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.

 




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.

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:

DNR Codes and Levels of Care – Understand Before They’re Needed

Many family caregivers of seniors will, at some point, have to answer the question “does your loved one have a DNR?

Too often that question will come at a stressful time, during a medical emergency.

What does that mean?” you may ask.

You won’t have to ask that, though, after you read this article.

DNR (Do Not Resuscitate), often referred to as “no code,” is an advance directive document that guides medical personnel to NOT perform CPR or otherwise try to revive your loved one if their heart is stopped.

If your senior loved one does not have a DNR in place, they are considered to be a full code and will receive all aggressive measures if their heart or breathing stops.

As a family caregiver you might be asked about their code status during an emergency — either full or no code or some level in-between.

A DNR advance directive is used only when the person is unable to communicate their own wishes and someone else needs to step in to direct their care, otherwise they will be asked to direct their care themselves.

CPR, cardiopulmonary resuscitation, is a technique that is used to reestablish a person’s heart rhythm and breathing, shocking the heart back to a normal beating rhythm. It can involve chest compressions, rescue breathing, defibrillation, medicine to stimulate the heart function, mask ventilation and intubation for mechanical breathing (also known as life support).

Details About DNR Orders

A doctor is required to sign a DNR advance directive to be placed in your senior loved ones medical record, unlike a living will which requires a signature of the person involved and possibly a witness. A new DNR is required upon each hospital admission, including transfers between facilities.

It is important to know that many EMS (emergency medical personnel) are not allowed to honor a DNR order unless specific to that state and properly executed. For example, some states have a DNR document for use by EMS and then another one for the hospital.

A physician order for life-sustaining treatment (POLST), which covers out of hospital DNR orders, may be available in your state. There are also bracelets or documents kept on the refrigerator to alert first responders or your senior’s wishes.

More and more people have created advance directives that will dictate what type of care they desire at the end of life. The number of older adults who are executing their advance directives, especially a DNR order, is increasing.

Unfortunately, many have not spelled out their wishes, leaving family caregivers to make these decisions.

DNR Expresses Wishes

A DNR tells the medical team that your senior loved one wants to die naturally without heroic measures of ventilation, intubation, or vasopressor support.

A DNR does not mean “do not treat” if a condition arises that could benefit from treatment such as IV fluids, antibiotics or oxygen.

While age should not be a determining factor in making a decision for a DNR order, for many older adults, particularly those who are already frail, performing CPR can be futile. Even if CPR is effective, the heart or lungs will potentially fail again.

Not only will it possibly not prolong their life, it can be damaging to an older person.

CPR can result in painful injuries or a loss of functional status after the CPR is performed. It is not unusual for fragile senior’s ribs to be broken and damage caused to internal organs during chest compressions. Adverse outcomes, such as hypoxic brain damage and increased physical disability, can result.

One report states that CPR is successful in only 20% of the cases.

Types and Levels of DNR Orders

There are different degrees of medical intervention, depending on the policy of the hospital or nursing home. It is a good idea to ask the facility for their policy regarding different levels of DNR care so you clearly understand the process when needed.

Some facilities use terms to describe how they handle DNR levels such as:

  • comfort care – only comfort will be given in the event a person’s heart stops beating
  • comfort care arrest – may use life-saving measures before the heart stops beating but only comfort measures once it stops
  • specified – written by doctor, dictates which methods can or can not be used, such as Do Not Intubate but can do chest compressions

Other facilities, especially long term care facilities, can define different levels of treatment in the event that a medical emergency occurs. You might see something like this in your care home.

Level 1:  Stay in the facility and be kept comfortable, but not given antibiotics or other medications to cure you.

Level 2:  Stay in the facility and receive all medications and treatments possible within the facility.

Level 3:  Be transferred to a hospital from a nursing facility but not given CPR or taken to intensive care.

Level 4:  Be taken to a hospital and given all possible medical interventions. Do everything possible.

Level 1 and 2 allow someone to die naturally in familiar surroundings.

