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When a Loved One Dies: What to Do Before & After, Part II

Frau legt Blumen auf GrabIn Part I of this blog, I gave a brief review of what took place during the last 6 weeks of my dad’s life and included a list of some things that can be done to make the last stages of a loved one’s life easier for caregivers, family members and the person who is nearing the end of his or her life. In Part II, I’ll review what I and my siblings have gone through in the almost 3 months since Dad died on Jan. 4 at age 97.

Mom died 20 years ago. We were happy with the mortuary that took care of her, so the first task upon arriving at Dad’s senior living apartment late that snowing night was to call them. They said they would be there within an hour, and they were. While waiting, we began notifying other family members.

Note: An important thing to be aware of is what the laws of your state are and the policies of the care center–if you are using one–regarding authenticating a death by natural causes. In Utah, where I live, if Dad had not been on hospice care with a Dr. assigned to him, the center would have had to call 911 and have paramedics take him to the hospital so a doctor there could verify that they were not in any way responsible for his death. This was one reason we were repeatedly encouraged to put him on hospice. That would not have been true had he died in his own home.

The Funeral or Memorial Service

The following day, immediate family members in the area met at the mortuary to discuss our plans for Dad’s care and services. They had determined the night before that we wanted embalming to be part of that care. (The family needs to have agreed before a loved one dies whether the choice is embalming or cremation.) I was relieved to find out that the mortuary notifies Social Security of a death and also orders death certificates. Whoever is handling the estate should have some idea of how many to order, as there is a charge for each one. Other things discussed were:

  • The date, time and location for a wake/viewing and funeral.
  • Who would provide program information, formatting and printing for the funeral.
  • If an obituary was to appear in the paper &/or online and when. The obituary could be written and agreed upon by family in advance of a loved one’s death.
  • If there would be graveside services.
  • Because Dad was a Veteran, if we wanted military honors to be part of the services (a flag draped over the casket, members of the armed services to be at the graveside, etc. We couldn’t find Dad’s WWII discharge papers, so a flag was our only option.)
  • Our choice of a casket (also something that can be done ahead of time) and a headstone. (Because Mom preceded Dad in death, we already had a headstone in place. His death date just had to be added).

Depending on your religious and family traditions, other things might need to be decided, like who will participate in the funeral, be pallbearers, etc. Dad had made some funeral plans years ago, but not all of them could be carried out. All 9 siblings were involved in those decisions, which became a little tricky at times, but fortunately, everyone agreed that when they were over, Dad’s viewing, funeral (church service) and graveside service were everything they’d hoped.

The Estate

After the services, came the tough decisions regarding what to do with Dad’s possessions and monetary assets. The first thing we had to do was to move his furniture and belongings out of his care center apartment so that rent charges would end. There were also many possessions still in the condo he had shared with his wife but left behind when he moved to the care center. Fortunately, everyone agreed to a random order of selection that gave each sibling a chance to take turns choosing the things they &/or their children wanted. The things no one wanted were donated to charity. We did not have a home to sell.

Because Dad had set up a family trust with me and one of my brothers as the trustees/executors of the estate, and he also had a Prenuptial Agreement with his third wife and a Will, some things went more smoothly than they might have. I had been handling all of Dad’s finances for some time, and had consolidated his accounts and assets as much as possible. We are still relying on the help of our investment counselor and the accountant who has prepared Dad’s taxes over the years. It may be necessary for you to involve an attorney, as well, depending on your family’s situation. Even though Dad only lived for 4 days of 2017, his Social Security and annuity payments for January were still considered “his.” We will have to file State, Federal and Estate returns for 2017, so some of his assets have to be held back to pay taxes and administrative and accounting fees. As a family, we are so fortunate that Dad left us with an inheritance rather than debts. That would involve another set of challenges.

Last week I finally got all of the required tax forms and information for 2016 to the accountant. We’ve distributed most of the monetary assets, making a distinction to the beneficiaries as to what amounts will be taxable and what will not, so money can be set aside by those individuals to pay taxes as their tax bracket dictates. There will still be a meeting with the accountant notifying him to whom the assets were distributed, so he can file K-1 (Estate Tax) forms for each one at the end of this tax year, and so 2017 tax forms can be completed as needed. I still have thank you notes to write and mailing addresses to change.  Other than that, we are left with just the many memories of our Dad, the long life he lived and the hope and faith that we will all see him again when it is our turn to pass on.

Summary: (Do as much as you can before your loved one dies.)

  • Select/Call the mortuary of your choice.
  • If a Dr. is not present, know the laws of your state for authenticating the cause of death.
  • Meet with the mortuary to plan services and burial/cremation, order death certificates, verify Vet status, select a casket and headstone where applicable.
  • Write an obituary and arrange for publication or posting on a website.
  • Plan funeral/memorial/graveside services.
  • Find important documents: trust, will, POA, living will, life insurance policies, annuities, etc. (Where possible, help your loved one get their affairs in order and these documents created/located while they can still participate!)
  • Devise a system for amicably dividing up possessions between family members.
  • Use professional help, as needed, for handling monetary assets/debts and tax issues (financial planner, investment counselor, accountant, attorney).
  • Notify the post office and others who will be sending mail to the deceased where to send it now.
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When a Loved One Dies: What to Do Before & After, Part 1

nursing homeMy 97-year-old father died on January 4, 2017. If you regularly follow this blog, you already know quite a bit about his struggles to stay alive the past two years. On most days, he soldiered bravely on, saying his goal was to “make it to 100!” But after Thanksgiving, he began a steady decline, making it more and more difficult for him to eat, breathe and get around. He frequently said “I’m done!” and “Just send me to the Other Side.” He also said he knew “We don’t get to choose when we go!”

