Thanks to Patricia Grace of Aging with Grace for an excellent interview on her BlogTalkRadio show last Monday.  I had the opportunity of sharing the core part of my new book, my new ADAPT method for adult daughters and sons.

I encourage you to listen to the archived recording of our wonderful 30 minute interview.  Click here.

Below are the 5 parts of my new ADAPT method, 5 steps to guide your aging parent through crisis and change.  (If you wish to get a more in-depth understanding of the ADAPT method, as well as a wealth of references and resources, be sure to check out my new book, “Transitioning Your Aging Parent: A 5 Step Guide Through Crisis & Change.”)

• “A” -> Assess. First, you need to understand your parent’s needs and values.  I provide tips on how to listen, observe, and have the right open-ended conversations about the critical issues facing older adults.  As a part of “Assess”, you also must consider your needs and situation.  Adult daughters and sons all too often overlook this self-assessment piece.  I have often heard, “caregiving is a marathon, not a sprint.”  Understanding the situation, your parent and your capacity will pave the way to a successful outcome.

• “D” -> Discuss.

• “A” -> As a family. Discuss as a family.  Reach out to your family, siblings and everyone integral to your parent’s care and well-being.  Realize that sibling rivalries and old childhood issues may rear their ugly heads. I advise family members on how to get past these obstacles.   By all means, make the discussion and decision-making open, transparent and grounded in consensus.  One important caveat is to let your parent’s voice be heard and considered.

• “P” -> Plan. Put the agreed-upon plan down on paper, listing the tasks, timetable and who’s responsible.  Share this plan with everyone who has given input, has a task, or needs to be kept in the communication loop.  Do not jump to a solution before the “discuss” and “plan” is done.

• “T” -> Transition. Execute the change.  I provide a number of tips to help ease the transition.  No matter how well you plan, chances are emotions will flare.  Recognize that stress and anxiety usually accompany a change.  Be patient, be flexible, but stay the course.

Patricia asked,

• “What do I hope readers will take away from this book? I hope they take away my process to use over and over, through every change in their parent’s life.  I hope they take to heart how important it is to: have a deep understanding for their parents and themselves; have everyone (integral to their parent) on the same page, and create and adhere to the plan to guide their mom or dad through the change.  If all of this is done with empathy and love, I believe the entire experience can build a foundation of trust and understanding, and bring the family closer together.

• “What is the best piece of advice I have for daughters and sons?” Start now BEFORE a crisis occurs.  Educate yourself about the aging process, your parent’s healthcare issues, their wishes and desires, and the community resources in your parent’s area.  My book is a great first book to read.  You’ll find a wealth of additional resources referenced there.  And, in the Appendix, you will find 3 new technology solutions for you and your parent.

While there are incredible challenges in aging and helping our parents as they age, there is also great opportunity for growth, creating a legacy, and connecting with each other in a deeper, more meaningful way.

If my ADAPT process is helpful to you and your parent, please comment below or send me a private message in the Contact Form.  Thank you!

The other day a reader asked me, “When is it necessary for a parent to move into assisted living?”  We have all heard about the studies that show most older adults wish to age-in-place. We probably have heard our parents voice that desire quite often. With the many quality home care agencies, and visiting nurse and physician programs, it seems that we should be able to honor their wishes.

But, the day may come when we need to think about a move to Assisted Living.  In this post, I provide key criteria that would indicate consideration of a move to Assisted Living.  As always, I encourage us (adult children and families) to be thinking ahead and to become knowledgable about local options in our community now.  Don’t wait for a crisis to occur when you have to abruptly choose an Assisted Living facility for your parent.

