The 40-70 Rule: Conversation Starters – Continued 2

A Senior Moment or Something More?

You’ve just stopped by your parents’ house for the second time in a month, noticed that your 70-year-old mother has forgotten the name of a close friend. Is it Alzheimer’s disease or dementia, a senior moment or just a passing phase? More importantly, how do you find out?

Make sure you consider your mom’s history and personality so that you can determine if this is a change. some people have always been bad with names, but if your mom is forgetting a close friend’s name and you notice signs of disorientation, you might say: “Gee Mom, perhaps you should see a doctor and get checked out. I’m sure it’s noting, but it would really put my mind at ease if you’d let a doctor make sure your memory is O.K.” Such a conversation starter focuses on the positive and not the negative.

The Medication Quagmire

When visiting you 85-year-old dad, you see bottles of medication on the kitchen counter, on the bathroom counter and on his nightstand. You wonder how he is keeping all of his medications straight. What do you ask?

It’s good to use humor and, in a situation like this, to assume that he is keeping them straight (innocent until proven guilty). There may be good reasons why some of his medications are in the kitchen (he’s taking them with food), while others are on the nightstand (he’s taking them before bed).

Pointing to a bottle and asking, “How the heck do you keep all these pills straight, Dad?” would be a good conversation starter. If the response includes the reasons you suspected above, then it sounds like things are under control. If, however, he says, “I don’t know. I do my best. I’m not even sure what some of them are,” then the situation probably needs more attention.

If he’s having a problem, talk to him about a pill organizer, which could help him keep his medications better organized: “Dad, I’ve heard about organizers that can help you keep your pills in one place and make it easier for you to keep them straight. Why don’t I check into it?” In addition, one service that Home Instead CAREGivers provide seniors is medication reminders to assist them in managing their daily medications.

The 40-70 Rule: Conversation Starters-Continued

You’re Going to Wear That?

You’re planning a birthday party for your 85-year-old mother and she insists on wearing her favorite blue dress. Because her eyesight is poor, she can’t see that the dress is stained and worn. What do you do?

It’s important to determine whether this is really an issue – that the stains are worth addressing with your mother. If so, be direct: “Mom, did you know that your party dress is stained?” Then offer to have it cleaned or, better yet, suggest a shopping trip: “Mom, this is a really special occasion. I’d love to buy you a new outfit. Let’s go shopping.”

If she still wants to wear the dress, then a family council or a fight with your mom is simply not worth it. You may need to figure out a way to overcome any embarrassment that you feel at your mom’s appearance, but ultimately what she wears should be her choice. The embarrassment that you feel is your problem, not hers. Chances are, though, if she knows you are apprehensive about the dress and willing to help her find a new one, she will agree.

When the House Is a Mess

You find that your 77-year-old mother’s house is often in disarray when you visit. You believe it’s time for her to make a change in her living arrangement. What do you say?

Observation and careful attention to the problem should be your first course of action. Avoiding diagnosing a problem and deciding on a solution quickly. Approach your mother with a sense of working together to find a solution rather that telling her what to do.

The specific circumstances – such as financial constraints – may be relevant. Is the problem simply that your mother is physically challenged by strenuous housework or is she deteriorating mentally? Does she just need help tidying up around the house or are other aspects of her personal care, such as bathing, going downhill?

Assuming that the problem is physical – where activities such as vacuuming or bending are becoming issues – then begin the conversation with an offer: “Mom, I have some extra cash. What do you say we find someone to help you with the heavy stuff, like vacuuming? It will be my treat.” Seniors are often very willing to accept help around the house. And most communities have ample resources such as cleaning services and companies like Home Instead Senior Care that can help.

The 40-70 Rule: Conversation Starters

To help adult children of older adults know what to say, following are various scenarios of common senior topics. Each backed by Home Instead Senior Care research conducted by U.S. Responses were developed in cooperation with Jake Harwood, Ph.D., communication professor and author from the university of Arizona.

When Health Changes Lifestyles

Your 70-year-old widowed mother has just been diagnosed with macular degeneration, a disease that causes deterioration of eyesight. How do you begin a conversation with her about the possible ramifications of this disease on her life?

Many seniors in this situation might begin the conversation with family themselves. If not, then it would be good to think about her personal circumstances and important areas to address. For example, if your mother lives in a remote area, transportation is probably the most immediate issue. Approach the conversation with the goal of trying to resolve this one issue, rather than multiple issues.