Some states may use different terms such as these:

AND – Allow natural death, used in end of life situations to be clear that an end is anticipated and the natural consequences of the condition are allowed to proceed

DNAR – Do not attempt resuscitation, this should be accompanied by specifics of which forms of interventions can or can not be used if the heart ceases beating

We prepared a Types and Levels printable version for use in speaking with senior loved ones and to keep handy should it be needed in the nursing home or hospital.

Executing Advance Directives

These documents should be executed and a healthcare power of attorney designated well before they are needed. During a medical crisis our senior loved ones may not be able to communicate their wishes to the healthcare team or family members and it will be too late.

An established healthcare power of attorney can make these decisions on one’s behalf following their advance directives.

It is a good idea to be sure that any power of attorney has been briefed about wishes and has a copy of the advance directives.

All family members should know who the power of attorney is so that there will be no confusion when the times comes that decisions are needed.

Your senior’s advance directives can be changed at any point in time if there are changes in their desires or the person they wish to make decisions on their behalf.

This can be a sad and uncomfortable topic to think about and discuss with our loved ones, but dying with dignity can be achieved when our healthcare wishes are expressed, no matter what our senior loved ones decide.




Do Not Resuscitate (DNR) – Do We Avoid Acting Because Term is Scary?

Most of us tend to put off things we don’t really want to do, even if we know they really need to be done.

Procrastination is human, but in this case risky.

We need to encourage our senior loved ones to execute their healthcare decisions, known as advance directives or DNR, and then make them known to important people in their lives.

Then we need to do the same for ourselves.

We should have those decisions written in a legal way and shared with those closest to us, including our healthcare team. This is something upon which we all agree, no matter what decisions you make or how long you have put it off already.

The number of people who have formally stated their wishes and made them known is rising, not just in the United States but also across the globe — but there are still too many of us who have not done so.

Did you know that only about one third of the general population has completed advance directives, even though these forms are free, straightforward, and easily available?

Advance directives empower individuals to manage the final chapter of life in a dignified manner and according to their own values. If advance directives are not completed, if there has been no conversation to express end of life wishes amongst the family, the result is often medical intervention that can be painful and without dignity when ‘doing everything’ is the only course.

Even if proper advance directives have been executed, if those closest to you aren’t aware of them, they could potentially not be followed as you would like.

What are Advance Directives?

A Do-Not-Resuscitate (DNR) order means that you or your senior loved one opts not to receive cardiopulmonary resuscitation in the event that the heart stops beating. DNR orders cover failure of the heart to beat, in which case CPR or chest compressions are typically performed in an effort to assist the heart beat and force the blood to be once again pumped to vital organs.

Many agree that CPR needs to be withheld if the person involved wishes it to be held. In addition, if the medical team agrees that CPR will be ineffective or has limited potential to benefit the person, life saving measures that could cause further harm should not be performed.

Put another way, will CPR benefit a person if their quality of life is so poor that meaningful survival is doubtful even once the heart resumes beating? This is a decision your loved one, doctor and family should discuss, especially if no written advance directives are in place.

Having a DNR order does not mean that you will not be treated for your medical issues nor that you have given up all desire to live, but that you feel that performing CPR won’t give you a desirable outcome, a good quality of life.

It is important to differentiate between a DNR order and a living will. The rules governing advance directives vary from state to state. It is prudent for you to check with a professional or agency in your state to be sure that the documents your senior has are valid in their state.

Dangers of CPR for Elders

Seniors nearing their end of life or even in the midst of a medical crisis are fragile. As often occurs, broken and cracked ribs are a result of CPR.  Frail, brittle bones crack with each chest compression.

If CPR is “successful” in that it revives our elder, he or she can endure pain and confusion that may last for the rest of his or her life. Oftentimes their life is prolonged for merely hours, days or weeks.

The statistics are grim:

  • about 15% of healthy people who have CPR in a hospital will survive;
  • 1-2% of elderly people will live past CPR performed in the hospital and go home;
  • many of those who do go home after hospitalization have significant lasting medical effects such as brain damage; and,
  • The statistics are worse for CPR performed outside a hospital.

