Can Dad Still Live Alone?

When you have an elderly parent, going home for the holidays can be traumatic.

Geriatric social workers, financial planners and staff at long-term-care facilities have seen the same scenario play out many times: Adult children are struck by dramatic changes in their parents’ abilities to care for themselves and their home—or they realize just how quickly Mom or Dad’s memory has declined.

[image]John Nickle

At that point, families swing into crisis mode. But with little or no time to research their options, they often are limited by what’s immediately available, says Tara Fleming-Caruso, an admissions counselor at NewBridge on the Charles, a retirement community in Dedham, Mass.

That’s what happened to Tim Prosch, a Chicago marketing consultant, on a visit to his parents, who lived in Montague, Mich. Soon after his arrival, he realized his father’s multiple sclerosis and his mother’s Alzheimer’s disease were progressing much faster than his parents had let on.

He had to scurry to get care set up for his parents in their home—and deal with his father’s trading in a PT Cruiser for a Cadillac he couldn’t afford.

Afterwards, Mr. Prosch wrote a book to goad his fellow baby boomers into making specific plans that they share with their children now, well in advance of any health crisis.

Other experts are urging families to have conversations long before any crises as well. Here are the most important topics to discuss.

Making a plan. Mr. Prosch urges couples to spend time in their 60s talking to their adult children about the size of their retirement savings, their preferences for living arrangements, long-term care and burial, and the point at which they would be OK giving up the car keys.

Those end-of-life issues are so awkward that he titled his book “The Other Talk,” hearkening back to the discussion many parents have with their children about sex.

A big part of his message: “You need to commit to full financial disclosure,” he says, adding that an audience of 50 murmured in protest when he told them that earlier this month. “It’s a cruel joke on your kids if you don’t do that. You need to prepare them for the day when they have to take control.”

To that end, he suggests putting all of the documents your children need in one binder, including your will, insurance policies and contact information, doctors you’re dealing with, diagnosis, a safe-deposit box inventory, funeral plans and the location of all of your financial assets and accounts.

After being injured on a sailboat in Italy several years ago—an accident that required 50 stitches—Mr. Prosch, now 65 years old, and his wife Pam put a binder together for their daughter, Dakota, 35.

Her parents “went through everything in their house that they considered valuable and had it appraised and took a picture of it,” she says. “They included all of their finances and a monthly budget. It’s a relief to have.”

Avoiding a crisis. For boomers caring for elderly parents, Hebrew SeniorLife, a Boston-area elder-care provider that runs NewBridge and other retirement communities, has put together a book titled “You & Your Aging Parents: A Family Approach to Lifelong Health, Wellness & Care,” downloadable at no charge atagingredefined.org.

Ms. Fleming-Caruso, who wrote a chapter about housing options in the book, says talking about a parent’s health outlook and wishes in advance can help families make more informed decisions about their care down the road.

For example, she recently worked with a woman who had helped her mother, after being diagnosed with dementia, move to an assisted-living facility.

But when her mother was hospitalized for another illness, the woman moved her to an assisted-living facility again, rather than taking more time to get her situated in a facility that could offer more care as the disease worsens.

“The daughter pulled her mom out of the hospital in the middle of several medication changes, which is a terrible way to transition an elder,” especially when the facility doesn’t offer round-the-clock care, says Ms. Fleming-Caruso.

She also encourages adult children to have conversations with their parents about their end-of-life wishes. Some strategies: You might go out to eat together or enlist an objective third party, such as a minister, social worker, geriatric-care manager or friend.

One of her colleagues, a social worker, had such talks with her father for years. When he suffered a stroke and was put on life support, “she knew instantly this was not what Dad wanted, because they had talked about this over and over again,” Ms. Fleming-Caruso says. “She was able to give him what he needed and say goodbye with a sense of peace.”

The woman’s sister, who hadn’t conducted such talks with their father, struggled with “unresolved issues” over his death, Ms. Fleming-Caruso says.

Fighting fraud. Financial exploitation costs older adults an estimated $2.9 billion a year in the U.S., according to the MetLife Mature Market Institute. The Eldercare Locator, an online directory (eldercare.gov) and call center ( 800-677-1116) supported by the federal government and run by the National Association of Area Agencies on Aging, is urging families to spend some time together over the holidays to talk and learn about ways to prevent financial exploitation.

