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Making the Connection

June 26th, 2017 by

As you age, memory fades. It’s not necessarily a sign of something sinister; forgetfulness has long been accepted as a natural part of aging. But scientists are beginning to understand how we form and keep memories.

At UCLA, scientists have discovered that synapses, the electrical trails between neurons, can become worn as we age. Memories and associations can become weaker over time as the synapses connecting the thoughts deteriorate. Scientists have previously focused their efforts on researching how brains make memories, not on how memories are stored in the brain. This new research suggests that connections between neurons can be reestablished by encouraging electrical activity in synapses.

One of the more promising ways this research is paying off for Alzheimer’s patients can be found in a UCLA study. For the first time in medical history, the study was able to show real improvement in the memories of Alzheimer’s patients. Researchers used custom treatments for each patient—including dietary alterations, brain stimulation, exercise, sleep training, pharmaceuticals, and a few other techniques designed to alter brain chemistry. The results are impressive: The subjects of the study show a partial reversal of memory loss and improvements in other systems.

As scientists learn more about how we make and store memories, our ability to combat diseases like dementia and Alzheimer’s will grow. Until scientists develop an effective treatment, it is still possible to take steps to minimize your risk of memory loss.

In order to keep your mind healthy, take inspiration from the UCLA study and work to maintain an active brain. A healthy diet that minimizes sugars and nontraditional fats has been shown to keep brains healthy. Drinking two cups of coffee a day can also help your body maintain its brain power. Exercise, even as little as a 30-minute daily walk, can help seniors maintain healthy brain function. Finally, keep your mind active by challenging yourself every day. Learn a new language, complete a crossword puzzle, or engage in a lively debate. Making yourself learn new information and recall it rapidly is an excellent way to keep your mind sharp.

While scientists figure out exactly how to reverse the process of memory loss in the aging population, it’s possible for seniors to take steps now to maintain a healthy, active mind.

 

Elder Orphans Plan Ahead

June 16th, 2017 by

Americans are getting older. It’s a great thing. The CDC estimates that the number of Americans who will live to be over 100 years old has grown 44 percent from 2000 to 2014. With the baby boomers aging into their senior years, this means that there will be an unprecedented boom in the senior population of the country.

While it’s wonderful that our population is living longer, there are some unexpected issues that come with aging. One of the biggest concerns facing seniors is how to plan for caregiving if they are Elder Orphans. Defined as a senior who either has no family that can help with their caregiving, or no one able to aid them, Elder Orphans are a growing segment of the senior population. This year, the number of Elder Orphans in the senior community has grown to nearly a quarter.

If you find yourself to be an Elder Orphan, there’s no need to panic, just plan.

The biggest concern for those who do not have family or friends to care for them is finances. Elder Orphans should work with a financial advisor to cultivate savings that will help them in case of medical emergencies. It is also essential that any living space is senior-friendly. If you’re planning on aging-in-place, that may mean renovations to your home including chair lifts and better lighting. It could also mean investigating local senior living communities to determine if that is a more budget friendly option.

Another issue facing Elder Orphans is isolation. Those without family to check on them can sometimes feel that they’ve grown isolated. This can lead to feelings of depression and also declining mental faculties. It is imperative that seniors keep and maintain social connections. This is especially important for Elder Orphans who don’t have family to rely upon for interaction. Be sure to cultivate a strong friend group and meet with each other at least once a week for a fun activity.

Though being an Elder Orphan requires a bit of extra planning, there’s no reason it can’t lead to a fulfilling life. If you’re aging and alone, plan ahead for a successful life as a single senior.

Elder Care Finances – Who to Select as Fiduciary

October 5th, 2016 by

One of the most difficult decisions you’ll make when creating your estate plan is who to name as your executor, your trustee, and agents under your advance medical directive and power of attorney. You may think the answer is obvious – your spouse, followed by your oldest child or all of your children, perhaps. To really make a good selection, however, it’s important that you understand the responsibilities that come with each of these fiduciary positions and whether the individuals named are capable of and willing to serve in each capacity.