This is not to say CPR is bad or everyone should have a DNR order in place, just that it is reasonable to consider if one wants CPR performed.

Whether or not one wants lifesaving procedures performed is, after all, a personal decision. There are many factors that might go into personal considerations.

Why Should We Make Our Wishes Known?

Besides the potential for further pain and suffering when our senior loved ones might not reap great rewards with desired quality of life, many prefer to die with the same dignity they lived their lives. They choose to allow the natural course of their life and failing bodies to unfold without the lifesaving measures that could keep them alive without dignity or quality of life not to mention further disability.

Most seniors have a view in their mind of their own end of life. They may have expressed it verbally to members of the family and may already have had lawyers prepare the documents.

Some older adults are fearful of talking openly about the subject to those they love because they don’t want to cause them pain. There may be fear that speaking about it will cause untoward events to occur.

If they don’t bring it up, you should. Ease into this discussion but handle it in such a way that shows your love and concern for them.

In the case of natural aging, we can often see our senior loved ones declining and know that they may not have many years ahead. This is a good time to be sure there are documents completed and a discussion is had by all. Unfortunately, in the case of a crisis such as an automobile accident, a fall with head trauma, a stroke or another medical emergency it may be too late or impossible to make wishes known.

We never know when the need could occur, so we should be ready now.

This is not just for your senior loved one but you as family caregiver as well. Planning for how and who will take over your caregiving duties is vital for your senior’s well-being in the event of an emergency involving you.

Would Another Term Be Less Scary?

Many across the healthcare field, especially those who deal closely with end of life issues, have started to use the term “Allow a Natural Death” (AND) instead of DNR. They feel that this term is more agreeable and clear in its intentions. We all want our loved ones and ourselves to have a peaceful and natural death.

In Texas, for example, they are using the term AND to open family discussions of end of life care with better understanding and outcomes.

Discussing resuscitation in terms of the damage it can cause if performed does not paint a very comfortable end for many. The opposite of having a natural death is having CPR performed.

Because this is a deeply personal decision for your senior loved one and even you, careful consideration with all the necessary information to make an informed decision should be taken.

No matter what decision about end of life care is made, it is recommended that you keep a copy of all advance directives, especially a DNR, POLST or Comfort Care DNR form attached to the refrigerator so that everyone can have access during a crisis especially first responders. Your senior’s doctor should have a copy and members of the family.

Don’t keep anyone in the dark, it could lead to disagreement when the time comes it is needed and ultimately lead to the wishes not being followed.

As we plan for our end of life, let’s make each day a reason to celebrate. Here is an important reminder for us all!

Top Five Regrets of the Dying

  1. I wish that I had let myself be happier.
  2. I wish I’d had the courage to live a life true to myself, not the life others expected of me.
  3. I wish I hadn’t worked so hard.
  4. I wish I’d had the courage to express my feelings.
  5. I wish I had stayed in touch with my friends.

Source: Guardian News Report

Holiday Family Gatherings: A Time for Enjoyment & Meaningful Discussions

Once again we’re preparing for families to come together over the holiday season. We long to see how our seniors are doing, especially those who are far away from us and living independently.

Are they ok? Have they been eating well? Is the house in good repair? Are they paying all the bills on time? Have they been keeping things from us?

Hopefully, during our visit with them to celebrate a time of family sharing we will be able to observe them for any signs that they need a little bit more help. There are many things we should be on the lookout for in their home, their own health and appearance, the car, the home and the yard.

You can read more about the warning signs in one of our earlier articles.

Another important thing we should do while we are visiting our senior loved ones is talk.

“Talk about what specifically,” you ask?

Serious Discussions with Parents & Other Senior Loved Ones

We might find some discussions hard to begin and others may be taboo in your family or culture. Unfortunately, once your parents reach a certain age (and you as well) it is recommended that these uncomfortable discussions happen and the answers clearly brought out into the open.

Whether you want to or not, some things are just better to know.

