End of Life Decisions: Has Your Senior Loved One Made Them? Have You?

What kind of healthcare treatment would you and your senior loved ones want to be given at the end of your life — or would you want any at all?

End of life care is something about which most adults in the US have heard and maybe even considered — thanks in part to television shows — with many having also heard about living wills.

Most have not taken things past the “thinking about it” stage, however, to having serious conversations with family or actually doing something to ensure their wishes are honored.

Enter National Healthcare Decisions Day (NHDD), an effort to educate and inspire individuals to formally express their wishes regarding healthcare and encourage healthcare providers and facilities to honor those wishes.

We thought this year’s NHDD would be a good time to revisit an episode of the Senior Care Corner® Radio Show from a few years ago, one in which we talk about NHDD and use it as a springboard to encourage family caregivers and their senior loved ones to have their own family healthcare decisions day.

Not only is it important for family caregivers to ensure senior loved ones express their wish, but the caregivers need to make their own end of live decisions.

Family Healthcare Decisions

First, I guess we should explain what we mean by the “healthcare decisions” families should discuss.

We’re talking about the type of care an individual wishes to receive — and the care she or he does not wish to receive — when potentially at the end of life, at a time when ongoing life depends on the measures performed.

Examples of these measures include receiving CPR, being placed on a ventilator, or being fed via a tube.

Why are we taking about this now?

Putting aside that we frequently talk about the need for living wills, advance directives, and the family conversations that help make those decisions, we want to get families planning to have these discussions when they gather from their scattered homes for family spring and summer events.

Listen to the feature segment in this episode for our discussion of family healthcare decision making, including reasons why it’s important and how families may approach the conversation.

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Preparing for the Family End of Life Care Discussion

Preparation can help families better face the elephant in the room and have a more successful discussion of end of life options.

  • Learn about what “advance directives” means. We don’t just mean the term but, more importantly, the implications for those making and formalizing the decisions, as well as their family members.
  • Research what is required in your state, or states for dispersed family members, and which decisions are covered.
  • Gain an understanding of various means of life support to give a better understanding of what is involved with the decisions to be made.
  • Consider consulting an elderlaw attorney or other legal reference source to determine what the necessary forms look like, what information is needed to complete them, and the steps to take to ensure they are enforceable.

Catch the full discussion in this episode of the Senior Care Corner Radio Show.

Additional Healthcare Decisions Resources

We hope you like this trip back to a prior episode of the Senior Care Corner Show and find it helpful to you and your family. We have also prepared this transcript – so you can follow along with the recording or read it at your convenience.

 




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.

 




Hospital ERs Changing to Provide More Senior-Friendly Care

How many family caregivers have visited an emergency room (ER) or emergency department (ED) in the past year with our senior loved ones?

No matter how many of you raised your hands it’s too many — and, worse, too much pain for too many older loved ones.

We dread it and what it means, but there are times when it simply can’t be avoided.

Family caregivers of seniors visit the ER pretty frequently, according to the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics, which tracks this data. As a matter of fact, during 2012–2013, there were an estimated 5.2 million ED visits per yeaer for injury and 15.5 million ED visits for illness among adults aged 65 and over.

The number certainly has increased and will continue to increase since that data was collected due to the increasing senior population.

Emergency Room Frustrations

There are many frustrations for family caregivers who sit in the waiting room for extended periods with seniors who may not understand why they are even there, not to mention the pain they may be experiencing that brought them there in the first place.

Older adults can be overstimulated by the hustle and bustle of a busy ER leading to increased confusion and even delirium.

Family caregivers are worried about their loved ones but also the jobs or the kids left behind to wait in the ER with grandma. We fear for the consequences of this injury or illness, worry about the next fall or medical crisis or how this might change our senior’s life and living arrangements.

Creature comforts are a concern as well for family caregivers and our seniors. It may be too cold or too hot in the waiting room, the noise level can be unnerving, seniors may be missing scheduled medication doses while they wait, they may be hungry or thirsty, they may have trouble using the restroom or are bored even though we try to keep them entertained.

All these scenarios are a recipe for disaster.

Specially Equipped Senior Emergency Rooms

There is a trend crossing the nation in the healthcare system, moving toward better meeting the needs of our senior loved ones, and is a change that is overdue.

Senior-friendly ERs are specially equipped to meet the needs and wants of seniors and their family caregivers.

