Posts by Maureen

We Can’t Go On Like This: Making Smart Housing Transitions

Posted by on Nov 10, 2009 in Housing Options, Living Arrangements |

As health, mobility or other circumstances change in your parents’ lives, it’s natural to start looking at how their living arrangements affect them as well as you and your family. Some of the following situations can cause concern and worry for those with aging parents, whether they live close by or far away. Your parent is recently widowed and you are discussing the idea of having them to move closer to you. They are resisting, in spite of your concern for their well-being. You think it might be time for your parents to down-size and consider a care home, but either this conversation hasn’t been broached…or there’s been a negative reaction when you’ve brought it up.  You are juggling too many balls – career, family and concerns about aging parents. Something has to give. If your parents move to a place that provides more services, your burden is eased. Mom is willing, but Dad says “no way.” In each case, your family is likely feeling some distress. This can show up as: ·        Fear of uncertainty ·        Fear of losing autonomy and independence ·        Stubbornness and resistance to change ·        Power struggles between the generations ·        Denial that a problem exists One way to address the fears is to get better informed about housing options. The good news is that it’s not a choice between one’s own home and a care home. Today’s housing options for older adults include adult lifestyle communities, apartment condos, independent and supportive seniors’ residences, and assisted living. The best option will depend on finances, preferences, and health and mobility needs. To find out what is available in your community, you can contact: ·        A local seniors organization ·        City or municipal offices ·        Provincial government websites (look under services for seniors) Unfortunately, living in denial and failing to plan ahead can have unpleasant consequences – emotional, practical, and financial.  But where do you start? Talking in depth as a family about what’s happening now and what could possibly happen in future is the first step.  If family dynamics are difficult, having the conversation may be the main challenge. Think about these ideas to help you to talk to each other.  Preparing for the conversation, DON’T:  Expect quick decisions, especially when there are several options to consider. “Parent your parent”. Meet as adults who are seeking a win-win solution. Think you can get an adult to do anything unless they want to do it. During the conversation, DO: See it as a series of discussions. Take small steps. Express concern in concrete terms; talk about what you’ve noticed. Talk about what the concern means to you practically and emotionally. Share experiences – both positive and negative – from others in similar situations. During the conversation, DON’T: Fall into conversation roles and patterns that have not worked in the past. Try a different approach. See the situation as either/or. Unless serious health problems exist, there are usually options for the next step. Here are a few more things for both parents and adult children to keep in mind: Planning in advance and for the long term increases a family’s options – and makes a “move of choice” more likely. There are costs, benefits and trade-offs whether you’re staying, moving, or waiting. A move too soon can be as bad as a move too late. Taking too strong a position, whether you are the parent or adult child, can affect the well-being of another family member. Consider more than the physical needs that housing satisfies. Social connections and a sense of belonging also keep you healthy. If talking...

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When Aging Parents are Unwell (3 of 3) Where to get help if your parent has a mental illness