  1. Do they have any advance directives? Is there a living will created about which you should know? What are their wishes for end of life care? Do they have a DNR or a healthcare proxy to speak for them if they can’t? It is important to hear directly from them what they anticipate their end of life to be. What if they get into an accident or have a medical emergency? If you don’t talk openly about this eventuality it will be more difficult, especially if you are at a long distance, to make decisions in an emergency without prior knowledge. Do they have burial plans already? Read more in one of our articles about advance directives.
  2. If they have executed these documents, where are they kept? Can you get a copy? Does the doctor know about them and do they have a copy on file? Do they need to be updated?
  3. If they don’t have them created, can you do this during your visit so all their wishes are documented in case of an emergency? Now is a good time to get important documents executed while you are there to get the necessary information. These decisions must be made before your senior is no longer competent to make his wishes known legally.
  4. Do they have a will? Who is the executor? Where is the will kept – who is the attorney? Where are the contact numbers for lawyers, doctors, and other people if you need them?
  5. Are they still competent to drive safely? Has the car been damaged since your last visit? Take a ride as a passenger to test them, even if it is without them knowing your purpose for going for an ice cream cone together. We talked more about our senior loved ones and driving in an earlier article.
  6. Are they declining in functional status? Does it look like they are having difficulty keeping themselves neat and tidy? Are their clothes clean and in good repair? Are they shaving? Do they have unexplained bruises? Are they appearing thin or weak? Are they having trouble balancing themselves when they walk or get up from sitting? Do they need more help?
  7. Is their home still adequate to age in place? Is it where they want to be or would they rather come closer to you, go to a senior living area or move to a smaller home that is easier to care for alone? Some seniors enjoy living in an assisted living facility where they have less responsibility and more opportunity for social engagement. Is their current home accessible to transportation services if they can no longer drive? Is their home in good repair with adequate safety modifications to prevent accidents? Can you work on some modifications while you visit and schedule other more involved upgrades for when you are not there?
  8. Are they depressed or isolated? Some seniors choose to stay home and reduce their visits to places, people and events that they once frequented for a variety of reasons. Perhaps they are afraid to drive, don’t want to go alone, can’t leave the house for too long for fear of needing a restroom quickly, or have side effects of medications that keep them from being active. Seniors need to be social, mentally stimulated and engaged to prevent boredom and loneliness. It might be a good time to get them reconnected, take them to the senior center and arrange transportation if necessary. Find things for them to be active and involved from home. Set up some technology and teach them to use it so they can use social media, Skype or Facetime to engage with distant family and friends.
  9. What about their finances? Do they have enough money to meet their needs? Are they paying their bills? Do they have a supplemental insurance policy or long term care policy which you should be aware? Are they struggling to make ends meet? Are they getting the benefit of all — well — benefits to which they are entitled?

And you thought you were going to get a vacation and enjoy some turkey or cookies? Just waiting for your senior to cook you your favorite meal?

Make the Most of Holiday Visits

Spending time with your senior loved one can be purposeful and a source of enjoyment at one time. Be observant in all the activities you share during your visit. Keep communication open and ask leading questions that require them to make full answers not ‘yes’, ‘no’ or ‘fine’.

You may be surprised what you can learn by keeping your eyes and ears open to nuances and maybe even the obvious.

Some of these discussions will be hard, some of these topics are difficult for you and them. They don’t want to think they are near the end but should be able to discuss it so that you are all prepared. Some subjects could be thought to be too personal such as finances and personal health. They don’t want to feel like they are burdening you.

Being prepared and able to plan ahead instead of trying to handle affairs in emergency situations will make you glad you had these holiday talks and got the answers you need to be a successful long distance (or nearby) caregiver.

Don’t forget that some of the things on the list above are things you should also have done for yourself as caregiver so that if something should happen to you, others know what to do to take over what you do so well if you get sidelined. Is your living will completed or advance directives? Have you gotten your preventive health care so that you don’t get pneumonia or flu that keeps you from being a caregiver for an extended period of time? Do it for them!

Be sure you also enjoy the time spent with senior loved ones over the holidays. This time is precious, after all.