A few modifications to be found there include:

  1. Specially trained personnel, including geriatricians (doctors who specialize in senior medical care) who understand the special needs of older adults, including dementia care
  2. Trained individuals who can counsel caregivers and our seniors about advance directives
  3. Slip resistant floors with low glare surfaces and improved traction
  4. More comfortable mattresses that are thicker to protect fragile skin
  5. More lighting in walkways and landscape to prevent falls in those with diminished vision
  6. Handrails and grab bars in more places, including rooms and hallways
  7. Larger clocks
  8. Bigger TV screens, often with closed captions on
  9. Blankets that have been warmed in warmers to comfort vulnerable seniors
  10. Call bell alerts for staff that are easier for less mobile or arthritic hands to push
  11. More calming décor colors including walls and furniture instead of institutional hues
  12. Acoustics to reduce excessive noise
  13. If wait time is expected to be long, they move the senior to a quiet room to reduce distractions that could lead to delirium
  14. Reduced number of transitions from ER to discharge, including fewer room changes that lead to confusion
  15. Thorough and frequent medication review to limit drug errors, interactions and severe medication side effects or adverse reactions
  16. Natural light to reduce confusion and delirium
  17. Chairs that are easier to transfer into and out of by seniors
  18. Equipment available to meet needs, such as bedside commodes
  19. Extra seating for family members
  20. Wipe off boards with information and reminders
  21. Sensitivity training for all staff for better communication and coping skills
  22. Discharge planning assistance with clear instructions and appointment scheduling

If your hometown ER is not specifically designed for senior care, advocate for the adoption of age friendly strategies for the seniors in your community.

Other Special Services in the Senior-Friendly ER

In addition to the actual facilities and staff, there are also positive differences in an ER that is specially designed for seniors.

Many healthcare systems have created ERs that go a step beyond when providing emergent care to people over 65. Services include staff trained to complete individual assessments on the elder in addition to addressing the reason that brings them for emergency care.

  • Depression scale is performed to determine if there may be problems affecting overall health and care.
  • Assessments of the elders functional status are performed in order to determine if there are further safety measures or equipment interventions that would benefit seniors when they return home to keep them safe.
  • Medication lists are reviewed and chronic disease management protocols are reviewed to be sure treatment plans are being followed correctly for health and safety as well.
  • Trained personnel ask questions about current living situations, support systems in the home, and listen to the stories told by the elders in their own words. This takes some listening skills and problem solving experience to be sure all needs are being met. If not, the unmet needs are addressed prior to discharge.
  • In addition to the other assessments, a cognitive screening is performed to determine if deficits are apparent that might require further intervention from medical professionals in follow-up.

Caring for the Whole Senior

Senior-friendly ERs don’t want to simply treat the illness or injury, prescribe more medications and send the elder home. They want to be sure that the senior is safe at home, managing their health and will be able to live their lives to the fullest.

Care managers can help fill any deficits by scheduling after-care appointments to further investigate unmet needs. They also follow-up the next day to be sure all instructions are understood and no other problems arise.

Healthcare providers in specially designed Senior-friendly ERs look at the whole person and take time to listen. Many seniors are vulnerable and require an extra level of attention to stay safe and well.

It has been shown that this type of intervention does not lengthen the amount of time spent in the ER because the care is coordinated. Partnering with the Emergency Medical Service (EMS) personnel helps with performing some of the assessments. EMS can look at the home environment, including food in the refrigerator or other areas of concern, while they are performing their in-home assessment prior to transport. This includes seniors who live in facilities other than home.

Senior-friendly ERs should also ask about how the family caregiver is coping. If the caregiver is nearing burnout, the senior will not be safe to return home. It is important that healthcare providers identify areas that can support caregivers keep the senior safe and healthy at home to avoid crises that lead to ER visits.

We hope to see more emergency rooms become senior-friendly to better serve the needs of our senior loved ones!

What Being A Caregiver Has Taught Me About My Own Aging

Being a family caregiver is an experience that will bring many moments of joy, sadness, frustration, and wisdom.

Living this journey can be life-affirming for many family caregivers. It is what you were meant to do – care for someone who once cared for you.

It can have its challenging moments but also brings clarity of purpose and insights if you pay attention.

What will you take away from your caregiving experience that will help you age successfully?

Lessons Learned as a Caregiver

Finding the silver lining in a every cloud, whether it has rain or emanates a rainbow is said to yield a positive outcome for the person who is willing to look for it.

Learning from experience and improving your personal aging experience are worthy goals for family caregivers.

Once you identify the areas which challenge you caring for a senior loved one, you can create an action plan for your own aging to allow you a more successful path in aging.

As I have learned, there are many aspects to that plan.

“I want to stay in my own home”

So you have decided you would prefer to live in your own home as long as possible as you age. Now is a good time to start incorporating universal design in your own home.