Here are criteria for considering a move to Assisted Living:

• Safety.  First and foremost, safety.  If a home aide or visiting nurse can no longer provide the level of care needed, or if your parent is confused and disabled so that their home environment is unsafe for them, then it’s time.
• Health.  If your parent receives a diagnosis of a degenerative disease, then it’s time to start thinking about a move and the options.  It helps so much to have the discussions and make the plans while your aging parent is in the early stage of such a disease and can be a part of the decision-making.  Yes, it is hard to confront the reality.  But, allowing them to be a part of the choice is so important for their adjustment.
• Your capacity. Do you (and those in your circle of care) have the time and the physical strength to care for your parent?  Do you have the time to coordinate the needed services, while caring for your own family and meeting your work responsibilities?
• Your parent’s social needs. Is your parent isolated or lonely, and unable to interact with others on a daily basis?  My mother tells me that when she moved to her retirement community, she suddenly realized how isolated and lonely she had been in her home (sometimes for weeks at a time during the harsh winter months.)  But, while living in her home, she accepted that as part of an older adult’s life.  As our parents age, they are continually faced with loss of  health and mobility, spouse and friends, and more.  Depression is common in the elderly.  Don’t minimize this need.

I strongly encourage you to consider each of these facets, safety, health, your capacity and your parent’s social needs, as you think about their need for an Assisted Living environment.

Here are some suggested ways to facilitate the selection and move to Assisted Living:

• Review the family resource offered below, from ALFA.  Learn about what to look for in an Assisted Living facility and find those in your area.
• Talk with your parent’s physician, friends and colleagues to get their recommendations.
• Define a list of your criteria, such as geographic location, quality, cost.  Also consider features important to your parent and you.  Are mobility and independence valued?  What activities are offered, besides Bingo?  Music, art therapy? Is there access and support for senior-friendly computers?
• Create a list of possible facilities.
• Contact and visit your top 3 choices.  Don’t just go on an open tour.  Make an appointment for a personal tour and establish a key contact there. Don’t be overwhelmed by the glossy marketing brochures and information you’ll receive.  Accept it and read later.  Ask to see rooms.  Schedule in time for a meal.  Say to hello to residents and staff as you pass them.   Observe interactions.  Make notes.  Follow-up with questions later with your key contact.  My advice to you, your parent and family:  call and visit as many times as you feel necessary.  Not only do you need the information, this will help you and your aging parent build a foundation of trust and comfort with the staff and community.
• If possible, allow your parent to choose his/her room.  And, as soon as possible, personalize their living space, so it feels like just an extension of their former home.
• Do not minimize the time and effort it will take for your parent to adjust to their new living situation.  Be available, listen, support and advocate (when needed) on their behalf.

A wonderful resource for families is ALFA (Assisted Living Federation of America.)  To reach their resources for families, click here.

I could not do complete justice to this topic in this blog post.  But, I hope I provided some key information and food for thought.  Please share your ideas and tips/strategies.

Shon will share how elder mediation can help your aging parent and your family.  Have you ever had challenges in getting your family on the same page when it comes to making decisions for your parent?  It could be a conflict over an issue such as, moving (to assisted living or nursing home), driving, estate planning,  or advanced directives.

• Listen in to learn how elder mediation can help you, your family, and your aging parent.
• What are the steps involved in the mediation process?
• What are the challenges and responsibilities inherent in the process?
• How do you find a qualified mediator?
• And… much more.

Visit Shon at his sites, http://eldercarelifesolutions.com/ http://eldercarelifesolutions.wordpress.com/

Don’t miss out on a chance to listen live and call in with your questions.

Listen online at: http://www.blogtalkradio.com/dalec/2010/06/29/elder-mediation–how-it-can-help-your-family

Call in at:  (347) 857-1461

Elder abuse can happen to any older adult in any situation.  It’s estimated that 1 in 5 cases go unreported.  Financial abuse alone costs our seniors $2.6 billion each year!

I encourage you to listen in to my presentation, “Elder Abuse, How Can I Help”, today on the AgeTek webinar, June 17th at 2pm Eastern.  I’ll be presenting the risk factors, symptoms and action steps each one of us can take to help prevent or stop elder abuse. Feel free to listen online at https://my.dimdim.com/grandcare/

Below is a special post with information that I do not have time to include on the call:

Elder abuse is something I don’t like to think about. It’s a tough subject to write about. But, each of us needs to raise our level of awareness so we can protect our aging parents. Elder abuse can take many forms. When I hear the term, I think about physical abuse and neglect of the elderly by hired employees in a nursing home. But, it encompasses so much more.