Timing is the key. There are rarely urgent deadlines that have to be met immediately – give yourself and your parent time to think about issues. Your mom would likely be receptive to a conversation that begins: “Let’s figure out a plan for how you can get around town if you no longer feel safe driving.”

Did Dad Hit a Light Pole?

A neighbor of your 83-year-old dad has called to tell you he saw your father back his car into a light pole. What do you say?

If the damage is visible, you could ask, “Hey Dad, what happened to your car?” Or you could bring up the phone call from his neighbor. “Fred from next door called and said he saw you run your car into the light pole.” This is an example of a situation that calls for more general observation. Take the opportunity to drive with your parent. Even a short drive would help you gauge your dad’s skills and deficits.

For instance, an older adult who consciously reduces driving at night because of vision issues or who drives a little slower to account for reaction time is probably safe. On the other hand, an 83-year-old who insists on driving icy highways at night while doing 75 mph is probably in need of immediate intervention. Then gear your comments accordingly. If you’re concerned that your dad is unsafe on the roads, make his safety and that of others your focus. “Dad, I’m worried that you’re no longer safe on the roads and that others could be at risk as well.”

The 40-70 Rule: Seven Tips to Help Boomer Children Communicate With Their Aging Parents

Many adult children of aging adults know how difficult it can be to talk with their parents about certain topics. Following, from Home Instead Senior Care and communication expert Jake Hardwood, Ph.D., from the University of Arizona, are tips to help family caregivers communicate with their aging parents on sensitive subjects.

1. Get Started. If you’re 40 or your parents are 70, it’s time to start observing and gathering information carefully and thoughtfully. Don’t reach a conclusion from a single observation and decide on the best solution until you have gathered information with an open mind and talked with your parents.
2. Talk it out. Approach your parents with a conversation. Discuss what you’ve observed and ask your parents what they think is going on. If you parents acknowledge the situation, ask what they think would be good solutions. IF you parents don’t recognize a problem, use concrete examples to support your case.
3. Sooner is best. Talk sooner rather than later when a crisis has occurred. If you know your loved one has poor eyesight or has trouble driving at night, begin to address those issues before a problem arises.
4. Forget the baby talk. Remember you are talking to an adult, not a child. Patronizing speech or baby talk will put older adults on the defensive and convey a lack of respect for them. Put yourself in your parents’ shoes and think of how you would want to be addressed in the situation.
5. Maximize independence. Always try to move toward solutions that provide the maximum amount of independence for the older person. Look for answers that optimize strengths and compensate for problems. For instance, if your loved ones need help at home, look for tools that can help them maintain their strengths. Professional caregiving services, such as those offered by Home Instead Senior Care, provide assistance in a number of areas including meal preparation, light housekeeping or medication reminders. Or find friends who can help.
6. Be aware of the whole situation. If you dad dies and soon afterward your mom’s house seems to be in disarray, it’s probably not because she suddenly became ill. It’s much more likely to stem from a lack of social support and the loss of a life-long relationship. Make sure that your mom has friends and a social life.
7. Ask for help. Many of the issues of aging can be solved by providing parents with the support they need to continue to maintain their independence. Resources such as Home Instead Senior Care, Are Agencies on Aging and local senior centers can help provide those solutions.

Returning Home: Medication Management

Medication mismanagement is one of the leading problems that sidelines a senior’s successful recovery.

Nearly 120,000 patients each year need to be hospitalized for treatment after emergency visits for adverse drug events, reports the Centers for Disease Control. As more people take additional medications, the risk of adverse events may increase.

Why Seniors Are Vulnerable

Although many seniors take regular medications, a recent hospital stay could result in new and unfamiliar prescriptions. Taking the right medication at the proper time and in the correct dosage is important to keeping an older adult on the road to recovery.

Following are key tasks that older adults returning home often need assistance with to ensure they remain safe and on track:

• Picking up prescriptions from the pharmacy.
• Ensuring medication is taken.
• Refilling prescriptions. (It’s best to go to a senior’s regular pharmacy to avoid adverse reactions from a combination of drugs prescribed by different sources such as hospital and primary care physician.)
• Organizing pills to ensure that confusion doesn’t lead to a medication mishap. A pill box can help track whether a senior has taken his or her medications. Some pharmacies will fill a pill box and others offer a service that seals each day’s medications in a blister pack.
• Tracking medications to help older adults more easily manage their health.

Make sure your senior has the support he or she needs to manage the tasks above.