Modifying your home for aging needs every time you renovate or redecorate will make aging in place easier for you as your function changes.

For example, exchanging broken fixtures for age-friendly ones will put you ahead of the game and make it easier for your own caregivers.

If your home or your location is not ideal, perhaps now is the time to determine if a move, downsize, or a walkable city is in your best interest.

“I want to be financially prepared for the future and all my needs for aging”

Because you know first-hand from your role as a family caregiver just how expensive aging can be, you know having a sound financial plan will make your future easier.

Rising healthcare costs, limited retirement accounts, cost of living expanding greater than fixed incomes, and outliving the years of funds in the nest egg can be overcome with more informed financial planning.

Are you putting enough money away, do you have a long-term insurance plan, have you maintained a budget and paid off large debt so that you will be ready for the future? We all want to age in place but not enough of us have made the appropriate financial plans to maintain our desired way of living.

It is not too early to seek the advice of a financial planner to help you make a plan for your own future.

“I want to use technology for my benefit and for the ease of my caregivers”

In this digital age, most family caregivers can see that technology has already provided many benefits for seniors who live at home. There are devices and apps that will help keep us safe at home, connected to the community and allow us to manage our personal data.

The best is yet to come!

These innovations will only continue to be created and improved so that when we are ready, there will be no hesitation to employing as much technology as available.

Staying aware of the innovations and using technology now will help in the future.

“I want to live near my kids and grandkids”

You know how important it is, as a family caregiver, to be accessible to your senior loved one. You will also want this because chances are your kids will be your caregivers as you are with your parents.

Being near them will be best for you both.

Does that mean you need to move closer to them? Is a family conversation in order to decide if there is a chance they will relocate after you move to be near them making it necessary for you to move again?

Is it possible for you to move in with them and share a household? Does it make better sense to both find a property that allows you both privacy but proximity?

There are many more options now than in the past such as granny pods that can make living together but separately more cost effective.

“I want to have all my legal documents in order now!”

Experts believe that two-thirds of adults have not created legal documents that express their wishes or created a will that dictates where their assets will go after they die.

This situation leaves family caregivers guessing what to do as end-of-life approaches and often stuck in the middle of other family members who try to fight for their piece of the pie.

Executing advance directives, such as a living will or a DNR (Do Not Resuscitate order) before you need it and then discussing your wishes with your loved ones will help make you an informed care recipient and not put your caregivers in a difficult position, as you might feel you are currently in with your own senior loved ones.

Having time to contemplate your wishes, filing accurate documents, and sharing this with those who need them instead of trying to do it all quickly in an emergency will allow you to make the best choices and create action plans, including funeral arrangements, to reduce the stress on your future caregivers.

“I want to downsize and declutter”

You may be struggling with the thought of having to dispose of your senior loved ones’ fifty years of possessions. What is the most important to save, what is worth selling, and what is just junk?

Most of us have piles and boxes of stuff stored that we may not even remember we have. Imagine storing this for many, many years. This is what many caregivers are staring in the face right now.

It makes us realize we don’t want to do this to our future caregivers. Now is a good time to start decluttering the basement and garage and closets throughout your home so you can donate or sell the belongings you have that you no longer need so no one else will have to later.

Depending on your personal caregiving situation, there may be more lessons you learn to help you age more successfully.

Can you add a few to our list?

What would you put on your own list?

The important idea is that we take action when we see a problem that we need to fix for ourselves instead of getting frustrated that your senior loved ones haven’t prepared well.

The time is now to start preparing for your future!

 




Seniors and Families Talking Turkey About the Future During the Holidays

Most families enjoy special moments during the holidays, whether they travel great distances to meet or just come across town.

It is a time of year when caregivers take a break from our hectic schedules to sit down with the ones they love and reminisce about the good times they have shared.

As seniors get older, these time become even more precious to them and the whole family.

It is important for family members to have enough time planned to get comfortable, have time to reacquaint yourself with out of town family, and spend time with your senior loved one when they can connect.

There should also be time set aside to “talk turkey” with the entire family around the table with your senior and take advantage of the opportunity of togetherness.

Talking Turkey About the Future

Many caregivers may be looking across the table at parents, grandparents or other senior loved ones who appear to be aging right before their very eyes.

Reality strikes as caregivers realize that these family times will not last forever.

This is a great opportunity to discuss topics that might have been hard to raise in the past, such as what would happen in case your senior is hospitalized, injured during a fall, gets a terminal condition, needs placement in a facility or should die suddenly.

