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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Brain Injuries from Falls Pose a Growing Threat for Older Adults: 7 Tips to Reduce Fall Risk

The older we get, the greater the risk of falling. Lost flexibility, diminished sense of balance, medications that cause dizziness or weakness, lack of attention, nerve damage to feet, chronic disease that takes a toll—any or all may contribute to a dangerous misstep.

A broken wrist, ankle or hip can be a major set-back for anyone; all the more so for a fragile older adult. But public health officials have identified another, growing risk for elders who fall: brain injury. According to a March report by the Centers for Disease Control, 2.8 million people suffered traumatic brain injuries (TBIs) in 2013 that resulted in emergency department visits, hospitalizations and deaths, with older adults accounting for the highest rate of TBIs—roughly one out of every fifty Americans aged 75 and older.

In addition, the CDC study found that the rate of hospitalizations for TBIs among these older adults jumped 27 percent between 2007 and 2013, “primarily because of falls.” Men across all age groups had a higher incidence of severe TBIs than women.

While the reasons for the increased rate of falls among older adults is unclear, the risks of brain injury for elders are significant. As we age, we shrink—including our brains. That process leaves more space between the brain and inside skull wall—a harder internal knock in case of a fall. Blood vessels connecting the brain and skull also get thinner and more easily damaged with age, increasing the possibility of a brain bruise, or subdural hematoma, which is effectively a slow leak. For those on blood thinners or anti-inflammatory medications, this kind of injury can morph into a severe health crisis. Moderate to severe TBIs also increase the risk of dementia significantly, anywhere from 2- to 4-fold.

While it’s impossible to prevent all falls, there are steps you can take to safeguard your loved one from unnecessary fall risk, as well as strengthen her odds (and yours!) of maintaining balance:

  1. Make surfaces safe. One of the easiest ways to minimize falls is to stabilize throw rugs with slip-proof backings or remove them altogether. If the rugs have sentimental value, consider creative repurposing, such as turning them into wall hangings. Use bathtub liners with suction cups. Mark outdoor steps with reflective tape. Add grab bars to toilets and showers, if needed. Be sure that stairs have sturdy railings.
  2. Wear well-fitting shoes and slippers. Loose slippers or house shoes may be more comfortable for elders struggling with bunions, neuropathy, arthritis or other forms of foot pain, but floppy foot-ware can also cause falls. An increasing number of shoe brands are now available with removable insoles for custom orthotics. A good podiatrist can provide essential foot care and recommendations for appropriate support.
  3. Understand medication side effects. Blood pressure meds can cause weakness or dizziness if your loved one stands suddenly. Pain meds can, too; they can also cause blurred vision or confusion. Sleep aids can be particularly risky for elders, and psychotropic medications require careful monitoring. Not all side effects are obvious; be sure that you and your loved one are fully aware of associated fall risks for all his medications—and arrange for extra help, as needed. Be especially careful to monitor side effects when your loved one starts any new meds.
  4. Illuminate hallways, stairs and walkways. A simple nightlight can help prevent a fall on the way to the bathroom. Motion sensors for both nightlights and outdoor lighting around stairs and walkways can provide needed illumination without driving up electric bills.
  5. Have regular eye check-ups. Blurred vision accounts for falls, as well. Be sure that your loved one has appropriate, up-to-date eyeglasses and annual ophthalmologist appointments to evaluate her for glaucoma and cataracts.
  6. Use a medical alert device. A variety of devices worn as pendants or bracelets contact emergency support if the wearer falls. Smartphones are not really a substitute; your loved one might not be carrying his phone at all times, or he could drop it if he falls. Worse, if he loses consciousness from a fall, a smartphone is useless. Make sure your loved one actually wears the device!
  7. Exercise for strength, flexibility and balance. This is probably the most important factor: fight the urge to become sedentary with age. The more we move, the greater our ability to retain strength, flexibility and good reflexes in case of lost balance. Strength workouts help to maintain bone mass. Exercises such as Pilates, yoga and t’ai chi improve core strength and balance. Walking outdoors on an even surface revives energy and mental clarity. Even a few minutes a day standing on one foot can make a difference. Consider arranging a session or two with a physical therapist or personal trainer to put together a realistic exercise program for your loved one.

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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The Loneliness Factor

No one is a stranger to loneliness. The “pain of being alone,” as philosopher Paul Tillich described it, is part of being human. But prolonged loneliness, the inability to find or maintain social connections, is a struggle for a significant proportion of older adults—and a predictor of poor physical, mental and emotional health, even death.