Posted by on Sep 1, 2009 in Health Care Team and System |

When Aging Parents Are Unwell: Part III Where to get help if your parent has a mental illness Mental health problems can occur at any age and any stage of life. Some individuals have chronic mental health problems that they must manage during their life time. Other people develop mental illness in later life.  The most common problems are depression and anxiety. Depression Depression is not an emotion!  It is a disorder with affective (mood), cognitive (mental), and physical symptoms. Depression is not feeling sad about a loss or disappointment. Surveys show that about 10-15% of otherwise healthy older people suffer from depression.  Depression is much higher when the individual has other health problems. As high as 30 – 45% in those who have had a recent heart attack, cancer, stroke, diabetes, and Parkinson’s disease. Wondering if your parent might have depression?  Here are some warning signs that you can watch for or ask about: May or may not look sad May cry easily Low energy, excessive fatigue Sleep disturbance Eats too much or too little Feelings of guilt or regret Withdraws from usual activities Avoids family or friends Easily irritated Not keeping up personal appearance Poor concentration or memory Thoughts of suicide How can you help? If your parent is showing several of these signs over a period of time, it is wise to talk about your concerns. Depression is treatable. Ask mom or dad to see the doctor. The most important thing you can do is be supportive. Know that depression does not mean the person is weak.  You cannot simply “pull up your socks” and get over it. Being around someone who is depressed can be “depressing.”  Keep your perspective and sense of humour. Be patient. Anxiety Feelings of anxiety are a normal reaction to fear and uncertainty, and everyone feels anxious from time to time. The mental health problem of anxiety is much more: it is intense; it lasts for long periods of time, and can occur “out of the blue.” One study showed that 10-15% of seniors have anxiety. This is probably underestimated. Anxiety can occur along with depression. Anxiety is both frightening and confusing to the individual. Symptoms, such as pounding heartbeat, can be so intense that the person thinks it might be a heart attack. Because the symptoms can occur without warning, and without any apparent reasons, the person may report “I feel like I am going crazy.” Like depression, anxiety is not caused by personal weakness and cannot just be ignored. Wondering if your parent might have anxiety?  Here are some warning signs to ask about or notice: Physical Pounding heart beat Shortness of breath Sweating Nausea Sleep disturbance Vivid dreams Behaviour and Thinking Avoid social situations Excessive worry Difficulty concentrating Irritability Racing thoughts Memory loss How can you help? Anxiety is not well understood.  People need to know that anxiety is a real problem and that treatment is available. Some older adults do not want to talk about their feelings and may have fears about seeing a mental health professional.  You can help by encouraging them to talk to a doctor. You can also help by recognizing that anxiety is a serious problem that affects the quality of daily life.  It will not go away by using “mind over matter” approach. Again, try to be supportive. If you are not sure how to do this, talk to a mental health professional for advice or visit the websites at the end of the article. Can medications help? When used carefully and appropriately, medications can relieve the symptoms of depression and anxiety.  Because...

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When Aging Parents Are Unwell (2 of 3): You CAN Prepare for a Visit to the Emergency Department!

Posted by on Jul 30, 2009 in Health Care Team and System |

When Aging Parents are Unwell You CAN Prepare for a Visit to the Emergency Department Frail seniors are likely to go to a hospital emergency department because of falls or serious acute health problems such as stroke. In most emergency departments, 50% of the patients will be over the age of 65. You may be the first family member called when a parent is taken to hospital.  There are some things that you and your parents can do to be prepared for the visit to the emergency department. Talk before the call comes! Talk to your parents about important documents. Have they assigned enduring power of attorney and written a health care (advance) directive?  Be clear that you are not asking to be named their advocate but you need to know if they have written these legal documents and where to find them Mutual understanding Ideally, there should be an understanding and agreement between what your parents expect and what you can provide.  Talk about these expectations – have some “What If’ conversations. Beliefs Do your parents have strongly held religious beliefs? Are there any treatments they wish to refuse on religious grounds? Medical information Do some research to understand the terms and treatments related to your parent’s health and medical condition(s). Write down the following information and keep a copy where you can quickly find it. * Who is your parent’s doctor? * What specialists do they see? * What medications do they take? * What health problems do they have? * Do they have any allergies? * Do they have medical insurance? An emergency bag Create an “in case of emergency bag.”  Include the medical information above, as well as a notebook and pen – you will want to write down information as the health team gives it to you. Add important phone numbers. Think about your own comfort as well as that of your parent. Bring layers of clothing, water and snacks, and reading material. Your benefit program Have you talked to your employer about benefits and time away related to caring for your aging parent? You will need to be with your parent in the hospital, probably for many hours and possibly for many days. For more information, consult the ElderWise e-Guide, Seniors in the ER: Survival Strategies for You and Your...

