Dignity: Are residents well groomed and dressed? Did the provider take the time to introduce you to the residents? Residents come first so if the provider needs to attend to a resident, you should wait patiently. If you ring the doorbell and they don’t answer right away, be patient. Perhaps they are helping someone in the bathroom.

Cleanliness: Is the home clean? Please keep in mind that it is a home. This means that there may be a load of laundry that needs folded. Perhaps they have just finished a meal and there are some dishes that still need to be washed. Are the bathrooms clean? How about the floors? Does it feel clean and fresh or do you find yourself wanting to reach for the hand sanitizer? If you notice any odors, are they from a recent accident or could they be a sign of care issues and unsanitary conditions? This should be questioned and evaluated.

Attitudes and Interaction: How friendly are the caregivers? Are they interacting well with the residents? Are they interacting well with you? I like to tell families that it is important for their loved one to have a good relationship with the staff, but it is equally important to have good communication between the family and the staff. After all, you are all on the same team-striving to make sure that your loved ones needs are met on every level. I have toured some lovely homes that sparkled throughout, only to be disappointed in the lack of interaction between staff and residents. The ideal caregiver has compassion and kindness. They consider caregiving to be their calling, rather than just a job.

Cultural Differences: Many of the Residential Care Homes are owned and operated by people of different cultures. In some countries, the elderly are held in very high esteem and these cultures seek to honor them. They serve their residents with love and respect. Something that you will need to consider is whether or not there is a language barrier? Will your loved one be able to communicate well? When speaking with a potential provider on the phone, don’t rule them out just because of their accent. Many times, if you are face to face, communication is much easier. It is easy for people to jump to conclusions and miss out on a great home. Kindness is a language that is always understood.

State Licensing and Enforcement Actions: Is the home licensed? You will want to check and make sure that the license is current. All providers should be ready to provide you with a copy of their most recent state survey or inspection. Just because a facility has been cited for a deficiency, it doesn’t necessarily mean that they don’t provide good care. Find out what has been done to correct the problem. A much bigger issue is if they have any “Enforcement Actions”. This is when they have been fined or perhaps prohibited from accepting any new residents. Many times, these matters are disputed and later resolved. However, you want to do your homework and see all appropriate documentation.

Listen to your feelings: What was your first impression? What feels like home to one person is completely different for the next person. Will your loved one be comfortable there? Will you be comfortable visiting there?Remember, you are not just choosing a house, you are choosing a lifestyle. Will your loved one have quality of life?

For a complete checklist, ask your Eldercare Consultant for the Graham and Graham “Touring Tips”. It addresses all of these areas and much more. Your Eldercare Consultant can save you time and stress by narrowing your search down to the options that make the most sense based on your loved one’s care needs, location desired, finances, and personal preferences. Our team has visited hundreds of care options and we are committed to helping you find the perfect match!

Author:  Stacy Gibson, Certified Senior Advisor and Eldercare Consultant with Graham & Graham LLC

Free Guidance and Options for Families

www.GrahamandGrahamLLC.com

1-888-217-1655

Sundowning or sundowner’s syndrome frequently occurs in those with Alzheimer’s and other types of dementia. Sundowner’s syndrome is characterized by an escalation of bizarre behaviors including confusion, crying, rocking movements, agitation, depression and fear. Paranoid hallucinations and wandering are additional symptoms, which are the most troublesome for relatives and caregivers. Symptoms often increase at sunset and continue until the early morning hours. Suspicious and paranoid behaviors, such as accusing a loved one of stealing a wallet or having auditory or visual hallucinations can be common. No one knows what causes sundowning syndrome. According to the Mayo Clinic, there may be a correlation between decreased levels of melatonin in elderly dementia patients and distress in the evening. Other theories suggest that symptoms in those suffering may be due to their inability to cope with the stimulation or stressors they experience during the day.

If someone you love begins exhibiting these behaviors, the first step is a visit to a physician to rule out other issues that may be contributing to the behavior.  For instance, a simple urinary tract infection can wreak havoc on the mental state of a person with dementia, as can undiagnosed pain or reactions to certain medications.