Advance Directives for Senior Loved Ones – Have Decisions Been Made?

Thinking about what will happen as the end of our life draws near is not a thought many people want to have.

But they should.

Considering the importance of making decisions about how we want things to occur is the topic of the recent National Healthcare Decisions Day. It is a time for all of us but especially our senior loved ones to consider their wishes and get them executed using a variety of different legal forms.

If your seniors have already prepared their advance directives then you will want to be sure you understand what they have decided and where these documents are kept so that you can find them when the time comes.

It is important to know who has been designated the healthcare proxy for your senior loved ones, if it is not you, so that you can maintain communication with them. If it is you then other loved ones should be made aware.

Living Will Numbers Growing

Living wills are being created by more adults than ever before, according to a recent study we read.

A living will outlines what you or your senior chooses to occur at the end of life and designates a proxy who will speak for the principal if he/she is unable to do so. Personal preferences are spelled out in this document.

The designated healthcare proxy is the one who makes sure your senior’s wishes are respected and carried out per their desires.

In 2010, 72% of the nation’s older adults had a living will or advance directive compared to 47% in 2000.

It was hoped that having a living will would mean a decrease in the rate of hospitalization in favor of hospice care but that has not evidently been the case. There has been an increase in the hospitalization rate among seniors. I don’t know that we can read a cause-and-effect relationship into that, though.

Hopefully the rise in the number of people creating advance directives means that we are all getting more comfortable discussing death and dying and willing to put our ideas in writing. We want to be a part of these decisions even when we can’t speak up for ourselves.

There is likely also some effect from highly publicized situations regarding those who did not have designations in place.

Maybe it is true that seniors want to be sure that at this time their family and caregivers are not burdened with making these decisions or handling the finances in a guessing game fashion. Having everything clearly spelled out will help family members not only do things the way they want but also with less trouble and guilt.

Advance Directives Explained

Living Will is a written statement detailing a person’s desires regarding their medical treatment in circumstances in which they are no longer able to express informed consent.

A do not resuscitate order, or DNR, is a medical order written by a doctor. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if breathing stops or if the heart stops beating.

Healthcare Power of Attorney is a legal form that allows an individual to empower another with decisions regarding his or her healthcare and medical treatment. Healthcare power of attorney becomes active when a person is unable to make decisions or consciously communicate intentions regarding treatments.

Elder Law Attorney is the specially trained professional that you and your senior will probably want to consult to help you get these documents properly executed as the regulations vary from state to state. There are several things that should be considered especially when siblings, property and assets must be distributed. An elder law attorney is skilled to provide recommendations about legal issues specific to older adults.

Completing a Living Will

This is likely going to be a difficult and sometimes uncomfortable conversation for you and your senior but one that you should try to broach soon. They may have already made these decisions and created the documents but you are not yet aware.

It will make things go much easier if you and everyone involved are aware of their wishes and who is responsible to carry them out so that there is no inaction or miscommunication in the future.

Some families choose to work with an attorney but other may prefer to complete documents on their own, either due to cost or because they simply feel more comfortable working that way. For those, we have found the resources offered by LegalZoom (affiliate link) are straightforward and provide what most people need.

Don’t forget to do your own paperwork and be sure there is a plan about who will care for your senior loved ones if you are unable to continue as their caregiver.

Who Will Be There to Care? Worries of Family Caregivers as They Age

We are so focused on caring for our senior loved ones that we don’t always contemplate our own needs, desires and future.

Our day to day caregiving duties can take a toll on our spirit, health, relationships and finances. Because it is taking a toll on us, whether we recognize it or not, now is a good time to reflect about our own aging and our personal feelings of the consequences of our aging.

What actions should we recognize as necessary in order to improve our longevity so that we can be there for our families and for those whom we act as caregivers?

Global Attitudes About Aging

The United States is not alone in having a population that is growing older. The rest of the world is also aging. As a matter of fact, statistically America is aging at a slower rate than many countries. China is facing an aging crisis with more seniors than family caregivers. Other countries such as Japan have rapidly increasing numbers of elders in relation to the overall population.