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When Aging Parents Are Unwell (1 of 3): Who’s who on the healthcare team

Posted by on Jun 27, 2009 in Health Care Team and System |

Originally published in the Lifespeak newsletter, January 2009. Compared to the younger population, seniors are more likely to use the health care system, including visits to the doctor’s office, medical clinics, the emergency room, and hospitals. Many older persons also require home care provided by the local public health services. During each encounter, senior sand family members will meet a variety of health care professionals. It can be confusing to figure out: Who is the best person to ask about problems or concerns? What role do these people play? Should we ask for professionals who are specialized in the care of older adults?  The following list identifies the most common health providers that you and your parents are likely to encounter in a hospital or in a community setting. When you meet these providers, ask for their name and their role. This might help you to know who to contact when you have questions or concerns.  Case Manager A case manager is a professional (often a registered nurse or social worker) who oversees the assessment and planning for care and services for an individual. Some Geriatric Case Managers can be hired privately on a fee-for-service basis. Discharge Planner A discharge planner is an individual who works in a hospital and assists patients to connect to healthcare services in the community following a hospital stay. Home Care Coordinator (Community Care Coordinator) A home or community care coordinator is a health professional who assesses and oversees the home care services that are provided to a client at home or in a community program. The coordinator determines eligibility for the services and then assigns the patient’s care to the most appropriate member of the team. Home Health Aide (Personal Care Aide) A home health aide or personal care aide is an individual who provides personal care: bathing, dressing, grooming, and assistance with eating. These aides may assist with rehabilitation; helping with range of motion exercises and other exercise programs under the direction of a professional such as a physiotherapist. The education of these workers is not standardized. In facility settings, this worker may be called a nursing attendant or assistant. Licensed Practical Nurse (LPN) or Registered Practical Nurse (RPN) A licensed or registered practical nurse is a graduate of an approved education program and registered with the provincial college that governs the profession. The LPN/RPN provides care as part of the health care team in hospitals, long-term care, and community programs. They administer medications and perform some nursing procedures. Registered Nurse (RN) and Nurse Practitioner (NP) A registered nurse is a professional who assesses a patient’s condition and makes decisions regarding appropriate nursing interventions. RNs can respond to complex situations involving patients with acute and chronic illnesses, deliver health education programs, and provide consultative nursing services to promote, maintain, and restore health of individuals and families. Nurse practitioners are registered nurses with advanced training in health assessment, health promotion, and illness prevention. NPs diagnose and treat health problems, order and interpret diagnostic tests, and prescribe drugs.  Pharmacist A pharmacist is a professional trained in the art and science of pharmacy. In some provinces, under certain conditions, pharmacists can prescribe medications. Should we ask for specialists? When older adults experience illness, they may need specialized care because of the complexities in diagnosis and treatment. Many health professionals have specialized education or experience in geriatrics or gerontology. Geriatrics is the study, diagnosis and treatment of common diseases associated with aging. Gerontology refers to “the study of elders” and includes the physical, mental, and social aspects of a senior’s life. In hospital: Ask for a geriatrician or...

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Responding to the Crisis Call

Posted by on Sep 15, 2008 in Caregiving, Health Emergencies |

What can you do when you get the call that your parent has a health or medical crisis? You are likely to feel the pull of trying to be in two places at the same time. Now is the time to recruit help, both personal and professional, to assist you.  What kind of help is available? Financial resources will influence some of these suggestions. Consider the following ideas: Inquire about public health care services such as home care, companion programs, and palliative care programs. Be sure that your parent is receiving the services that are available. In the hospital or long-term-care settings, talk to the care providers, particularly, the physician, the nurse in charge, and members of the interdisciplinary team (i.e. physiotherapist, social worker, dietitian). Get their contact information, including email and provide yours, so that you can keep in touch even at a distance. Ask your parent for permission to be included in care planning. Inquire about “geriatric” services in the hospital or community. These health care providers have specialized in care of older persons. You might find a Geriatrician or a Geriatric Nurse Practitioner or Clinical Nurse Specialist who will help guide your family through the process. Check out private services, such as personal and private care, to provide some respite for you. Recruit help from family and friends. Your parents might have very close friends who are willing to take on some responsibilities such as visiting, checking the house or minding the pets. These friends might know the community resources better than you – ask their advice. Take care of yourself!  You need to attend to your own physical, emotional and mental health needs and this might mean that you cannot always do what others expect or what you demand of yourself! When called upon to support an ailing parent, we often do not know the timeline involved; the demands might go on for many months. We need to pace ourselves or we risk burning out. Helping a parent can take its toll. Mobilizing your support network and finding services can help you to be supportive without wearing yourself out....

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