Caring for an elderly family member can be extremely demanding – especially if you are still working full-time. Even if you are not working outside of caregiving, Adult Day Care provides needed respite for you. Often Adult Day Care is a must, but you know it’s important that your loved one is well cared for during the day.

Adult care programs vary in their services depending on the facility and the needs of the aging parent. Some offer therapies (such as physical, occupational, speech). Others offer music programs, arts & crafts projects, discussions on current events, and times of reminiscing and visits from many community volunteers of all ages. Adult care programs all offer the ability to visit the facility before choosing one.

The cost of an adult care program varies depending on the location, the type of facility and the activities offered. Locally a full day of adult day care costs between $60 and  $80 per day. Most have a sliding scale, which is offered to lower income families, making it affordable for almost every budget.

However, it still places extra demands on the budget. Potential ways to offset cost of adult day care include Medicaid, some long term care insurance plans, Program of All-Inclusive Care for the Elderly (PACE), Veterans and Medicare Advantage Part C. To find out about funding available in your area, review the individual programs to see what type of coverage is available.

If you need help with finding facilities in your area or sorting through the requirements to qualify for getting your loved one into the facility, you can contact Lisa at The Shifting Path: By phone: 408-219-7231 or by email: lisa@theshiftingpath.com

Noticing the early warning signs is important. One of the biggest early warnings is getting lost.If not addressed early enough, it can become dangerous for not only your loved one to be on the road, but also for other drivers and families out there.

First it is important to look at the cause of your parent getting lost.  Sit down and talk with your parent about the situation that occurred.

• Did something along the way distract him/her while driving? Is this the first time it has occurred and was just due to something unusual that day?

• Find out if they have noticed other moments of forgetfulness that are of concern -  greater than not knowing where they put the car keys?

• How does your parent feel about driving? Does it feel stressful to them? Can they easily see traffic lights and street signs? Or do they find themselves driving closer and closer, slowing by the sign to see it?

• If your parent is on more than one consistent medications check with their doctor to see that those medications are not interfering with each other and causing other side effects. Certain medications or combinations of medications can affect senses and reflexes.

Ensuring regular doctor check-ups is important. Getting their eyes, hearing and reflexes checked is vital. Another area of concern could be sleep. Anyone, no matter their age, can appear to be intoxicated when poor sleep is involved. Have their doctor help them establish healthy nighttime sleep conditions to ensure proper rest when driving.

If all of the above has been done and your loved one still gets lost frequently or has other issues when driving, it’s time to make the difficult decision of putting on the brakes and having them turn in their keys. Just because they are no longer able to drive, it doesn’t mean they have to loose their independence. Talk to them about redefining their independence by reframing the situation into a positive form.

AAA has a Senior Drivers Program where you can get driving fitness tips, videos and more, including state License Policies and Practices. They also help with planning for continued mobility (post driving), which is extremely helpful.

Visit: http://www.seniordrivers.org/home/ for more information.

It’s also important because if a crisis occurs, you want to be prepared with the back-up support you need.

First, you must have a doctor’s Power of Attorney in order to talk to a provider. A power of attorney (POA) or letter of attorney is a written authorization to represent or act on another’s behalf in private affairs and business. A doctor will not talk to you unless you have this document in place.

Therapists can help with issues such as depression and anxiety that aging parents and spouses may possibly be struggling with on and off. There can also be a lot of confusion and frustration involved on their end because things are happening to them that they don’t understand.

Also, having a good therapist on-hand to help in dealing with speech difficulties after a stroke, makes life much easier for you and your loved one.

If you are being assisted by an in home caregiver or long term care caregiver, you will want to make sure you get a daily report of how your loved one did each day and the activities they did. This helps prevent double work, and it also gives you a good assessment of not only how your loved one is doing, but also how well the care provider is doing their job.

Be sure to get to know your pharmacist because this is the person who will be more aware of the different medications your loved one is taking – especially if your loved one is seeing several different doctors.

Keep all care provider information in an easy to access place so you can call with questions or be prepared in case of an emergency.

When you do call, get organized before hand. Prepare a list of questions, have all the information you need handy, such as POAs, lists of medications and any symptoms. Ask questions and make sure you understand the answers – have them repeat any information if needed and take plenty of notes.

Better care and effective communication with all the providers leads to a better quality of life for your loved one.

res·pite/ˈrespət/Noun

1. A short period of rest or relief from something difficult.

Respite means getting time away for you, the caregiver, to do things for yourself, which will rejuvenate you and help come back fresh and energized.

When it comes down to it, respite is about self-care. It’s vital to take time just for yourself to avoid burnout and exhaustion.