An executor is the individual, corporation or trust company named in your last will and testament to wrap up your affairs, pay any final debts, and distribute your estate in accordance with your wishes. This person’s responsibilities begin after you pass away and upon their qualification in circuit court.

Depending on the assets passing through your will, this person may be required to file an inventory listing all of the assets of the probate estate, as well as annual accountings until the estate administration is complete. There are several steps that must be taken in the administration of a probate estate, and we find that in many cases, this process takes about a year to complete.

A trustee performs many of the same tasks an executor does, in accordance with the terms of a trust agreement. A trust may be created under a will or as a separate document. If the trust is created under a will, the trustee will generally need to report to a commissioner of accounts throughout the administration of the trust. However, if the trust is created in a separate document, there is generally no requirement that the trustee be overseen by a commissioner of accounts. The trustee must administer the trust in accordance with the provisions of the trust agreement, and, like an executor, has fiduciary duties toward the beneficiaries. The trustee must provide accountings to the beneficiaries at least annually and keep them reasonably informed about the administration of the trust.

Executors and trustees are often tasked with gathering all estate or trust assets and ensuring they are properly titled, opening estate or trust financial accounts (checking and investment accounts, for example), paying bills and administrative expenses, and distributing assets in accordance with the provisions of the will or trust. In the case of a trust that continues for the benefit of a beneficiary or beneficiaries, the trustee may have continuing obligations for several years.

An agent under a power of attorney is an individual, corporation or trust company you name to assist you with your financial affairs. This person may have the authority to assist you immediately upon your signing of the power of attorney, or only at your incapacity, depending on the terms of the document. A power of attorney generally gives the agent the ability to assist you with just about anything you could do yourself, including write checks, pay bills, buy and sell property, and maintain investments and insurance policies. The agent’s authority ends upon your death.

Because your executor, trustee, and agent under your power of attorney all have access to financial accounts and assets, it is of extreme importance that the individuals you name be fiscally responsible, trustworthy individuals. If your spouse or children have problems with spending too much money, gambling, addiction, or any other issues that might not make them the best individuals to handle your financial affairs, consider naming a trusted friend, a corporation, or a trust company. You should also consider the location of the individuals you are naming – if you appoint someone in California as your executor, be aware that he or she will need to fly to Virginia and qualify in court as the executor. An out-of-state executor will also be required to pay a bond, regardless of any provision in your will to the contrary.

An agent under an advance medical directive is different, however – this is the individual or individuals you name to make medical decisions on your behalf in the event of your inability to do so. Under Virginia law, this person may only serve once your attending physician and another licensed physician or qualified clinical psychologist have declared you unable to make your own decisions. Although it is not necessary that this individual be financially savvy, it is important that you select someone who understands your wishes and will ensure they are followed in the event of your incapacity. You should also consider naming an individual who will be emotionally capable of making difficult decisions in such a situation.

Before selecting individuals to serve in each of these positions, consider their skills and abilities (can they handle this responsibility and will they do a good job?), their availability (will they have time to serve?), their location (will distance affect their performance?), and any family dynamics that may affect the individual’s service (does this individual get along with the rest of your family?). If no one in your family would be a good selection, or your family members do not get along, a corporation or trust company may be a good fit for you.

Special Contribution by

Portrait of Bill Fralinwilliam-fralin-logo

Get Financially Fluent

May 26th, 2016 by

 

Do you know how much money you have in the bank? How about how much money your parents have?

As seniors age, financial decisions become crucial. Are your loved ones prepared to age in place? If they’re aging in place, can they afford to upgrade the house to make it safe and limited-mobility friendly? Would downsizing or moving to a refined residential community be a safer option? What happens if a medical emergency befalls a senior?

