours as a caregiver.

Whether you need daily, weekly, or occasional respite, you will be able to find the care you seek in most areas of the country.

Here are some opportunities for respite:

  • Family and friends – enlisting the help of family members or friends to help you do every day tasks that can relieve you to care for yourself. Perhaps they can help cook meals, take your senior to appointments, or just spend time with them while you get some rest.
  • Paid caregivers – hiring caregivers from a home health agency to provide support such as household chores, personal care, shopping, cooking, companionship, and other tasks can allow you to do things you may need to do, including remaining in the work force.
  • Day programs – senior centers can keep your loved one safe during the day, occupied with activities or learning something new. They are great places for socialization with their peers. Usually they serve a hot, nutritious meal and many provide transportation as well. There may be a fee for this program.
  • Disease specific (therapeutic) respite programs including dementia respite – these programs provide failure free activities, socialization and mental stimulation for people with dementia and give their caregivers a much needed break from caregiving. They may be run by faith-based organizations or other nonprofit groups to help support those challenged by dementia. A small fee for supplies and food is customary.
  • Retreat – how would you like a retreat specifically designed to nourish and refresh those who daily put loved ones’ needs first and give care on a daily basis? There is a place that has been offering caregiver respite and a way to look at your role with a new vision and a renewed commitment to continue in that role, but with a resolve to care for yourself at a deeper level. This particular retreat takes place in St. Francis Retreat Center at Mepkin Abbey in Moncks Corner, SC. 
  • Out of home respite care in a facility – an assisted living facility, memory care, long term care facility, or even a hospice house will provide short-term care in their facility for up to a week (or longer as needed). This care is paid for by the senior or their caregiver and not covered under Medicare. It could be a weekly or per diem charge.
  • Palliative or hospice care – if your senior qualifies for this medical program, they can provide in-home care services that will help relieve some of your duties. This is covered by Medicare or Medicaid if your senior is qualified.

Help Paying for Respite

For many seniors and caregivers, paying for respite may be out of reach, even if the fees are small.

If your senior didn’t set aside enough funds to cover their retirement, healthcare and cost of living as they age, they probably don’t have the money to pay for supports such as respite or other long term support services (LTSS).

Sometimes a long-term care insurance policy may cover some of the costs of in-home care when a doctor says it is necessary. You should check your senior’s policy if they have one and use the benefits for which they have been paying for years.

There may be respite vouchers available to family caregivers through the State Lifespan Respite Grantees. Funded by the Administration for Community Living, US Department of Health and Human Services, State Lifespan Respite Programs or Projects are run by a designated state government lead agency, which works in collaboration with a state respite coalition and an Aging and Disability Resource Center Program/No Wrong Door System. The goal is supporting a statewide system of coordinated, community-based respite for family caregivers caring for individuals with special needs of all ages. Currently 37 states participate in the program. Here is a link to more information to help you access these services.

Some disease specific organizations, such as the Alzheimer’s Association, also have respite funds available to eligible caregivers in the form of vouchers that can help with the cost of respite.

Your local Area Agency on Aging can help you locate other resources to help fund respite care so that you can continue to provide care for your senior loved one.

You can also see if there are more benefits for which your senior may be eligible to offset the costs of care through this government resource website.

Seniors who are veterans can apply for in-home support through the Veteran’s Administration. This is an often overlooked source of assistance that should be investigated for any veteran.

Benefits of Respite

The obvious benefit for respite care is that family caregivers can begin to find time to care for themselves. Getting a rest, caring for your own health needs, working, socializing with friends, and getting mental health breaks is good for caregivers and essential to continue to be an effective caregiver.

However, there are other benefits for our senior loved ones when family caregivers get the support they need.

Getting as much support for seniors can prolong the time spent living independently at home. This can delay when placement in a facility becomes the only safe option.

Caregivers can avoid the potential for neglect or even abuse of their senior loved ones when frustration, anger, and fatigue are remedied by help from others in the form of respite. Caregivers can display their emotions by yelling, striking out at seniors or neglecting their needs when fatigue sets in. A nap or walk can make a big difference when tempers flare.

Accepting respite is not a failure but a good decision for both caregivers and seniors receiving care.

Seeking the perfect solution or a combination of more than one will make a big difference in everyone’s life.