I am a perfectionist and a control freak. I am fiercely independent. I have a strong sense of personal duty. I am bulldog-never-give-up stubborn and I like to finish what I start. My mother has noted that I am addicted to work. All of which means that I am considerably more at ease giving help than receiving it.
That attitude doesn’t cut it in caregiving.
You can’t sit with someone 24/7 and also go to the grocery store. You can’t be a singularly devoted daughter and not be cheating your husband and children (and employer) of the attention they deserve. You can’t cater exclusively to your care recipient’s needs without seriously undermining your own. In fact, often you can’t even take good care of someone by yourself; it is patently impossible simultaneously to be doing solid research on next generation therapies while keeping the ice chips flowing.
This is where you need to let go a little, and allow friends and family in.
I am lucky. I come from a Southern tradition where people expect to “do” for each other when someone is going through a rough spell. You don’t ask “What can I do?” You turn up. You bring food. You wash dishes and haul trash and run errands. You listen.
Consequently, I have a lot to be grateful for. The colleague who came on her lunch break—in her work clothes—to force me out on a walk every day—and who went at my breakneck pace, no questions asked. My aunt who, knowing I was alone and probably not eating, simply appeared in the hospital waiting room with a jar of warm, homemade potato soup. The friends and family who over the course of weeks turned up with dinner and good gossip and very much patience. I am eternally indebted to all those who gave us so much love and help and support without even being asked.
But the further reality is that this burst of loving support only lasts so long. It is crisis driven, and when your crisis should be past, people shift their attention to the next needy candidate. This is not to say they disappear; simply that they are less aggressively present. I have a feeling that is true the world over.
So I have had to learn to ask for help.
To actually schedule those walks. To arrange for others to take on some chores. To share information that further enables the sharing of tasks. To recognize that I neither can nor should do everything myself.
I urge you to recognize this truth for yourself. To form a team of caregivers. That doesn’t mean you simply go away; there are a lot of ways to organize the team.
- There is the rotation method: In my grandmother’s waning years, each of her children were responsible on specific weekdays; in another family, siblings flew in for week-long stints to provide hospice care for their sister.
- There’s the divide-and-conquer method: Many families divvy up chores by skill-set and geography; people across the country can pay bills, do research, even set up appointments while those nearby provide hands-on help.
- There is the family and friends method: In one of the loveliest acts of devotion I have ever seen, when one man grew too weak to join his Friday golf group, they came to him, bringing lunch and laughter and normalcy—and giving his wife a full afternoon off every week.
- There is the outsourcing method: One long-distance caregiver organized a bevy of “staff” for her mother: the “housekeeper” who provides 40-hours a week of company and ensures she is well-fed and takes her medications; the “private exercise coach” who in some circles would be called a physical therapist; the driver and yardman and grocery home-delivery service that make continuing to live at home possible for this lady.
What is common among all these examples, is that the primary caregiver wasn’t afraid to let go a little—to ask for, and to accept
I’m following their lead. And if I can do it, you can, too.
Or a stumble.
When you are older, a fall can literally change your life.
falls are the leading cause of accidental death in people over age 65 (so while you are worrying about how to pry the car keys away from Mom, give some thought to talking her out of her high heels, too).Older people are both more prone to falls and more vulnerable to their effects.
Why? Changes in vision and hearing, reflexes and coordination. In addition, diseases complicate matters: hypotension can cause dizziness; Parkinson's Disease can affect coordination; Alzheimer's Disease impairs judgement. And medications can cause any of those issues. Then when a fall occurs, older, more porous bones simply snap.
So what's a caregiver to do? You can swaddle your parents in packing blankets—or take more practical steps to help them stay well-balanced and not tempt fate. We've discussed some ways to improve their balance
as well as offered practical tips for things you can do to make their home safer
. Now, we offer a free brochure with good background information and more practical tips.
Met Life's Mature Markets Institute, in partnership with the National Alliance for Caregiving, have published this handy booklet entitled, The Essentials: Falls and Fall Prevention
. We recommend that you download and read yourself. Written in a friendly, Q & A format, this handy brochure details
the most common causes of falls, as well as how to evaluate the risk of a fall and basic fall prevention techniques. It concludes with three pages of resources., organizations that can help keep your parents on their feet.