Knowing he had lost the will to live, and as the family member with the POA over his care, I had some difficult decisions to make. The senior care center where he lived helped me connect with a Dr. who made “house calls” and also worked with a Hospice provider. Once your loved one is on hospice care, a Dr. will be part of the team, but because Hospice would stop Dad’s diabetic care, which he was getting through a home care agency, I put off switching immediately from Home Care to Hospice.

Dad, the doctor and I sat together and updated Dad’s Care Provisions. Dad was adamant that there would be “no more hospitals,” so we added that to DNR and “no extreme measures,” along with a provision for no antibiotics. Dad was highly prone to aspirational pneumonia, which he’d had 7 times, so it was presumed that would be his cause of death. He was aware of what trying to save him from that would involve, and decided that he wanted to die at home. A copy of the provisions was hung on his door, where it would be easily accessible.

I alerted immediate family members to Dad’s steady decline and his wishes, and most of them came to visit with him sometime during the Holidays while he was still alert and able to recognize his 9 children. He was able to be at the home of one of my brothers for Christmas, and we helped fill one of Dad’s last wishes by taking him on 2 drives to see Christmas lights.

The aides and CNAs at the care center were made aware of Dad’s care provisions and failing health, and they increased their surveillance and assistance. Dad was only in pain when he tried to get up and walk, so we refused opioid pain killers for the time being, as we knew they would increase his risk of falling.

On Mon. Jan. 2, I visited Dad at his dinner hour and was told that he had eaten almost nothing all day. He also seemed to be hallucinating, seeing and hearing things that weren’t there. That was a symptom when he’d had pneumonia before. Because he wasn’t eating, insulin for his diabetes was no longer an issue. The next morning I called the hospice nurse and told her we were ready to switch. Before I could get myself over to Dad’s apartment, hospice people were there setting up a hospital bed and arranging for their own oxygen supplier to provide Dad’s 24/7 oxygen.

Although hospice care doesn’t provide medication to effect a cure, they will provide whatever is necessary for comfort care, and oxygen is considered one of those things. The nurse also said that even though he wasn’t in pain, morphine would help to relax his muscles and blood vessels, making it easier for him to breathe. Dad’s breathing became more labored throughout the day, and when the morphine was finally administered, for a while there was a noticeable change for the better. Even though he wasn’t talking, the nurse said he probably could still hear, so we gave family members who couldn’t get there a chance to say goodbye with the phone to his ear.

We were told that Dad could live for several days like this, so when he didn’t seem to be responding at all, we went home that evening to try to get some sleep. We came back the next morning and “sat vigil” all day. By evening, even with the morphine, his breathing was very labored. We were again advised that he could live through the night, and that sometimes a dying person will wait until their loved ones have gone before they let go of this life. Because a snow storm was threatening to make travel impossible, I slowly made my way home up slippery hills. I had just gotten into bed when the Care Center called to say “He’s gone.” I made my way back through the snow, and found the hospice nurse already there. She assured me that I didn’t need to feel bad about not being there at the moment of his passing, that maybe I had to go before he could “go,” too.

I felt more relief than sadness to see that Dad was no longer struggling to breathe, and my religious beliefs helped me to know that he was in a “better place,” freed from his worn out body. However, I know that everyone experiences the death of a loved one and grieving in their own way.

In a future blog, I’ll share my experiences and what I learned about what needs to be done after a loved one dies.

Summary:

  • Update your loved one’s Care Provisions. Put the document where it can be easily seen.
  • Ensure a family member has the legal right to make medical decisions for your dying loved one.
  • Talk with a Dr. about certifying the need for Hospice or comfort-only care, and decide who you will call. If your loved one has Home Care, that agency might be able to provide Hospice Care.
  • Keep family members updated on your loved one’s condition, and when they can visit.
  • Allow comfort care, as needed. This is not the time to worry about drug addiction.
  • Be aware that refusing to eat and difficulty breathing can be normal end-of-life signs.
  • Get a doctor’s confirmation that it’s time to follow the dying person’s last wishes, whether they be to maintain life in any way possible, or to take no extreme measures.
  • Even though he or she can’t respond, talk to your loved one. Hearing can be the last sense to go.
  • Don’t feel like you have to be there the moment your loved one dies. Sometimes they won’t “leave” until you do.

By Marti Lythgoe, DTN Home Care Writer/Editor

Why Seniors Don’t Want to Eat & What You Can Do About It

Old woman eating at homeMany seniors are not eating a balanced diet as they age, no matter whether they live on their own, with family or in a senior living facility. Seniors who live alone are at increased risk because there is no one to observe their eating habits. There are many causes for seniors who are under-eating, over-eating or not eating nutritious meals.