Going too long without respite care, you are more likely to develop physical and emotional health problems. Your loved one needs you, so the worst thing you can do is burn yourself out to the point where someone else needs to take care of you now.

Caregiving is a demanding and difficult job and respite helps to maintain a healthy life-balance.

Activities such as a book club, walking/hiking, playing bridge and an exercise class, are all examples of respite. Essentially respite is about the caregiver taking care of themselves and finding additional joy and fulfillment in outside activities.

Respite should not be confused with receiving help from others for caregiving responsibility – that’s not the same as respite care.

Types of respite care services:

In-home respite

Informal family support and relief

Online caregiver communities and video workshops

Volunteer or paid companionship

Personal care or skilled health assistance

Out-of-home respite

Adult day programs

Residential respite care

Caregiver support groups

How to Select Independent Providers

Although you are anxious for relief, taking time to find the right person is essential for your peace of mind and your loved one’s safety. Make sure you:

• Are clear about the tasks you need help with and have listed them in writing.

• Screen each candidate both over the phone as well as in person to make sure he or she is a good fit.

• Agree on a compensation schedule and pay for services after they are completed – never in advance.

• Request work and professional references and be sure to follow up with them. You can even conduct a background check. Ask your local police department, legal aid service or attorney for referrals to reputable investigators.

There are several non-profit and state agencies that will help pay for respite care. Also, some states use waivers through Medicaid to apply federal funds to offset respite costs.

To learn what is available in your area from your state, check Family Caregiver State Contacts. Research individual programs such as Medicaid, Veterans’ Benefits and your loved one’s long-term care policy for means of coverage.

It’s important to first identify the needs of the senior. Once you have done that, you can then narrow down your choices and pick a facility that meets their individual needs.

Below are some basic definitions of each type of facility courtesy of the Assisted Living Federation of America (ALFA) and the California Registry to help you understand the differences so you can choose the right facility:

• Assisted Living – is a residential setting that offers choices in personal care and health related services. It’s a long-term care option that combines housing, support services and health care, as needed. Assisted living is designed for individuals who require assistance with everyday activities such as meals, medication management or assistance, bathing, dressing and transportation. Some residents may have memory disorders including Alzheimer’s, or they may need help with mobility, incontinence or other challenges. Residents are assessed upon move in, or any time there is a change in condition.

• Independent Living – is a residential living setting for elderly or senior adults that may or may not provide hospitality or supportive services. Under this living arrangement, the senior adult leads an independent lifestyle that requires minimal or no extra assistance. Generally referred to as elderly housing in the government-subsidized environment, independent living also includes rental assisted or market rate apartments or cottages where residents usually have complete choice in whether to participate in a facility’s services or programs.

• Congregate Housing – is similar to independent living except that it usually provides convenience or supportive services like meals, housekeeping, and transportation in addition to rental housing.

• Residential Care Facility – is a small residential care home, licensed for 2 to 6 people and provides a safe, comfortable and dignified environment for those who need help intermittently throughout the day and night. RCF’s are not allowed to provide skilled nursing services (unless there is a credentialed RN or LVN individual working in the home), but they can provide assistance with all daily living activities, such as bathing, dressing, toileting, urinary or bowel incontinency care. For those elderly suffering from Alzheimer’s disease or other kinds of dementia RCF’s can be an ideal care setting because there are few people for the resident to have to deal with, and the number of staff is small, one or two people. There is a lot of close supervision and support for the Alzheimer’s patient, which can lower anxiety and stress. In a residential care setting an elderly person still has the ability to carry on as normal a life as they wish or are able. They can go shopping, have friends and family visit whenever they want, go for walks, dine out, etc.

• Continuing Care Retirement Community – A continuing care retirement community (CCRC) is a community, which offers several levels of assistance, including independent living, assisted living and nursing home care. It is different from other housing and care facilities for seniors because it usually provides a written agreement or long-term contract between the resident (frequently lasting the term of the resident’s lifetime) and the community which offers a continuum of housing, services and health care system, commonly all on one campus or site.

• Nursing Home – Provides 24-hour skilled care for the more acute patients. Patients generally rely on assistance for most or all daily living activities (such as bathing, dressing and toileting).

For more information on the types of facilities, visit the Assisted Living Federation of America (ALFA) and the California Registry.

If you need further assistance in choosing a living facility that is right for your loved one, contact Lisa at The Shifting Path to help you narrow down the choices to prevent wasted time and energy visiting facilities that don’t meet the criteria for your needs.

Being a part of the sandwich generation, it’s important that we not only lead by example, but also that we preserve our sanity by leaning on the support systems around us.

You are not weak to ask for help. Quite the opposite is true. You are keeping yourself strong; and keep in mind that capable organizations are created solely for the purpose of supporting you, the Caregiver.