The National Center on Elder Abuse (NCEA) lists these other forms: emotional or psychological abuse; verbal abuse and threats; financial abuse and exploitation, sexual abuse, and abandonment. It can happen anywhere: nursing home, private home and other institutions. Surprisingly, it affects the elderly across all socio-economic classes. Dementia is an especially strong risk factor.

This particular article focuses on Elder financial abuse. The elderly can be financially abused by mail fraud, phone fraud, business fraud and stealing by a family member or hired caregiver, or visitor. Today, I heard yet another instance of a trusted caregiver stealing a large sum of money, $20,000, from an elderly man.

Here are some key ways we can prevent financial abuse from happening to our elderly loved ones.

• Stay in frequent contact with elderly relatives, and keep lines of communication open.
• Be observant and perceptive about any physical or behavioral change.
• Choose any caregiver carefully. Never select one through an ad. Use a licensed, bonded agency. Hire an investigator to ensure the potential caregiver is not a convicted felon.
• Keep a photographed inventory of all jewelry in a locked box.
• Use a criss-cross shredder on any paperwork containing identifying information.
• Protect incoming and outgoing mail. Getting a Post Office box is a good preventive measure.
• Obtain a credit search for your parent 2-3 times a year.
• Have Caller Id on the phone. Teach your parents to not answer “unknown” or “out of area”. Tell them that scam artists use the phone as a weapon, and it is OK to hang up on someone.
• Tell them “You will NEVER win a foreign lottery”.
• Have a duplicate copy of their banking account statements sent to a trusted family member.
• Tell them to not assume a handyman is to be trusted, even if he has a wonderful name and is charming. Check the Better Business Bureau and state licensing. Always get 3 estimates. Obtain a written contract. And, never pay more than 10% or $1,000 up-front, whichever is less.
• Have a second line of defense at their front door (a peephole or locked screen door).

Report any suspected mistreatment immediately. Contact the Helpline for your state athttp://www.ncea.aoa.gov/NCEAroot/Main_Site/Find_Help/Help_Hotline.aspx

I’ll share how to use my ADAPT method to manage a caregiving crisis.   I’ve just released the ADAPT method in my new book, “Transitioning Your Aging Parent: A 5 Step Guide Through Crisis & CIhange”.  If you want to learn about the benefits of ADAPT for you, your aging parent and your family, please tune in.   I’ll also be sharing other tips and resources in my book.  And, I’ll be glad to answer your questions.

Before or after our radio interview, be sure to check out the wonderful resources and services offered by Denise Brown.  Denise was a pioneer in bringing support to caregivers via the Internet!    Thank you, Denise, for all you do for caregivers.  You are an guiding force and inspiration.  It is an honor to be on your show.

Denise M. Brown, a certified professional coach, helps family caregivers of aging relatives find the answers to their questions: Why me? Why now? What now? Denise began working with family caregivers in 1990, launching Caregiving.com in 1996. Her insights about the family caregiver experience have been featured in Time magazine, The Wall Street Journal and Chicago Tribune. Her Internet talk show, Your Caregiving Journey, airs several times a week at http://www.blogtalkradio.com/caregiving. She has authored two books for family caregivers: Take Comfort, Reflections of Hope for Caregivers and The Caregiving Years, Six Stages to a Meaningful Journey.

Don’t miss out on a chance to listen live and call in with your questions.

Listen online at:  http://www.blogtalkradio.com/caregiving/2010/06/14/adapting

Call in at: (646) 652-4944

Here is the link for Denise’s excellent website and portal to her caregiver support groups: http://www.caregiving.com/

“Transitioning Your Aging Parent: A 5 Step Guide Through Crisis & Change”

It was written to help adult children and families navigate the many changes their aging parents will face. Dale Carter has developed a new framework, ADAPT, from her personal experience, her background as an educator and project manager, and a sincere desire to help families and their aging parents. Readers will learn how to use the framework, apply specific strategies, and seek out appropriate resources that are right for their situation. Personal stories are woven throughout to illustrate the concepts.

