It’s Midnight: Is Your Parent Safe at Home Alone?

One of the major thresholds of parenting is knowing when you can leave your kids at home on their own. Are they responsible enough to make appropriate choices while you’re out? Could they leave the house safely in case of an emergency? Would they be able to handle the unexpected, like a fall or scraped knee?

As our loved ones age, similar concerns can arise about their ability to continue living alone. It’s a complex dilemma for adult children, because we want to see our parent as we (ideally) always have: competent, strong, the person we turn to for advice and support.

But there may come a time when the risks of an aging parent living alone outweigh the benefits of independence, particularly for someone with cognitive or physical issues. So, how do you know when it’s no longer safe for your loved one to be on her own?

Here are a few key questions that can help to guide your (joint, if possible) decision:

Does your loved one know what to do in case of emergency?

While, of course, you don’t want to wait until an emergency happens to answer this question, you can learn a lot by asking how your parent would handle various scenarios, such as a fire, a power outage, a fall, or simply not feeling well.

  • Does he know when it’s appropriate to call 911? Can he show you how he would use the phone to do this (without actually placing the call)? Older adults may fall back on “calling the operator”— and become confused speaking to an automated call service.
  • Does she know how to use her emergency pendant? Does she actually wear it all the time? Over and over, we hear of loved ones who leave their pendants on a dresser or don’t understand what it’s for.
  • Is he able to call you or another emergency contact? Can he make an appropriate judgment as to when that’s necessary? Not wanting to “be a bother” can be overdone to the point of avoiding asking you for help when it’s essential; at the opposite extreme, an anxious parent may call so often that it’s difficult to discern when an emergency is real.
  • Is she physically capable of getting out of her home if there is a fire or other emergency, such as a carbon monoxide monitor alert? This requires good judgment as well as mobility and speed.

Does your loved one engage in unsafe behaviors?

This can run the gamut from leaving an unwatched pot on the stove or forgetting to turn off water in the bathroom, to insisting on maintaining old routines that are beyond their capabilities, such as shoveling heavy snow or driving when no longer able to react quickly.

This issue can have another, complicated dimension: if one parent still cares for the other, but has compromised judgment around safety issues. For example, leaving a sleeping spouse alone in order to run errands or socialize—believing “nothing can happen” while the partner is safe in bed—can be risky if the one supposedly asleep falls while going the bathroom or becomes confused by the spouse’s absence.

Does your loved one have friends nearby who check in regularly?

Being social increases the chances that your loved one has friends and neighbors who care about her well-being and who will take the initiative to check in. These are people with whom you can share your contact information, people you can count on to be your eyes and ears on the ground if you do not live nearby. Conversely, if your loved one has always been more private or isolated socially, his ability to care for himself alone requires greater attention.

Does your loved one’s living situation enable you to sleep at night?

Ultimately, the decision about whether to leave an aging parent living alone is a matter of confidence in your loved one’s judgment and your own — and what risks you both are willing to take. If your concerns are keeping you up at night, that may well be the best indicator that it’s time to consider bringing in help or looking for a safer living situation with appropriate support.

It’s possible, of course, that your loved one may choose to remain in an unsafe living situation. If legally competent, he or she has the right to do so. Should this be the case, you may want to explore options so that you’re prepared in the event of (the almost inevitable) crisis.

Working through these issues often prompts difficult but necessary conversations. An Aging Life Care Professional™ can help you and your loved one to find the best solution together.

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care™ manager. Drawing on more than 30 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsALCM.

Image Credit:  Brooke Campbell

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Juggling Care Coordination For Yourself or a Loved One? How to Save Time and Trouble

When you have a complicated medical condition, keeping track of all the doctors’ appointments, tests, medications, prescription renewals, insurance questions and myriad other details can feel like a full-time job. Managing your own care on top of doing your best to battle fatigue, pain and a raft of other symptoms can be downright exhausting. Managing a loved one’s care can be exhausting, too.

Not everyone can afford an Aging Life Care™ Manager to take the load off. Here are some key strategies, based on our years of experience, that can help you to keep better track of all the moving parts.