Signs to look out for include inconsistent financial activity, confusion about recent financial arrangements, changes to key documents or an older adult’s feeling uneasy about someone seeking control of their finances.

The Eldercare Locator, with help from the National Center on Elder Abuse, has put together a free consumer guide, “Protect Your Pocketbook: Tips to Avoid Financial Exploitation” (available at www.n4a.org) to help get the conversation started.

Write to Kelly Greene at familyvalue@wsj.com

As Population Diversifies, Rethinking How We Care For Elderly in New York City and New Jersey

By Liz Seegert

DEC 11, 2012

 

The elderly population of the future may not look much like the old people of today. It will be less white and with fewer native English speakers. That means physicians, nurses, social workers and health aides will have to adapt to our increasingly diverse society, according to Peggye Dilworth-Anderson, professor, health policy & management, and interim co-director of the Institute on Aging at the University of North Carolina. She says that not understanding the “cultural context” of each patient can lead to inappropriate diagnoses and treatment and contribute to health disparities.

Dilworth-Anderson presented her research recently at the annual meeting of the Gerontological Society of America, and afterward spoke with reporter Liz Seegert. Here is the edited interview:

What does cultural competency in health care mean? 

Many times, it comes down to trying to get inside the other person’s head, to find out where he or she is coming from, what the belief or value systems are, that make this person respond a certain way to health care.

What is the connection between cultural competency and health disparities?

One of the first steps in making sure there is equity in health care is to step back and look at the world from the patient, family, and caregiver point of view.

For example, older African American women belong to a culture that cherishes and protects them. So the family is very involved and wants to know that their mother or grandmother is treated with respect and dignity. This is also a culture that maintains a high degree of privacy and personal boundaries. It can be difficult at first to get an honest assessment of an elder person’s condition, because they may not be immediately forthcoming. Trust takes time to build, and care can be challenging until that comfort level is there.

You define “access to care” pretty broadly.

Where care is located – like in a neighborhood clinic, or big urban hospital or how easy it is to get to – is only part of the equation. It also involves how you’re treated when you get there, if providers understand your background and take it into account. Are they good at reading between the lines and interpreting what’s being said in light of your beliefs?

In Latino and African American cultures, multiple family members are part of the decision-making process, and want to be included in all conversations. That’s a difficult balancing act for providers because of HIPPA privacy regulations. So a patient has to waive privacy. There may also be a delay in getting a diagnosis or treatment for a condition like dementia, because in those cultures, it’s just considered a normal part of getting older.

Your research found that some minority caregivers are not taking advantage of all of the support services available to them. Why not?

If memory loss or agitation is just accepted as a natural part of growing older, these families probably would not take advantage of outside help.

Another piece of this is to look at where information about support services is available. A caregiver may not pick up a pamphlet in a doctor’s office, but if that same information was put in neighborhood gathering spots like beauty parlors or churches, it would be perceived as more trustworthy.

Not long ago, I was surveying an elderly African American patient and her caregiver, and other family members insisted on knowing the questions and answers. I had to understand that this was part of their culture, to know what was going on with this older person in their lives. If I hadn’t done that, there never would have been any trust between us.

What’s needed to improve cultural competency among health providers?

This really gets to improving workforce training. We’re teaching health providers with models developed 20 years ago that may no longer be relevant. We need to rethink what we perceive of as “normal” aging.

We need to look at how people are the same and how they’re different. For example, the Hmong, Vietnamese, and African American cultures all hold the elderly in high esteem. However, each group has certain ways of caring for them, according to their customs. We need to know this and respond appropriately.

We need fresh voices at the table. The policy process should include caregivers, and those representing families. It needs to be a more culturally-diverse group. We need to work within communities, to recognize and take advantage of support systems, where there is already a culture of trust. We also need to take a look at existing policies and revise them to reflect our world in 2012 and beyond.

At NorthStar Care & Guidance, we are available to talk with you and your family about all of your live-in home care needs. NorthStar Care & Guidance is an elder care agency providing assistance to seniors with elder care in New York City and New Jersey. Call  888-288-6152 for more information.
This article was produced by Kaiser Health News with support from The SCAN Foundation.

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