Join Dale Carter as she shares what she learned in helping her own mother navigate crisis and change to renewed health and happiness.

Discover how to approach any change or crisis in your parent’s life with clarity and confidence.

Discover how this new framework will guide you in making the right decisions for your parent while balancing your own personal needs and family responsibilities.

“It’s almost as though you took all my years of training and managed to put order to it. The ADAPT method of caregiving will decrease stress and give great comfort to families in the eldercare world. My fear is that we can’t get it out to people fast enough.”
~ P.K. Beville, M.S., Founder, Second Wind Dreams & Geriatric Specialists

To preview the book or purchase your copy, click here.

Until I visited our Area Agency on Aging last week, I had no idea what an incredible resource these agencies are to adult children and their aging parents across our country.

I had these misconceptions.  How about you?

I was 100% wrong.  I corrected my understanding when I met with Tricia Gordon and Kim Charles of REAL Services (Indiana’s Area 2 Agency on Aging.)

Let me share what I learned so you too can understand the value Area Agencies provide older adult and their families.

What are Area Agencies on Aging (AAA)?

AAAs were established under the Older Americans Act (OAA) in 1973 to respond to the needs of Americans aged 60 and older in every community.  There are 650 Area Agencies on Aging across our country.   These agencies provide a range of options to allow older adults to choose home and community-based services and living arrangements.  ”AAAs make it possible for older adults to remain in their homes and communities as long as possible.”

How can I find one based on location?

Use the Eldercare Locator ( http://www.eldercare.gov/) and enter a zip code, city or county.  You can also call  800.677.1116.

Why is the name different from Area Agency on Aging?

Our community’s Area 2 Agency on Aging goes by the name REAL Services.  The Indiana Family and Social Services Administration designated REAL Services as the Area Agency on Aging for 5 local counties.   I learned that each Area Agency on Aging in Indiana goes by a different name.  That unique name is helpful for raising awareness and outreach within the community.

What services do Area Agencies offer?

Home and Community based services can include:

• Information and Referral
• Legal services
• Case management
• Transportation
• Respite
• Skilled nursing
• Home health aide
• Attendant Care
• Emergency response system
• Home delivered meals
• Adult day services
• Homemaker
• Bath aide

More detail at: http://www.n4a.org/files/about-n4a/community-based-services.pdf

What is the process when an adult child or elderly person calls in?

Here is how our community’s agency handles calls.  The call center accepts the call.  It never goes to voicemail, and is always answered by a person.  Beyond answering the caller’s question, about 50% of the 2,000 calls each month result in what’s called “options counseling”.  The Aging and Disability Resource Center (ADRC) Options Counselors listen for other needs and determines other services/programs the caller may need.  The approach is holistic.  Part of the options counseling is to help the caller understand financial eligibility.  Options may include private pay, government assistance, or Medicaid/Medicare insurance.

If  necessary, the counselor may refer the caller to a Geriatric Care manager who will provide an assessment of needs and requirements (often quite complex) of the older adult, and work with the family to arrange the right resources and services important for quality of life.

I also learned that the call center staffers are certified in suicide prevention and know how to de-escalate a situation or refer it to 911 when necessary.

How are Area Agencies unique?

Area Agencies across the country can be unique and still stay true to the foundational mission as set forth by the OAA.

• Funding can vary from state to state and agency to agency in terms of funding by various grants and state programs.
• There may be special programs or initiatives.  In our area, a home was renovated and modified to meet the needs of elderly and disabled.  It is called the “Caregiver Connection” and offers educational opportunities, training and support  for caregivers of older persons.  What a great service to area  families!  You can read more about it at http://www.southbendtribune.com/article/20100128/News01/1280308&Template=printpicart
• Specific challenges within the community as well as agency leadership and staffing all contribute to the unique nature of each agency.

