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

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.

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If you’re a caregiver to an older adult, you know that bathing is a common and difficult challenge.  I learned this first-hand when my mother had her health crisis.  I suddenly realized the 2 bathrooms in her 1980’s home prohibited her independence in bathing and toileting.  And, those are two activities of daily living that you can’t ignore.  I quickly did the basic things, like clearing the rooms of scattered rugs, installing a raised toilet seat, and getting a shower seat for a walk-in shower (thank goodness there were not tubs in both bathrooms!)  My mother later moved to a continuing care retirement community where I learned all about bathrooms designed to ADA specifications.  Mom loved her spacious bathroom with no-threshold shower, grab bars all over the place and various types of lighting.

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I found out recently that the marketplace is full of innovative bathroom equipment for older adults.  Home builders and remodelers are starting to incorporate tubs, showers, toilets designed to meet the needs of older adults.  But, you don’t have to have a huge budget or grand remodeling scheme to consider some of these items.

If you have an elderly family member, you’ll want to take a look at some of these innovations.  You may have an immediate need or just be thinking ahead as you replace older bathroom fixtures.  In this post, I’ll share some of the items I was able to personally view in a local wholesaler’s showroom.  And, I’ll provide a few links to helpful resources.

First of all, before you head out to shop and get bedazzled by all the incredible innovations out there, start by learning the basics of bathroom safety and design.  This short article on bathroom safety by the University of Missouri extension agency is a great primer.  It provides easy-to-understand usage diagrams and will walk you through the basic features of grab bars, tubs, showers and toilets.  http://extension.missouri.edu/publications/DisplayPub.aspx?P=GH7060

Now consider the functionality your aging parent needs and available budget.  You want to also be sure to pay attention to proper installation,  and if needed, training to use the equipment properly to avoid falls and get the most benefits.

Here are a few of the items I viewed.  Thanks to Gail Sager, of Mid-City Supply for explaining the products, functionality and benefits.

1.  Showers. While senior living facilities need to abide by ADA (American Disability Act) requirements, home owners need only use them as a guide.  Two factors to consider are the person’s mobility and the structural constraints of the bathroom and home.  Features include built-in shower seats, grab bars, flexible shower arm and single lever faucet.  There is a new feature being offered, a zero threshold shower base.   It offers a “flush, integrated trench drain”, level with the floor, preventing water in the rest of the bathroom.

2.  Tubs. There is a great variety of tub models.  I’m sure we’ve all seen the commercials for the walk-in tubs.  Gail said there are a few differentiating factors to consider.  Does the tub door open in or out?  If there is a mobility issue, choose the open-out door.  Since the tub cannot be filled until the person is sitting in it, select a model that fills and drains quickly.  She showed me a model that filled in 4 minutes.  The seat is heated.

There is a new model of tub that includes a hydraulic lift.  It includes an “easy-transfer automated door that lowers to open and rises to close, a bench-less design and a quick drain feature that allows the bather to exit in seconds instead of minutes.”  Wow.  My next question.  How much?  It is $12,000.  That is a lot of money, but consider that one year of nursing home care averages $75,000. All of these items help an elderly person remain in the home, ease the burden on the caregiver, and minimize safety issues of falling and injuries to the caregiver.

3.  Toilets. There are many recent innovations here.  There is the taller toilet.  I was also shown a toilet seat, 19″ side to side, that was designed for large people.  The bidet toilet is becoming popular.  The unit I was shown featured a panel to control spray pressure, water temperature, and drying.  Operation requires electricity. Bidet seat and toilet is priced at about $3,000.  Bidets can also be purchased as attachments.  Gail mentioned that this type of toilet is becoming popular beyond elderly use.

I hope I’ve got you thinking about bathroom safety and opened your mind to some of the new possibilities to support safety, independence and quality of life for your aging parents.  Please comment below with any related products or experiences you would like to share.

