Moving to a smaller house or apartment in a retirement community almost always involves a certain degree of trauma, both for the elder who's moving and for family members. However, by planning ahead you can reduce the discomfort involved and turn what might well become a nightmare into a pleasant event.
Begin by Planning for the Move
Where is the elder moving? Go to the actual house or apartment with tape measure, pad and pencil and write down measurements. Floor space is important, but don't forget about ceilings. Many elders own large pieces of furniture that may not fit into rooms with low ceilings. Your work here will determine which pieces can move with your elder.
And while you're at the actual location, talk to several other elders who already live there. What is their life style? Do they go outside the property on frequent trips? How do they dress? Casual lifestyles will require an entirely different style of dress than more formal ones.
Gather Supplies and Contact Helpers
Having all the supplies you will need in one place will speed your task. You'll want a number of storage bins; five or six should be sufficient to hold sorted items. Plastic bags can be used for discarded belongings and as a container for articles to be donated to charities. Packing boxes and supplies such as padding materials and wide sealing tape are must-haves. Labels and dark marking pens are essential to ensure that boxes go to their intended location.
While you're in the gathering stage, begin to contact helpers you'll need. Among these may be:
estate sale professionals
certified appraisers
moving companies
house cleaners
repair specialists (electricians, plumbers, carpenters, painters)
Ask friends, relatives, and senior real estate specialists for recommendations. Also, check with the Better Business Bureau to ascertain whether problems have been reported about particular companies or individuals.
Approach Your Task One Room at a Time
Who should help? The elder and one family member should assume responsibility for sorting all items and some packing. Do not include everyone in the family if you want to make the job quick and easy because distractions increase in geometric proportion to the number of persons doing the sorting.
Sort all the items in one single room at once, beginning and ending in the kitchen. Why start there? Because kitchens in small houses and apartments typically are short on storage space, and the elder needs time and experience to determine which items are true necessities, and which may never be used. If you reduce kitchen items to a bare minimum at the beginning, your elder can determine what's needed and what's not by living with them ahead of time. After living with fewer items, your elder may find that items once thought essential may not be needed. Complete work in the kitchen at the very end of your tasks.
Even though you intend to stay in only one room, distractions will occur. Resist them by stacking items that belong in another room at the door. A bin or box placed just inside the door can contain all the items that have homes elsewhere.
Make your motto One Thing at a Time; One Time for each Thing. Once you've picked up an item, decide then and there what its fate should be. Place it in one of the bins you've labeled:
Discards
Donations
Distribution to Relatives
Keepers
Uncertainties
Large collections of books may require their own bins. You might have bins for Collectors' editions, books to be stored, books to be sold to book dealers.
When you have finished categorizing all the items in the room, start the packing process. Items in the Uncertainties bin can be packed for storage.
If an unbreakable item is to be moved only a short distance, don't waste time on elaborate packing and padding. Items like crystal and china, however, require excellent packing, regardless of the distance they will be moved. If you can't do a great job, leave packing fragile items to professionals.
Mark boxes as you go.
Mark boxes as you go.
Mark boxes as you go.
Nothing is more frustrating than finding that you've shipped your elder's bed linens to Aunt Minnie and kept a silver salver you meant to send your nephew.
Don't try to do everything at once. Do only one room on any given day, and take the time to enjoy reminiscing as you sort items.
This is also the perfect time to have a certified appraiser come in to appraise items that may be of significant value. Very expensive items may be auctioned at an auction house such as Christy's or Sotheby's. Less expensive items can be sold to local antiques dealers. By having an idea of their value before going to dealers, you reduce the chance that dealers can scam you.
You could also consider selling items through an on-line auction. If you do so, remember that you will be responsible for shipping items and ensuring their condition to successful bidders.
Distribute Items to the Intended Recipients
Schedule a single day for distribution of items. In-town relatives can come to pick up items intended for them; they may also be helpful by taking bags to charities, books to resellers, boxes to storage, and trash to dumps.
Use this day for shipping as well. Small items can be shipped via UPS or FedEx; large pieces of furniture and antiques may require special handling by movers. Once you've finished distribution, you should have a considerably reduced pile of boxes and furniture. These boxes should contain only items to be moved to the elder's new residence or to storage. Remaining items should be those to be sold in an estate sale.