Has the family discussed these possibilities and are they ready for the challenges that may face them if a tragedy occurs?

Together there are some questions you should be asking out loud and expect answers from your senior loved one.

Do You Know…

  • if your senior loved one has advance directives, such as a living will or a healthcare/durable power of attorney? Who knows where they can be found when needed?
  • who is the power of attorney or the executor of their estate and how do you contact them?
  • their wishes for medical care if a calamity strikes? Do they want to be kept alive artificially or do they want nutrition to be given in the form of a tube feeding?
  • if they wish to have a Do Not Resusciate (DNR) order or do they want everything done despite potential consequences?
  • who will take care of their pets if they no longer can?
  • if they have a funeral home picked out or a burial site already planned/paid for, do they want to be cremated, do they have an outfit already picked out and a plan for a memorial service?
  • the names of their doctors, which medications they take, which hospital they prefer, and when they had a flu or pneumonia shot?
  • if there is a will directing who gets what in their house or their finances?
  • where their checkbook is or which bank they use?
  • if they have a safety deposit box with valuables and/or important papers?
  • if there are passwords for accounts or computer sites that you will need to know to access if they no longer can do so themselves?
  • do they want to stay in their home for as long as possible, if they’re OK if they need to go to a senior living facility near you, or prefer to be close to friends and the community they know?
  • who they want controlling their finances if they can’t any longer?
  • everything they would want you to know in the case of emergency?

Time Is Now

Now is the time to learn all you can so caregivers can help them through the tough spots as they age and especially in the event of an emergency.

Being informed will allow caregivers to act quickly and decisively when time is of the essence.

It is a good time to make observations about the functional abilities of your senior instead of accepting that everything is fine.

What can you see for yourself? Is there food in the kitchen and its not all spoiled, are their clothes clean, are they physically stable, is the home in good repair, is the car damaged from fender benders of which you aren’t aware, are there unpaid bills laying on tables or counters or other problems that become obvious when you look closely?

If your family doesn’t agree on some of your senior’s decisions, now is the time for open dialogue.

Siblings arguing over what senior loved ones want in the emergency room is not going to help keep them alive.

Be sure their wishes are clearly understood and written in the form of an advance directive that will help guide healthcare professionals when the time comes.

Also be sure that your senior is integral to every step so that they can speak up for themselves and let everyone know their wishes.

Some seniors may need you to be aware of their personal schedule when you visit to talk turkey especially when these topics are discussed. Perhaps they have a special nap time or take a bath at a certain time. You should work the family into their schedule for best results and allow for rest periods as needed.

Tough Talk

Some of these topics are hard to talk about but openness is vital. Ignoring the issue will not change the outcome.

A little planning will be helpful such as have someone be the recorder so there won’t be any miscommunication or lost details in the future.

If necessary, create a schedule with out of town family and keep things short and to the point.

This isn’t the time to bring up old hurts or blame family members for past issues, put the focus on your senior’s needs and wants.

It may be painful to think of your senior as being mortal or that they may not be able to care for themselves, but getting these issues out in the open so everyone knows what to do in an emergency will be empowering for family caregivers.

Just as important, it relieves your senior loved one of a burden, as they will not longer have to worry about leaving all those issues for a loved one to resolve later.

Caregivers Need First Aid Knowledge BEFORE an Emergency Happens

Emergencies that can require caregivers to administer medical help to a senior loved one can happen to anyone, at any time of the day or night.

Are family caregivers ready to minister to senior’s health needs? Are you?

Of course, if it is something traumatic, the first course of action is to call 911.

If it is not life threatening or while awaiting first responders, caregivers need to know what to do.

Medical Treatment for Seniors

Basic medical care techniques are skills most family caregivers should have in case of emergency.

It is a great idea for family caregivers to take a few classes in first aid, including CPR, Heimlich maneuver, and emergency first aid.

These techniques can be life saving for your senior loved one.

There are many organizations that provide these helpful classes across the country, such as the Red Cross, American Heart Association, and local healthcare systems.

If you can’t locate a class near you, there are online training courses you can take from home.

There are some events that are more likely to occur in seniors such as these:

Falls

Seniors are at risk for falling, especially if they have trouble with balance, loss of muscle mass or multiple chronic health conditions.

It is important to prevent falls whenever possible, but they can still occur.

If your senior falls, don’t try to get them up without checking them out first. They could be injured and getting them up too quickly could make the injury worse.

Here is a video helping your senior get up more safely after a fall. If they appear to be injured with a broken bone, stroke or head injury, call 911 and keep them still until help arrives.