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It’s a fact
: The older we get the more likely we are to fall and the more likely we are to hurt ourselves on the way down. In fact, the Centers for Disease Control estimate that each year 30-40% of Americans over age 60 fall at least once. This is something you want to be very careful about when it comes to your parents.
Now, you are unlikely to convince the folks to replace that brick terrace with nice smooth concrete, and even more unlikely to successfully eliminate the step between the living room and dining room, but there are
a lot of environmental factors that are easily controlled, as we discussed in our previous post
There are also two key interventions regarding their person. Help them practice good balance
. Yep. Practice. There are a host of balance enhancing exercises, most of which can be done anywhere with no special equipment. For instance, try simply standing on one foot for 10 seconds, with your other leg bent back like a stork. Then switch legs. (Do this in front of a counter or a chair back, so there is something to grab if necessary). Not as easy as it sounds, is it? But with practice you will even be able to do it with your eyes closed. Tai chi is also terrific for balance and your gym should be able to show you other useful exercises. Don’t keep them to yourself; remember, this is about your parents, so make sure they do them, too. Check their medications
. The American healthcare system (don’t get me started) makes sure that everyone sees a lot of specialists. Every one of them manages to prescribe one or more new medicines. Very few first ask about what else someone is already taking. And let’s be honest: even if the doctor asks, practically no one actually knows the answer. Layer on our odd proclivity to take other people’s drugs (“This worked great for me, you should try some.”) and there is no telling what kind of internal stew any one of us is brewing. But I digress.
It’s a good habit to routinely rifle through your parents’ medicine cabinet, check expiration dates, note the full range of what is there, and cross-check for interactions. At the same time you can weed out the ones that cause dizziness or balance issues (a problem with several frequently prescribed sleep aides, for instance), then proactively ask the doctor for an alternative. The bottom line:
You need as much in your favor as humanly possible.This post is part two in a series.
Be sure to read Preventing a Fall (Part 1)
with 6 simple ways to make your parent's environment safer, and Preventing a Fall (Part 3)
with a link to a brochure with additional tips.
It can happen in the blink of an eye.
And everything changes.
Old bones shatter more dramatically—and heal more slowly. And the enforced idleness isn’t just inconvenient. (Though it is. For everyone. Believe me on this.) It can set off an avalanche of related health problems, from muscle atrophy to cardiac issues. So you really, really, really don’t want your aging parents to take a tumble.
The good news is that a few simple steps can help forestall that fall in the first place.
Pump up the lighting
. My family may call me hypocritical for writing this, because in an effort not to waste electricity we generally stumble around in the dark, but in truth, good lighting is invaluable in preventing a fall. Fundamentally, you have to be able to see where you are going—and aging eyes do that less well with every passing day. So use higher wattage bulbs, brighten up dim corners and be sure to install motion-sensor night lights. As a corollary to the whole vision thing: make sure your loved one’s eye-glass prescription is up to date. Clean up the junk
. Piles of old papers. Clothes on the floor. Stacks of books. Every one of them is a fall waiting to happen. This is particularly true on the stairs; stray objects blend into the carpet and are rendered invisible, especially to those heading downstairs. Rearrange the cabinets
. Put the things your parents use every day within easy reach, thus eliminating the temptation to climb on a step-stool (or worse kneel on the counter. Come on; you know you do it.) Go skid-free
. Move throw rugs out of the path of travel or fasten down their corners with double stick tape. Replace standard bathmats with non-skid mats and add the non-skid strips to the tub. I know they are ugly, but not as ugly as a shattered leg. Grab on
. Every stairway needs a sturdy handrail, preferably on both sides. And while you’re at it, replace the bathroom towel racks with grab bars—there are good-looking ones now. Otherwise, when your parent slips on some water, they will end up yanking the towel bar out of the wall on their way down, and you’ll have to call a plasterer as well as 911. Raise those hems
. Long dresses. High heels. Long dresses with high heels. Even the most nimble of us get caught. So banish the stilettos and get the hemlines off the ground; tea-length gowns are lovely even on the most special occasions. And remember, fashionistas aren’t the only ones at risk: backless slippers and loose pants are both equally threatening.