By the time he was 97, my father had multiple problems that made it difficult for him to eat a balanced diet. During the last few months of his life, the only thing he ate willingly was strawberry ice cream. The assisted living center he called home provided 3 nutritious meals a day and snacks in between meals on request. They were very accommodating with his diet–limiting sweets and carbs, cutting everything into small pieces and eliminating foods known to be a choking or swallowing hazard. However, unless a family member was there with him at meal time to encourage him to eat or even help to feed him, he rarely ate vegetables and expended most of his energy and appetite on small bites of protein and the ice cream that easily slipped down his throat.

Causes of poor nutrition

Some of Dad’s problems could be similar to what’s causing your elderly loved one to under-eat, over-eat or not eat a balanced diet. Watch for these risks and hazards interfering with a balanced diet, and consider what can be done to prevent or get around them:

  • Poor appetite – not motivated to eat: Many seniors’ sense of smell and taste diminish with age. Nothing looks good or tastes good, and often times there’s no one there to direct them toward healthy choices and encourage them to “eat to live.” They often don’t associate what they are eating with how they feel or could feel. They don’t even feel hungry. We continually reminded Dad of the relationship between his diabetes and his need eat in order to increase his energy level.
  • Nothing looks good: Especially if someone else is fixing them food they’re not used to, seniors might not recognize the food they’re given and resist trying it. Even when familiar food was cut into small pieces for Dad, he would often say, “What in the world is that?” We would have to tell him before he would try it. When we were growing up, we had a large vegetable garden and ate meat sparingly. But somehow in his later years Dad lost his appetite for anything green and insisted that at his age he shouldn’t have to eat vegetables! Broccoli was the worst!
  • Swallowing problems, choking and food aspiration: Just like other parts of our body, throat muscles and valves can wear out and cease to function normally. Food may go only part of the way down and have a hard time getting into the stomach. Problems with the trachea (windpipe) can include narrowing, inflammation and even failure to close while swallowing. Problems with throat muscles and valves can cause food aspiration and choking. Seniors become fearful of eating for fear of choking to death.
  • Fatigue—too much effort, lack of eye-hand coordination: Sometimes an elderly person feels too fatigued to get out of bed to eat breakfast, starting a downward cycle of energy loss. Even the act of getting food to the mouth or chewing can seem like too much of an effort, especially when not driven by hunger. Embarrassment over spilling can also be a deterrent.
  • Missing or broken teeth/chewing problems: Some seniors have missing or broken teeth that make chewing difficult. Others have dentures, but find them uncomfortable and not as easy to chew with as their original teeth. It may be difficult to get them to brush regularly, but regular trips to the dentist for cleanings and smoothing of rough edges can help.
  • Medication side-effects: Sometimes medications can affect appetite or interfere with digestion. Check with the Dr. to rule this out as a cause and to determine what supplements might be helpful. 

Strategies to Try:

  • A 91-year-old friend of mine likes foods that are spicy or sour. Try adding herbs and spices to food, or try foods that are naturally more flavorful.
  • If your loved one lives in a facility and can go out, try taking him or her to a restaurant or to your house for a home-cooked meal—someplace where food is likely to smell and look different. Sometimes we brought in take-out in for Dad. He ate a huge meal at my house on Thanksgiving, but he was too weak to come often.
  • A speech therapist can help to diagnose swallowing or aspiration problems. Stretching the trachea or esophagus may help. Swallowing exercises and strategies can sometimes shorten choking episodes. Avoiding foods with crumbs like toast, breading, ground beef or cookies, may eliminate some hazards. A Dr. may prescribe drinking only thickened liquids and cutting food into small pieces. Having a caregiver present at meals to act as a coach can often help. Dad had a hard time remembering the strategies he was taught.
  • A glass of juice or a protein drink consumed while still in bed might jumpstart someone without the energy to get up or move to a table. Sometimes help with eating is needed. Soup or stew could be served in a mug, enabling the food to be brought closer to the mouth without spilling. More activity can equal more energy and enhance appetite. An in-house physical therapist can suggest low-stress exercises appropriate to a person’s age and health.
  • If your loved one is in a facility, talk with the staff to see what they’ve observed. Join him or her for some meals to see for yourself what is happening. Whole-meal drinks like Boost or Ensure can supplement a diet that is poor in nutrients.
  • Hire a home care aide who can shop and cook and sit with your senior during meals. Sometime loneliness or depression can cause a person to not want to eat. Dakota Travel Nurse Home Care provides home health aide services to individuals who need assistance with activities of daily living. Services can be provided as little as one hour per visit or up to 24 hours per day. Home Health Aides can assist with meals and companionship and a whole list of other things.

Call Dakota Travel Nurse Home Care today for a free, in-home evaluation of services needed. 701.663.5373

by Marti Lythgoe, DTN HC Writer/Editor

Home Care: the preferred & most affordable long-term care option

Lovely Patient and DoctorOne out of two North Dakotans will need long-term care sometime during their lives. North Dakota ranks 7th in the nation in the highest proportion of individuals age 85 and older, with 14.2% of the population made up of individuals 65 and older. If you have a spouse, the overall risk that one of you will need long-term care during your lifetime is 65%. It’s only smart to make decisions for yourself and your loved ones as to what you will do when more care is needed than a family can give.