One of the most time-consuming aspects of managing a complex disease is dealing with a variety of medical specialists. They may be part of the same healthcare system or different systems; if the latter is true, more time is involved with sharing medical records and insuring that the specialists communicate with each other. A few tips:

  • Create an easy note-taking system that enables you to keep track of what was said in each appointment, relevant test results, and any other observations you want to share with the physician. You may want to keep a notebook or maintain your record electronically on a smart phone or tablet. Explore apps such as CareSync or CareZone that streamline personal health record-keeping. This will help you to manage important details between and across specialists’ appointments.
  • Make sure that all healthcare consents are in place so that the specialists can consult with each other. Without permission, especially across systems, they will not be able to share confidential medical information.
  • Have someone accompany the patient who also knows his or her medical story and is good with details. This might be you, another family member, or a friend. If you are the patient, and you’re having difficulty keeping track of all the details, then bring someone along who can fill in the blanks.
  • Bring a written summary of the patient’s relevant medical history along to appointments with specialists, especially if they are new to the case. This will save everyone time, and allow you to think ahead about key details that must be mentioned. When creating the narrative, keep these points in mind:
    • You only need a concise summary of the medical history; don’t write a full biography. The past six months to a year of details will be enough. Confine the rest of the past history to one paragraph.
    • Include a list of medications that have worked and those that have not.
    • List the other doctors that the patient has seen.
    • List previous relevant treatments and outcomes.
    • Bring a list of questions that you want answered. Be sure you get the answers before you leave!
  • If possible, when there are many specialists involved and important decisions to be made, request a group meeting. This may be easier to accomplish when all the specialists are in the same healthcare system. In any case, it does not hurt to ask. You must be your own best healthcare advocate.

If you are feeling overwhelmed by all of this, and hiring an Aging Life Care Manager exceeds your budget, consider one other option: a consultation with an Aging Life Care Manager can help you, your loved one and family to sharpen your care coordination skills and identify community support services that may be affordable or even free.

And be sure to do your own cost-benefit analysis; especially if you are taking time off from work in order to provide care management for a loved one, and losing income as a result, you may just find that hiring a professional will save you money, time and much stress in the long run.

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care™ manager. Drawing on more than 30 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsALCM.

Image Credit: Chilanga Cement Flickr via Compfight cc

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Assisted Living Tips Plus Two Events You Won’t Want to Miss

We’re entering a busy fall season here at Deborah Fins Associates. Debbie was quoted in two articles in Consumer Reports that focus on how to make wise decisions for your loved one when considering assisted living:

Putting the Assisted Living Facility Contract under a Microscope
Elder Care and Assisted Living: Who Will Care for You?

And be sure to put these two informative events on your calendar for October and November:

To register for the MOLST workshop, download the PDF here.

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care™ manager. Drawing on more than 30 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsALCM.

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Riding the Health Care Rollercoaster: How to Keep Your Balance and Plan Ahead

As of last Friday, the GOP push to repeal and replace Obamacare (officially, the Affordable Care Act) died in the Senate when three Republicans — Susan Collins of Maine, Lisa Murkowski of Alaska and John McCain of Arizona — joined with Senate Democrats to block a stripped-down version of legislation from going to conference committee with members of the House of Representatives.

At least, it seemed as if Senate Majority Leader Mitch McConnell’s efforts to push through repeal and replace legislation were finally over, with McCain’s dramatic thumb’s down vote in the wee hours of Friday morning. But reporters have taken to calling this the Zombie Bill, because it keeps rising in a new form when everyone has written its obituary.

Sure enough, on Saturday, President Trump took to Twitter to threaten Republicans with loss of government subsidies to Congressional health insurance coverage if they didn’t keep trying: “If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!” he tweeted.

Medicaid Cuts Off the Table — For Now

While it’s not clear what impact that threat will have on Republican leadership, it is clear that the health care insurance exchanges are in for more rocky pricing and the risk of insurers dropping out of the marketplace. Uncertainty breeds higher costs. The President has threatened to allow Obamacare to die on the vine, starved of federal subsidies that make insurance premiums affordable for lower income citizens.

For now, however, it appears that significant cuts to Medicaid over the next decade, a central point of contention in the bill, have been taken off the chopping block. That is a major victory for disability advocates, who protested fiercely on behalf of the millions who depend on Medicaid for home- and community-based care to remain independent. Medicaid also covers nursing home care, rural health clinics, services for pregnant women, inpatient and outpatient hospital care, and more for individuals who meet financial and clinical needs criteria in each state.