Senior Emergency Kit

Whether accompanying your loved one to a doctor’s appointment or in response to a medical crisis, it’s critical to have your loved one’s medical information easily and quickly accessible.

The Senior Emergency Kit features several worksheets that family caregivers can complete with the help of a senior loved one. This toolkit can be kept in an easy-to-reach location, such as a nightstand, to allow easy access to information.

Returning Home: The Next 30 Days

As your senior loved one starts feeling better, returning to a more normal routine will likely be a welcome outcome. Experts generally agree that first 30 days are a critical time for hospital readmissions. Even with good progress, though, a senior who has been in a hospital or facility for some time could be having difficulty returning to “functional status.”

This status refers to the ability of a senior to perform tasks that are typical of a daily routine. These tasks are usually referred to as “activities of daily living” or ADLs. The self-care tasks (eating, bathing, dressing, toileting, transferring (walking) and continence) are especially important, because these are the basic ADLs considered essential for independent living.

Health-care providers usually ask whether the person requires help from someone else to complete these basic tasks. They will also ask about the person’s ability to manage household affairs, such as using the telephone, stove or washer. These are called instrumental activities of daily living (IADLS.)

Even seniors who are healthy sometimes need help with these activities. And, often, those who have been in a hospital or facility need extra help to be able to take care of the typical tasks that healthy individual can take for granted.

Returning Home: Time to go Home

It’s the day you and your senior have undoubtedly waited for: time to go home! All hospitals and facilities have their own patient discharge procedures but, regardless of their policies, you can be better prepared by ensuring that you have all you and your senior need to be ready when you step out the door.

Following is a checklist adapted from the Centers for Medicare and Medicaid Services* that can help ensure that you and a loved on haven’t forgotten anything:

• Confirm where you loved one will be going – back home or to a rehabilitation facility or care community.
• Ask staff what your loved one can do to get better.
• Ask about problems to watch for and what to do about them. Write down a name and phone number to call if you have problems.
• Review with medical staff the list of drugs, vitamins and herbal supplements your senior loved one will be taking. Write down a name and number to call if you have problems.
• Confirm the medical equipment your senior will need. Write down a name and phone number to call if you have questions about the equipment.
• Ask if your senior will need help with the following:
  • Bathing, dressing, using the bathroom or climbing stairs.
  • Cooking, food shopping, house cleaning, laundry, and paying bills.
  • Getting to doctors’ appointments, picking up prescription drugs.
• Ask staff to show you and your senior any tasks that requires special skills such as changing a bandage or taking medication.
• Ask the social worker any final questions about what insurance will cover. If you need help with costs, ask about your options.
• Ask for written discharge instructions and a summary of current health status. Bring this information and list of medications for follow-up appointments.
• Write down any appointments in the coming weeks.
• Get prescriptions and any special diet instructions.

Being prepared will help make you a more confident caregiver and put your loved one at ease.

If you can’t be there when an older loved one goes home from the hospital, a CAREgiver from the Home Instead Senior Care network’s Returning Home program can assist.

Returning Home: Ask Questions

Even before you know how long a loved one might need to be in a hospital or facility, start working with medical professionals. Get the lay of the land, as they say. Early on, it’s important to ask questions – and lots of them – of key people caring for your older loved one.

The questions and the answers you receive will help determine what that older adult will need at home and the schedule he or she must follow for a smooth transition. Some of the questions can be difficult to ask such as, “Will my loved one ever be the same?” But it will be vital to know the answers if that senior can expect the best possible outcome.

The Right Questions

Ask your medical team – whether it’s doctors, nurses or rehabilitation professionals – these questions about your senior:

• What time of day does the doctor make rounds so I won’t miss him or her with my questions?
• What is the prognosis? What is the likely outcome? Will my loved one recover?
• How long will my senior be in the hospital or facility?
• What condition will my senior likely be in when released?
• Will my loved one go straight home or to another facility?
• How much will my loved one be able to do when he gets home?
• What are the warning signs that my loved one needs help?
• Can my loved one be home alone? If not, how much help will she need and for how long?
• If I am the primary family caregiver, how much help will I need?
• What type of equipment – and care – will my loved one need at home?
• Will I need a prescription for any of this equipment or care?
• How many follow-up appointments will be needed and how soon do you need to see my loved one?

Social workers and case managers can help put a discharge plan into action. A social worker is a professional who provides counseling, guidance and assistance, and can help a senior focus on his or her environment. Social workers often work hand-in-hand with case managers who assist in the planning, coordination, monitoring and evaluation of medical services for a patient with an emphasis on quality care.