When the Time Comes

Of course, you won’t know until the time comes how much care will be required, but knowing what’s available for all levels of care can help you start looking and preparing financially now for the various long-term care options you may need. See our blog “Is Long-Term Care Insurance Right for Me?” to learn more about one financial-planning alternative.

We compared the four types of long-term care and have compiled an estimate as to what each of them will cost as of the beginning of 2017based on the 2016 average. However, depending on which part of ND you live in and your individual care needs, costs can vary widely. Don’t take our word for it. Use this information as a basis to make some calls and compare services and costs for yourself.

Nursing Facilities

Most residents of a nursing facility are admitted after a hospital stay or directly from their homes. They need 24-hour skilled nursing care for complex medical needs. The average length of stay is less than a year.

  1. The average cost of a room for one day in a nursing facility was $258.78 or x 30 days = $7,763.40 per month. Nursing facilities are allowed to charge extra for a private room and services. The average daily additional charge for a private room was $13.31 but varied based upon size and location of the room.

A list of ND Nursing Facilities and the cost range from low to high can be found here. It comes from the ND Dept. of Human Services – Division of Medical Services. The list includes these Bismarck facilities and their cost range as of 1/1/17:

  • Bismarck Baptist Health Care Center $196.66 – $551.32
  • Bismarck Good Samaritan Society, Bismarck             $211.27 – $628.96
  • Bismarck Missouri Slope Lutheran Care Center $193.00 – $633.74
  • Bismarck Sanford Health, St. Vincent’s Care Center $181.47 – $622.21
  • Bismarck St. Gabriel’s Community $220.93 – $639.79

Assisted Living Facilities

Assistance with daily care, social opportunities and activities, and the need for supervision are the top issues considered when moving into an assisted living facility. Most offer a full range of services from bathing to medication management to hospice care, but the level and cost of services can vary from place to place.

  1. The average charge for rent in a one-bedroom assisted living facility was $2,341 per month, with a very broad range of $923 to $4,380 per month. Not included in rent is an average service package of $1,017, with a range of $13 to $4,000 per month. Some facilities have fixed services fee, while others charge on a sliding scale, based on the level of care needed.

The cost of assisted living is dependent on the size of the living space, the location in North Dakota, and the amenities in the rental package. Most tenants pay for rent and services from their own private funds, with long-term care insurance assisting in 23% of the cases.

Basic Care Facilities

A basic care facility provides 24-hour supervision in residential-type private and semi-private rooms. Most residents need assistance and supervision and suffer from confusion. An all-inclusive rate provides room, meals, personal care services, supervision, activities, transportation, medication administration, nursing assessment and care planning.

  1. The average cost of basic care was $3,668 per month, with a range of $2,300 to $5,100 per month. More than half (57%) of the residents living in basic care need Medicaid or other assistance to pay for their care. Only 10% of residents have LTC insurance.

One-third of reporting basic care facilities charge extra for a private room. The average additional daily cost for a private room is $8.53 per day, with a range of $1.18 to $25.00 per day. A little over half (56%) of the reporting Basic Care Facilities charge the private-pay residents more than those on assistance. Of those charging more, the range was 1 cent per day to $82.00 per day.

Home Care

For seniors who would like to live in their own homes, but who require assistance with daily living activities, home care is a great option. Agency services are provided based on individual needs. Care provided can be as little as one-hour-per visit or 24-hours-a-day. Care can be provided by a companion, certified home health aide or registered nurse depending on individual needs. The cost varies based on frequency of care and certification level of the caregiver.

  1. The average hourly rate for in-home care across the state is $25 per hour. The average daily rate for 24-hour care is $300 per day. For more information on the cost of in-home care services in North Dakota, visit http://www.dibbern.com/home-health-care-costs/cost-for-north-dakota-home-health-care.htm

Dakota Travel Nurse Home Care offers services ranging from skilled-nursing care to housekeeping. Home health aides can assist with daily activities such as bathing, continence, dressing and grooming, housekeeping, shopping and companionship. Skilled nursing care can be provided by an RN or LPN when ordered by a physician for a patient with a chronic condition requiring ongoing medical care.

Every situation is different. Be sure the home care agency you choose assigns an experienced registered nurse to visit your home, evaluate and assess the patient’s and the family’s needs, and draft an individualized plan of care.

Never too Soon

It’s never too soon to learn more about the facilities and services that will be available as you or a loved one ages and needs more assistance. The following resources and others available online will help you to formulate a plan for now or for the future:

Resources:

 

10 Risks & Tips for Keeping Seniors Healthy and Safe in Winter Weather

Senior man in winterCold and snowy winter weather can cause health and safety concerns for seniors and their caregivers. If you worry about your loved one being alone, homebound or going out in the cold, here are 10 risks family members and home health aides should watch out for, and related tips for prevention.