While symptoms of true sundowning cannot typically be prevented, there are strategies for reducing disruptive behaviors in your loved one during the evening hours. Some suggestions include establishing a predictable routine to reduce anxiety and help loved ones feel secure during the day. When sunset occurs, closing the blinds and engaging in quiet and calming activities with your loved one can also reduce symptoms. Exercise during the daytime hours may help those with sundowner’s relax during the evening and sleep better at night. Other suggestions to relieve symptoms include light therapy and ensuring rooms in the house are well lit prior to sunset. Lastly, medication may reduce symptoms of depression, anxiety and paranoia, and can help establish nighttime sleeping patterns.  For those who are consistently up all night, or may be at risk of wandering out of the home, secure memory care facilities and some residential care homes can be the right solution.  Compassionate, trained staff are able to provide an increased level of care and supervision, as well as care during the nighttime hours. While there is no cure for sundowning syndrome, with patience, and treatment interventions, symptoms may decrease over time.

The most common form of hearing impairment in the aging population is presbycusis, which results from the natural aging process of the central and peripheral auditory systems. Symptoms of hearing loss include difficulty hearing high pitched sounds, including the voices of women and children, and tolerating loud noise, including television or radio volume set at a level that others are unable to tolerate. Those with hearing loss may also experience problems hearing conversations above background noise. Because of hearing impairment, the elderly may stop participating in social activities and become withdrawn, at the very time in their life when regular communication with others is critical to their mental and emotional wellbeing.

If you suspect an elderly family member suffers from hearing loss it is essential to see a professional.  A physician can make a referral to an otolaryngologist (an ear, nose and throat specialist), or an audiologist (a health care professional who specializes in hearing loss). An audiologist will conduct a hearing test by using an audiometer to check the level of hearing impairment. They will determine whether a hearing aid or another type of assistive device is necessary. In addition to hearing aids, or surgical implants, there are other forms of assistive devices available for the hard of hearing, such as closed caption TV, alert systems and hearing impaired telephone devices. If you suspect a loved one has a hearing impairment, get help immediately. Untreated age related hearing loss can result in isolation, frustration, limited social interactions, loneliness, and a loss of independence. Many treatments and assistive devices can restore life’s enjoyment to those with age related hearing loss and allow full participation in daily and social activities.

Some suggestions for communicating effectively with hard of hearing seniors include the following tips: enunciate clearly, face the person, maintain eye contact, do not cover your mouth, and sit at eye level. Before starting any conversation, turn down the television or radio. Background noise can make understanding the conversation difficult. Speak slowly and clearly during a conversation and use body language or hand gestures when appropriate. Do not eat or drink when speaking with someone who is hard of hearing. If hearing problems are worse in one ear, try speaking (not yelling) into the other ear during the conversation. For severe hearing impairment that can’t be treated, use a dry erase board or a note pad to convey vital messages. Lastly, be patient and repeat any words or phrases when it is necessary.

Communication Tips:

• Enunciate clearly.
• Speak into the good ear.
• Do not eat or drink when speaking.
• Sit at eye level.
• Do not cover your mouth.
• Face the person.
• Use hand symbols or body language.
• Use a dry erase board.
• Lower background noise from the TV or radio.
• Maintain eye contact.
• Repeat words when it is necessary.

Don’t allow age related hearing loss to isolate a family member. Seek help from an audiologist or a consultant on aging. With proper knowledge, assistive devices, and the use of verbal and non- verbal techniques, seniors with hearing loss can rejoin family conversations an social activities.

If you have concerns about your loved one’s driving abilities the first step is to have a respectful conversation with them.  Be aware that this may be a sensitive issue, but also be firm if you have genuine concern.  Safety for themselves and for others must come first. Come to the conversation prepared to offer solutions – alternate transportation options.

Share examples of what you have seen.  “You have had several fender-benders recently”, “I’ve noticed you are breaking suddenly at stop lights”, “You don’t seem to be able to turn your head when changing lanes”.  If other family members or friends have noticed as well, it may be helpful to have the discussion together.

Offer to help them make an assessment of their driving abilities.  There are several steps to ensure safe and defensive driving.

•Vision – a senior may experience changes in night vision, so they should have their eyes checked frequently. The doctor performing the eye test should be informed that they are testing for driving sight.

•Hearing – just as important as being able to see clearly is the ability to hear what is happening on the road.

•Medications – some medications can cause drowsiness and others can cause confusion. Check with the physician to ensure that medications are safe to take when driving.

•Senior safety course – there are defensive driving courses designed especially for older drivers. Various organizations sponsor them, such as AARP.  Contact the automobile insurance company as they often offer discounts for those seniors who take an approved course.