So, now you know!  Your Area Agency on Aging is a phenomenal resource.  You may not see a lot of marketing/advertising about them.  Spread the word to your friends, neighbors and family.  It doesn’t matter if you’re in California and your aging parent is in Florida.  You can reach the agency closest to your specific need by going online at http://www.eldercare.gov/ or calling 800.677.1116

Remember, the Area Agency’s mission is to help older persons remain in their own homes and communities for as long as possible.  They are waiting for your call!

Last week when I attended the Aging in America conference, one of my goals was to learn about the best tools and methods to help older adults manage their medications.  I wanted to be able to help my elderly mother and my readers.

The first session I attended was “Engaging the Older Patient in Medication Management” by Linda M. Strand, pharmacist and professor.  Linda’s presentation turned my preconceived notion of the “medication management” problem upside down and on its head.  I truly believed it had to due with lack of adherence.  Not so! Linda told us that 80% of drug therapy problems were NOT due to drug adherence. But, there is good news.  There is a service (reimbursable by Medicare D) that can help enormously…Medication Therapy Management (MTM). However, the public and healthcare/eldercare professionals need to know it exists.

Linda told us that 1/3 Americans take more than 5 medications.  Also, older adults often have multiple physicians and may go to multiple pharmacies.  Without a service like MTM, there is no comprehensive oversight to manage a person’s medications.  Consider the consequences of this lack of management:  the possibility of drug interactions, ineffective drugs (due to low dosage…), the patient’s lack of knowledge of how to take the drugs or inability to take the drugs.  In Medication Therapy Management, MTM, a pharmacist works together with the patient, caregiver, and other health professionals to “promote the safe and effective use of medications and help patients achieve the targeted outcomes from medication therapy.”  (www.pharmacist.com)

How do I find Medication Therapy Management (MTM) for my parent? Here are some good starting points.

• Check with your pharmacist.  Here is a program I found offered by CVS.  http://www.silverscript.com/en-US/medication-therapy-management-programs.aspx
• Check with your primary care physician.
• Check with your local medical-based university or healthcare center.

Is it reimbursable by Medicare?

• Some insurance plans cover MTM.
• Medicare D mandates it for certain patients.
• The Centers for Medicare and Medicaid Services (CMS) targets those who have multiple chronic diseases, are taking multiple Part D drugs and are likely to incur annual costs of $3,000+ for covered Part D drugs.  I like it that the individual must choose to opt-out. Hopefully the opt-out feature raises the level of awareness of the service.

My suggestions for an adult child of an elderly parent:

• Educate yourself about the value of MTM by speaking with your parent’s pharmacist or primary care physician.
• Determine best provider of MTM for your parent (based on program and cost).
• Schedule the service and accompany your parent.  Our aging parents really need our advocacy and support when it comes to the overwhelming world of drugs.

I hope this information helps.  If your aging parent has actually used this service, can you please share their experiences in the Comments section.  Thank you!

The following are 10 tips Julie shared to help us be proactive and take action now to help de-clutter our parents’ home.  Do not wait.  Do this now for the sake of your parent(s), your family and you.  I can tell you by personal experience, you do not want to have to do this in “crisis mode.”

• Have the important conversations with your parent. She advises us to approach our parents with love and talk with them about their wishes.  Ask and gain an understanding about their financial situation.  Be sure to know where all the important and legal documents are.

• Start to de-clutter your parent’s home. She shares that they won’t like this, but we can just say that we’re helping them “thin out” the stuff.  The clutter can be both a fire and tripping hazard. Remove food that is expired.  Also go through linens and kitchenware that are no longer used.  On a personal note, my husband set out a table with 8 place settings of the best of my mother’s everyday china.  Upon seeing that, she allowed us to give away the rest of her dishes and glassware.

