Tag Archives: geriatrics

Worried About Elderly Parent’s Driving? Ask these questions…


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Without a doubt, the decision to hand over the car keys is one of the most difficult decisions and transitions an aging family will make. It’s the one day-to-day task that is critical to an older adult’s ability to maintain their independence and without the ability to drive they become more dependent on you and a bit more isolated from society.

 

It’s a BIG deal and not an easy issue to address…

 

Unlike other areas of day-to-day life, your elderly parent behind the wheel of a car may not only be risky for them but it can put innocent people in harm’s way as well. A little tough love may need to be applied to convince your mom or dad they are not safe behind the wheel of a car. Ultimately, you have to ask yourself and them does a person’s right to remain independent supersede public safety?

 

The decision of when to retire from driving should be based on abilities not age or diagnosis. But how do we know when it’s time to get serious about this conversation about handing over the car keys? Before you endure any more sleepless nights consider making an appointment with your mom or dad’s physician and start asking these questions about safe driving.

 

Is mom’s vision good enough for her to drive safely? Vision is essential to safe driving so obviously a loss of it puts your elderly parents and other people on the road at risk. On the other hand, vision changes don’t preclude the inability of an older adult to be a safe driver. Ask about the types of vision exams that have been conducted and if your elderly parent has a diagnosis related to vision.

 

Is dad’s physical health good enough for him to drive safely? Driving is an activity that requires a certain amount of physical abilities such as muscle strength, endurance and range of motion. A limited range of motion in our neck makes it difficult to maneuver a car; same with upper and lower mobility. Also, ask about medication interactions and dizziness.

 

Is dad’s cognitive abilities good enough for him to drive safely? People tend to think that because they can accurately report the day of the week or remember what state they are in that their memory is fine. What the average person doesn’t realize is that it’s the fluid memory that’s most important when it comes to driving safely; judgement, reasoning and the ability to think quickly. Ask the doctor what types of cognitive screens they have conducted and what the results were.

 

Again, not every elderly driver is unsafe on the road and the decision needs to be based on abilities not age or diagnosis but I’m tired of this issue being swept under the rug. Believe me when I tell you I understand the issues go much deeper and a simple trip to the doctor is probably not going to solve this problem for you. But without a doubt, a trip to your elderly parent’s doctor is the first place to start. If you’re concerned, the sooner the better.

With my clients, I’ve been more than a little disappointed at the lack of comprehensive assessing that’s being conducted and the lack of support in asking the tough questions. How about you? Have you had any luck in this area? By leaving a comment, you can help another adult child of an elderly parent…

 Painful and sad moment for an older woman

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Struggling With an Elderly Parent? Consider This…


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It’s not easy caring for an elderly parent and the worry that keeps you up at night can keep you emotionally spent. Your head is spinning and you feel ultimately responsible for what happens to them. On the other hand, you want to run as fast and far as you can from the big hot mess known as their life…

You’re overwhelmed, frustrated and confused!

If your mom or dad are suffering from some horrible form of dementia, this is understandable and there is plenty we can do to help. However, if your elderly parent is toxic and always has been chances are you’re feeling a bit resentful and burned out. If you feel you’re being sucked further into their toxic vortex I want you to seriously consider this….

They are who they are and you are who you are; you are not one in the same. Do what you can to get the right professionals involved and release the rest. When elderly parents are toxic, it’s best to get out of their way and let them carry on…

 

 

Can You be Old and Happy? It starts with your mid-life self…


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Can you be old and happy?

I asked this question of a group of seniors this week and, without hesitation, they answered a resounding YES!

No doubt, happiness is a challenge late in life when you’re faced with multiple losses one after another; loss of independence, spouse, friends, home, financial status, health, memory…..

The key to maintaining a sense of happiness as we age is certainly attitude and the ability to adjust to change. The good news is, there are attitudes that you can foster to ensure that you will remain happy as you grow old!

Five Keys to happiness and aging…

Acceptance: One thing that’s universal about aging is that your life will change in one way or the other. If we can’t accept these changes, we are destined to stay stuck in time and hold on to a world that really doesn’t exist any more.  On the other hand, by accepting changes we put ourselves in a position to adjust and reclaim our sense of self and well-being. A sense of self that is based on our values not values dictated by our families, society or the health care system.

Flexibility: Rigid thinking is the cousin to denial and puts us at risk of not accepting help when we need it. Without flexibility, we can become unhappy with the events of our lives and learn to see our world as all gloom and doom. Flexible attitudes put us in the position to “re-invent” ourselves as we age. You’re going to be put in a position time and time again where you’ll need to find common ground. Whether it’s with your family, your retirement facility or your van driver, you are going to need to foster a bit of patience and flexibility or you’ll be miserable trying to control the world around you.