You can ask these professionals:

• Where do I go to set up durable power of attorney for health care? (Your loved one should establish this legal instrument that allows patients to select the person they want to make health-care decisions for them if they are unable to do so)
• Who is assigned to my loved one’s care?
• What is the best facility for my senior if he can’t go directly home?
• What will my loved one’s insurance cover?
• Do I have options, and what are they?
• Will my loved one need home health care or palliative or hospice care and, if so, will I need a prescription?
• Will my senior need support for activities of daily living?
• What if my loved one is the one returning home and she’s been caring for her spouse with dementia? How do I get them both help?
• What are the best resources that can meet my loved one’s needs?
• Where do I go to find these resources?
• Where can I find the equipment that I need?
• If it’s not covered by insurance, how will it cost and are alternative funding resources available?
• If my loved on need in-home care, what are my options? (Hospitals won’t recommend, but they will provide options and background information.)

When you know the score, it’s time to begin planning just what your loved one needs to return safely home.

Returning home: Introduction

Start Planning Now

When a doctor admits your loved one to a hospital or facility it’s often a traumatic experience, whether you were expecting it or not.

And, as a family caregiver, it’s unlikely that you’re thinking too far ahead. Just get through one day at a time, right?

However, while a senior is still in the hospital or rehabilitation facility, it’s important to begin preparations for the time your loved one will return home. That’s because a smooth transition home is vital to a successful recovery. Consider this:

• Nearly 20 (19.6%) of Medicare patients discharge from the hospital are readmitted within 30 days of discharge, accounting for $17.4 billion of spending, according to the New England Journal of Medicine.*
• One chronic condition that often sends older adults back to the hospital is heart issues. In fact, approximately 30 to 40% of patients with heart failure are readmitted within six months of hospitalization.**

Many issues factor into why older adults are vulnerable to problems at home after they have been in a hospital or rehabilitation setting.

“The key issues that send seniors back to the hospital are medication problems, falls in the home and not following up with the doctor,” said Lanita Knote, President of the American Association of Managed Care Nurses.

Add to that list home safety issues, nutrition and hydration challenges, and overwhelming responsibilities for the primary family caregiver, seniors and their families can face a difficult road ahead.

Planning during a crisis is never as effective as being prepared in advance. Preparations is your best strategy for avoiding the many pitfalls that can sabotage your senior’s health and well-being when he or she goes home.

The Home Care Solution: Who to Call for Home Health Care

When hiring home health care, seek out a licensed medical caregivers designated as ‘home health agency,’ advises James Summerfelt, chief executive officer of the Visiting Nurse Association. “The term often indicates the provider is Medicare-certified and has met minimum federal requirements for patient care and management.”

Eligibility for Home Health Care under Medicare is Determined By the Following:

• You must require intermittent skilled nursing care, physical therapy or speech therapy.
• You must be homebound.
• You must currently be under a physician’s care. All home health services must be ordered by your physician.

Services are delivered at home to recovering, disabled, chronically or terminally ill persons in need of medical, nursing, social, or therapeutic treatment and/or assistance with the essential activities of daily living.

When interviewing an agency make sure you understand exactly what services it will provide and those it will not provide, including those it is forbidden to provide by state law. Families are allowed to provide any care for a family member, but professionals have to abide by state law. For instance, in many states, invasive procedures such as injections and maintenance of feeding tubes may not be administered by non-skilled professionals. You may need a doctor or a nurse to perform these procedures.*

Questions to ask a home health care provider:

• Is the home health care agency Medicare-certified? That means it is approved to provide services to patients with Medicare.
• Does the home health care agency offer a full range of home health care services including skilled nursing, physical, occupational and speech therapies, IV therapy and home health aides.
• How do I receive home health care agency services? A referral van be made by anyone involved in a patient’s care – physician, family or others. If someone other than a physician makes referrals, many home health care agencies contact the patient’s physician to approve orders for service.
• Does the hospital discharge planned, doctor or social worker recommend the home health care agency? Those recommendations can serve as a second reference.
• Does the home health care agency have the staff available at nights and on the weekends for emergencies?
• Where else could I find information about Medicare-Certified home health care agencies?
• Does the home health care agency have staff available to provide the type and hours of care as prescribed by the physician?

Information about Medicare-certified agencies in you geographic area are available online at www.medicare.gov, including Home Health Compare, which allows you to compare the home health care agencies in your area. You can also call 1-800-MEDICARE for more information.