In fact, people like being asked to help! It makes them feel good. Just think back to the last time you helped someone. How did you feel? Probably great, right? That’s exactly how others feel when you ask for help.

You don’t have to do it all yourself.

Here are 5 things you can do right away to start getting the help and support you need:

1. Make a list of family friends, and neighbors who can help you, include their phone numbers and email addresses.

2. Make a list of tasks that they can help you with, whether it be grocery shopping, picking up prescriptions, help with transportation to doctor’s appointments or even reading a book or doing a puzzle with your loved while you take a break for a few hours. Also note their availability.

3. Local organizations, such as Heart of the Valley, Alzheimer’s Association, American Diabetes Association, in home care service companies can serve as forms of help and respite.

4. Caregiver support groups can be found in local hospitals, community centers, disease specific organizations, hospice care organizations, and long term care facilities.  Many give support specific to your family needs. They provide a safe place to make connections with those who are experiencing the same challenges, as well as challenges that have not yet been experienced. In this environment caregivers are able to express their needs. Support groups provide help on topics that are most important to the caregiver with advice from experts in the field of aging on emotional care, working effectively with your aging loved one, reliable products and services, and preparation for future needs.

5. Adult Care Centers are another resource that can provide much-needed respite for caregivers, allowing you to spend time taking care of yourself while having the knowledge that your loved one is being cared for in a friendly, caring, and knowledgeable manner.

Providing for an aging parent can be stressful. If you don’t take care of yourself it will become draining and unmanageable to take care of the needs of your loved one. It’s important to be surrounded by others who can help.

Local Caregiver Support Groups

Cupertino – Cupertino Senior Center- meets the 2^nd Tuesday of the month from 3-4:30

Alzheimers Specific Support groups

No matter what your age, it’s never too early to start discussing options for the legal, financial, and practical decisions that come along with eldercare.  Preparing in advance is much easier, preferably while you or your loved one can still participate fully.

However, regardless of whether there’s a need now or you are planning ahead, it’s important to do your research and find a financial planner and an attorney who understands the laws and regulations, both federal and state, that affect elderly persons. It is best to choose a Certified Financial Planner-Personal Financial Specialist (CFP-PFS) which is the most significant credential, Certified Public Accountant (CPA)  or a Chartered Financial Consultant (ChFC)

Here are three key things to do when searching for the right professionals to suit your needs

1. Get referrals and check backgrounds with the CFP board or other relevant professional organization. Anyone can call themselves a financial planner without being licensed. Again, it is best to choose a CFP who must commit to continuing education on financial planning and ethics.
2. Interview candidates and ask if they’re fee-based versus portfolio percentage based, how long they have been in practice and what credentials they hold.
3. Make a decision based on what your needs are as well as choosing someone you are confident is professional and will be able to handle your information and questions in a timely manner not only today, but also years down the road.

Once you’ve found the right candidate for your needs, the three most important tasks and questions for your parents/ or you and your spouse will be:

1. Assess your overall financial picture.
   
   You have worked hard all your life to save for retirement, so it’s smart to think about how you plan to pay for all the potential expenses that might incur as well.
   

• Start with creating a worksheet of expenses to get an idea of how much income you’ll need in retirement. Things like mortgage or rent, utilities and phone, food, clothing, entertainment (including dining out) transportation, insurance premiums and other regular expenses.
• Write down other expenses, such as travel, out-of-pocket medical expenses, home repairs and other items.
• Figure what your income will be. What you’ll receive from social security, retirement, wages, investments and other sources.
• Keep in mind inflation and also that your expenses in retirement may be quite different from current expenses since your habits and routines are likely to change, your financial planner can help you to gauge inflation.
• Is there anything you need to be doing or know about now, such as tax laws, to be better prepared later?

2. Are you prepared to pay for care? What are your options?
   .
   With an uncertain future for Medicare, you should have a Plan B in case these expenses will need to come out of pocket.

• Find out what long-term care costs are where you live.

• Research the types of long-term care coverage available, what’s covered and what’s not so you know what all your options are. Medicare coverage may not pay for many of the long-term care services that people often need, so it’s a good idea to know what’s covered and what’s not now.

• Find out what public programs you are eligible for, what they cover, what private financing options are available, and which ones work best for you.

3. Is your will and trust (if applicable) up to date and reflective of your wishes?

• What are your preferences for medical treatment should you become seriously ill using advance directives? Particularly if you have a chronic illness, look at disease specific situations that occur and include those in the directive.

• Identify and document who will manage your affairs if you cannot. Discuss this with your attorney and your loved ones.