Here’s the bottom line: Look around your parents’ house. Anything that has ever caused you (or worse, them) to slightly stumble is an accident waiting to happen. Fix it now.This post is the first in a series on Fall Prevention. Be sure to also read
: Preventing a Fall (Part 2) which offers tips to help balance and Preventing a Fall (Part 3) with a link to a brochure for more tips. Also visit our Facebook Page and download our Fall Prevention checklist, found under "Reports."
Family caregivers are motivated by many things, including guilt, filial duty, and societal expectations. But most are motivated by love and a desperate desire to make things better for a person whom they hold dear.
In the process they often forget themselves.
This is the easiest mistake to make—and it can be fatal. Literally. So whether you have slowly slipped into the caregiving role or had it thrust on you unexpectedly, here are five things that can help you stay on a more even keel.
- Find help BEFORE you're completely overwhelmed. Start enlisting other family members and friends, explore community services (some volunteer organizations offer free help), think about scheduling a home aide or visiting nurse.
- Seek out other caregivers. There’s nothing like wisdom born of experience—and there’s no reason to recreate the wheel. Support groups—whether in-person or online—are a great source for practical advice, understanding ears, and the support you may need for tough decisions. Ask your doctor for a reference or look online for caregiver groups.
- Get organized. All the medications and prohibitions and medical appointments can begin to run together, until you hardly remember your name, much less what you are meant to do with this blue contraption or whether a reading of 380 is good or bad. Use a tool (such as CaringWise) to keep it all straight.
- Sort out all the legal and financial issues now, so you are ready when problems arise. Hard as it is to find the time, it will be much easier now than later.
- Remember your own life. The one you had before all this started. It’s really easy to lose yourself in caregiving…and it’s really difficult to find that person again. So make sure to take time for yourself and the things that are really core to your being.
You’ve taken the plunge. You’ve had “The Talk.” You’ve identified the documents your parents need to put in place. Now you need some legal help to make it happen. If you don’t already have an attorney well versed in these issues, how do you find one? It’s not a simple as opening up the yellow pages. You’ll need to ask a lot of questions. Ask for Recommendations
Ask your friends. Ask your co-workers. Ask other lawyers. Even ask your parent’s doctors—especially if they see a gerontologist. Be sure to ask not only why they like the person, but what they don’t like about them. Ask for Facts
When you first call an attorney’s office, you will usually speak only to a secretary, receptionist, or office manager during the initial call. But no matter who you talk to, they should be able to answer some basic questions, that may determine whether you want to move on to an appointment.
Ask for Advice
- How long has the attorney been in practice?
- Are they licensed in eldercare or Trust & Estate Law?
- How long have they practiced in this field specifically?
- What percentage of their practice is devoted to this area of the law?
- Is there a fee for the first consultation and, if so, how much is it?
- What should you bring with you to the initial consultation?
You (and your parents) will be able to tell a lot just by how comfortable the attorney makes you feel. Do they listen to your concerns? Do they ask questions? Do they answer your questions? Or are they already thinking about their next client? In my view, it doesn’t matter how technically proficient someone is if you feel like a number, not a person. And let’s not forget money. Any reputable attorney should be able to give you a close estimate of how much the process will cost. You need to be comfortable with that number; there is literally no point in having a lawyer you don’t call because it is too expensive.
An ABC News poll I read recently reported that an astonishing 50% of Americans don’t have a will. One can safely assume they don’t have a healthcare proxy, much less long-term health insurance, either. This is something you will want your parents to focus on before it is too late.
Face it, emergencies are hard enough when you are completely prepared for them. Anyone at any age can have an accident (which is why you need all these documents yourself, too). And if you think these are tough discussions when your parents are healthy, believe me, it is far worse to wait until something catastrophic has happened. Moreover, the older your parents are when you bring this up, the more it sounds like you think they already have one foot in the grave. The bottom line: Don’t put off talking about this
Here are the six documents you want to be sure your parents have in place (ad that you know where to locate).
