AGING LIFE CARE® ASSESSMENTS: Empowering Quality Aging

Unveiling the Assessment Process

At Caring Considerations/ Aging Life Care Manager, we understand the intricate challenges families face while caring for seniors. Our assessments will create a roadmap for balanced, enriched, healthy living. We confront obstacles, align goals, and ensure documentation of your healthcare.  Assessment can mean different things to you and to us.  Here’s our most common approach.

Through targeted questions and the gathering of information, we uncover your unique situation:

Health Snapshot: Medical history and recent physician visits.
Medication Check: Medication list and reviewing management systems.
Safe Spaces: Home assessment for secure aging.
Wellness: Nutrition and overall health.
Legal Review: Your documentation for incapacity planning.
Emotional Insights: Psychosocial understanding.
Future Readiness: Funeral plans and crisis prevention.
Create a Plan of Care and Informed Steps Ahead…

Our assessment also covers these crucial aspects:

Defining Goals: Your aspirations and their aspirations.
Addressing Concerns: Primary worries and fears.
Visualizing Success: Ideal outcomes for your family.
Effective Strategies: Past successes and failures.
Family Dynamics: Understanding inter-family conversations.
Comprehensive, Electronic Health Documentation…

We finish an assessment by providing a verbal and email report packed with insights and actionable recommendations.

What’s your definition of an assessment? We want to know how we can elevate your family’s quality of life. Contact us at 571-488-9396  [email protected]




CAREGIVING TOOLBOX:  Life Enrichment Visits

Aging in Place vs. Senior Living

Yes, senior living can be the answer for many when it comes to loneliness, but parents have the right to make decisions. We are very independent beings and many of our aging parents are not prepared to live in a senior living community. For them, aging in  place is the best option.

Our response to this need and desire? A Life Enrichment program. Here’s what Caring Considerations will do to help reduce isolation.

We Want To Get To Know You

The in-person, Life Enrichment sessions are customized to meet the specific interests of seniors in ways that are meaningful and relevant. Clients typically receive weekly visits, but we will discuss a schedule to meet a loved-one’s desires.

What Are Life Enrichment Visits?

We provide hourly curated engagement, recreation, and social activities as part of a holistic Aging Life Care® plan.

Physical

  • Workout buddy – PT prescribed exercises and seated exercise videos
  • Walking Companion

Creative

  • Writing
  • Craft projects
  • Reminiscing & conversation

Brain Fitness

  • Math Brain Boost
  • Trivia (variety of topics: sports, movies, country specific, holidays)
  • Word puzzles

In our Aging Life Care® consulting practice, we witness numerous lingering issues resulting from the COVID lockdown.  Older adults want to remain independent, but often lack the insight and energy to incorporate more social opportunities.  The isolation imposed by the lockdown is perpetual and increasingly a barrier to  seniors returning to the life they enjoyed prior to the pandemic.

An Added Benefit

When your parent doesn’t want to move to assisted living, but you worry about them, Life Enrichment visits can be a non-threatening “check-in.”  Although we don’t provide personal care, we can provide feedback about your loved one’s overall well-being.

Contact Us

To learn about this program and more, call 571-488-9396 or email us at [email protected].




Living with Family – Expectations and Boundaries

If your family has decided that an older adult needs constant care and that living together is probably the best solution, then you may be wondering why any further discussion is necessary. Even if you think it isn’t, consider taking a few minutes to sit down with your loved-one to answer the following questions. Doing this may help prevent misunderstandings in the future.

1.Will home care still be used to care for a loved one? If not, who will take time from their career (family) to care for an aging parent? What will be the trigger to get professional help?

2. How will this affect lost income? Will that person be compensated by the family? Who will relieve the primary care provider when they need a break?

3. Is the home accessible: ramps, railings, stair lifts, spacious bathrooms, etc.? Will there need to be modifications/renovation? How much will the modifications/renovation cost? Who will pay for them?

4. What is the budget for caregiving, room and board, etc.? Will you need to learn about Medicaid Community Based Services? What other services are needed?

5.What training will the primary caregiver need? Who will pay for the training?