Skin Cuts/Tears

Seniors skin becomes more fragile with age and loss of collagen. It becomes thinner and more vulnerable to tearing.

If a cut is superficial, cleaning and applying antibiotic ointment may be all that is needed; a bandage can help keep it clean but sometimes air drying is effective.

If a cut is deeper, stop the bleeding and assess to see if it will need more medical attention.

Some cuts bleed more than others, depending on their location and can be frightening. Also be aware that seniors who take a blood thinner may bleed more, take longer to cease bleeding and may need medical advice or a checkup to see if their medication levels are appropriate.

Choking

Older adults can experience difficulty swallowing and may have choking episodes, especially on certain foods such as hard meats, gummy foods, and stringy vegetables.

Coughing occurs often but choking is serious and needs immediate medical attention, especially if the airway is blocked.

If your senior grabs their throat, has trouble speaking, is unable to breathe and turns blue, or can only nod their head, first call 911 and then perform the Heimlich maneuver if you are trained.

Poisoning

Seniors can have trouble with their medications and take them incorrectly, causing poisoning. They can also unknowingly ingest something toxic.

It is a good idea to remove any dangerous chemicals from their reach and put the poison control number on the refrigerator in case it is needed quickly.

If you suspect they may have been poisoned, call poison control to get instructions before doing anything, including making your senior vomit.

Managing Medications

Medication nonadherence will result in medical problems for senior loved ones.

In fact, not taking medications correctly results in 125,000 deaths and 11% of hospitalizations annually.

Seniors may have difficulty with medication management for a variety of reasons such as:

  • Simply not remembering to take medications as prescribed at the correct time or as directed
  • Skipping doses because they feel better
  • May not be filling the prescriptions: 20-30% of prescriptions are never filled
  • May stop taking prescriptions due to side effects or thinking that they aren’t needed; 50% of people stop their medications or treatments as directed
  • Fear of side effects
  • Cost of medications, co-pay
  • Inability to secure transportation to pick up drugs at pharmacy
  • Running out before they have another doctor visit to update prescription
  • Having to split medications for correct dosage
  • Lack of understanding about consequences of nonadherence or benefits of medications
  • Food and/or drug interactions interfering with efficacy of medications

Proper medication management of prescriptions to treat hypertension will lead to 45% better blood pressure control.

However, in 2014, 26.3% (4.9 million) of Medicare Part D beneficiaries using blood pressure medication were nonadherent to their regimen.

Taking medications properly, including all over the counter medicines and supplements, will help your senior manage their chronic diseases and avoid potential health emergencies.

Supplies to Keep on Hand

Most of our senior’s homes have many supplies on hand from years of needing ‘cures’ but they may not have everything that you need in an emergency.

It is a good idea to take an inventory in their bathroom and fill any gaps with new supplies.

It will be very important to take the time to read the labels and expiration dates on all their products to be sure they are not too old to be used — and possibly even harmful if used. Discard any expired products and replace with newer items.

This is a good time to organize all the health products so that they are easy to find when needed.

  1. Keep an updated medication list including generic names, dosages, time of day, precautions and pharmacy contact number; emergency contact information is also helpful
  2. First aid kit – don’t forget to keep it up to date and change out any expired products
  3. Wound care products including bandages of all sizes, hydrogen peroxide, cotton balls, antibiotic cream, gauze, tape
  4. Ace bandage
  5. Antacids for heartburn
  6. Thermometer
  7. Pain reliever
  8. Constipation relief, diarrhea relief
  9. Ice packs
  10. Heating pad that is new, replace any older model which could have faulty heating controls or wiring
  11. Antibacterial hand cleaner
  12. Non-latex gloves
  13. Cortisone cream for itching
  14. Hemorrhoid cream and/or wipes, witch hazel
  15. Moisturizing lotion that is nourishing to protect dry, cracking skin
  16. Flashlight and batteries
  17. Sunscreen and after sun lotion
  18. Tweezers and scissors
  19. Eyewash, eye drops
  20. Know where to find advance directives, insurance cards and other documents if need to go to hospital

Caring Means Being Prepared

This may seem like an overwhelming amount of information needed to be prepared for an emergency but most common and on hand already.

It is important to gather all the supplies needed and have them on hand as you won’t be able to run to the store to get necessary items in the midst of the emergency.

Readiness won’t just happen but a few small steps toward preparedness will be well worth it if an emergency does arise for your senior loved one.

Prepare for the Next Health Checkup – Family Caregiver Quick Tip

As family caregivers, we know the medical checkups our senior loved ones have are important to their health and wellness.

