Many of us often make mistakes when communicating with people who are living with dementia. It’s a learning process, but here are a few key practices which may help you. Remember, those living with dementia have a disease and cannot control their behavior. Their reasoning and logic skills are impaired. Changing our approach can reassure them and reduce anxiety.

Try these tips for successful interactions.  Above all, empathize.

1. REDIRECTION

• Be patient. To redirect is to lead. People prefer to follow someone they trust and enjoy, not someone who frightens or shames them.
• Use a calm, friendly tone. Make sure your body language reflects your soothing words.
• Avoid arguing or using reason. Do not say “Mom, if you do that, you’ll fall!” People with dementia lose the ability to follow logic. This is not an effective motivator. It only makes them defensive, which is counterproductive.

2. VALIDATION

• Enter their reality. Validation works through empathy, building trust, and developing a sense of security. If they believe their Mother is still living, ask them to describe Mom rather than say their Mother died years ago.
• Acknowledge their feelings. Do not argue. Instead, acknowledge their frustration and fear. Let them know you recognize their anxiety. Start with, “That must be upsetting.” instead of, “You’re wrong about that.”
• Dealing with paranoia. Do not dismiss their comments with “That’s not true.” Instead say, “I’ll help you with that problem.”  Recognize that although hallucinations can be disturbing, they are very real for those living with dementia. Empathize and reassure.

3. FIBS/LIES

• Last resort. You must know your family member to know if fibs/lies will be helpful to reduce anxiety, help by redirecting them.

I knew a daughter who received multiple phone calls from her Mother daily.  “Have you seen my sweater?  Do you have my sweater?”. After a lot of frustration and multiple times of saying “No, Mom.”, she  finally just said, “Yes Mom.  I have your sweater.”  She said, “Ok” and hung up.

•  When therapeutic fibs don’t work. If a person is suspicious, do not use fibs/lies. They can cause an escalation in the situation and distrust in current or future interactions.

4. TRUTH

• Share the truth. We often try to protect those with dementia by not telling them the truth. Not sharing the full truth can be frustrating and lead to agitation. Sometimes, calmly telling the truth can help the person. Communication practices should take into consideration the stage of dementia.
• The truth is better. In early stages of dementia, the truth is better.
• When the truth is better left unsaid. If what you share with them will only make them sad or experience emotional pain they will not remember later, it is not always best to be truthful. It’s not helpful to make someone re-live sad moments by being truthful.  In these cases, try to change the subject.

A FEW MORE TIPS

• What might be causing the behavior? Are they uncomfortable? Are they in pain? Thirsty?
• What caused the behavior? What did you learn that will help for next time? How did you respond? What did you do right? What might you try next time?
• Allow free-will. Do not restrict or try to stop a behavior unless it is harmful. Use the techniques above to prevent harm.

A consultation may help you cope with a loved-one who is experiencing certain behaviors.  Call or e-mail to learn more. 571-488-9396  [email protected]

“Do you want to be resuscitated if your heart stops—meaning if it happened at this moment, would you?”

Depending on the stage of a person’s life, many reply, “No, I don’t want to be resuscitated and those wishes are documented in my Living Will (aka Advance Directives).”

The difference between a Living Will and a Do Not Resuscitate (DNR) order and how they are used is a common misunderstanding among older adults and their adult children.

The Problem

If your heart stops and you are unconscious (aka cardiac arrest), someone will call 911.

Paramedics will arrive and attempt to resuscitate you by default. They will not ask to see a copy of your Living Will or Advance Directives while fighting to save your life.

How will you communicate your wishes outside of your legal advance directives?

Unlike most Americans, you have been conscientious about legally preparing for the future. You have been thoughtful and diligent about getting your ducks in a row.

Our Observation

We estimate at least 90% of older adults and families we serve do not recognize the difference between the legal documents designed to carry out your end-of-life wishes and a Physician-signed Do Not Resuscitate (DNR) order.

The reason may be that when we are younger, our Advance Directive may indicate the desire to prohibit life-sustaining interventions in the event of a lengthy coma with no reasonable expectation to survive. (Do you recall the case of Terri Schiavo?) When medical professionals have determined your body cannot function without artificial means (i.e. a ventilator) our Living Will reveals our wishes to family.  However, outside of traumatic permanent injuries, most of us want to be resuscitated when we are young.

Older adults often feel differently. By their advanced years, many adults have dealt with cancers, several chronic conditions such as COPD, diabetes, heart disease, arthritis, dementia, etc. By the time they reach a certain age, they may feel fulfilled and are comfortable with letting nature take its course.

The Solution

If you do not want to be resuscitated, then it is time to talk to your doctor. Debbie Aggen RN, CMC, CDP tells her clients, “A DNR is not a document written up by an attorney. It is a medical order from the doctor. Medical professionals have to follow a doctor’s order, that includes Paramedics, EMT, hospitals, nurses and home care aides or others who may be in your home.“

Ask your doctor if it is time to consider a DNR.