Move the Elder to His New Residence
Will the mover actually show up on time? Will the mover actually show up at all? Increase the probability of a good outcome for the move by contacting the mover to confirm arrangement a week ahead and the day before the actual move is scheduled. Of course, missed appointments may still occur, but if you've checked out the company with the Better Business Bureau and reminded the company of your appointment, the chances are good that the move will go as planned.
Accompany your elder to his new residence and help him with the moving-in process. Even if not all boxes can be emptied in a single day, he will feel more comfortable if a few items that are meaningful to him are unpacked and placed where he can find them.
Hold an Estate Sale
Once the movers have left the premises, the estate sale professionals should come in to evaluate and price items for the estate sale. Give them a key to the house, and then get out of their way. If you have chosen well, these professionals can do a great job of pricing items to sell and clearing the house of whatever remains. They will take a percentage of the sale receipts as compensation.
The days of the sale are good days to keep your elder busy elsewhere. A tearful elder does nothing to help sales.
Schedule a professional cleaning service to clean the house once the estate sale is over. When that has been completed to your satisfaction, turn the keys over to your senior real estate professional and give yourself a big pat on the back. You're done!
Click here for a checklist to help you through this process. Or copy this address into your browser address bar.
By Phyllis Staff, Ph.D.
Senin, 14 Juli 2008
Scaling Down (Almost) Painlessly
Why Everyone Over 50 Should be Training for the Senior Games
by Phil Campbell, M.S., M.A., FACHE
Senior Games participant and author of
Ready, Set, GO! Synergy Fitness - 2nd Edition
New biomedical research proves why everyone over age 50 should be training for the Senior Games.
Research discoveries in 2002 show that we can unleash the most powerful body fat-cutting, muscle-toning, anti-aging substance known to science, naturally, with specific types of exercise, and the workouts necessary in training for many of the Senior Games events do the job.
The American Heart Association recently cited research showing that high-intensity exercise can significantly lower the risk of heart disease. Simply, as exercise intensity goes up, the risk of heart disease goes down.
The researchers compared the impact of different levels of exercise intensity on men with an average age of 66. The subjects in the high-intensity exercise group produced a 31 percent risk reduction for heart disease, which was 14 percent better than those who performed less intense exercise.
"The harder one exercises ... the lower the risk of heart disease," says lead researcher Dr. I-Min Lee, associate professor Harvard Medical School.
Anti-aging exercise
Anaerobic exercise (as contrasted with aerobic exercise) involves short, high-intensity sprint training, rather than endurance training.
Researchers show that high-intensity anaerobic workouts that include the short-burst get-you-out-of-breath sprinting types of exercise make your body release significant amounts of growth hormone (Impact of acute exercise intensity on pulsatile growth hormone release in men, 2000, Pritzlaff).
As children, growth hormone (HGH) makes us grow taller, but when we reach our full height, this hormone actually changes roles. When we're adults, increasing HGH reduces body fat and trims inches. Growth hormone actually becomes the "fitness hormone" for middle-aged and older adults.
New studies show that HGH can be increased by as much as 530 percent with the anaerobic exercise of sprinting, (The time course of the human growth hormone response to a 6s and a 30s cycle ergometer sprint, 2002, Stokes).
Anaerobic sprint workouts can be involve many sports, including running, swimming, cycling, cross-country skiing, and all these are Senior Games events.
Whatever you do, don't do this!
Don't jump in, ease in to anaerobic exercise. Anaerobic fitness training is clearly the most productive, but it's also the most dangerous. Hamstring pulls are a painful potential injury, so flexibility training is essential to every fitness plan.
Everyone, especially those with heart conditions or medical problems, should get physician clearance before performing anaerobic exercise. Even young athletes should progressively ease into high-intensity anaerobic workouts.
Older adults get results with less effort
When you see an 80-year-old participant running a 10-K or working out in the gym, don't think that it's unfortunate that she can't run as fast or lift as much as her 60-year-old counterparts. It's easier for her to reach higher intensities.
The American Heart Association study proves that exercise intensity is relative to a person's age and fitness level. In other words, an older person can reach high-intensity levels with an effort level that might be considered low-intensity for a young athlete.