In a 2010 study of adults 45 and older, AARP research found that 35 percent of the 3,012 survey respondents were lonely. Even as we live in a time of unprecedented interconnectivity, the study noted that the Internet can actually increase a sense of isolation: “For example, 13% of lonely respondents felt they have fewer deep connections now that they keep in touch with people using the Internet, compared to 6% of non-lonely respondents.”

Social Isolation Is a Health Risk

The health impact of social isolation is huge. Researchers have found that those with limited social connections run a higher risk of disrupted sleep, heart disease and stroke, compromised immune systems, inflammation and increased stress hormone levels. In fact, a 2014 scientific literature review of the neurology of loneliness by Cacioppo, Capitanio and Cacioppo noted that “social isolation was as strong a risk factor for morbidity and mortality as smoking, obesity, sedentary lifestyle, and high blood pressure.”

While living alone may be an active choice for those who enjoy solitude, many older adults find themselves isolated when they outlive spouses and friends. Mom may not want to move from her home, even as she can no longer maintain it and her neighbors have moved on. Dad may find it too difficult to get out anymore, now that he can no longer drive. Adult children who work full time and are busy raising a family can be caught in the middle, worried about their parents’ well-being but unable to visit more often.

Balance Right to Privacy with Need for Social Connection

Given the risks, how can you balance a respect for your loved one’s right to privacy and the need to be sure she’s safe and well living alone?

  1. Increase contact. This may seem obvious, but upping the frequency of visits, calls or Internet chats as your loved one ages—especially following a major life event, such as the death of a spouse or loss of independence due to inability to drive—can help to alleviate some loneliness. When you stay in touch with your loved one more often, you’ll also be more alert to changes in his mood, energy or attention that can signal a health issues.
  2. Encourage relationships with people of all ages. Introduce your loved one to a younger neighbor down the street. Look for community service programs that connect elders with teens. Contact local elder affairs programs that provide friendly visitors. Brainstorm with your loved one about the kinds of people she would welcome, so that she doesn’t risk becoming invisible to those around her.
  3. Facilitate ties to your loved one’s religious community. If your loved one was once active in his church, synagogue or mosque, but has drifted away due to difficulty getting there, contact his clergy about the situation and request outreach. Most religious communities, when made aware of an isolated elder, will strive to stay in touch through visits and even provide transportation to services and other community events.
  4. Consider adult day centers. Just the opportunity to get out of the house a few days a week, even for a few hours, can help to dispel loneliness. Your loved one’s local elder services program may offer programs and transportation for a fee.
  5. Get a consult from an Aging Life Care Professional™. If your loved one is lonely and struggling, but unwilling to accept visitors or attend social events, even with you, it may well be time to get a professional assessment that can guide you about caregiving options. An Aging Life Care Professional can also serve as a mediator or buffer for difficult conversations with your loved one about the future, including a move to independent or assisted living, where socializing is built into the life of the community.

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: CC0 Public Domain

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Is Long Term Care Insurance Worth the Investment?

Getting older is an expensive proposition. With each decade, the risk of living with a chronic disease, some form of dementia, or other disabling condition, increases. Chances are that most of us will need some kind of assistance with daily care in the future, and many will need to pay privately for that help because their assets exceed the threshold for subsidized care.

Those expenses can add up quickly. According to the Massachusetts Executive Office of Health and Human Services, the average private pay cost of a nursing home in the Commonwealth was $354 per day in July 2016. Forbes pegs the hourly rate of an agency home health aide at $20 per hour; in Central Massachusetts, the average hourly rate is closer to $24.

For women, the cumulative costs are typical higher, simply because women tend to live longer than men in a supported care setting. According to the Forbes article, men will need 18 months of paid care, on average; women, three years.

Understand the Tradeoffs

For those without family members or friends who can be their at-home caregivers, Long Term Care (LTC) insurance presents one way to help cover future expenses. But LTC policies can be a pricey investment. Premiums increase as you age; chronic pre-existing medical conditions can rule out coverage options. Basic policies may not even cover the full daily cost of a nursing home.

So, how do you know whether to buy a LTC policy, when to buy it, and what to look for? The answer depends in part on how much risk you want to take, what you expect will be your future assets, and what you can anticipate about your own health based on family history.

Don’t count on Medicare: those benefits cover only acute hospital stays and limited rehabilitation care. In Massachusetts, MassHealth pays for nursing home expenses, but only after other funds are exhausted. The extent to which the federal and state governments continue to subsidize health care expenses through Medicare and Medicaid is the focus of heated debate nationwide, with no clear answer in sight.