Purpose: There’s a tendency to isolate from society, as we age, and feel we have nothing to contribute. This can lead to a lack of meaning in our lives, which can lead to depression.  Cultivate a curiosity about the world around you, find meaning in every day life and stay engaged with the world around you.  Make no mistake about it, older adults still have plenty to give and there are life lessons to be taught. Finding meaningful activity and projects that bring us purpose and foster happiness will give us a reason to “get up” and get dressed each day!

Gratitude: Fostering an attitude of gratitude is universally healthy regardless of your age but it becomes particularity important as we age. It’s easy to become down heartened when your life becomes less and less about who you are and more about your disabilities and doctor appointments. By fostering an attitude of gratitude, we will start seeing that our glass is half full versus half empty. You can start fostering this right now by listing 5 things you’re grateful for…

Courage: You’ve probably heard the saying “old age ain’t for sissies” and let me tell you it’s the truth. It takes a huge amount of courage to face the bad news, hold your head high and find the dignity to carry on. The emotional strength it takes to push through the fear and sadness can be critical in forming a sense of happiness late in live. Expressing your fear can lead to a shift in understanding and foster the courage you need to push on and find a new happiness for today.

I was so inspired by the seniors I was with this week as we discussed happiness and aging. Their openness and insight touched my heart and inspired me to cultivate my own attitudes about happiness and aging….

How about you? Do you think about your own happiness and aging? Do you find the above attributes important? Do you have your own ideas about the keys to happiness and aging?

Leave a comment…. I’d love to hear from you!

Announcing my Partnership with Covell Care and Rehabiliatation


covellcareblogwidgetI say it time and time again; the key to quality geriatric care management is collaboration between health care professionals. This is especially true as it pertains to the relationship between physical/occupational therapists and geriatric care managers. I believe so strongly in this relationship that I have partnered with Covell Care and Rehabilitation in Northern Colorado to provide geriatric care management services; together we are much stronger than we are individually!

Krista Covell-Pierson, OTR, BCB-PMD and I have worked together for years as support group facilitators and members of a clinical rehabilitation team. I have a huge amount of respect for her clinical skills, integrity and ability to always go the extra mile for her clients. I am blessed beyond belief to be working with her and this amazing group of physical and occupational therapists to make their clients’ late life experience more meaningful.

For more information about  Covell Care and Rehabilitation’s geriatric care management program go here…

The Secret to Helping Aging Parents


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When it comes to our aging parents, it’s natural to want to ride in on our white horses and save the day. You know they need help and you feel, as their daughter or son, it’s your job to see they get that help. My typical client is a child of an aging parent that is overwhelmed with worry, frustrated by obstinate behavior or struggling to navigate the elder care system. They want solutions now; but the truth of the matter is we don’t “control” the situation or our aging parents (unless we’re in the realm of guardianships) and it’s very rare that a solution comes over night.  The secret to helping your aging parent  is to position yourself as an influence in their life not the person that’s there to take charge and control the decision making process.

Rethink What Helping Means…

Change is hard, especially when you’re 90 years old:  I often ask my clients of aging parents to stop trying to control the details of the situation. Explore the possibility that you can influence your aging parent but you do not control them. You cannot force them to make a move, to accept more help or stop driving but you can influence them. You do have the power to be a compelling force for change by practicing empathy, educating yourself and engaging in the process.

3 Steps to Influencing Aging Parents

Empathy: The number one thing you can do to become an influence for your aging parent is to understand where they are coming from. Put yourself in their shoes; understand how difficult this is for them and stop thinking of how difficult it is for you (sorry if that sounds harsh). The power of empathy can move you from a place of frustration to a place of understanding and trust. Your aging parent’s ability to trust you to do the right thing makes planning and coordination of elder care much easier. Trust also facilitates the exchange of thoughts and ideas which can lead to a shift in attitude. Once a shift in attitude takes place you need to understand what your best options are.

Education: Knowledge is the most powerful tool you have when it comes to helping your aging parents. When your mom finally agrees to hire help in her home you don’t want to lose momentum by fumbling around trying to find resources and giving her a reason to say “forget it”.  Know your local resources before you need them; become aware of what different levels of care and services are available and have a basic understanding of how elder care is paid for. Start your education early. If you wait for the crisis, you will be making decisions based in fear not knowledge and that is not a position you want to be in.