Because our seniors’ abilities to sit and wait are not endless, nor is our time, we need to make the most out of the time we spend with the health care professional.

What do we need to get from our limited time in the doctor’s office?

Family caregivers need to get their questions answered and leave the office with all the pertinent information they need to be the best advocate for their senior’s health.

Caregivers are doing even more tasks for seniors in addition to the day to day chores they do to keep them safe and happy.

They need to get directions, instructions and resources to help them complete these diverse and skilled tasks.

Preparing for the Next Checkup

Here are a few tips to help family caregivers make the next visit to the doctor or any healthcare experience better by being prepared:

  1. Update your family health history to include any new health problems for your senior or any close relatives to be ready to share with your medical team.
  2. Create a list of any recent or new symptoms, issues or questions for your doctor, including any changes other doctors may have made since your last visit with this professional. Don’t assume your senior’s doctors are communicating, though you may find they are doing so.
  3. Bring a full list of the medications your senior is taking, both prescription and over-the-counter.
  4. Make a note of any other changes in eating or sleeping and symptoms of depression or anxiety.
  5. Give some thought to the future, ask what to expect, such as changes in health due to a chronic condition, so you can be prepared. Discuss advance directives if you haven’t yet.
  6. Be ready to face discussions such as quitting smoking, losing weight or health care decisions.

Play through a scenario in your mind, with the help of your senior, of questions that will ensure that you get all the answers you seek and your fears communicated for the benefit of both you and your senior’s well-being.

Don’t be afraid to take with you papers with lists of questions or reports you wish to discuss.

Be mindful of the time you need and be prepared to schedule another appointment without your senior to discuss more in-depth concerns.

Additional Resources

Here are some additional articles family caregivers may find helpful when they are in control of the healthcare visits:

Advance Directives Considerations, Facts & Myth Busting for Caregivers

Do you know what an advance directive is, much less whether your senior (or you) has one somewhere — or should?

An advance directive is defined as a written statement of a person’s wishes regarding medical treatment made to ensure those wishes are carried out should the person be unable to communicate them to a doctor.

Helping your senior loved one execute an advance directive, or doing it for yourself or with your spouse/significant other, is important for everyone involved.

It won’t be helpful to wait until a crisis occurs to decide one might be necessary.

Setting them in advance of the need is the best way to ensure the desired care decisions are made.

As a matter of fact, it will be too late if you wait until it is needed.

Advance Directive Considerations

When an individual is contemplating preparing advance directives, there are some things to consider.

  • Who do they want to make decisions for them if they become unable to express their own wishes for care and treatment?
  • Is there a second person they would choose to act as alternate in case the first person is unable, unwilling or unreachable when an emergency occurs?
  • What kind of decisions do they want their representative to make? Legal? Financial? Medical? Do they prefer different people make different ones, such as different children?
  • What do they want done if they become a victim of illness or trauma? How in depth do they want to be treated?
  • If they are in a coma, what care do they want performed? Artificial respiration? Feeding tubes? For how long? Resuscitated? Put on life support? Physician’s assessments?
  • If they become disabled and their representative deems, based on medical advice, they will have a poor quality of life, do they want to be revived?
  • If they are put onto life support, how would they want the decision made to remove it, if at all?
  • If they are dying, what kind of care do they want? Comfort care and pain control only? Intensive care? Care at home? Do they want to be transferred to a hospital?
  • Are there facilities where they prefer — or refuse — to go for treatment?
  • If they are dying, do they want pain relief even if it reduces their alertness or makes them unaware of their surroundings?
  • Do they want someone with them when they are dying? If so, who?
  • What kind funeral and burial arrangements do they want? Are there specific desires such as clothing, burial location, music or prayers that they want?

Types of Advance Directives

There are several types of advance directives. You should consider checking with an elder law attorney to ensure that they are executed according to the laws in your state. For example, witnesses are needed but each state varies on number and relationships to your senior, so get the information you need before these documents are executed.

Living Will

The most well known and oldest type of advance directive is the living will. This document directs the physician to withdraw or not perform medical interventions if your senior is in a terminal condition and unable to make decisions about their own medical treatment.

Some living wills are specific to treatment modalities, such as tube feeding for nutrition or IVs for hydration, and others are non-specific.

They may read something to this effect: life-sustaining measures that would serve only to prolong my dying be withheld or discontinued.

Healthcare Power of Attorney

Another type of advance directive is the power of attorney for healthcare or healthcare proxy. In this document one designates a person to make health care decisions if they are temporarily or permanently unable to make their own decisions.