According to a recent Pew Research Center study, in 2010 the proportion of people 65 and older was the greatest in Japan, where it was at 23% versus 13% in the United States. By 2050 those numbers are projected to grow to 36.5% in Japan and 21.4% in the US.

Those surveyed in the countries with the largest senior populations reported having little confidence in their ability to continue with an adequate standard of living in their old age. Most in these countries believe that it is the responsibility of the government to see to the needs of the aged but this idea does not instill confidence in that actually occurring and feel that the burden will fall to the family. Americans seem to be more confident in their ability to maintain a standard of living and don’t think the government should be responsible but the aging individual himself.

Perhaps many in the US realize that fewer workers adding to the tax base will not support the care of our aging seniors so that feel they need to plan for their own future.

As our life expectancy also lengthens it will cause us to work longer, stay healthier, and be sure our financial future has been planned out to ensure that we can maintain our standard of living for a longer period of time. One concern is our ability to pay for healthcare, as the cost for health services is projected to rise rapidly.

What Can Caregivers Do?

There are many potential actions and considerations for family caregivers as we ourselves age.

Plan to push your retirement back to an older age

Many have realized that the dream of retiring at age 62 or even younger may not be a reality and working until age 70 is more of a reality than desired. Make arrangements with your employer to work a flexible schedule so that you can provide the caregiving you need without danger of putting your job at risk.

Make a financial plan for your retirement

Work with an adviser to answer the tough questions about how much money you will need to save to maintain the standard of living that you desire at the same time paying for any healthcare costs you might encounter. You may need to consider your current spending, creating a budget and a plan to eliminate your present debt in order to sail into retirement financially sound.

Now look into your senior’s financial planning and be sure it is optimized now so that your finances are not being spent on their care needs.

Care for your own health

Make lifestyle choices regarding your habits and create an action plan to improve your choices. Keeping healthy now will mean that your future healthcare needs may be held in check.

  • Are you eating healthy? We all know we need fruits and vegetables, lower fat, lower salt and more fiber. Are you doing it?
  • Are you drinking enough water and getting enough sleep?
  • Are you physically active and not just being busy? It is important to get your heart rate going not just being busy with routine chores.
  • Have you stopped smoking and is your drinking in moderation only?
  • Will you be healthy enough to continue to be a caregiver or will you need a caregiver yourself?
  • Are you going to be able to care for your senior loved one if you are fighting chronic disease and disability in yourself?
  • Will you be able to afford your own impaired health?

Get respite, ask for help and accept help that is offered whenever it is offered

Let others help you. Have little jobs ready to give to others when they offer, don’t just say you are doing fine. Let someone sit with your senior so you can take a hot bath, go for a walk, meditate, read a book, attend a support group, or just sit down alone.

There are organizations and senior care centers that can provide respite care.

Plan for the possibility that someone will need to replace you as caregiver

Do you have a living will or advance directives in case of an emergency? It is not just our seniors that need to execute their wishes. Have you made someone your successor if you are the proxy for your senior, do they know where your senior’s documents are located, will they know how to get into the safety deposit box or even that one exists? Will they be able to function as your senior’s financial executive?

Is your senior’s information regarding banking, retirement plans, insurance, and financial investments accessible if you aren’t able to be in charge? Is yours?

Get emotional support throughout your caregiving journey

Caring for others while maintaining a healthy marriage or partnership can be overwhelming at times when duties have you pulled in many directions. It takes a network to fulfill all the roles you play at times so take advantage of it so that you can prevent burnout.

You might benefit by connecting with a friend to talk with about your stressors, share with a sibling some of the caregiving duties, seek out professional counseling from a specialist or church leader, join a support group either personally or online, keep lines of communication open within your network, and find time to nurture your relationships with others important to you and the one with yourself.

Don’t neglect your own needs – remember put the oxygen mask on yourself first.

We can’t change the fact that we are aging as are our senior loved ones and our family members. That is the circle of life.

However, our attitude about aging and the preparations we make to face the future will help us do it the best that we possibly can.