  1. Falls outdoors. Many seniors have difficulty walking due to arthritis, results of a stroke or other illnesses. A single fall can cause a life-threatening injury. To help avoid falls, seniors should wear appropriate shoes outdoors. Make surfaces less slippery by putting road salt, sand or kitty litter on sidewalks and driveways. Whenever possible, get help with chores that involve being outdoors.
  2. Hypothermia. An elderly person who goes outside in winter without proper clothing can quickly fall victim to frostbite or hypothermia (body temperature below 95 degrees [35° C] and can’t produce enough energy to stay warm.) Inadequate indoor heat also can cause hypothermia. Keep home temperatures above 65 degrees and dress the person in layers. Do not rely on shivering alone as a warning sign, since seniors tend to shiver less or not at all as their body temperature drops. Call 911 if you think someone has hypothermia.
  3. Frostbite can cause damage to the skin and even to the bone. It usually affects the nose, ears, cheeks, chin, fingers, and toes, and can even result in loss of limbs. Seniors with heart disease and other circulation problems are especially at risk. Prevention includes covering up all parts of the body when going outside. If skin turns red, dark or starts to hurt, go inside right away. If frostbite occurs, place frostbitten parts of the body in warm (not hot) water, and call for medical help.
  4. Carbon monoxide poisoning. If your loved one’s home is heated with a fireplace, gas furnace or gas-powered space heater, invest in carbon monoxide detectors. They can be purchased at a home improvement store for as little as $30. Carbon monoxide in the air can displace the oxygen in the blood stream and cause headache, dizziness, nausea, convulsions and even death within two hours. The effects can be even faster for people with heart or respiratory illnesses.
  5. High blood pressure and heart attacks. Cold weather causes blood vessels to constrict, which increases the risk of heart attack for people with heart disease or other conditions that strain the heart’s ability to pump blood. The heart has to work harder to maintain body heat, while falling temperatures may cause an unhealthy rise in high blood pressure, especially in seniors. This is another reason to keep the elderly inside and warm.
  6. Influenza can more easily result in pneumonia in seniors. Flu and pneumonia vaccines, while not 100% effective in preventing those illnesses, can reduce the severity of the symptoms and protect against complications. Vaccines are strongly recommended for persons 65+ years old and those who suffer from chronic health problems such as heart disease, respiratory problems, renal disease, diabetes, anemia, or any disease that weakens the body’s immune system. Because the influenza vaccine is only effective for one year and viruses vary annually, it is necessary to get a flu shot every year. It takes about two weeks to develop full immunity.
  7. Painful joints. While many people with arthritis say their joints become more painful and stiff when the weather changes, there is no evidence that cold weather causes joint damage. Mild daily exercise can help. For example, indoor swimming is easy on the joints. Staying indoors doesn’t have to mean being inactive. Keep your senior in shape by walking in place, using a stationary bike or working out with a fitness video. Daily stretching exercises can help maintain flexibility. Check with your physician before beginning any exercise program.
  8. Vitamin D deficiency. Being indoors and out of the sun most of the time eliminates a source of vitamin D. Encourage eating foods high in Vitamin D, such as milk, grains and seafood, or ask your doctor about a vitamin D supplement.
  9. Seasonal Affective Disorder (SAD) & depression. A lack of natural light can cause depression in both young and old alike. As the elderly are more likely to stay indoors, keep lights on, open curtains and blinds to let in natural light, and encourage the person to sit close to a window. The winter months and bad weather also can lead to social isolation. Help your senior to spend more time with family, friends and neighbors, and when weather makes visiting difficult, call them for a chat.
  10. Dry skin. Heated air can be drying. Because dry skin can lead to other skin complications especially in diabetics, it’s important to monitor carefully. Shower with warm, not hot water. Limit showers to 5-10 minutes. Gently pat skin dry. Use a gentle cleanser and a thicker moisturizer that will help skin retain its moisture. Run a cool mist humidifier in the bedroom.

Winter poses challenges for seniors, but with awareness and planning, they can stay healthy and be ready for spring. Dakota Travel Nurse Home Care can help aging adults maintain health and independence by providing companionship, meal preparation and personal care. For more information, call 701.663.5373.

Resource:  http://www.chiff.com/a/seniors-winter.htm

Caregiving Tips for those Suffering from Alcoholism

Mother and daughterAlcoholism is a disease. Like any disease, it needs to be treated.  Alcohol addiction complicates being a caregiver and makes the role much harder and more stressful than caregiving already is. It increases the clients’ needs, comprises their health and complicates medical conditions. Alcoholism can be the cause of a need for care in the first place. Because the aging process affects how the body handles alcohol, the same amount of alcohol can have a greater effect as a person grows older. Caregivers have to address all the stresses and added health problems of continuing alcoholism, as well as dealing with alcoholics who can be irrational, unreasonable and often dishonest about their addiction.

Talk About It

Dealing with an aging parent who has an alcohol addiction problem isn’t quite like any other challenge. You have to cope day after day with someone who can be kind and communicative one moment and raging and incoherent the next. You have to try to keep a family member safe who could stumble and fall when drinking alone or pass out in an alcoholic stupor.

Since most alcoholics don’t admit they have a problem, it can feel like trying to help someone who refuses to be helped – or who doesn’t acknowledge needing help in the first place. Sometimes all you can do is to connect with others in groups like Al-Anon who have been there, and learn and receive comfort from their shared experiences. It may be difficult to speak openly about a loved one’s alcoholism and the challenges of trying to keep them safe, but it can be very comforting to learn you are not alone and that you are not responsible for curing the addiction. 