Unfortunately, as your loved ones age, they will most likely need help planning and managing their finances. It’s an uncomfortable topic for many, but having a rational, detailed conversation about expenses and savings now can prevent a great deal of stress for seniors and their caregivers in the future.

To fully take over finances, a caregiver must have the following:

  1. A plan. Seek out a financial advisor, and get a realistic portrait of the lifestyle that your loved one’s savings and earnings will allow. Know your options; learn how to make their money grow.
  2. An OK. Once you’ve discussed finances, it may be necessary or best for you to take over as the primary decision maker, depending on how comfortable your loved one feels about the idea. To properly take over finances, a loved one or caregiver needs a power of attorney or a living trust to begin making financial decisions. Consulting an Elder Law Attorney is highly recommended.
  3. The contents of accounts. Once you have the ability to help your loved one officially, it’s time for a full assessment. Go through documents and statements to get a full picture of how many bank accounts, stock portfolios, Long Term Care Insurance policies and other financial accounts your senior has. Once you have the full picture, it will be easier to understand the financial situation and move funds, should that be necessary.
  4. A breakdown of the bills. Finally, make sure you have a system for organizing and paying bills. One of the first signs that a senior may need help at home is failure to pay bills.

Ensure that your loved one stay on top of their finances so that they can age with confidence. If they need help, step up by helping them get organized, stay current, and invest in growth. With some careful financial planning, you can help your loved one’s later years become golden.

Seniors Surge

May 26th, 2016 by

People are living longer. Medical advancements, a cultural focus on health, and progress in technology have allowed people to extend their lives. Seniors are becoming one the fastest-growing groups all over the world.

The National Institute on Aging (NIA) predicts that seniors will become 17 percent of the world population by 2050. This population explosion will affect the whole globe in a myriad of ways.

In the U.S., the NIA estimates that our aging population will double in the next three decades, meaning 88 million seniors will be living here. Throughout the globe, the so-called “oldest old” population—seniors living to be 80 or older—will triple in the coming decades.

What does this mean for you and your aging loved ones? It’s time to prepare.

Unless lawmakers and the population of the U.S. prepare for this senior boom, the country will face limited or nonexistent resources for their aging population. Programs like social security and Medicare will be stretched to the brink, while hospitals and doctors’ offices will be filled with seniors who need specialized gerontology care.

Some industries are already preparing for the senior boom. Caregiving companies are increasing staff and focusing on helping seniors age at home successfully. Tech companies are developing senior-friendly devices that will help the aging and their caregivers monitor health, medication distribution, and even movement throughout the house.

The senior surge also affords you an excellent opportunity to discuss aging with your soon-to-be-senior loved ones. Make sure your loved ones have a sound financial plan for their later years, and consult with a financial advisor if you’re concerned about retirement funds. Nail down your loved one’s wishes ahead of time: Do they want to age at home? What would they want done in case of a health crisis? These topics are often uncomfortable but utterly essential to a happy, worry-free aging process.

Whether you’re a soon-to-be-senior or a caregiver to a senior, it’s time to prepare for the senior surge.

Express Yourself

April 20th, 2016 by

What are you doing to make sure you’re aging well? Most people watch their diet, visit their doctors more frequently, and try to exercise more. But is that enough to make your senior years successful?

A documentary, Alive Inside, argues that to truly age well, one needs the arts. The film explores the role music plays in memory, citing cases of patients with dementia and even seniors with typically failing memories suddenly being able to recall vivid scenes from their past with the aid of familiar music. The idea is this: Playing favorite or familiar music for a subject will help trigger vivid recollections, even if the subject’s brain isn’t functioning as it once did. This musical therapy has even inspired the Music and Memory Project, which funds iPods for seniors who can deeply benefit from enjoying music that meant so much to them long ago.

