Fairmount Assisted Living & Memory Care
blog-banner2.jpg

BLOG

Fairmount Blog

Caregiving From a Distance

Caring for a loved one when you live in a different town may be challenging. How do you know Mom is taking her medications? How do you know if Dad is not overexerting himself?

There are several steps you can take to ease the stress that comes with long-distance caregiving. Schedule check-in times. Regular phone calls can be a good way to check in. Schedule a specific time of day and/or days of the week that you will call.

Some seniors have difficulty hearing on the phone. Arrange for special equipment if needed. Ask open-ended questions so that you elicit a response other than yes or no. When you listen to your loved one, make note of how they speak. Listen for changes in how they are connecting with you. Is their tone different? Are they less engaged than normal?

Email and video chats are also good options for contact. It may be easier for Mom to let you know how she's feeling by typing rather than talking. A video chat may assist you in seeing how Dad is looking physically.

Enlisting Local Support

When you are caring for someone from a distance, it may be beneficial to enlist the help of friends or other resources in the local community. Consider asking one of your parent's friends, church members, relatives, or neighbors to check in on a regular basis. Communicate to this person some of your concerns or wishes. Ask that they let you know if something looks amiss.

Identify who can be contacted in an emergency. Knowing that a trusted individual is nearby in time of need is reassuring. Be sure to offer a thank you of some type. Be willing to reimburse someone for their time in actual payment or gift card. Even if the friend is unwilling to accept payment, a thank you note is always a great way to show appreciation.

No trusted people nearby? Consider community resources. Good places to start are your Area Council of Aging, local churches, and non-profits serving families and seniors. Even if the organization does not have its own companion program, it more than likely can direct you to a place that does.

Arranging for Care

You have identified that a parent needs assistance. This may be hands-on assistance or simple "check-in" companion care. Avoiding a conflict at the front door is a good start. What type of care does your parent want? What type of care will they accept? What type of care do you think your parent needs? Having a conversation with your parent ahead of time preserves their independence and is respectful.

This conversation may eliminate an uncomfortable first visit with the companion. What if your parent doesn't want help? A friendly neighbor or church member may simply visit and observe without making your parent feel intruded upon.

Once a relationship is established with the "visitor" or companion it will be easier to notice other areas of need. If there are more substantial needs identified, plan for the next step in care.

Medicare Coverage

Now that you have become involved in assisting with your parent's care, you are trying to figure out how their health insurance works. Your parent has Medicare. In your mom's wallet you find her red, white, and blue card. You don't know how it works but you know it seems to cover her well.

Most of us who have used insurance are used to commercial health insurance through our employer. Medicare coverage has different parts. Part A covers inpatient care such as hospital stays, rehab facilities, and some home care services.

Part B covers outpatient care such as testing and physician office visits. Part D covers prescriptions. What about C? Part C is Medicare Advantage or Medicare Replacement plan. It provides the same services as Parts A, B, and D under an umbrella plan.

Medicare Advantage

October 15th - Dec 7th is open enrollment for Medicare. This is a time for beneficiaries to make changes in the way they receive their Medicare services.

The most common change people make is to choose a Medicare Advantage plan. These plans look very much like some managed care commercial plans. These plans usually have some form of provider network with whom they contract. They are required to cover the same things that original Medicare covers, but may structure services differently.

Additionally, by managing their services, they often may offer lower rates to their members. Many times there will be no monthly premium and may offer $0 copays for office visits. Some offer services above and beyond what Medicare covers. While some do not, many Medicare Advantage plans also cover prescriptions under the same umbrella of care.

Some areas of the country offer more Medicare Advantage plans than others. It is important to review which plans service the county of your residence. Equally important is to consider your current costs and coverage. If you are happy with what you have, then you don't have to change a thing!

Memory in Aging

Many people believe that dementia is a normal part of aging. This is not the case. Not all older people become "senile" and in fact in many cultures, elders are the keepers of great wisdom. The reality is that some people will develop a cognitive disorder in later life while others will not.