Questions to Ask

Discuss medical interventions and how they may affect you with your doctor. Medicare will cover the doctor conversation.

Here are questions to start the dialogue:

• What are the chances that CPR will save your life?
• What happens to my body when CPR is administered?
• When would artificial nutrition be appropriate?
• What if I just want to be kept comfortable? When would respiratory therapy be considered?
• DNR: Where should the DNR go and who should have it?

The two most important places a DNR should be kept:

• The Refrigerator
• In Your Wallet.

Make several copies and make sure your family and doctor also have a copy.

Consider how a Living Will and a DNR affects your life.

Your life is your choice.

Still Have Questions?

Do you need additional information about a DNR? Contact Us. We look forward to answering your questions.

For some of us, what we hear on the news about the pandemic occurring in nursing homes, and other congregate living communities can be frightening.  Is now the best time to move? For independent living retirement communities (aka CCRC’s) much is the same.  Here are two communities in Northern VA sharing what has changed, if anything.

Goodwin House (Bailey’s Crossroads and Alexandria 703.820.1488) has seen very few changes.  Due to their geographic location, move-ins remain strong during the pandemic.  By proactively sharing how infection control is managed, older adults are feeling comfortable to continue their transition plans to enter a robust retirement community.  However, according to Sue Dolton in Sales and Marketing, Goodwin House has seen about a 47% drop in new inquiries.  Tours are not being done and some older adults are postponing decision to become a priority club member (aka waitlist). Potential residents indicate they feel the world is uncertain.  Others find the prospect of putting their home on the market and having buyers walk through their homes feels unsafe at this time.  What older adults do not appear concerned about is the current real estate market and the strength of their finances according to Sue.

Resident life in Goodwin house has changed to some degree.  There is no congregate dining currently. Three meals a day are being delivered to residents in their apartments.  Activities and events are occurring, but differently.  Many opportunities to be active are happening outside in the warmer weather.  Masks, 6 ft. social distancing, etc. is the standard practice during gatherings.

Non-essential, non-emergency visitors are discouraged. Visitors are screened. Testing of residents and staff is ongoing at Goodwin House to ensure a safe and healthy community.

In Loudoun County, Ashby Ponds, (703.723.1999) a continuing care retirement community developed and managed by Erickson Living, has seen a modest decline in new inquiries.  According to Holly Henderson, Director of Sales, the community and its marketing partners quickly recognized reductions in advertising (direct mail, digital) would be wise for the time being.  What has remained strong are the number of inquiries and engagement levels for Priority List members.  These members are still learning about the campus by speaking with residents and employees about how Ashby Ponds is responding to the COVID-19 crisis.  Like other senior living communities, Ashby Ponds is taking all necessary precautions to protect everyone’s health.  Families of current residents share grateful messages to the staff for keeping their loved ones safe during the pandemic.

Move-ins at Ashby Ponds are occurring due to a continued hot real estate market, according to Holly. “…Some new residents literally had no place to go” because their homes sold quickly. Other potential residents are waiting to move until a vaccine can provide a higher level of comfort or, at the very least, lightening of government restrictions.  However, Holly noted an uptick of cross country moves so residents can be nearer to family in Northern Virginia, providing a better support system during the pandemic.

There’s no doubt that making the decision to move without being able to visit does present a challenge in really getting the feel of the community lifestyle in person. Currently, Ashby Ponds is using technology like never before, such as for virtual tours of apartment homes.  The anticipation is for Virginia to be lifting restrictions soon and the summer and fall will be an even busier move-in season than normal.

As many of us are on ‘hold’ to make changes in our lives, it’s good to know older adults are moving along to make their dreams and plans of living in a retirement community a reality no matter what the circumstances may be.

For further information or help with selecting the best senior living community for you, call 571.437.9396 Caring Considerations Email: [email protected]

It can be a little confusing. Both terms use the word care.  When an older adult needs help, we commonly think of someone who can come to the home and help around the house. They are known as Aides (or caregivers, certified nurse’s aides, companion, private duty aides).  While this is true, isn’t it also true that older adults need help with more complex tasks such as advocacy, coordinating services, medication, Dr. appointments, managing finances, emergencies, etc.?  Are Aides expected to perform those tasks?

The answer is no.  A son or daughter would usually perform those higher-level duties. But what if an older adult didn’t have family support?  (We’ll get to that later.)

Here’s what an Aide would be doing:

Many family members help with personal care (ADLs) and Care Management. Care Management which can be described as all the other aspects of life: advocacy, care coordination, Dr. appointments, decision support, medication management, and being available 24/7 for an emergency.