Engagement: By staying engaged with your aging parent, you increase your opportunity to influence and support them.  It’s similar to staying engaged with your teenager; you want to be emotionally available when the opportunity arises to impart wisdom. Practice empathy, educate yourself and there will come a time when the conversation turns to the realization that changes need to be made.  Instead of becoming overwhelmed and frustrated you will be in a position to influence your aging parent’s decisions. Engagement allows you to become a partner with your aging parent and influence their path in rich and powerful ways.

Practice it over and over: empathy, educating, engagement

At the end of the day, we all want what’s best for our aging parents but often times there is a huge gap between what we want and what they want. It does you no good to “charge in on your white horse” thinking you have all the answers and force solutions on your aging parents; no matter how obvious the problems are. Help your aging parents create solutions for themselves not solutions that you think are best. Maybe it’s time for you to start thinking outside the box; become a positive influence for your aging parents. Rethink the way you’re helping your aging parent!

Aging with Autonomy in the Retirement Community


You’ve made the decision to down size and move to your senior apartment or retirement community. The estate sale is complete, furniture moved in and your name is on the door. Now is the time to create a plan that will keep you in that apartment for a very long time: A plan that allows you to maintain your independence and remain safe. We’re going to refer to this as “Aging with Autonomy” versus “Aging in Place”, which emphasizes living long term in one’s home of ownership. Your new apartment is your home now and you can live in it for a long time but you must be assertive about prevention. I like to refer to this as preventative planning in late life. If the goal is to maintain autonomy in late life, you must become pro-active about aging with autonomy.

What is autonomy? Autonomy is the state or condition of having freedom to determine one’s own actions or behaviors. In a senior community, we frame this as your right to make health care decisions for yourself, your right to have free choice with your routine and personal preferences. When this view of autonomy with its emphasis on independence, self-determination and freedom runs up against the rules of a senior living community, it can create a challenge to maintaining your autonomy.

Education + Preventative Planning = Autonomy

Barriers to Autonomy

Functional Decline:  ability to perform activities of daily living can create a dependency on caregivers and family. Safety becomes a factor and can be a pre-curser to a fall or other health crisis.

Cognitive Decline: confusion and difficulty with executive functioning puts an older adult at risk of medication errors, being taken advantage of financially or losing the ability to drive.

Loss and Grief: the consistent loss that is experienced by many older adults such as loss of a spouse, friends or other loved ones puts them at an increased risk of isolation and depression.

Facility Culture: some retirement communities take the issue of autonomy more seriously than others. Rules and regulations can create a “fall in line” mentality that chips away at an older adult’s self-esteem and ability to make choices.

These barriers to autonomy, while overwhelming, can be conquered with preventative planning. Not all aging resources are the same: individuals and communities are all different. However, there are starting points that you or your aging parent can educate yourself about. Become familiar with identifying the above barriers and educate yourself regarding community resources. Community resources that you need to know about before you need them: before your autonomy is as risk.

Overcoming Barriers to Autonomy

Functional Decline: if you notice that you or your aging parent are having a difficult time walking, getting in or out of a chair or (God forbid) have already fallen, you need to see a physical therapist immediately. The best place to start with this is your physician, as he or she will need to write an order. This type of therapy can be done on an out-patient basis and should be covered under your Medicare B. Some Medicare B therapist will come to your home; others will have an office that you will need to go to. Your retirement community may have this service available so be sure to ask them first. You need to get to the bottom of why falls, dizziness or poor balance are occurring and a physical therapist should be able to help with this.

Cognitive Decline: If you notice that you or your aging parent are getting medications confused, missing appointments or calling people in the middle of the night asking bazar questions, you need to have them screened for cognitive impairment. This type of screening and testing varies greatly from community to community but the best place to start is with your physician. If it becomes clear that you are dealing with some form of dementia, I want you to ask to see an occupational therapist. An occupational therapist can do additional screening but what they do that the doctor cannot do is translate that information to your activities of daily living and help you strategize ways to maintain your independence.  Same as with the physical therapist this service can be covered under your Medicare B, sessions can be conducted in your home or at an office. Start by talking to your retirement community.

Loss and Grief: if you or your aging parent have experienced significant losses and don’t seem to be coping well: isolation, irritation or low motivation, I want you to seek counseling. You start by talking to your physician and communicate the symptoms. The doctor may prescribe an antidepressant but where the real growth and processing can take place is with a good counselor. Although the specifications have changed lately, you may be able to have this covered under Medicare B short term. This is probably the most lacking of services available to you so you may have to play detective to find the right therapist but don’t give up. The ability to maintain a positive outlook and cope with loss can critical in maintaining autonomy.

Facility Culture: your facility may have a lot of rules that don’t make sense to you. These rules may even cause you anxiety and leave you feeling like you have no control over your life. Communicate with the administration, get involved with a resident committee, make as many choices as you can and don’t automatically take no for an answer. Talk to a counselor or find a local geriatric care manager to advocate for you. Tape the serenity prayer to the mirror in your bathroom it can come in handy.