Caregiving Tips

Judgment and preaching do not help when caring for an addicted elder. Try to find a physician who views addiction as a medical condition and will treat the person with compassion and likely, medication. Don’t be ashamed to tell a doctor that your elderly parent has a substance abuse problem. People can die from untreated withdrawal, e.g., during hospitalization, when medical intervention could have made them comfortable, or even saved them.

Ask your doctor or pharmacist if drugs are safe when combined with alcohol. Many medicines—prescription, over-the-counter, or herbal remedies—can be dangerous or even deadly when mixed with alcohol. They can increase the negative effects of alcohol consumption.

Taking Care of Parents Who Didn’t Take Care of You, a book by Eleanor Cade, addresses the dilemma of adult children of abusive, neglectful or absent parents who have made the choice to care for their elderly parents. “The challenge,” says Cade, “is for caregivers to make sure they are responding to the situation, not their emotions. It is important to be flexible enough to recognize that negative thoughts and positive actions can co-exist. Being flexible also means adapting and changing our caregiver role as needs be, understanding that good caregiving requires diplomacy, outside support, and a practical network of assistance.”

Take good care of yourself. Caregivers need to exercise, eat nutritious meals, abstain from using tobacco, alcohol, and drugs, get enough sleep and make time for partners, children, and friends in order to keep their lives in healthy balance.

Establish boundaries with elderly alcoholic parents, other family members, and yourself. For example, this could mean limiting visits, not taking phone calls after a certain time, and deciding for oneself what is reasonable or possible as you go about caring for this person. Many elders will tell you that alcohol is their “only pleasure.” And for some it is. Don’t let this affect the care you know they need to have. Just remember that compassion in treating the symptoms, or controlling the alcohol or drug amounts to keep them from falling, are often the only choices you have.

If you need help in caring for an elderly parent, contact Dakota Travel Nurse Home Care at 701.663.5373 for a free evaluation.

Resources:

The What/Why/Who/Where of Hospice and Palliative Care

Doctor Examining Senior Male Patient In Bed At HomeAs the medical power of attorney for my 97-year-old father, I am often asked if I want to switch him from In-Home Care to Hospice or Palliative Care. I have had to weigh the differences and try to decide what is best for him as he ages and goes through various health crises.

Dad currently lives in an assisted living center that provides a high level of care for its elderly residents, but we outsource his oxygen provider, and we have a Home Care Agency that handles his diabetic care and comes in three times a week to shower and shave him. These services are paid for by Medicare. My primary dilemma has been over his diabetic care, which is not included with hospice and strictly palliative care. In Utah, he could switch to hospice care at any time and stay where he is, but that varies from state to state.

Perhaps you or a loved one will be put in the position of having to make a decision similar to mine. When that time comes, the more information you have about each type of care, the easier your decision could be regarding what will provide the services you will benefit from the most. There are many resources you can turn to for information, including DTN Home Care, but here is a brief overview to get you started.

What are hospice and palliative care?

Hospice care provides medical services, emotional support, and spiritual resources for people who are in the last stages (six months or less to live) of a serious illness, such as Alzheimer’s, cancer or heart failure. Hospice care also provides support for family members that help them manage the practical details and emotional challenges of caring for a dying loved one. Hospice and palliative care both focus on addressing issues causing physical or emotional pain, or suffering. The goal is to keep you comfortable, and to improve your quality of life vs. continuing with treatment to prolong your life.

Some hospice providers offer palliative care as a separate program or service, which can be very confusing to patients and families. Click on this link to access a list of questions that includes answers to common questions about the difference between hospice and palliative care.

What services are provided under hospice care?

Common hospice services include:

  • Basic medical care, with a focus on pain control and providing comfort measures.
  • Access to a member of your hospice team 24/7.
  • Medical supplies and equipment that are needed for comfort but not curative care.
  • Counseling and social support to help with psychological, emotional, and spiritual issues.
  • A break (respite care) for caregivers, family, and others who regularly provide care.
  • Volunteer support, such as preparing meals and running errands.
  • Counseling and support for family members after a loved one dies.

Why choose hospice care?

During the last stages of a serious illness, many patients and caregivers feel that they have lost control over their lives and over what will happen to them or their loved ones. Hospice care can provide options that could give you more control. It can help you to make decisions related to end-of-life care that are important to you. It can help the dying to be more comfortable and also provide comfort, emotional and even spiritual help. However, it is important to know and understand the services your hospice provider offers, as they are not all exactly the same.

Who is on a hospice care team?

In addition to a doctor and nurses, hospice teams usually include:

  • Social workers.
  • Medicine specialists.
  • Spiritual advisers.
  • Nursing assistants.
  • Trained volunteers.

Some hospice teams may also include respiratory, music, physical and occupational therapists; pharmacists; psychologists and psychiatrists. Some people worry that they will lose the care of their regular, trusted doctor. But he or she can work with the others on your team and stay involved in your care.

Who is eligible for hospice services?

Usually, these two things must be true in order to be eligible:

  1. You or your loved one has a terminal illness that cannot be cured.
  2. Your doctor expects you to live six months or less, if your illness runs its normal course.