Know Before You Buy

If you suspect that the odds of chronic, debilitating illness are against you, and if there is a high likelihood you’ll need help with basic activities of daily living (dressing, bathing, eating), then a LTC policy might be the right investment. Here are some basic tips:

  1. Buy before you get sick. While there’s no way to know the future, you will have a better chance of getting an affordable LTC policy if you buy while you’re still in good health. Balance this against the number of years you will need to pay premiums before you might need the benefits. On average, it pays to investigate this form of insurance and buy a policy during your 50’s or early 60’s.
  2. Look for a policy with the shortest elimination period. Typically, LTC policies have some kind of a waiting period before benefits can be claimed. A 90-day elimination period is common. Be sure to understand the time frame for which you will still have to pay full price for care until the policy kicks in. Some policies offer a “no elimination” period for home care benefits, which can be very helpful for families
  3. Buy inflation protection. The cost of long-term care will continue to rise. Since you’ll probably be purchasing a policy several decades in advance, you want to be certain that you’re covered for future, not current costs.
  4. Look for portable, flexible coverage. Your benefits should follow you wherever you live, both at home and in a long-term care setting, as well as geographically. Ideally, you want a policy that also gives you flexibility to hire the care that you prefer, and not be bound to a home healthcare agency.
  5. Name a third party contact. For your own protection, identify a family member or trusted friend who can be notified in case of failure to pay a premium or policy cancellation. If memory becomes an issue, you want to be sure of back-up to maintain coverage.
  6. Work with a reputable agent. LTC insurance policies are complicated. You need someone you can trust to help you sort out all the options, including the relative advantages and disadvantages of group versus individual policies. You also want someone who will find you a policy with a company that has an excellent track record with customer service.
  7. Include LTC insurance as part of your estate plan. Be sure to consult with your financial adviser to develop an affordable plan this is right for you. You want to be certain that you can still afford LTC policy premiums even after you stop working. Some policies enable you to change coverage and benefits as your circumstances change.

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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Replenishing the Well: How to Set Personal Boundaries as an Aging Life Care Professional™

In the helping professions, it’s far too easy to stretch yourself thin. We all got into this work because we wanted to support those in need and to make the world a better place. There is abundant opportunity to make a difference—because there is no shortage of suffering, sadness, pain and loss. But no one can do this work for long before learning, sometimes the hard way (read “burnout”), that we all have physical and emotional limits that must be respected, or we can’t do our best for those we seek to serve.

Setting professional and personal boundaries as an Aging Life Care™ Manager does not mean shirking responsibilities or being insensitive to clients’ needs. It does mean recognizing the importance of self-care as the foundation of being fully present for others. This holds true for all caregivers, whether a family member, friend or career professional.

Setting Realistic Boundaries Is Essential to Well-Being

Given that the overwhelming majority of professionals in this field (and caregivers, in general) are women—and that women are socialized in our culture to put the needs of others before our own—learning to set realistic boundaries can be difficult. It may even feel physically uncomfortable to say no when the default is to say yes to a plea for help.

But boundaries are essential to maintaining personal wellbeing and integrity. Especially when we find ourselves overwhelmed by a rash of client crises, severe illnesses or deaths, we need to be vigilant in finding ways to replenish emotional resources. The alternative is physical and mental exhaustion that can lead to poor judgment, sickness, accidents or worse.

Here are five ways to set realistic professional boundaries and foster your personal wellbeing:

  1. Manage client expectations about your availability. Be clear about your professional hours and availability in your contract and conversations. Consider whether you can realistically offer 24/7 response, especially if you are a one-person practice. Sleep matters. So does your emotional well-being.
  2. Give yourself permission to not answer the phone during off hours. There are many ways to screen calls, from voice mail to professional answering services. Pick the method that suits your personal style and budget, and hold to it. The vast majority of those calls can wait until morning. The ones that can’t, you’ll undoubtedly be able to anticipate.
  3. Think carefully about how big a caseload you really need to maintain. As the Baby Boom generation ages, there is plenty of work to go around. The real question we all need to ask ourselves is how much we can actually take on. Financial goals provide part of the answer. Professional career goals need to be accounted for, as well. Ultimately, however, it comes down to how to balance the ability to provide quality service with maintaining physical and mental health, as well as fostering quality relationships with our own loved ones.
  4. Carve out time for activities that replenish you—and stick to it. Exercise, walks in the woods, films with a friend, date night with your significant other, a good novel, even that trashy TV show you love watching—whatever healthful activity works for you, discover it, claim it and do it. Regularly. The time you spend feeding your soul will not only give you a much needed break; it will recharge your batteries and enable you to be all the more effective in your personal and professional relationships.
  5. Seek joy and laughter. Even in the midst of struggle and hardship, there is much to celebrate in life. Our clients teach us these lessons every day. Stay open to the possibilities.

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: Dingzeyu Li

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