But music isn’t the only thing keeping seniors young at heart. Both the National Endowment for the Arts and the National Institute on Aging have programs that promote all forms of the arts to seniors. Whether painting, composing, dancing, or appreciating, an appetite for the arts seems to help seniors enjoy the aging process. Some seniors write novels or screenplays that a senior acting troop can bring to life. Some seniors paint abstract or classical art to decorate their rooms or local senior centers. The form of expression doesn’t seem to matter as long as something is being expressed creatively.

Some scientists believe that it’s not the art, but the social engagement that is critical to keeping seniors vital. But studies have shown that listening to familiar music, even without engaging with others, can improve memory.

So this weekend, why not plan to include a little art in your life? Catch a concert or go to the symphony with friends. Sign up for a painting class and learn a new technique. Or sit down and write out that story idea that’s buzzing around in your head. Expressing yourself creatively may be the key to keeping yourself happy as you age.

Are Your Parents OK? Here’s How to Check

April 8th, 2016 by

As your parents age, are you confident that they’re coping with the changes that come with age? Are you sure?

Many aging Americans don’t like to admit when they need help. Others can’t see that they might need some assistance with everyday tasks. While it’s important that parents know there is no shame in asking for help, there are a few ways you can assess your loved ones and make sure they’re still thriving while living independently.

  1. Check out the car. On your way into the house, take a detour to your loved one’s vehicle. Is there any noticeable damage? Did your parent tell you about scraping the paint or dinging a door? If a senior has a banged-up car and hasn’t mentioned any accidents, it may be time to take them for a driving evaluation.  
  2. Give a hug. You should, of course, always offer a hug to a loved one you’re visiting, but this hug isn’t only a show of love: Take the opportunity to gauge any frailness or weakness you spot in the hug. When you’re close, evaluate the senior. Are they brushing their teeth? Do they smell clean? If you notice anything odd, don’t hesitate to bring it up.
  3. Get a snack. Even if you’re not hungry, ask for a snack and something to drink. This gives you the chance to check out the senior’s kitchen, and evaluate its general upkeep and what’s in stock.. It also gives you the opportunity to watch your loved one in action. Can they make a cup of coffee? Are they struggling to cut up a piece of fruit? Pay attention to how they navigate the kitchen.

If you think your parents need assistance, it’s time to sit them down for a gentle, honest talk. Consulting experts in aging such as Capital City Nurses for home care, or A Geriatric Care Manager for other advice is a good idea. If there are any physical changes to your loved one or to their vehicle(s), it may be time to bring them to a doctor for an evaluation as well.

Whether you’re just checking on a relative or worrying about mom and dad, it can be hard to evaluate if a senior is thriving in their environment. With these tips, you can take a look at your loved one and determine if they need some extra help managing their home or their health.

When Is It Time? Making The Difficult Decision to Move a Family Member to Assisted Living or Memory Care

March 30th, 2016 by

Suzy Murphy debra levy

special contribution by Susy Elder Murphy, BA, CMC
owner, Debra Levy Eldercare Associates

One of the most difficult decisions that any family faces is making the decision about when, or if, moving a family member to assisted living is the right thing to do. As Aging Life Care™ Managers, this is often when we are called on, whether to schedule an office consult with concerned adult children to discuss options or to meet with a spouse in their home and assess whether or not their husband or wife can still be safely cared for there. It is nearly always an emotionally fraught decision. Sometimes adult children promised their parents that they would “never put them in a home,” whatever that may mean in today’s world where some skilled nursing facilities actually more closely resemble a Hilton Garden Inn with nurses, and long before being faced with the realities of a difficult diagnosis, such as Lewy Body Dementia. When I meet with couples who may have been married for 60 years or more, they are often wracked with guilt because they feel that they have in some way not fulfilled their wedding vows to care for their spouse “in sickness and in health,” promises made decades before the diagnosis of a chronic and progressive illness such as Parkinson’s Disease has begun to take its toll on the strongest of marital bonds.