Your senior doesn’t have to be in a terminal condition for the representative to be asked to make decisions. The person designated needs to be informed about what is desired and strong enough to dictate to health professionals that the wishes be upheld.

Not everyone can be strong in a crisis so this person should be chosen carefully.

Durable Power of Attorney

A durable power of attorney differs from a healthcare power of attorney in that it often includes the ability to perform financial transactions in addition to medical decisions.

This power can be helpful if this person needs to apply for benefits for your senior such as Medicaid while your senior is medically compromised.

The Five Wishes

A list of wishes outside the realm of legal medical wishes is The Five Wishes. This is a special document that goes more indepth about what your senior (or you) would want to happen in a variety of instances, such as having the family pet on their bed at the end of life or who should be called to their bedside, what type of music they want played in the room, and a myriad of other desires for comfort and peace in addition to the medical wishes.

The Five Wishes is a loving picture of the person your senior loved one is, how they want to face the end of their life, and how they want their family to be part of this journey.

Busting Advance Directives Myths

Many people across the country, no matter their culture or upbringing, hold misconceptions about end of life and advance directives. Let’s dispel some of those misconceptions — and myths — now.

  • No one, including healthcare personnel, can force your senior loved one to complete an advance directive. It is a voluntary action.
  • Doctors and healthcare personnel will not stop treatment or refuse life saving measures, such as antibiotics or intravenous fluids, because there may be a Do Not Resuscitate (DNR) order. If something can be done without heroic measures, they will do it. Advance directives do not mean “do not treat.”
  • A Do Not Resuscitate (DNR) order means that if your heart stops beating or you stop breathing, no chest compressions or other heroic measures, such as intubation, will be performed. CPR, cardiopulmonary resuscitation, will be done in the absence of a DNR order. In many states, EMS will perform CPR in transit.
  • Advance directives are not irrevocably written in stone and can be rescinded if the subject of the directives has a change of mind in the future. Advance directives are documents detailing healthcare wishes — and wishes may change. (Actually, it is a good idea to review advance directives on a regular basis to be sure they continue to be appropriate. Does your senior still want to be buried or do they now wish to be cremated? Do they want the firstborn to be in charge or the youngest child?)
  • The personal representative can be changed if life changes occur, such as divorce, death or conflict. The person just needs to properly update their advance directive as needed.
  • Family members can not interpret what your senior loved one “meant” in their advance directives. The physician must decide the wishes of your senior based on the document so be sure wishes are clearly stated and the family knows what is expected.
  • It is true that without any advance directives, a physician may choose to perform any interventions and make critical decisions for your senior or a court may appoint a guardian who is unfamiliar with their values and wishes. This may lead to some treatment that they do not want.

Importance of Advance Directives

Advance directives allow your senior loved one the right to die with dignity, using their definition of dignity.

Once seniors have decided what they would like to happen as they age and are near the end of life, ensure family caregivers and family members know your senior’s wishes so they can carry them out without confusion or indecision.

It is also important to provide copies to key individuals such as the power of attorney, family members and physician. The forms should be accessible in case of emergency.

Being prepared is the ultimate gift to the whole family and to oneself.

National Hospice Month – End of Life Benefits for Seniors and Families

When you say hospice, many people either shut down their listening or cringe at the image they have in their mind.

Many people, particularly older adults, have a belief that talking about hospice could mean your life is over.

People die who receive hospice care, I have heard people say.

That is true, of course, but it isn’t hospice care that’s causing death.

The whole point of hospice is to welcome the eventual death facing us all in the most dignified and comfortable manner we can. Family caregivers still provide the majority of care and staff support them in a variety of ways – physically, emotionally and spiritually.

Very few people want to die in a hospital bed if they have a choice. Most people would rather be surrounded by those who mean the most to them, including their beloved pets, their comfortable bed coverings, their own home and the faces of those whom they have nurtured and who continue to nurture them.

This isn’t restricted to older adults, many young people – very young people including infants – can be served by caring hospice personnel in their own home with their family around them.

Hospice Facts

The statistics might surprise many of us.

The most recent facts and figures about hospice care come from 2014 from the National Hospice and Palliative Care Organization (NHPCO).

It is estimated that 1.6 – 1.7 million people receive care under hospice annually.

That number has been happily growing each year as more understand the benefits of the services provided.

By 2007, of those who died with Medicare benefits, 30% received hospice care at the end of life.

The median length of service (time spent receiving hospice benefits) in 2014 was 17.4 days; the average length of service was 71.3 days.

About 59% of people receiving hospice, get the care at their ‘home’ wherever they call home, such as personal home, nursing home or residential center. About 32% received care in an inpatient hospice facilty.

