You think your older loved one shouldn’t be driving, but you really don’t know what to do or how to approach the subject. Rarely does a topic create as much angst in older drivers and their families as this one. The key to the dilemma of what to do about an impaired older adult and driving is a well used mantra: Just Do It! Don’t wait until tomorrow. Don’t be an ostrich. Too much is at risk. In March of 2008 I wrote a four-part series for SCC’s on-line newsletter All Things Senior titled: Getting From Here to There. Two years later, it’s time to revisit the issue.

If a senior adult’s ability to safely operate an automobile seems to be in question, the first place to start is to have a serious but sensitive discussion with the older adult. If the older adult is resistant to reason, take the initiative to contact their physician to share your concerns. The American Medical Association promotes physician involvement in assessing older adult driving skills and publishes The Physician’s Guide to Assessing and Counseling Older Drivers. Familiarize yourself with it and provide a copy to your loved one’s doctor.

Sons, daughters, nieces, nephews, and grandchildren are the ones who are tasked with confiscating the keys, disabling the vehicle, or reporting the unsafe driver to the proper authorities. Not a fun task by any means. Ignoring the issue only increases the chances that the older adult will harm others as well as themselves. If involved in an accident, the elder driver may be at risk for legal reprisals for driving against the advice of their doctor or when medications or their medical diagnosis might impair safe driving. Continuing to operate a car under such circumstances could jeopardize their long term financial security as well as their physical well-being.

If you really want more information or tools to help address the driving dilemma, follow this link to the All Things Senior articles. And remember—Just Do It!

Wishing safe travels to all,
Connie

What follows is an article I recently wrote for a senior oriented publication. I hope it helps you make appropriate arrangements for potential ER visits by the elderly in your life.–Connie

Hospital emergency rooms are a vital part of the health care system in America. At the same time the emergency room experience can be frightening and confusing, especially to older adults. The older population will make up 30 percent to 40 percent of emergency room visits by 2030, according to estimates from the American College of Emergency Physicians. Only infants go to the emergency department at a higher rate than people 75 and older, according to a recent federal government survey.

When Jan Coe’s mother sought medical care in an ER for post-surgery complications Coe’s eyes were opened to the difficulties older adults face in the ER. Coe arrived at the hospital to find her parents “parked” in the ER hallway. “They were both overwhelmed and not able to process everything that was going on around them,” said Coe.

More often than not hospitalization for an older adult occurs through the emergency room. Emergency rooms operate at a necessarily high pace that can be overwhelming, even disorienting to the elderly. Often questions are couched in medical jargon that is unfamiliar and confusing. It was certainly true for Ms. Coe’s parents. “Neither of them was able to sift through information as quickly as it was presented to them at the ER. Neither had ever been to an ER before.”

ER staff can wrongly conclude that an older adult is demented or not well educated. Other issues such as poor hearing or impaired vision could result in the older adult giving wrong answers, or leaving out information critical to getting appropriate care. A few institutions are now recognizing the special needs of older patients by staffing their ERs with geriatricians and geriatric nurse practitioners. Others have created fellowship training in the new subspecialty of geriatric emergency medicine. Unfortunately these initiatives are the exception rather than the rule.

“ER’s do a great job under difficult conditions,” says Connie Taylor, an Elder Care Coordinator and owner of Senior Care Consultants. “It is especially critical for an older person to have family support or an advocate, anytime they experience a medical emergency.” When family is at a distance or unavailable, Taylor has been that advocate. She responds to the needs of her elderly clients anytime of the day or night to ensure they do not have to go through an ER visit alone. “I know my clients’ medical history. I have records at my fingertips 24/7.”

With the number of older Americans on the rise and the pressing concerns about health care cost containment, having a care coordinator or patient advocate in the ER is a win-win situation for all involved. “When I am with my client in the ER, they know there is another pair of eyes and ears to help them filter through information and questions. Out of town or vacationing families don’t have to panic if mom or dad has to go to the ER, and best of all, the ER staff has a professional partner on hand to ensure they have everything they need to make the right treatment decisions,” says Taylor.

Coe is no stranger to helping older adults either. She owns Homewatch Caregivers, a non-medical support service agency. After Coe’s ER experience with her mother and father she concluded, “It is a reality that older people process information much more slowly than younger folks. How do you reconcile ER staff demands and elderly responses? I don’t know, but I do know that it helps to have an advocate with them. I don’t even want to think how all this would have gone had I, or someone else prepared to deal with the medical team, not been with them.”