While dementia is not a normal part of the aging process, some cognitive changes are part of normal aging. The most common change is the slowing or decline in the speed of processing information. This is evident when more time is given for a senior to answer a question or perform a task. It is not the lack of understanding actual information but the length of time it may take to process.

It is therefore important to remember that a senior most likely understands material as well as his younger counterpart, but may take longer to absorb its content. Seniors may need additional time or smaller chunks of information when being presented with new material.

Recall and Reaction in Aging

In addition to slower processing speeds, normal cognitive decline in seniors may show up in recall and reaction speed. Information seems to linger on the tip of your parent's tongue. The senior may know the answer to a question but cannot quite pull it out of his mental filing cabinet. Reaction time may be slowed.

This may have implications for performance on some activities that require quick decisions or changes in attention. One such activity is driving. The age-related cognitive decline should be mild and shouldn't interfere with day to day functioning.

Normal aging also may bring decline in vision and hearing abilities. A senior who has difficulty with seeing or hearing may also have resulting difficulty in learning information. This may appear as cognitive decline when it is in fact not. Whenever possible, the use of hearing aids or glasses should remedy these difficulties.

Mild Cognitive Impairment

Mild cognitive impairment (MCI) is progressive memory loss or processing that generally happens after age 50 and is beyond what is expected with normal age-related cognitive decline.

However, MCI does not meet the list of criteria needed for a specific dementia diagnosis. A senior who has mild cognitive impairment may show signs of memory deficits that are more than expected for her age or education level while other cognitive functioning remains normal.

Also, generally, activities of daily living are completed independently and in normal fashion. Sometimes MCI is a term used in the medical field when no specific dementia diagnosis has been rendered, but symptoms have become much more distinctly obvious to family members.

What is Dementia

Dementia is a pervasive and progressive deterioration of intellectual ability that occurs over an extended period of time. Dementia is NOT a part of the normal aging process.

Dementia often begins with symptoms of memory loss but is not limited to this. Memory loss is often the first and most obvious cognitive change noticed by a family member.

Other symptoms generally accompany dementia such as changes in a person's orientation with place and time, language functioning, loss of ability to think abstractly and solve problems, power to exercise good judgment, changes in visual and spatial ability, and changes in personality.

Dementia is an umbrella diagnosis which has several types. Alzheimer's Disease is one type of dementia. To better understand the term "dementia" is to say, all Alzheimer's Disease is dementia, but not all dementia is Alzheimer's.

Causes of Dementia

The type of dementia is based upon the presenting symptoms and the categorization of the suspected underlying disease that caused it.

Many times causes of dementia are difficult to determine. Some dementias are treatable, while others are not. Some treatable forms of dementia are toxic, metabolic, depression-related, and medication-induced.

Some forms of toxic dementia may be over exposure to alcohol, drugs, or heavy-metals. Metabolic related dementia may result from thyroid disease or vitamin B-12 deficiency as an example. A senior may present with dementia-like symptoms in the context of a depressive episode.

The most common and reversible type of dementia is medication-induced dementia. If identified early, intervention can result from a conversation with the senior’s physician or pharmacist.

A proactive approach to reduce the occurrence of this dementia, might be to manage the senior’s medication early on, and have the medications reviewed regularly.

Irreversible Dementias

While treatable dementias may include toxic, metabolic, depressive, or medication-induced, there are some dementias that are not treatable.

The dementia that most are familiar with is Alzheimer's disease (AD). Other types of dementia include Parksinson's disease, dementia with Lewy bodies, vascular dementia, infection or injury-related dementias.

AD is the most common form of dementia followed by vascular dementia which is caused by decreased blood flow in the brain in such diagnoses as stroke.

End of Life Planning

Seniors are living longer and sometimes even healthier lives. Some of this is due to changes and trends in lifestyle. Some of this longevity is due to medicines and medical technology. Living longer should be a good thing, right?