The new study confirms the need for higher intensities, but it also shows that beginners and older adults reach the more productive levels of exercise intensity with less effort than a triathlete, for example.
Newcomers to high-intensity exercise may initially get great results by performing the anaerobic training with power walking, but a fine-tuned triathlete may need more work for the same results.
If you're over age 50, get physician clearance first, select a Senior Games event or two and get started with a gradual buildup training program.
If Using The Stairs Has Become A Daily Struggle, A Stair lift Could Change Your Life
Using stairs is an everyday nightmare for many people. As we grow older the stairs in our home can become more of a struggle due to mobility problems associated with old age, an accident or illness. Often when out shopping or in a public place an alternative can be found such as a lift or escalator, but the stairs at home can become a daily challenge. Many people who experience difficulty climbing the stairs come to dread having to use them. For people whose bathroom or toilet is upstairs it can be even more of an issue.
When faced with the challenges that limited mobility brings to the home, there are several options. An expensive and disruptive choice is to move into a bungalow, which can be very stressful, especially if the move is away from family and friends. Some people are forced simply to live downstairs. This can lead to a fall in their standard of living, from lack of space and privacy. Another option is to extend the living space downstairs, which can be costly and disruptive and may not be worth the effort when it comes to selling the house. Other people do nothing at all and continue to struggle on a daily basis, increasing their risk of injury from falling.
But there is really no need to continue to live in dread of the stairs or make drastic decisions such as to move. Having a stair lift installed has made life easier for thousands of people with limited mobility. Buying a stair lift can really improve quality of life for someone who wants to stay independent in their own home. The initial cost may be daunting but that needs to be weighed up against the alternative costs and inconvenience of moving to a bungalow or extending the downstairs.
There are many advantages of choosing a stair lift. Out of all the options mentioned above, having a stair lift installed causes the least disruption. In fact, after an initial visit from a representative of the stair lift company to take measurements of the staircase, a stairlift can be installed within a day. The color and upholstery can be chosen especially to blend in or compliment the existing décor. Stair lifts are safe and very easy to operate. And above all for a person with limited mobility a stair lift can give them some freedom and allow them to remain in their own home.
By Caroline Smith
Solitary Confinement -- for Life
Sixty-five year old Arthur Jones served a self-imposed life sentence - in his own home.
Arthur lived in a high crime neighborhood, so he built iron cages around his outside doors and installed bars on all the windows. No one could find it easy to break in to Arthur's house!
I met Arthur a few years ago, although you would hardly call our interaction meeting. When I arrived to deliver his meal, as part of the Meals-on-Wheels program, Arthur barely cracked open his front door even though his cage clearly protected him. He refused to open the cage door at all, so, to give him his meal, I had to angle the box through the bars. Without doubt, this maneuver scrambled the hot contents of his boxed meal, but Arthur would have it no other way. He clearly feared me, a 100-pound woman, and everyone else.
I wish I could say that Arthur's family came to his rescue, finding for him the medical and emotional treatment he needed. I cannot. Arthur's depression and paranoia compounded relentlessly, killing him at far too young an age.
Many elders live like Arthur, holed up in their own homes, barricaded against the world. Who cares? Family and friends must care, and they must assume the primary responsibility, acting before their elder's condition rivals that of Arthur. We cannot shift this burden to our government. We cannot wish it away. Those among us lucky enough to have elders in our lives must shoulder the responsibility of seeing that they do not succumb to depression.
At this holiday season, many elders experience transitory depression, as celebrations bring memories of friends and loved ones who have died. Decreased hours of sunshine may add to their depressed feelings. How do you know if your elder suffers from serious depression? And, if you suspect depression, what you should do? Here are a few tips.
What signs should lead you to suspect serious depression?
Lethargy and or refusal to get out of bed;
Changes in Sleep Patterns, such as sleeping all morning
Unusual Complaints
Memory loss and loss of ability to concentrate
Frequent sighs or weeping if unusual for the sufferer
Feeling fear and loneliness;
Thoughts of death
Refusal to eat
Refusal to take prescribed medications
Thoughts or talk of suicide (remember, the notion that suicides do not signal their plans is a myth!)