“An ounce of prevention is worth a pound of cure.”   Wise words from ole Ben Franklin. Doing what it takes now to prevent a larger, more costly “cure” in the future applies directly to care planning for the elderly. Too often seniors and their families resist spending the ounce of prevention in the unrealistic expectation that the pound of cure can be avoided entirely. Thinking this way is a recipe for a devastating crisis for the older adult as well as for all involved in caring for them.

One of the hardest things I face working with seniors is resistance to accepting incremental help as they age, especially if there is any financial outlay for the help. I like to think that age brings a degree of wisdom. In this case it is only penny wisdom. Ben Franklin is somewhere shaking his head in dismay. And, if you want to get biblical about it, think about the parable of the young virgins who did not plan ahead appropriately—their oil ran out.

Ben would be jumping up and down on the side of the ounce of prevention. I think he would buy into this elder care mantra: Spend the money for the care you need today. Okay, I’ll give you a minute to recover from your shock. Yes, spend the money, spend it for the care you need, and spend it today. Folks who follow this script end up getting exactly what they say they want–to stay as healthy and independent as long as possible. Health and independence are preserved at a lower overall cost. Ben would smile.

Recently I attended a Life Care Planning workshop where I became totally convinced that Life Care Planning is the best way to cover all the bases for long term care planning while ensuring resources are used or preserved in the most advantageous way. Life Care Planning marries the knowledge of an elder law attorney with other professionals such as geriatric care managers, benefit specialists, etc. The concept is holistic. Plans are customized to meet the long term care objectives of the elderly and their caregivers. Call me. I’ll tell you more and help you find a Life Care Planning practice in your area. It’s the ounce of prevention that is worth a ton!

With thanks to Ben,
Connie

You are wearing the plastic ID bracelet on your arm, you are in the bed, and you are being cared for by healthcare professionals wearing name badges from your local hospital. All the external clues tell you that you are, in fact, in the hospital. But, everything may not be as it seems.

With increasing frequency hospitals are providing multi-day treatment for patients they are classifying as outpatients. The treatment you get while you are technically not admitted may not look any different from the person in the next bed who is, in fact, admitted. The real kicker is that your admission status may be switched retroactively!

A lot is at stake for Medicare beneficiaries who are mostly elderly and may not be in the best position to advocate for themselves following a hospitalization. Hospital fees normally covered under Medicare Part A may be billed to the beneficiary. Equally devastating, an older adult needing rehabilitation in a skilled nursing facility may find Medicare denying coverage for the cost of their treatment because they were not designated as an inpatient during their hospital stay.

The Center for Medicare Advocacy, Inc.’s article “Observation Services”: What Can Beneficiaries and Advocates Do? provides detailed information to help beneficiaries and their advocates take heart and take action if it looks like the admission status has been inappropriately classified as observation or outpatient.

With all that the elderly and their caregivers have to cope with during any medical event requiring hospitalization, this is one headache they could do without. Having an advocate is immeasurably important. I know. It’s what I do.

Proud to be an advocate,
Connie

Pain manifests itself in a number of ways. There’s localized physical pain—the kind that when asked, you can literally put your finger on it. Generalized pain is diffuse and sometimes difficult to describe. It is like background noise that is always there. Think of your refrigerator at home. It constantly hums but you don’t hear it. You notice more the silence if it quits humming. Of course pain can be intermittent as in pain that only hurts when you move a certain way. Regardless, it is natural to try to avoid pain. We want it to go away. When pain is intractable or intense, it can immobilize us both physically and mentally. On the emotional side, it can make us a bear to live with. We don’t like anybody and we sure don’t like ourselves when we hurt.

When working with the elderly it is important to be mindful that pain may lead to reduced physical activity, lack of interest in personal grooming, poor appetite, disrupted sleep patterns, and an ill mood. Left untreated, the door is open for depression as well. From time to time ask your older loved one if they hurt anywhere? Look for the furrowed brow or the facial grimace. Notice if they seem to be favoring one extremity over another. Be alert to any significant changes in their daily routines. Those older adult with dementia may not be able to adequately communicate it if they are experiencing pain, so caregiver attentiveness to any nonverbal clue is essential.