•Driving ability – When there is concern about an elderly loved one’s ability to drive you may want to schedule an assessment with a certified driver rehabilitation or occupational specialist who can do a comprehensive evaluation of your loved one’s skills required for driving. This third party evaluation can often help seniors understand their driving abilities and accept their limitations more easily.

•The National Highway Traffic Safety Administration, along with AARP and the USAA Education Foundation has published a booklet called Driving Safely While Aging Gracefully that can help older adults assess their driving skills and abilities.  http://www.nhtsa.gov/people/injury/olddrive/driving%20safely%20aging%20web/

What do you do when a driver refuses to give up the keys?

Sometimes no amount of rationalization with an older driver can convince them to stop driving.  This can be a very difficult situation for a family member, but safety must come first for all involved.  Ask yourself this question:  Would you be comfortable with your child, or grandchild riding with this driver alone?

The Department of Motor Vehicle (DMV) in most states will work with family members that are concerned about an older adult’s driving abilities. The DMV, if requested, may simply notify your loved one that they need to schedule an eye exam and safe driving test.  A physician can also write to the DMV that their patient is not safe to drive.  This takes the responsibility off of the family member if the DMV finds that the senior can no longer continue driving.

Safety for loved ones, as well as safety of others sharing the road with them, must be the top priority in this often stressful situation.  Some older drivers may be aware of their declining skills, and be relieved to have someone else make this decision for them.

Hospice care is a form of palliative treatment which focuses on the physical, emotional and spiritual care of terminally ill patients with fewer than six months of life expectancy. Due to a lack of understanding of the many benefits that hospice can provide, hospice providers often express regret that patients and families do not always access hospice benefits soon enough.
The focus of care is on making the terminal patient as comfortable as possible and providing support services for the family. End of life care for a terminally ill patient consists of a team- based approach of medical doctors, nurses, home health aides, social workers, bereavement counselors, clergy, trained volunteer staff and ancillary medical staff. The patient, family and medical professionals actively share in making any decisions regarding care, medical treatment and pain control. During the patient’s final days, family members engage in care giving and administering medications with support from volunteers and palliative health care professionals. Team members also facilitate the delivery of pain medications, medical equipment and provide education and training for family members in supportive, palliative patient care. In addition, care and respite services are available in various health care settings including nursing homes, the hospital and assisted living facilities. Psychological and spiritual counseling on death and bereavement are provided for the terminally ill patient and the patient’s family. Services and support are available 24 hours a day and seven days a week. The expenses associated with hospice care services are covered with Medicare health insurance. Whether a terminally ill elderly patient is at home or in other care settings like an assisted living facility, end of life care provides family members and terminally ill patients the support they need during the final days of life.

Individuals with elderly or disabled relatives know that it can be very difficult to determine when their loved ones need assistance with everyday activities that would prevent them from being able to live independently.  This is particularly true for those whose family members have dementia or early Alzheimer’s disease.  The effects of dementia can be subtle making the need for long term care not as apparent as an actual physical disability.

The following questions can be used to determine whether a loved one is having difficulty in performing everyday activities.  The results may reveal whether the family member can live independently or whether intervention is necessary. Long-term care situations can be stressful for individuals receiving care and caregivers alike, as they try to figure out the level of support they need, where the care should take place and how to pay for care.

Independent Living Test: 

Medications 

• Are prescriptions not being refilled, resulting in failure to take medication when scheduled?
• Has taking medication become difficult due to poor memory or confusion? Evidence may include pills taken together that should not be, different pills mixed in a pillbox or an oversupply or under-supply of pills.
• Have conditions previously under control become acute because medication is not being taken correctly?

Food and Groceries 

• Based on past food habits, are the cupboards frequently empty or being filled with unusual foods?
• Is the food in the refrigerator often spoiled or kept long beyond the ”use by” date?

Daily Business 

• Is the mail being picked up and opened regularly or is it remaining uncollected and/or unopened?
• Are credit cards or checkbook being misused or not balanced as well as in the past?

Social Contact 

• Has the amount of social contact changed dramatically, so that there are few public outings or limited social visits with close friends?
• Has the ability to drive deteriorated? Is there a fear of driving or a recent history of multiple minor accidents that is leading to isolation?

Living Habits 

• Has there been a change in living habits such as a change in dress or appearance, or a decline in personal hygiene not related to physical disability? Is dress appropriate for the weather?
• Have housekeeping habits changed so that a normally neat and orderly home is now cluttered and not cleaned regularly?
• Are pets that were normally well cared for suddenly not being fed or cared for as they had been in the past?