People who live longer than six months can be re-evaluated for eligibility to continue with hospice care. If the illness gets better, patients may no longer qualify for it. Hospice care is generally paid for by Medicare, Medicaid, and private insurance. Care also may be available to those unable to pay.

Where is hospice and palliative care available?

Hospice care can be provided in your home. Family members or loved ones may provide much of the daily care that is needed. The hospice team will work with them to help give the best care possible. A member of your hospice team may visit you for an hour or so once a week or more, as needed. Hospice programs also may offer services in a hospice center, nursing homes, long-term care and assisted living facilities, or hospitals. The choice of locations may vary from state to state.

For more information on where you can obtain hospice and palliative care, contact DTN Home Care or a local hospice provider.

by Marti Lythgoe, DTN Home Care Writer/Editor

This blog is not intended to be medical advice. Please contact your own team of specialists.

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10 Tips to Help the Elderly and their Caregivers Enjoy the Holidays

Holidays can be smiling family with gifts at homeboth a joyful and a stressful time for all of us, no matter what stage of life we’re in. But as a family member ages, it can become more and more difficult to continue the family traditions everyone expects, and at the same time ensure that our elderly loved one’s physical and emotional needs are taken into account. Caregivers often struggle with how to juggle events that can be highly stressful, confusing and even depressing for an elderly family member with the needs and expectations of others.

Situations will vary based on the health issues and mobility of your elderly family member, but these 10 tips could help all families and the elderly person they care for find more joy in the holiday season:

  1. Simplify your holiday. Caregivers of an elderly family member with younger families of their own have a lot on their plates during the holidays. Over-the-top expectations and an “I want to do it all” attitude can bring on a lot of stress. Simplify routines and modify traditions to reduce stress by making a list of all of your chores and then eliminating those that aren’t truly necessary. Figure out how to continue traditions but perhaps in slightly new ways.
  2. Plan ahead. If older family members tire easily or are vulnerable to over-stimulation, limit the number of activities they are involved in or the length of time they are included. The noise and confusion of a large family gathering can lead to irritability or exhaustion, so consider designating a “quiet room” and schedule time for a nap, if necessary.
  3. Modify festivities to accommodate individual limitations. Be conscious of potential difficulties with an event or holiday plans for someone with physical or other limitations
  4. Ask your loved one about their memories. Holidays often bring back memories. Older people whose memories are impaired may have difficulty remembering recent events, but they are often able to share stories and observations from the past. Use picture albums, family videos and music to help stimulate memories and encourage seniors to share their stories and experiences.
  5. Create new memories. In addition to familiar traditions, seniors need new things to anticipate. Add something new to this year’s holiday celebration. Enjoy activities that are free, such as taking a drive to look at holiday decorations, or window-shopping at the mall or along a festive downtown street.
  6. Plan how you will pass along holiday traditions. Use the time together for new ways of storytelling and recording family traditions. Step back from simply celebrating the holidays, and think of new ways to record the stories and memories that your parents hold dear.
  7. Find ways to celebrate long-distance holidays. Circumstances may prevent you from being with your aging parents for the holidays. Be creative and use your imagination for celebrating holidays with elderly parents. For example, hold a “virtual get-together” using Skype, com or FreeConferenceCall.com.Give everyone a chance to talk or even sing together. Reaching out to older relatives who are alone is something all of us can do.
  8. Acknowledge feelings of grief. Your parents might have new stories about long-time friends that have died. You may have feelings of sadness because they are aging and things are slowing down. If this is the first holiday after one of your parents has died, grief will be very real for everyone. Get a sense of where everyone is emotionally, and what they fear, dread or look forward to about the holidays. Don’t expect immediate agreement about what should be done. Grieving is personal and takes different forms for everyone.
  9. Avoid embarrassing moments. Try to avoid making comments that could embarrass an older family member who may be experiencing short-term memory problems. If an older person forgets a recent conversation, for example, don’t make it worse by saying, “Don’t you remember?” Just repeat what was said and go on.
  10. Monitor medications and alcohol. Help seniors adhere to their regular schedule of medications during the chaos of the holidays. Also, pay attention to their alcohol consumption during holiday parties and family gatherings. Alcohol can illicit inappropriate behavior or interfere with medications. 

If you need extra help with your loved one during the holidays, give DTN Home Care a call at 701.663.5373. We have staff who can help.

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I’m Bored!

Senior man relaxing in armchairIf you’ve been a parent, you’ve surely heard “I’m bored!” countless times. Children often have difficulty thinking of something to do or initiating an activity or a get-together with a friend. The responsibility often falls to parents to suggest the obvious activity or call another parent to arrange a “play date.” If you are the caregiver of an elderly parent or spouse, you may have experienced the same thing. Boredom that leads to depression is a major factor in many homes, senior health care facilities and assisted living homes. The responsibility now may fall on you to keep your loved one busy and involved with other people. Aging is a process, but boredom can be a danger to seniors.

When my husband was first diagnosed as being in the early stages of Alzheimer’s disease, I was told to expect that something with which he would gradually have more difficulty was planning and initiating a healthy variety of activities. I was also told that it would help his emotional health and mental abilities to interact with other people. Knowing this has helped me to take the initiative when it comes to suggesting and planning things we can do together, and also to suggest opportunities for him to call or do things with friends and acquaintances.