Prolonged life comes with its own challenges. Living longer increases the need for end-of-life planning. This includes financial planning, management of one's own body with its normal deterioration, social changes, and navigating family dynamics, to name a few examples.

How does one identify the pros and cons of longevity versus quality of life? How does a senior begin the process of identifying and communicating his or her wishes regarding these issues? There is a big push in the medical setting to encourage people at any age to consider advance directives. What are advance directives and how can they help?

Advance Directives

Advance Directives can give a senior the voice to know feelings and wishes about end of life care are communicated and honored. These documents can assist in ensuring that medical decisions are in line with the senior's wishes.

This reduces the chance for being given too many treatments or perhaps not enough. It also reduces the potential for stressful decision making in time of crisis for seniors, their families, and caregivers.

Each state has its own rules and regulations about needed documents. When a senior moves to another state it is important to review these documents in the context of their new home.

It would be equally important for a senior to review their documents from time to time, due to changing feelings about one's circumstances and lifestyle.

Reviewing Prescription Coverage

Medicare Part D is the type of policy that covers prescriptions under original Medicare. For those who have used a stand-alone policy in the last years, be advised, prices are going up. Premiums and deductibles may be noticeably higher this year. It pays to shop around.

Medicare consumers have until December 7th to make a change to their prescription coverage policy. One handy tool to do a comparison can be found on Medicare.gov website. On this website, a consumer can plug in their zip code and specific prescriptions and do a comparison.

The most important factors to compare are, cost of premium, cost of deductible, gaps in coverage (donut hole), and co-pays for generic versus brand name prescriptions.

Listening and Dementia

Do you remember a time when you were trained to practice "active" listening rather than "passive" listening? Active listening is not only beneficial in the professional work environment, but also plays an important role in communicating with those with dementia.

Listening begins with silence. Focus on what they are telling you and do not interrupt. Paraphrasing or repeating back what the person has said to you, even if it doesn't make sense, shows that you have heard what they are telling you. The goal is to show that you care and respect what they have to say.

It also may help you to understand their point of reference. It is common to feel the need to argue or to provide correction when what is said does not make sense. People with dementia often get facts wrong or remember events incorrectly. It is okay.

There is no reason to insist upon being right. Step in to the other person's world and honor their memory no matter if it is their own creation. Who knows, maybe their version is more interesting!

Resident Art

Art is good for the soul. Artistic expression is an important component of any activities program in the assisted living setting. Prompting memories, emotions, discussions, and brain engagement are some of the benefits of providing an outlet for art.

Creating resident art provides an expressive outlet that taps into a deeper memory, one that doesn't require words.

Holiday Memories

Have you ever thought that you really should write down memories and stories shared by your aging parents or grandparents? Recording memories is a great way to extend your listening ear to an aging loved one. Sharing shows you are interested in their past and what has created the person they are today.

With busy schedules, well intended visits may become rushed. You never quite get around to sitting and listening, much less recording what is shared. The holiday season is a great opportunity to weave in time for sharing memories.

Often seniors are interested in sharing their traditions. Traditions such as hanging lights on a tree, decorating cookies, lighting the menorah, or making latkes together are some common memories shared by families.

Many times holiday traditions are rooted not only in religion, but also in culture. They may serve as a link to the country of your grandparent's origin. Consider weaving in their experiences while creating your own family traditions.

Evoking Holiday Senses with the Elderly

Smells, textures, sounds, and sights are changing for an elderly person. Loved ones with dementia may even be experiencing feelings and emotions of childhood.

What did your loved one like to do as a child? Evoking the senses may be a way to tap into your loved one's world. A simple yet wonderful activity is making cookies. Stimulate the feeling of touch by squishing the dough through your hands to form shapes. If you use spices such as cinnamon or nutmeg, allow your loved one to smell them.

Bring out creativity and use frosting and sprinkles to decorate together. Talk about the shapes and colors. Tapping into senses is a way to communicate without words.