Solicitations 

• Is there a sudden increase in ordering unnecessary items through mail or televised Advertisements?
• Increase in calls to Family Members or Health Care Providers
• Have unnecessary calls been made to 911
• Has there been a marked increase in panic calls to family or medical providers without apparent need?

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If you dread approaching the subject with your parents about senior housing and care you are not alone.  For most of us this conversation is right up there with having “The Talk” with our teens about the birds and the bees – awkward and uncomfortable.  But the message I have for you today is that open, honest conversation NOW is so much better than trying to figure things out on your own later.  Equipping yourself with a strategy and clarifying your parents’ goals and preferences will help relieve anxiety for all involved.   Encourage your siblings to be involved in the discussion.  This will ensure that everyone understands your parents’ desires and needs, and will keep peace in the family, as well as lessen guilt when those tough decisions have to be made.

Set the Tone

To begin your discussion, choose an appropriate time and place which respects your parents’ feelings and privacy.  Be aware of your own stress levels and choose a time when they will be lowest.  The key is to approach the subject with a goal of honest, direct communication.   Ask for permission to discuss the topic.  For example, “Can we talk about what is important to you should either of you require care or assistance in the future?”  If someone they know has recently experienced a crisis of this type, it is the ideal time to bring this topic up.  Provide “what if” examples, such as “What is important to you if you could no longer live at home?” “What if you could no longer care for yourself?”

Practice Good Listening Skills

Recognize that your goal is to assist your parents in exploring their situation and options – not to force an agenda or opinion of your own.  Think ahead and prepare for your reactions.  Avoid getting frustrated if your parents are not receptive initially to the discussion. The caretaker role reversal which so often begins to take place between adult children and their aging parents can feel stressful for both parties.  It’s helpful to keep in mind that your parents are still adults and treating them as you would any other adult will go a long way in keeping the relationship comfortable.

People are more relaxed when they feel they are being heard and understood.  As you listen carefully to their concerns you will then be able to hear and dispel some of their fears, such as the loss of independence or freedom.  Ask non-threatening, open-ended questions such as “What concerns you most about moving into an assisted living community dad?”  Emphasize the positive aspects of minimizing many responsibilities and gaining the freedom to do other things.  When you resist the temptation to make decisions for them you can take the long way through discussion and allow them to come to decisions themselves.

Educate Yourself

There are two things you need to educate yourself about:

First, educate yourself on the types of care options available to seniors.  Understand what home care provides, what a retirement or an assisted living community offers, etc.  For many elderly persons, their only knowledge of long term care options is a nursing home.

Second, if you are not aware of your parent’s financial situation, this would be an appropriate time to find out.  Ask about monthly pensions, social security amounts, savings accounts and investments, any long term care policies or whole life insurance that may be converted to cash.  Find out if either of your parents served in the military during a period of war time. (There may be benefits available to help pay for long term care.)  Although this discussion is again uncomfortable, this information is needed should you have to find long term care options quickly at some time.

It is also vitally important that your parent has a “Durable Power of Attorney” (POA) established prior to becoming incapacitated.  This will allow whomever they choose as their POA to make decisions on their behalf, and can specify if those decisions include medical, financial decisions, or both.  They (and all of us), also need an “Advanced Directive” specifying what their wishes are for care should they become too ill or hurt to express their wishes.  Many fear a loss of freedom if they assign someone as their POA, but a POA can specify that it takes place immediately – or at the time the person becomes incapacitated.

Don’t Make Promises

Please, for your sake and your parents’ sake, do not make promises such as “You can just come and live with us and we will take care of you”, or “I will never put you in a nursing home”.  Care needs and circumstances can change, and you may have made the promise with the very best of intentions only to find that this is no longer the best solution.  Unfulfilled promises can create such great anxiety, and guilt and potential conflict in a family.

Setting the Stage

These conversations aren’t initially easy and can be challenging.  Your loving and honest direct communication with your parents will set the stage for future open conversations.  This is an opportunity to become closer to your parents as you move through this life journey together.

Author:  Michelle Graham, CSA, Certified Senior Advisor, Eldercare Consultant, CEO and Founder of Graham & Graham LLC

Free Guidance and Options for Families:   www.grahamandgrahamllc.com