Why does keeping seniors busy and social matter?

No one likes to be bored, at any age. Senior citizens are no different, but when they reach their later years, they begin to experience some significant changes in their physical and mental health that tend to limit their activity. We may think of difficulty with memory as the first mental symptom to appear, but often the first noticeable changes are more related to cognitive abilities—the ability to make plans and carry them out, the ability to follow directions, the ability to use language as effectively—all changes that affect a person’s ability to participate in stimulating activities. This means that they need support in more ways than just help with remembering words and upcoming events. Meaningful activities and opportunities to socialize are vital in helping seniors maintain their ability to live independently and even live longer, happier lives, no matter what their physical problems may be.

Community help for seniors and caregivers

As long as a senior’s physical health doesn’t limit their mobility to the point of keeping them homebound, helping them to get involved in community-based programs that promote social interaction and physical activities can be a win/win for both senior and caregiver. Your community may have a Senior Center that offers free exercise programs, various classes geared to older learners, or other skill-building activities like art and music that allow seniors to interact with others, at the same time as filling their days with something other than boredom. Activities and interactions like these can lead to better cognitive, mental and physical health, as well as less anxiety and depression and an increase in happiness and sense of self-worth. A social network and a sense of community with other seniors helps to prevent a feeling of isolation and not fitting in.

In July of 2016, DTN Home Care began a unique collaboration with Proximal 50, a comprehensive wellness center committed to making positive changes in health and quality of life for clients. They provide customizable health and wellness services, including physical therapy in the home for DTN Home Care clients who are homebound. They are our exclusive, recommended provider of in-home physical therapy. You can find more information about our partnership in our blog here.

Alleviating feelings of isolation

My 97-year-old father lives in a very nice assisted living center that plans many activities for its residents, and yet he often reports feeling lonely. Research reveals that nearly 20 percent of seniors feel isolated. The causes for feelings of loneliness and isolation can vary widely, but there are some we can be aware of and help to alleviate. Not having access to transportation may prevent traveling to activities outside the home. For as long as your loved one is able to move about, arranging for or providing transportation to activities in the community or church may be all he or she needs to become involved. Even a short scenic drive can be a big boost to morale. Many organizations can use senior volunteers to perform tasks that are neither too mentally nor physically taxing.

When a person’s physical health limits their mobility and makes it difficult to leave their home, arranging regular visits from family, friends or even professional in-home aides who will read, play games, do puzzles or simply visit and reminisce can be a big boost to mental health. Reminding a senior resident of in-facility activities may be all it takes for them to get involved. Research has also discovered that men tend to have fewer social networks than women and are more likely to experience isolation. Men might need more encouragement and ideas of how to keep busy and be social than women do.

Senior isolation is a social and health issue that affects everyone

Healthy seniors can contribute to communities by bringing a sense of energy, wisdom and experience, and by lending a hand in a variety of meaningful ways. Preventing feelings of boredom and isolation should be a major concern of health care providers and caregivers to the elderly – as high on the list of importance as adequate medical care and supervision. Boredom leads to multiple physical and emotional issues, including:

  • Feeling worthless
  • Feeling that life is no longer worth living
  • Feeling intense restlessness
  • Feeling unloved or uncared about
  • Feeling suicidal

The National Institute of Aging has identified regular stimulation as a major factor in quality of life between groups of seniors. Those who are mentally stimulated and enjoy social interaction are less likely to suffer from chronic illness and physical limitations. The fight against boredom and depression should be at the top of your senior’s treatment plan.

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Press Release: DTN Home Care Now Offers In-Home Safety Assessments

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PRESS RELEASE: Dakota Travel Nurse Home Care is pleased to announce we recently hired Nicole (Nikki) Kinn, Registered Occupational Therapist, to do Home Safety Assessments and give recommendations that will help “Keep Home an Option” for you or your loved one.

During a Home Safety Assessment, Nikki will assess and provide recommendations for issues such as:

  • Fall risks and hazards
  • Kitchen and cooking safety
  • Medication management
  • Safe bathing/showering techniques and equipment
  • Self-toileting
  • Dressing made easier
  • Transfer status throughout living space
  • Mobility and related adaptive equipment
    • Front-wheeled walker
    • Four-wheeled walker
    • Cane
    • Wheelchair
    • Grab bars
    • Toilet frame

Nikki is a registered occupational therapist and is licensed to practice in the state of North Dakota. She has worked with the geriatric population for the past 10 years. Her primary focus is increasing her clients’ quality of life and the safety in their home environment.

Nikki completed the Masters Program in Occupational Therapy at the University of Mary and has had additional training in accident and fall prevention, interventions for the cognitively impaired and maintaining good nutrition in the elderly population.

If you or your loved one wants to schedule an in-home safety assessment, please call our office at 701-663-5373. We will be happy to answer any questions you have regarding the scope and benefits of this service.

Dakota Travel Nurse Home Care is licensed by the North Dakota Department of Health to provide in home healthcare services. We are locally owned and operated in Mandan, ND. We provide in home nursing care, home health aide care and at home companion care. Call (701) 663-5373 today for a free consultation!