• Discuss and document your preferences. Be sure to organize and collect important documents in one location and create copies of everything and keep them in a separate location. Let your loved ones know where they can find them.

It’s a good idea to establish you and your spouse’s – or your parent’s – wishes now to ensure that they’ll be taken into account should you become unable to express yourself in the future.

While it’s easy, and sometimes natural, to feel as if your role as “the child” has now become that of parent and caregiver, it’s important to remember they are still your parent – an adult whose needs and desires are important to respect.

Here are some tips on how to keep healthy boundaries and respect on both sides.

1. Talk about it now. Be prepared. While your parents are still able to care for themselves, it’s important to discuss the possibility that they may need you to become their caregiver at some point in their lives. Find out what is most important to them, so you can honor their wishes later on.

2. Remember to have fun.Don’t talk only about the medical issues. Keep the relationship healthy and add a little laughter into yours and their life. Besides, laughter helps ease any tension or stress that goes along with caregiving. Caregiving can be a very rewarding experience; it’s all about keeping perspective.A study reported by the Journal of Mental Health Counseling in 2003, showed that “possessing hope and utilizing laughter and humor to cope with life’s stressors and losses” are especially important to elderly people as they experience a decline in their independence.However, laughter is just as important for your well-being. So laugh and have fun – a lot! Take a few moments out of the day for hot chocolate, a game of cards, and a puzzle, or just to sit outside and enjoy the fresh air and the view.

3. It is just as hard for them, as it is for you. Aging is hard for everyone but especially for the elderly who may be in denial and won’t make it easy for you. Keep in mind that it’s difficult for them to come to terms with the fact that they need help with things they’ve been so independent with their entire lives.

4. Put yourself in their shoes. You know how hard this is for you as their caregiver, imagine that you are your parent and slowly have to let go of control and independence of your life.A loss of independent living may negatively impact a person’s mental health, thus reducing his or her ability to cope. Be empathetic. You want them to still be able to make as many choices as they can. You may think you know what is best for them, and you might, but the more you can empathize, the easier it will be for you, and them, to cope. This isn’t to say it’s ever easy – just easier.

5. Don’t’ forget the little things. Sometimes the things that may seem silly or unimportant                 to you are very important to your parent. Respect their needs and perspective even if it is not                 your own. By stopping to see their view, you are showing them the respect they deserve.                         They will more likely be willing to work with you when they know that you want to help                       meet their needs and concerns.

6. Remember the little things for yourself too. In the process of giving so much to another it’s important to remember to take care of ourselves.Go on a date with your spouse or your best friend. Take your kids to a movie while your spouse cares for your parent. Get a massage. You will be unable to care for others if you don’t care for yourself first. So be sure to get plenty of rest, nutrition and take a little extra time just for yourself each week.

Caring for elderly parents while also trying to balance your own life can be an emotional and              stressful, and also a rewarding time. Remembering these six tips will help ease some of the                stresses.

And if all else fails remember to set limits and take a breather if you feel the tension building              to anger. Coming back with a fresh perspective will make all the difference in the world.

Tulsi Patel, RDHAP

(Registered Dental Hygienist in Alternative Practice)

Finding a resource for the care of your loved one’s dental needs can be a challenge particularly when it is difficult for that person to be mobile.  Even more challenging is finding a hygienist, who demonstrates care and empathy with an elderly person when dental care can be stressful. While having my own teeth cleaned, I found that special someone.

I can tell you that I am a big wimp at the dentist. My teeth are sensitive, and I would much rather do anything else than go to the dentist. I am very upfront to the hygienist about my child like behavior, most of them have laughed it off, and proceed in their usual manner. As a result, I have tried several different hygienists, until I found Tulsi.

Through making a connection with Tulsi, I discovered that she works in the office just a couple of days per week, because her passion is to bring her caring skills to those who have difficulty going to an office setting. Through her mobile services, Tulsi is able to offer comprehensive on-site preventive dental hygiene care.

Tulsi’s credentials are impressive and her passion in working with special needs patients is inspiring. She graduated with a BA in Dental Hygiene from the University of Southern California. She also completed specialized education to work with the elderly and special needs patients which included extensive training in “healthcare issues which commonly afflict the elderly and homebound special needs patients” from the University of the Pacific, School of Dentistry. She is also a Dental Coordinator for the San Andreas Regional Center to serve special needs patients.

To obtain services, a prescription for treatment from the patient’s physician or dentist is required. As a courtesy, Tulsi will bill Denti-Cal, and most major insurances. You can contact Tulsi at 408-242-0840 or at onsitedh@gmail.com.

Brain Game Suggestions:

Chess

Checkers

Dominos

Backgammon

Scrabble