I give talks on this subject at assisted living communities in our area and they are always well-attended by adult children and spouses who have the same questions for me: What are the options and how can we afford to pay for this care? More of us have long term care insurance which may cover most or even all of the cost of care, but many families are dipping into hard-earned savings, or looking to government benefits to help cover the costs. I recently met with a brother and sister who live in this area and were concerned about their parents who live in Florida. They began trying to look at different communities on their own and quickly realized that they needed the guidance of an Aging Life Care Manager to help them understand the alphabet soup of categories of care that their aging parents might need. As members of the Aging Life Care Association (ALCA), we do not have a financial relationship with any community or resource that we refer our clients to, and our recommendations are based on our clients’ needs and our experience in the geographic area we serve.

To use the “Smith” family as an example, mom is age 85 and takes a few medications for chronic conditions such as hypertension and thyroid imbalance, but has had noticeable memory loss for the last several years. Dad, 89, also has some memory issues, but has also recently been diagnosed with congestive heart failure, including a hospitalization to treat that condition. Mom and Dad are both happy in Florida and have some extended family there, as well as many friends and activities they enjoy, although both of their adult children live here. “Don” and “Amy” wanted to know if they should continue to travel back and forth to Florida to deal with intermittent health crises such as their dad’s recent hospitalization, or, whether it would be better to bring their parents closer to them here.

We began with a discussion of finances. The Smiths have modest income of about $3500 per month, and are not eligible for the Aid & Attendance benefit through the VA, since neither parent served in the military. They have savings of about $50,000 and a condo worth about $100,000, which is fully paid off. They currently live within their means and cover their out of pocket medical expenses and living expenses out of their monthly income, usually with some left over at the end of the month. My first suggestion was that they get a more comprehensive assessment of their parents’ medical condition, particularly their dad’s congestive heart failure and their mom’s memory impairment. They plan to have a comprehensive assessment by a geriatrician of both of their parents, and I was able to refer them to an ALCA member in Florida who could assess how they are actually functioning at home. My colleague in Florida could assess if their memory issues are causing them to forget to take medication, compounding their other medical issues, and also identify what local resources they could tap into to support their continued care in their familiar home as an option that might be sustainable for another year or two.

At the same time, we explored different housing options in this area. I suggested that they look at communities that offer independent living (a private apartment with a full kitchen and a congregate dining meal plan of 1 -3 meals daily and weekly housekeeping) with the possibility of a subsidy, as well as the availability of ala carte services such as medication management, and assistance with bathing, as a way to stretch their savings out for as long as possible. Some of these communities also offer assisted living options (a private apartment but with only a kitchenette and 3 meals and snacks daily, as well as weekly housekeeping and laundry) with more comprehensive nursing oversight, as well as possible subsidies. In the event that one of them needs skilled nursing care, possibly Mr. Smith due to his advanced age and congestive heart failure diagnosis, I explained how Medicaid would come into play to pay for most of his care, and referred them to an elder law attorney who specializes in Medicaid for additional guidance. In the event that Mr. Smith predeceases Mrs. Smith, we also explored the possibility of a small group home to meet her care needs, due to her memory deficits and the strong possibility that she might have early to mid-stage dementia. Group homes offer private bedrooms, shared meals in a communal dining room and a less institutional setting than a skilled nursing facility, for about half the cost.

At the end of our 90 minute meeting, Don and Amy had a short list of communities near their homes in the metro DC area that could meet their parents’ medical and financial needs, as well as a referral to the Aging Life Care Manager in Florida to help them understand what options are available to their parents there, as well as to get a more complete assessment of their needs. We will remain in touch as they explore the options and, as a family, make the decision about when it is time to move their parents.

Susy Elder Murphy is the owner of Debra Levy Eldercare Associates, an independently owned and operated Aging Life Care Management practice founded in 1988. She is also President of the Mid-Atlantic Chapter of the Aging Life Care Association. She can be reached at smurphy@care-manager.com

Top 10 Signs Your Elderly Parent Needs Help at Home

March 28th, 2016 by

David Letterman was famous for his Top 10 lists on his late-night television show. Most of them often brought a chuckle, while some were downright awful. But what Mr. Letterman understood was the power of creating an easy-to-remember list that could be recited the next day at lunch or around the water cooler at work.