- Healthcare Proxy. Accidents do happen. If your parents are unable to make (or communicate) their healthcare decisions, who would they like to be deciding for them? (Probably not the ER doctor whom they have never met). This document must be put into place before it is needed.
- Durable Power of Attorney. The non-medical corollary to a healthcare proxy, this document empowers an “agent” (you?) to make financial and other decisions on your parents’ behalf. While this document also must be put in place before it is needed, it can be structured to only take effect if your parent actually becomes incapacitated.
- Advanced Directives/Living Will. If an accident leaves your parents incapacitated, do they want life support? Having these wishes down in writing can forestall the need for family members to make gut-wrenching choices. Important reminder: A living will does no good locked in a drawer. Make sure that each sibling (or other potential family caregiver) has a copy, and that at a time of crisis everyone at the hospital gets one, too.
- A financial plan. What happens if your parents need expensive and potentially long-term medical care? Are their assets sufficient? (Really? For both of them? For how many years?) Do they have long-term care insurance? If so, what does it cover? Thinking through these issues when there is time and freedom to make proactive decisions can make a tremendous difference down the road. Good advice is critical. Find a financial planner who is objective and understands the specific issues that you are confronting.
- Funeral plans. Burial or cremation? The town where they live or where they grew up? Church service or graveside? Which readings? Which music? Which clothes will they be buried in? Death brings a cascade of decisions at a time we are least equipped to make them—which can cause unnecessary strife among the survivors. Better if they decide when it is still a theoretical discussion.
- The Will. What happens to the house? Who gets Grammy Hope’s silver service? Why don't I get more cash when I did all the hands-on care for the last three years? Even in highly functioning families, siblings rarely get through the division of property without someone’s feelings being hurt. The kindest thing parents can do is leave crystal clear directives. It is often useful to consider asking someone outside the immediate family to take the role of executor, which can forestall further conflict.
If all this seems overwhelming, it doesn't need to be. Find a good eldercare or Trust & Estate attorney
to help you. They’ll have the forms you need, know the pitfalls to avoid, understand the questions to ask. Starting with: When are you going to talk to your parents?This post is part two in a series. Also read: “The Talk.” Helping parents prepare for their latter years.
For those of us in the so-called “Sandwich Generation” there are two dreaded conversations: Lecturing our teenagers on the necessity of safe sex. And talking to our parents about preparations for their latter years.
In both situations, the other party is no more eager than we are to have “the talk.” So as with most things that really have no pressing deadline, we let it slide. Here’s the bad news: It isn’t going to get easier. And here’s the really bad news: If you wait too long, both conversations will be entirely moot.
As far as the teens go, you’re on your own. But here are a few pointers to ease into the talk with your parents.
- Don't assume the worst: Even if you are 100% certain your parents haven’t given their future a second’s thought, give them the benefit of the doubt. Everything about this conversation is likely to make them feel defensive—especially if you couch it as trying to take care of them. They are the parents; they are supposed to take care of you. You are upsetting the natural order here, and it’s insulting.
- Make an example of someone else: Do your parents have friends or your friends have parents who didn’t adequately prepare? Now is the time to leverage their misfortune. “Wow, Mom, did you hear about Mrs. Smith losing her house? So sad—and so unnecessary. I would hate to see that happen to you. What plans have you made?”
- Don’t make it age-related: Do you have a will? A health care proxy? Advanced directives? Long-term care insurance or a reasonable plan to pay for help should disability come your way? (Me neither, but we both should.) If you haven’t gotten around to these things yourself, you have the perfect excuse to bring it up. “Tom and I want to make sure the kids will be all right if we get hit by a bus, so I’ve been checking into which legal documents we need. Evidently, everyone should have X, Y and Z. What arrangements have you and Mom made?”
- Have reinforcements: If you have the good sense not to be an only child, it can help if your siblings are united on this front. Not that 8 of you gather around like an intervention (that comes later, when you are trying to pry the car keys out of your reluctant parent’s hand), but so you know you can count on their support when your father says indignantly, “Marjie was here last week talking to me abut Advanced Directives, like I have one foot in the grave!”
This is part one of a series. Also see: Putting the House in Order: Six things your parents should think through before they need to