There are a lot of changes associated with aging that cannot be alleviated. However, most pain is treatable. A trip to the physician is a must to be sure the appropriate treatment is prescribed and monitored closely. Medication side effects and interactions can be addressed with the older adult’s doctor. Other treatment modalities such as physical therapy may also need consideration. We all want the best quality of life possible. I can’t imagine anything much better than getting rid of unnecessary pain.

Here’s to feeling no pain!
Connie

If you are the adult child running into a veritable brick wall in your efforts to help your parents put supportive services in place, you are probably asking yourself, “What is the big problem?” The problem is the Big R—resistance. I’m willing to bet you are hearing, “I don’t need it. I don’t want it. It costs too much. I don’t want anyone coming into my house.”, or any number of other help-deflecting roadblocks. It can be very frustrating, huh? Even so, don’t let the Big R of resistance do a double R of ruining a relationship.

To deal with the Big R, children need to realize that resistance is feeling based. Your parents are not comfortable admitting, especially to you, that they need help. And really, they don’t want to see themselves as being less than totally capable and independent. Take a deep breath. Close your eyes and honestly imagine what it would feel like to have someone suggest you need the help you are suggesting to your parents.

The best advice I can offer you when you are facing the Big R is to realize you probably can’t force the issue. True, the choices our parents make in their striving to remain independent could result in them becoming prematurely dependent. But adults are allowed to choose–for better or for worse (assuming a court has not deemed otherwise). Actually verbalizing to your parents that you recognize they still make their own decisions and that change is hard can help ease tensions. You can try sharing some of your own feelings about care planning (see When Feelings Block Care Planning 2/28/2010).

Sometimes nothing works to overcome the feelings of the Big R. You haven’t failed. Your parents have chosen. Take another deep breath. Try to relax. It’s what they had to do when you became old enough to make all your own decisions. Love them anyway and keep our number handy if a crisis develops.

Breathing deeply,
Connie

Were you searching for “elderly care”, “durable power of attorney”, or “senior care”? SCC is “All Things Senior.” You have landed just where you need to be. SCC offers real solutions to those who are searching for real-life custom-made solutions to their geriatric care management needs.

Aside from our direct services, our free downloads, and educational DVD’s, the online newsletter may be just what you are looking for. If you find something of value at one of the pages, let us know. We really care. Call us (1-866-770-1770) or email us (sencare@bellsouth.net). We respond quickly.

Most people breathe a big sigh of relief when they find our website. You don’t have to keep searching. SCC will design a premium care plan that fits you and the older adults in your life.

Ready when you are,
Connie

I don’t know if it is true so much in other places, but here in Appalachia folks play it real close to the vest when it comes to talking about money—especially their own money and how they manage it. Keeping up with bill paying, carefully checking each statement for accuracy, balancing the checkbook, or simply the act of writing checks, can become a burden for the elderly. And yet that old engrained idea that to talk about money issues is “not nice” or to ask for help isn’t okay is hard to shake.

I am proud to say my own mother still keeps her own checkbook and balances it to the penny every month. Still, there are times when she gets mail related to some aspect of her finances that she just isn’t sure she completely understands, or occasions when the bank statement doesn’t balance, or she forgets to send in a payment on time. I get the call and am very grateful that I am close enough to be able to help and am especially grateful that she asks. Many older adults don’t have a family member or trusted friend close enough to give them that sort of support. Many don’t want anyone to know they might actually need that sort of support. And yet keeping all the day-to-day financial stuff straight is key to independent living.

A sure threat to independent living is when the utilities, property taxes, quarterly taxes, or credit card statements don’t get paid timely. Daily money management is just one of the ways that an elder care coordinator can help seniors maintain their independence and give them peace of mind. Elder care coordinators who engage in daily money management services carry appropriate insurance and should be able to provide references to ease any concerns regarding their trustworthiness. The care coordinator will work with the older adult to develop a plan to review statements for accuracy, make sure financial obligations are disbursed appropriately, and that accounts are kept in balance. Mail can be reviewed, explained, and then acted on appropriately.