We’ve created such a Top 10 list, but it’s not intended to make you laugh. It is intended to be memorable and frequently discussed with your loved ones. While you may not want to recognize one or more of the signs on this list because to do so would be to admit that your aging parents need some help at home, it’s vitally important that you know what to look for so you can act before an accident happens.

Here is the list: 10 Signs Your Elderly Parent Needs Help at Home

  1. Stacks of unopened mail or unread newspapers and magazines
  2. Spoiled food in the refrigerator
  3. Empty pantry and cupboards
  4. Declining personal hygiene (body odor, unkempt hair, unbrushed teeth)
  5. Mood swings and unexplained changes in mood
  6. Lack of interest in hobbies, reading, and conversation
  7. A strong smell of urine in the house
  8. Piles of dirty laundry and beds without sheets or blankets
  9. Difficulties with standing, walking, or mobility
  10. Forgetfulness beyond a simple “senior moment”

If you’ve noticed one or a combination of the above signs, then it may be time to start the conversation about next steps for your aging loved one. Many options ranging from part-time home care aides to assisted-living facilities are available. There are many ways to help you protect your elderly parent when you notice the signs. This list of indicators is a place to start.

Help for Adult Children of Aging or Sick Parents

March 11th, 2016 by

 

Special contribution from Barbara Kane, LCSW-C and Linda Hill, LCSW-C, of Aging Network Services

As geriatric social workers, we work with adult brothers and sisters who are caring for their aging parents. They are often reengaging with one another in very intense circumstances, sometimes after decades of being focused more on their own families than on their family of origin.  The stakes are usually high, as can be the associated emotions and opinions about how to best help their parents. As they sit in our Bethesda office, sometimes with one or two siblings on a conference call, they may silently wonder whether they are even going to continue a sibling relationship once this last parent dies. The process is never easy, but once we have a plan of care in place, siblings frequently look at one another with a rush of gratitude and maybe even a new respect.

Coordinating care for aging and ill parents is difficult for many adult siblings and frequently reawakens old wounds and conflicts. The presenting problem is not the sibling relationship; it is the effective care of the aging parents. Still, working to resolve issues related to taking care of their parents may offer siblings a fresh opportunity to resolve past conflicts.

Division of Roles

We often find that discussing roles and responsibilities is an opportunity to coach siblings on how they can work together more effectively. In a consultation, we may interrupt them to show healthier ways of communicating, both listening and talking. With siblings, we point out that each has different temperaments. We work to help them acknowledge and respect these complementary differences and the strengths of both.

After a couple of sibling sessions with the help of our coaching, we advise siblings to continue these meetings on a regular basis themselves.  Perhaps monthly meetings which they can regard as care planning discussions or business meetings is a good way to check in with each other.

Here are some questions that siblings may use to guide them in their discussions:

  • Do you feel that I have been doing enough?
  • Do you feel that I have been doing too much?
  • Is there anything that I have said or emailed over the last month that bothered you?
  • Do you feel that I have asked you for approval for big care decisions during the last month?
  • Do we need to revise our division of labor?
  • Do you feel I have been respectful of you in tone and action?
  • Have we communicated enough over the last month?
  • Are any old wounds festering?
  • Overall, how do you feel we are doing as a team?

It may seem that monthly meetings are not necessary.  But even if the aging parent is quite stable, sibling relationships need to remain on an even keel throughout this journey of caregiving.  Many families are split by geographical distance and it is often the out of town sibling who has the harder time with feeling out of the circle of care. These meetings, even over the phone, can go a long way towards keeping all the siblings feeling good about each other and the work they are doing together.

For this may be the last time that adult siblings have such a profound reason to come together.