What Hospice Can Mean to Your Senior

Hospice care will provide a variety of services for your senior with the talents of an interdisciplinary team.

  • Pain control
  • Medication management
  • Personal care
  • Assistance with spiritual care
  • Medical supplies and equipment
  • Caregiver education
  • Special services such as therapy (physical, occupational and speech)
  • Respite care
  • Volunteer services

These services can make the end of life a much different experience for seniors and their loved ones.

Hospice Staff Support Family Caregivers

Family caregivers may find that they receive as much or more supportive care from electing to get hospice services for their loved one than they might imagine.

Hospice personnel involve family caregivers in the plan for their loved one. The wishes of the care recipient are paramount but helping the caregiver provide care and obtain resources is also a function of hospice.

Social workers can connect families to resources of which they may not be aware for the benefit of the senior, both now and after their death, such as community services. They provide emotional support along the way and for up to 18 months after the death of your loved one. They are skilled at helping you cope with end of life caregiving challenges and then help you heal after care.

Chaplains can support your loved one’s journey as they make peace with their own life, their family relationships and strengthen their faith to face what the future might hold for them. Chaplains also help family members who might be struggling with the “why me” or “what now” questions that could appear as the end of life approaches.

They can help families make peace with what is coming and help find comfort in after care.

Hospice Medical Professionals

Did you know that there are Dietitians in hospice care that can help family caregivers who are needing more assistance to find comfort in food for their loved ones? There are!

Food is a comfort for most people. We show our love through food – baking, cooking and just watching others eat what we prepare.

This doesn’t change at the end of life. What could change are the amount, texture, temperature and choices of food that your loved one might need to find comfort near the end of life. The hospice Dietitian can help you and your family members with these choices.

Most of us know that Nurses and Nurses Aides are the foundation of hospice care and they provide the hands-on care that family caregivers and senior loved ones need. They can offer strategies for caring for your senior that you might not already know which can make your caregiving journey a bit easier.

These Nurses are shoulders to lean on, ears to vent your problems to, and friends throughout this journey. They understand your concerns and will try to make your experience as a family caregiver better and hopefully lighten your load even a little bit.

Cost of Hospice Care

Most families worry about the cost of hospice care in addition to medical costs associated with a terminal illness. According to the NHPCO, hospice care is covered under Medicare, Medicaid, and most private insurance plans.

People receive hospice care regardless of their ability to pay.

Medicare is the primary payer for hospice care and picked up the bill 85.5% of the time in 2014.

Veterans are eligible for hospice care through the Veterans Administration, which partners with community providers. Many hospice providers participate in a program called We Honor Veterans and serve veterans in need at the end of life.

The numbers in need of this service are great, as 1 out 4 dying people in America are veterans.

Some hospices are learning to best serve the special needs of veterans who have unique illnesses or traumatic life experiences that require a modified approach.  Considerations include location as many are rural (3 million of the 8 million Veterans), different wars or trauma, homelessness, PTSD, or substance abuse.

Electing Hospice Care

Every person who believes that comfort and dignity are important to them as they face their own end of life, whether they are young or old, should put their desires into writing.

This can be done in a variety of ways, such as the Five Wishes (we also discussed it in our inaugural podcast) or a living will format.

Be sure to discuss your thoughts with your family so everyone knows if you don’t want heroic measures taken — clearly define what you consider to be heroic and what you feel you want done — so they will honor your wishes.

Preparing them to act on your behalf is vital!

Depending on your state, there may be specific forms that need to be completed, witnessed and executed accordingly in case of future disagreement among the family. It is important to create them correctly but also important to share them with those involved so that they can proceed on your behalf.

They won’t be written in stone, so if you change your mind in the future, the documentation can be amended.

There are so many options that you can set forth, not just heroic measures desired or not desired but things that will bring you joy such as:

  • Allow my dog on my bed to be with me at the end
  • Keep daisies on my bedside table or keep flowers out of my room
  • Dress me in my favorite pink nightgown and matching robe while I am the end of life
  • Bury me with my grandmother’s ring or cameo earrings
  • Don’t close the curtains, I love the sunshine on my face

These may seem like insignificant or even silly things, but they could make a big difference in the way a person faces their end of life, wants to be seen by others, and keeps their end dignified based on their own preferences rather than what someone else might think they want.

This month is a good time to learn more about how hospice can benefit your senior loved ones, you as a family caregiver, and the rest of the family. It’s a good time to express wishes and communicate desires with the family.

Someday when the pages of my life end,

I know that you will be one of its most beautiful chapters.

~ Unknown