Here’s what Care Management would be doing:

Consultations are a big part of Care Management. Individuals and families are often faced with a learning curve to solve problems and concerns such as,

• “Would all of our lives be better if she were in an assisted living?”
• “How can I get him to accept help?”
• “How do I handle worsening memory loss ?”
• “Am I doing the right things?”
• “Who will be there for me as I age?”

For those who do not have enough family support, there are major benefits to hiring an Aging Life Care™ Professional. As we age it’s important to have healthcare advocacy and other support 24/7. Care Management will help create a team of reputable experts to keep everyone in check and focused on the best results for the client. Think of us as surrogate daughters with vast knowledge in aging well!

Caring Considerations 571-488-9396  [email protected]

*Aging Life Care™ Professional, Certified Care Manager and/or RN, Licensed Social Worker

I often find our local, northern Virginia government confusing and overwhelming.  We hope that if you need mental health resources that you will contact our Aging Life Care Professionals at 571-488-9396 or reach out to the entities below:

Local Resources:

• Fairfax-Falls Church Community Services Board offers help for mental health, substance abuse, and developmental disabilities. Click here for a flyer on getting help during COVID-19, or call 703-383-8500 for more information and to apply for services.

• Prince William County Community Services Board provides mental health, developmental disability, substance abuse, emergency services and early intervention programs for residents of Prince William County. You can visit their website for more information, or call 703-792-7373 (Woodbridge) or 703-792-5241 (Manassas) if you need assistance.

• PRS provides skills training and supports to individuals living with mental illness, substance use disorders, mild intellectual disabilities, autism spectrum disorders  throughout Northern Virginia and in the District of Columbia. For more information on services offered in Virginia, call 703-536-9000 or click here.

• If you need mental health support, or assistance with other essentials like finding food and paying rent/mortgage, dial 211 to be connected with someone who can help.

For Immediate Help:

• Disaster Distress Helpline. Call 1-800-985-5990 or text TalkWithUs to 66746.The Disaster Distress Helpline (DDH) provides crisis counseling and support for anyone in the U.S. experiencing distress or other behavioral health concerns related to any natural or human-caused disaster, including public health emergencies.

• National Suicide Prevention Lifeline. Call 1-800-273-TALK (8255) or click here to chat online. Offers 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals.

• Caregiver Help Desk. Contact Caregiver Action Network’s Care Support Team by dialing 855-227-3640. Staffed by caregiving experts, the Help Desk helps you find the right information you need to help you navigate your complex caregiving challenges. Caregiving experts are available 8:00 AM – 7:00 PM ET.  
•   If you are in an emergency, call 911.

For LGBTQ+ Individuals:

• LGBT National Help Center. Call 800-246-7743 or visit glbthotline.org. Offers a talkline and weekly chatrooms for youth, providing confidential peer-support, information, local resources and community. 

• The Trevor Project. Call 1-866-488-7386 or text START to 678678. A national 24-hour, toll free confidential suicide hotline for LGBTQ youth.

• Trans Lifeline. Dial 877-565-8860. Trans Lifeline’s Hotline is a peer support service run by trans people, for trans and questioning callers.

For Survivors of Assault and Abuse:

• National Domestic Violence Hotline. For any victims and survivors who need support, call 1-800-799-7233 or 1-800-799-7233 for TTY, or if you’re unable to speak safely, you can log onto thehotline.org or text LOVEIS to 22522.

• The National Sexual Assault Telephone Hotline
  Call 800-656-HOPE (4673) to be connected with a trained staff member from a sexual assault service provider in your area.

For Veterans

• Veteran Crisis Line. Call 1-(800) 273-8255 and press 1, text 838255, or click here to reach a qualified responder with the VA.

• Department of Veterans Affairs. Click here for a resource guide to help veterans manage stress during the pandemic.

Please continue to take care of yourselves and each other, and remember that my office is here to help. Be sure to visit the COVID-19 page on my website for more information and resources. If you have any questions or concerns, or if you need assistance, please don’t hesitate to call us at (703) 256-3071.

Sincerely,

Gerald E. Connolly
Member of Congress

5 Things an Aging Life Care™ Professional Did Today – The last one may surprise you!

You asked your attorney, “How do families cope with all they have to know about taking care of an aging parent?  When do they find the time and how do they know they’re making the best decisions?” That’s when your attorney gave you our number and after a brief conversation you recognized this was the help you had been looking for.

Senior Living Myth Five:

Medicare pays for long-term care.

False. Let’s clear up some of the confusion surrounding this issue. First, let’s define ‘long-term’. The quick answer is long-term care is care that last longer than three months. While Medicare Part A covers up to 100 days of rehabilitation and skilled nursing, this is considered short-term. Requirements include hospital admission of three days or more and a doctor’s order for rehabilitation therapy or skilled nursing. Long-term care insurance policies can have a 90 day (or more) waiting period to receive benefits for long-term assisted living.*

Overall, there are only three options for long-term care:  Long-term Care insurance, your own resources, and if you have no resources, Medicaid.  Veteran’s Aid and Attendance can also pay a portion of care and there may be some subsidies available through a state.