• Discuss and document allocation of personal property and heirlooms.  Create a wish list and have an appraiser assess value of the special items.  The goal is to keep the tally equitable and fair.   Better yet, suggest “gifting” of special items while your parents are still alive (to minimize fighting).  Don’t let something like a Grandfather clock or a Civil War sword break your family apart.

• Tell Mom you are helping her “thin out” the house, and every time you leave the house, take a few bags of donation items with you.  Julie has a great saying, “Dress the less fortunate”. On a personal note, my mother loved the idea of us giving bags of her clothing away to a charity that took it all to Appalachia.  She would ride in the car with me as I dropped the bags off, so the receivers could thank her personally.

• If your parent has already moved out of the house or passed away, begin the process of clearing out the house by using 3 separate piles (or even rooms) for donation, sell and keep.

• When in doubt, always have a personal property appraiser evaluate antiques and items you’re unsure of. Julie shared a story about finding a $50,000 vase in a laundry basket that a family was going to toss.  In her book, she talks about a painting the family considered ugly that was valued in the 6 figures.

• Continue to keep in touch with siblings and keep everyone on the same page. From my experience, this should be an guiding principle in all conversation and all decisions.  It is the only way that the whole family will keep their relationships strong and healthy through it all.

• Always come from a place of love. As Julie says, in the end, life is much, much more than the things, the stuff.  It’s about the wonderful deep and abiding relationships within our families.  That is what is priceless!

I highly recommend Julie’s book.  As I read it, I could tell it was a real labor of love.  As Julie shares her lifetime of experiences and wonderful story vignettes, she provides an adult child with a roadmap for these later years with our parents.  You’ll find guidance and inspiration to do the “right thing”.  And, it will make all the difference!

Resources:

1. Julie Hall’s book, The Boomer Burden: Dealing with Your Parents’ Lifetime Accumulation of Stuff
2. Her website: http://theestatelady.com/
3. My BlogTalkRadio interview with Julie

For those on Medicare, Open Enrollment period for 2010 begins November 15^th and extends through December 31^st.  Be sure to check out the newly modified MyMedicare.gov site.  Let me give you a quick overview of two key features.

I especially like one new feature that gives you the ability to create and print a personal “On the Go” report, listing information your parent can share with health care providers (including emergency info, eligibility dates for preventive services, drugs, favorite providers, pharmacies and plans).  I like this new report for 2 reasons:  I noticed there are 2 preventive services my mother has not yet had, and this “report” is a great item for her to post on her frig (in case of emergency) and for me to have in my possession.

The most important tool to utilize this year is the tool to compare the standalone Medicare prescription plans (PDP).  Recognize that changes for 2010 vary by plan.  The Health Policy Institute at Georgetown University reports, “Among the five most popular plans, the premium for one is up by 22 percent for 2010, while the premium for another is down 3 percent.”  Paul Precht, director of policy for the Medicare Rights Center, advises to look beyond the premium, and consider what’s covered, expenses for the year and whether your drugs are still covered.

Understand that it is essential to compare plans and costs due to all the changes for 2010.  Here are my suggested steps for you at http://mymedicare.gov/

• Obtain a logon and password at the site
• Your parent’s current plan information will display
• Select the option to “Find and Compare Drug Plans”
• Follow the steps required.  Enter Medicare Insurance info, select County, and either enter the Drug List ID (from previous entry) or enter drugs to create such a list.  (NOTE:  Save this Drug List ID somewhere so you can retrieve it in future years.  I was very glad I had printed it off last year.)
• You will then be presented with the option of selecting 3 other plans in your area and creating a comparison with your parent’s current plan.  There are various sort options for your report.  I sorted by “estimated annual costs”.
• Print out the comparison to share with your parent.

If you’ve not done this process before online, it is rather tedious to enter all the info, but it is well worth the effort in cost savings for your parent.

I read somewhere that only 7% of all those enrolled in Medicare D plans switch plans.  I have heard first-hand from other senior friends that all the Medicare choices are just too confusing.  But, I encourage you to pursue the comparison.  Ask an adult child, friend or even your local pharmacy to help you.

http://www.mymedicare.gov/