Massachusetts Struggles with Rising MassHealth Costs

Here in Massachusetts, about 1.9 million people are covered by Medicaid, known as MassHealth. Enrollment has increased in recent years due to expanded eligibility under Obamacare. In fiscal year 2015, 30 percent of the Commonwealth’s $15.6 billion in Medicaid spending went to long-term care.

Rising costs for MassHealth have become a stumbling block in finalizing the fiscal year 2018 budget. Governor Charlie Baker is wrestling with state legislators over how to pay for rising MassHealth costs and whether to institute tougher eligibility rules.

How to Plan Ahead in the Midst of Uncertainty

So, what’s next? How can you plan ahead for long-term care for a loved one or even yourself in such a volatile political climate?

Our best advice is to team up with a good elder law attorney. These are legal experts who have extensive experience with issues affecting us as we age and for those with disabilities. Answering questions about eligibility, unraveling issues with getting benefits, negotiating Byzantine rules and regulations — all this and more are their specialties. An excellent resource is the National Association of Elder Law Attorneys. Membership indicates a commitment to the field. The initials CELA refer to Certified Elder Law Attorney.

It’s also worth speaking with a financial adviser to help you create a realistic, comprehensive plan for the future. The Certified Financial Planner Board of Standards, Inc., website is a good resource for finding a trustworthy fiduciary adviser.

As with any decision about hiring a professional consultant, get referrals and research pricing to be sure you can stay within your budget. At the same time, remember that an investment in a good elder law attorney and financial adviser may save you a considerable sum down the road — not to mention, provide you with much-needed peace of mind.

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care™ manager. Drawing on more than 30 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsALCM.

Image Credit: Charlotte Coneybeer

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On Creating Dementia-Friendly Communities

By now, we are all far too familiar with that ubiquitous announcement in airports and train stations: “If you see something, say something.” Of course, we’re all supposed to be on the lookout for suspicious, dangerous behaviors among our fellow travelers.

But that phrase takes on a totally different significance when we are asked to be on the lookout for people at risk who need help. Specifically, how can we be of most help to our neighbors and other community members who are dealing with Alzheimer’s and other forms of dementia?

That’s the mission of the Dementia Friendly America® Initiative. A coalition that brings together nonprofits, medical professionals, community leaders and people living with dementia, the initiative promotes a four-step process at the local level to assess needs of people with dementia and how the community can respond to make basic services and resources more accessible.

Building a Dementia-Friendly Community

Currently, more than three dozen states are working to promote dementia-friendly communities, including Massachusetts. In Boston, Jewish Family & Children’s Services and the Department of Elder Affairs are leading an effort to promote this model statewide.

So, what does this effort involve?

The basic idea is to examine all the different sectors of a community to determine the best way that each could be more welcoming and supportive of people with dementia. For example, how can public signage be designed to make it easier for those with Alzheimer’s to find directions or public services, such as hospitals or the library? Or how can emergency responders be better trained to help people with cognitive impairments? How can bank tellers, librarians or store clerks learn to recognize the specific challenges faced by people with dementia and make their services more accessible? Sensitivity, planning and education can go a long way toward making a community more inclusive.

Making Restaurants More Inclusive

Purple Table is another creative approach to fostering dementia-friendly communities. Participating restaurants provide reserved tables in quiet corners that are well lit and close to restrooms for customers with Alzheimer’s and other forms of dementia, as well as those with autism, PTSD, hearing or vision impairments, or other conditions that require special accommodations. Staff are trained to provide extra attention and to show patience and kindness to these guests. In Central Massachusetts, to date, The Red Raven in Acton offers Purple Table reservations.

Religious communities can also play a very important leadership role in the effort to make communities dementia-friendly. Religious leaders are often aware of members in their community who are dealing with dementia. Home outreach, help with transportation, ensuring that religious spaces follow principles of universal design — all of this and more are ways to be sure that community members with cognitive impairments do not become isolated.

What Each of Us Can Do

And what about “see something, say something”? If each of us pays a little more attention to friends and neighbors who seem to be having a more difficult time managing day-to-day, offering a helping hand, contacting their family if needed (to the extent that this kind of communication is welcome), chances are we can make our own little corners of the world more inclusive and welcoming, too.

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care™ manager. Drawing on more than 30 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsALCM.

Image Credit: Nina Strehl

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