By assessing the above barriers and creating your preventative plan, you can maximize your chances of living in your apartment for some time. It’s critical that you are pro-active, communicate your wishes and reach out for the help you need. I can’t emphasize enough the need to plan ahead because once the barriers start mounting up, without a plan; you lose your choices and autonomy. You may even be forced to re-locate to a less than desirable location…

I hope this information helps in some small way and always remember…. When in doubt, turn to your local area agency on aging. Every county has one!

You can also feel free to contact me at (970) 223-5656, luannsmith100@gmail.com or leave a comment on this blog..

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Aging Parents: Disengage


When you step in to help your aging parent, you may find yourself taking on the role of enforcer, controller or nagger. Try to see your parent as an individual and understand that this is their life. You may not like it or understand it but in the end it is their life to live. What you can do is understand your role in their life: are you their caregiver or are you their daughter. The line becomes blurred at times which can cause a great deal of stress for you, your husband, and your children.

When you find this happening, disengage: release and detach yourself from the situation.  Step back and take a look at it with fresh eyes. It may be wise to seek the help of professionals or trusted friends. Your parents have lived a life time of making decisions (good and bad), a life time of patterns (good and bad), a life time of being who they are (good and bad).  You will not change this overnight and as long as they are not putting themselves or others in danger (this is always the fine line) this is not your battle to fight for them.

My dad is a self-neglecter so believe you me I know how scary and frustrating it can be to watch your aging parent struggle. Sometimes I talk to him over the phone and worry that he doesn’t “sound good”.  The concerns start rolling over in my mind. I hope he’s taking his medicine. I wonder when the last time was he had a decent meal. I often worry about how bad it’s going to get and when I have to be more assertive about stepping in. Then I detach myself a little and really think about it (usually with my sister or best friend).

I come full circle to understanding this is who he is. He’s made choices that I am very proud of: others maybe not so much. He’s a human being in charge of his life. When he needs me, I will do my best to be there for him but until then I give what he will accept and love him unconditionally.  I never end a conversation without telling him I love him and I know for now this is the best I can do…

Aging Parents: Hospital Discharges


Hospital discharge planning is the process of developing a plan post hospitalization for an individual to receive appropriate services {think home health, rehab or nursing home}. The hospital by law must identify, at an early stage of hospitalization, all patients who are likely to suffer adverse health consequences upon discharge. For our purpose, this identification begins at the time of admission when your parent presents their Medicare card. The nuts and bolts list of what is required of the discharge plan process is very lengthy {dare I say boring} but what you need to know is this:

  •  The doctor following your parent in the hospital is the one driving the discharge time frame. If your primary care physician is not following in the hospital they cannot write orders regarding your treatment or hospital discharge.
  • That physician is very aware of the Medicare A guidelines in terms of billing and believe it or not their hands may be tied. This all relates to diagnostic related groups which you can read more about here…
  • If your hospital says to you: “I’m sorry but we’ve assessed your mother and believe she does not need a discharge plan” you can have your physician request one.
  • A discharge planner is responsible for arranging the services your parent will need at the time of discharge. Your discharge planner may be referred to as a care manager, social worker or registered nurse.
  • You have the right to appeal your discharge and there are very specific steps in place to do this. Speak with your physician, discharge planner or patient advocate for specifics.
  • The hospital indication that it’s time for discharge does not mean mom is ready to live at home independently but that the condition she was admitted for is stabilized and her time under Medicare A has come to an end.
  • Your hospital discharge planner will provide you with a list of available services i.e. home health agencies, skilled nursing facilities and can provide you with education but cannot give an opinion or recommend a specific organization.
  • Be open and honest with your discharge planner. If your dad was struggling at home before this hospital admission, he will probably need additional help {either at home, rehab or nursing home, companion care} at the time of discharge.
  • In order to receive skilled Medicare A services following the hospital admission, your mom or dad needs to be in the acute care setting for a minimum of 3 DAYS! This means that if discharge to skilled rehab happens on the 2nd day your parent will not receive inpatient Medicare A coverage for their rehab. Be aware, ask questions and advocate!

A discharge planner’s job is a pressure cooker type job with high expectations and huge case loads. I recommend that within 48 -72 hours of your parent being admitted to the hospital {depending on the situation: if it looks like a short term stay move quicker} YOU ask to speak with your discharge planner. The RN on the floor or someone at the nurses’ station should be able to provide you with the name of your discharge planner and how to get in contact with that person.

I’m happy to answer any questions you may have! Leave a comment…