Resources:

1.  Thanks to Gail Sager and Heather Hosterman at Mid-City Supply Co., Inc. Elkhart, IN http://www.plumbingshowrooms.com/

2.  A list of design and product suggestions from AARP http://www.aarp.org/family/housing/livable_communities/articles/bathroom_checklist.html

3.  Excellent article, “Safety with Style – Bathrooms for Aging American” http://ageinplace.com/safety-with-style-bathrooms-for-aging-americans/

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If you are a woman over the age of 40, you need to read the new book, The Daughter Trap!  No matter how informed and proactive we believe ourselves to be, there is one certainty.  None of us are prepared for the nitty-gritty realities of our parents aging.

The Daughter Trap explores the impact of eldercare falling on the daughter.  I like the way the book is broken into 2 sections, “The Problem” and “The Solution”, offering examples and scenarios, but also resources, insight and a call to action.

Author Laurel Kennedy includes over 200 first-hand accounts by caregivers as she walks us through a myriad of eldercare issues, probing deep, always asking why? Why is there a cultural expectation of the daughter as sole caregiver?  Why do”employers ignore it, parents expect it, and women accept it?”  Kennedy acknowledges caregiving can be a wonderful loving opportunity.  But, due to the realities of aging and eldercare, she urges us to expand our thinking about our role and options for our parents (and ourselves).  You will walk away with ideas for balancing caregiving with family, work responsibilities and personal needs.

Some of the chapters that make this book unique in content are the chapters on dealing with sibling rivalry, caring for in-laws, the male caregiver, and dealing with physicians and hospitals.  In each chapter, Kennedy carefully presents the issues, available resources and “lessons learned”.  The chapter on physicians and hospital should be a wake-up call for each of us and our medical community.  Learn about the “medical home”  and why it is so critical for your parent’s well-being.

I found the last section of the book, “The Solution”, to be a real gem.  Find out about new housing alternatives for the elderly, model eldercare programs offered by a few innovative employers, and the potential benefits of new technology to aid in eldercare.  If you are an employer or can give input to your employer, I urge you to carefully read the chapter, “It Takes a Company.”  I immediately thought back 5 years when I helped an employee through a very difficult situation in caring for her mother.  Corporate support would have made a world of difference for her and me!

In  summary, I highly recommend Kennedy’s book to help you be informed, inspired, and provoked to action!  It’s a book you’ll want to read and re-read, share with family and friends, and keep handy as a resource.

The Daughter Trap: Taking Care of Mom and Dad…and You by Laurel Kennedy

The program began.  And, I discovered that ‘Connected Living’ is all about social engagement with minimal emphasis on technology.  In fact, founder Sarah Hoit says that technology is just the channel for connecting residents with their families and with each other in their community.  This philosophy was quite evident through a most enjoyable and engaging program.

First, we played a game, complete with prizes!  Ginna, our leader, asked the residents:

*  Who is oldest?  (A lady who is 99!)

*  Who is youngest?  (A lady who is 63!)

* Who has lived here the longest?  (I think the answer was 27 years)

* Who has the most children?  (A couple sitting behind me won that with 9 children)

* Who has the most grandchildren?  (We had a tie between 2 ladies, each with 22 grandchildren)

As you can well imagine, people were learning all sorts of new things about the people sitting right next to them.  We learned that ’Connected Living’ will help build upon the connections that residents already enjoy in their community.   There are 2 new Discussion Group events scheduled.  The first is titled, “The Greatest Generation”, World II Experiences.  Residents will be able to share experiences of growing up during the Great Depression.  The second is “Memorial Day” to honor and remember those who served our country.  I can only imagine the wealth of life stories and the wisdom that will be shared during those discussions!

At a personal level, with Connected Living’s touch screen PCs, simple interface and one-on-one help from staff Ambassadors, residents will be able to invite family and friends to join them on St. Paul’s special social network.   It reminds me of a private Facebook group.   Besides email, residents will be able to record their memoirs, share photos, and connect to the World on the Internet.

The benefits include:  bringing families and generations together, creating lifelong learning opportunities, AND building community.  ”Connected Living” is offered to all residents at no-charge, and there is a 24/7 call center available for questions.

As the program ended, residents enjoyed a reception and immediately formed a line to get their logins.  My friend wasted no time.  She wanted to go down to the computers, log on to Connected Living and invite family and friends.  So, we did.  I don’t know who was more excited, her or me!

If your aging parents are living in a retirement community or assisted living, I strongly suggest you check out Connected Living.

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!

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