*Insurance policies vary

Senior Living Myth Four: “I’m probably going to live in my home just as I am now and then I will pass-away quietly one night.”

Well…..maybe. Wishes can come true, but the odds are against you.  According to the Centers for Medicare/Medicaid (CMS), seventy (70) percent of us will need at least some care as we age. Weigh all your options, and find out if you and your loved-ones feel comfortable making important decisions during a crisis. Remember, right now the decision is yours….until your children have to make a decision for you.

You can move into a senior community earlier (e.g. while you’re in your 70’s) and enjoy the independent resort-style living.  If you feel some responsibility to your children, moving before a crisis is a gift to them.   Moving at a younger age can provide more choices. Transitioning never gets easier as you age.  I have often heard, “I wish I would have moved sooner,” but I have never heard a senior living resident say, “I wish I would have stayed at home longer”.

In the end, it’s your decision.  You may wish to remain at home, make changes as needed and then move to assisted living if necessary. After all, thirty percent of us will not need care in our later years.

Senior Living Myth Three: “I will lose my independence.”

I can totally understand the feeling of being under someone else’s roof and having to change lifestyles and habits.  When was the last time you did that?  Was it in your parent’s home or perhaps in college? The transition can feel overwhelming at first.  You may feel you have no control and you are dependent on others or perhaps being driven by a schedule feels unpleasant.

The truth is, older adults who live at home are almost always dependent on others. Do you pay someone to take care of your yard or shovel your snow?  You may not drive anymore, so does your family or neighbor help you with shopping?  Do you have to schedule it in advance? Do you rely on others to change light bulbs or make small repairs?  Does your daughter fill your medication box?  The need for help has probably happened slowly.  Change is much more difficult as we age. Talk about what you are going through with a compassionate family member, friend, minister, rabbi, nurse or counselor.

Taking time and taking steps to care for your emotional and physical well-being shows your independence.

Focus on what you will gain.  I no longer have to shop and cook, but I can if I want in my apartment. I will be less lonely. I no longer have to worry about home maintenance.  I will only have to pay one invoice each month for most of what I need.  These things and more can make an older adult feel more independent.

Participate in the community events as little or as much as you want.  You do not have to participate in things you don’t want to do.  Recognize you do have a voice in what happens in a senior community. Resident council meetings are opportunities to enhance the community you live in. Start your own gathering or club.  Getting involved in your community shows your independence and gives you a sense of purpose—something all of us need.

Senior Living Myth Two: “I would consider a retirement community, but I cannot afford it. Besides, I own my house free and clear.”

I hear this explanation, but I often ask families if they have calculated the cost of care and housing in detail. Many assume living in their home with home care is less expensive. Consider the following questions:

1. How much does it cost to live in my home? It’s important to include taxes, meals, utilities, car costs, insurance, etc. I also recommend calculating annual home repair costs at 1% of the value of your home. Living in a senior community eliminates most, if not all, of these costs.

2. How much does home care cost when I need 12-to-24-hour care every day? Some of us may underestimate, or even deny, that we will need care someday. Seventy percent (70%) of older adults will need care for 2–5 years. In the DC metro area, caregivers cost about $26 per hour. That adds up to over $18,000 a month for 24-hour home care. Now add that to your monthly living expenses from above.

3. Have you considered alternatives to a “buy-in” community? Many people assume there are only buy-in retirement community options. However, there are rental options that do not require a large buy-in (e.g., $300,000). When learning about any retirement community or assisted living facility, keep in mind how much care is offered and what the contract covers.

4. Would you consider a smaller apartment and/or a different location if it meant an overall lower monthly cost? If you are willing to make compromises, you may find the perfect place with lower costs. Would you consider a one-bedroom apartment vs. a two-bedroom one? Would you consider moving out of state to be near family if it meant your monthly expenses would be lower in a retirement community?

5. Have you discussed financial planning with the help of a professional who can calculate the potential scenarios and associated risks? What expectations do you have for children to contribute (or to not contribute) to your care and housing?

6. And last, what is your REAL reason for not learning more about senior living options? Most of us have difficulty imagining the day when we can no long dress, bathe or go to the bathroom by ourselves. Many people are anticipating dying earlier than they actually will. Ask yourself, “What kinds of emotions arise when I think about needing help one day?”

Retirement communities, assisted living, etc. are not for everyone. Many of the options are driven by finances and sometimes there is no perfect solution. If someone is 75 and has not thoroughly investigated facets of senior housing and care while they are still healthy, then it’s time to become educated and have the conversation.