6. If there is dementia, wandering, or severe behavior issues that become unmanageable, how will they be handled?

7. How and who will be educated about dementia? Everyone in the family or only the primary care provider?

8. Will there always be joint (family) meals? How much time will be spent together daily, weekly, etc.?

9. What household space is available (or can be designated) for private, more secluded time for everyone in the family?

10. How will grandparents interact with grandchildren or participate in discipline?

11. Do family members living together agree on the division of duties? Are there conflicts over tasks, duties & expectations?

12. Will the family be willing to or need to hire a professional counselor or mediator to resolve issues?

13. What will the older adult (e.g. grandparent) be able to contribute to the household activities?

14. Do the grandparents have local opportunities to engage with peers (e.g. senior center)?

15. What if an adult child needs to move? Is there a back-up plan?

We all have expectations and boundaries when living together. Communication early on may help set the stage for future conversations and negotiations.

If you find it difficult to come to a consensus, or you need help in exploring living and care options, contact us at 571-488-9396 [email protected]




Decisions: From Independent Households to Extended Family Households

You may recall the days when parents lived with their grown children (think The Walton’s).  Many cultures adopted this arrangement for financial or traditional reasons. Then an era of independence became more common.  I recall my grandmother wanting her own household in the sixties. Over time, changes in society have caused us to re-examine independent households in favor of extended family households.  The 2008 recession, living longer, and managing chronic conditions have been catalysts for change.  The fact is, living with family is becoming more popular.

Is it right for you?*

We spoke with a few families who have made the change.

Kathy and her husband, Richard lived very close to Kathy’s father, Bill.  The grandchildren enjoyed frequent visits to Grandpa’s house.

One day, they found Grandpa Bill unresponsive on the kitchen floor.  Fortunately, he was okay, but Kathy and Richard agreed it was enough of a scare to start the conversation. There was no reason why Dad couldn’t live with them.

It took Bill, a widower, a little while to get used to the idea. But when he thought about the future and his daughter’s responsibilities, he felt it would be a wise move.

“What really helped my father accept a new living arrangement was having a lot of control.  He helped hire an architect and Dad directed most of the in-law addition designing.  Dad was still sharp. He listened to our ideas, and he enjoyed the process.”

When I asked Kathy how they prepared to combine lifestyles, she said it was pretty easy.  Richard, the son-in-law, worked during the week and Kathy was able to spend some time with Dad.  When the weekend came, Grandpa Bill respected their family time.  Richard had no problems with his father-in-law being around. There were some shared meals, by invitation only. Grandpa Bill always knocked on their door in the morning just to say Hi and I’m okay.

What really worked out well is the in-law suite. It was very private and self-contained.  Hiring a good architect made all the difference, according to Kathy.

To finance the home addition, Grandpa Bill paid for most of it. Kathy and Richard were able to create an upper level master suite and bath, so they agreed to pay a portion of the renovation taking into consideration future home equity.

What didn’t work so well, according to Kathy, was her brother’s  response.

“During this time, my brother had to learn that I was the Executor of my Dad’s estate and that I was named as having Power of Attorney. I let my Father have that conversation with my brother.  But I knew my brother didn’t want the responsibility of caring for Dad full-time and everything that comes with it.  Eventually everyone came to terms with the financial implications.”

Parents Living with Dementia

Kathy’s family was blessed with a relatively smooth arrangement.

Other families have a more complicated situation. For instance, when memory loss affects one or both parents.

The person living with dementia may experience confusion, suspicions, and even more severe behavior issues. Some families assume resistance is stubbornness. Most of the time, it is fear of the change and a new environment.

The trigger to change living arrangements? When one-on-one caregiving becomes necessary, many older adults move in with their families.  Without some forethought, the primary caregiver, usually a daughter and her family, can find the arrangement burdensome to a point of compassion fatigue.

Did the Walton’s have the right idea? In our next blog, we will discuss questions, expectations and boundaries.

If you or someone you know is exploring living and care arrangements for a loved one, we can help make the transition a little easier. 571-488-9396 [email protected]

*Names are fictitious.




Dementia Communication: Our Four Best Tips

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.
  1. 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.
  1. 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.
  1. 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]




Eliminate the Confusion: Advance Directives vs. DNR

“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.