When I wear the Daily Money Manager hat, it truly isn’t just about the money. Underneath, my Care Coordinator hat is firmly in place. I can’t help but be attuned to other aspects of how the older adult is functioning. Having an elder care coordinator in the home on a routine basis can be a great asset in monitoring for when other support services might be needed too. What do you think? Take a moment to share your two cents worth. How do you think the services of a daily money manager would play out with the older adults in your life?

Watching the accounts,
Connie

“Just the facts, mam,” is Joe Friday’s famous line from the old Dragnet TV series. It was the detective’s way of trying to cut through extraneous emotions. When it comes to planning for long term care needs, knowing just the facts won’t guarantee success by a long shot. Emotions are a huge part of the planning process. The unaddressed feelings of older adults, as well as the feelings of their adult children or other caregivers, often short-circuit the process before it can get started. Even when “the talk” gets going, left unattended, feelings can fester and derail efforts prematurely.

So, what’s up with all the feelings? It depends. If you are the adult child who is concerned about your parents’ well-being you may be feeling:                                                                                                                                                                    –hesitant because you’ve never had to take a leadership role in your family,
–fearful that your parents will be hurt or offended if you bring up the subject,
–anxious because you believe the situation isn’t far from a crisis, or
–resentful thatyou could end up being burdened by care responsibilities or decisions.
Take a little time to let the feelings surface enough to recognize and name them. Don’t shove them to the back of your mind. Realize that timing can be important. Let your parents know ahead of time that there is something of importance on your mind that you would like to discuss with them. Let them pick the time of day that suits them best. Be up-front about your feelings. “Mom/dad, I want you to know that I am hesitant to talk to you about the future and how you might want your care managed. I’ve never been much of a ‘leader,’ but I care too much about you to put this off. I hope you’ll help me—I hope we can help each other.”

If you need more coaching, give me a call. If your own best efforts don’t work, give me a call. Sometimes someone outside the family can make more headway. As always, sharing comments here with other readers is encouraged. Whatever you do, don’t let your own feelings stand in the way of getting a plan in place for the older adults in your life.

Feeling hopeful,
Connie

Disaster preparedness isn’t seasonal and shouldn’t be a gambling matter. Senior citizens may be feeling pretty lucky that the Knoxville area has dodged the winter weather disaster bullet so far. I’m wondering how many of them routinely gamble with fate and how many take measures to stack the deck in their favor? While folks may not think of East Tennessee as a “high-risk” area for natural disasters, they do happen and everyone needs to be prepared. The recent events in Haiti, the snow storms on the eastern seaboard, and the excess rain in Southern California have all gotten me to thinking about how older adults fare in such situations. So I turned to an expert.

Susan Millard, an Elder Care Coordinator with SCC,  is also a Disaster Mental Health Manager with the American Red Cross. She has responded to local events such as the aftermath of the 2002 tornados in Morgan and Cumberland Counties, a railway chemical spill in Knoxville, numerous hurricanes in Florida (2004 & 2005), and even to New York City following 9-11.

Susan has first-hand knowledge about the physical and emotional impact seniors can face when a disaster strikes. “As a general rule, seniors are our vulnerable population. Children under six and adults over sixty or more likely to be injured or killed in a disaster.” Thinking ahead, being realistic, and developing a plan is key. Susan advises seniors “to have enough food, water, and medications to survive for a minimum of three days. If the disaster were to result in prolonged displacement, have a plan for relocation. Who could help transport the senior and take care of them once they arrive?”

In a disaster, three days can pass quickly without much improvement or access to help. All Things First Aid, the American Red Cross, and FEMA have comprehensive suggestions that will help ensure seniors are as prepared as possible for any untoward event. All these sources emphasize the need for preplanning with a heavy emphasis on communicating the plan to others. From Susan’s experience, “One of the major hurdles during a disaster is family members trying to locate their loved one(s). It may take days or weeks to determine if everyone is okay. Both parties – the senior and their family members – should have an advance plan to contact each other in the event of an emergency.”

But what about the emotional aspect of coping with a disaster? “It may depend on the senior’s history of coping in past situations,” says Millard. “Seniors have a lot of life experience and may be quite resilient. On the other hand, if the senior has dementia, anxiety, or depression their symptoms may exacerbate. Having to relocate creates additional stress. Being prepared, realizing that change is a part of life, and having a support system is key to survival in any situation.” Good words to take to heart. No need to play the odds—be prepared.