Significant changes in personality
Irritability
What Can You Do?
A few simple steps may improve their condition rapidly:
Call more often than usual.
Take your elder for outings away from the house.
Schedule a medical appointment to confirm or deny your suspicions, and be the one to take your elder to that appointment. Depression often accompanies the early stages of Alzheimer's disease and other dementias.
Check bottles to be certain that your elder is actually taking prescribed medications at the recommended dosages. Too many or too few pills in the bottle can warn you of problems. If you find evidence that medications are not taken as prescribed, gently probe to see if you can learn why.
Include the elder in parties and holiday festivities, but keep the duration of their participation at a level they can handle comfortably.
Drop in more often than usual on homebound elders.
You don't have to be a doctor or social worker to recognize the signs of depression. Take action now to protect those who protected you.
By Phyllis Staff, Ph.D.
When Assistance with Long Term Care Becomes Necessary
According to the Administration on Aging, it is estimated by 2030, the older population will more than double to approximately 71.5 million. It is also estimated that between 39 to 49 percent of people will use nursing home services during their lifetime. Unfortunately, there may come a time when your loved one may require assistance with long term care. The following is a list of warning signs one should be aware of when evaluating your loved one's situation. If the senior exhibits two or more of these signs, assistance is likely required:
? When your loved one or their spouse can no longer provide care due to debilitating health conditions
? When your loved one experiences difficulty with walking, or is unsteady when standing
? When your loved one's safety is compromised due to hazards in the home such as stairs, poor lighting, cluttered walkways, and dangers in the kitchen or bathroom
? When your loved one needs assistance with daily activities such as bathing, dressing, and meal preparation
? When your loved one becomes confused about taking their medications
? When your loved one is afraid of falling or being alone
? When your loved one exhibits changes in personality or has sudden mood swings
? When your loved one is no longer able to manage their finances and requires assistance with administering their monthly household expenses
If you feel assistance with long term care may be necessary, have a discussion with your loved one and talk to them about their concerns and desires. It's important to help your loved one maintain their independence for as long as possible. Your loved one should be involved in the decision making process as long as their decisions do not negatively impact their health and safety. Talk with other family members and get their input as well. If necessary, discuss your concerns with your loved one's physician, attorney or financial advisor, and make sure all aspects of their long term care needs have been met. It's never too early to be concerned about your loved one's long term care needs. Being aware of their needs and continually reevaluating their situation will help ensure the long term needs of your loved one will be met.
By Torey L. Farnsworth, CSA
Arizona Assisted Living Homes -- The Alternative to High Priced Senior Care
The cost of skilled nursing care is slowly rising. Currently, the average cost of care in Arizona ranges from $3,500 to $4,500 per month. Skilled nursing facilities are great for seniors who require skilled nursing care by medical professionals such as registered nurses or physicians. However, is skilled nursing care appropriate for those who only require assistance with their activities of daily living (ADLs) such as bathing, dressing and going to the bathroom? Is it realistic for someone to pay $3,000 to $6,000 a month for skilled nursing care when their only requirement is assistance with their ADLs? Believe it or not, there are many seniors who do not require skilled nursing care and remain in nursing homes due to their lack of knowledge of the options available to them. There are affordable alternatives to nursing home care. When a senior requires long term care without 24 hour medical supervision, the preferred alternative is Assisted Living Homes.
You may ask, "What is an Assisted Living Home?" In Arizona, an Assisted Living Home is a regular home located within a residential neighborhood and licensed by the Arizona Department of Health Services to provide assistance 24 hours a day to those who need care outside of their own home. Assisted Living Homes are licensed for up to 10 residents. There are three levels of care an Assisted Living Home can be licensed for: Supervisory, Personal and Directed. Every Assisted Living Home is licensed for one or more of these levels of care. In sum, Assisted Living Homes are homes licensed to provide care for seniors who are no longer able to live alone, and do not require skilled nursing care.
What are the benefits of an Assisted Living Home? An Assisted Living Home gives residents a feeling of being at home instead of an institutionalized setting. Each caregiver and manager is required to become certified, and often times the caregiver or manager lives in the home full time. Each home provides 24 hours of care, 7 days a week. Many homes offer hospice care, respite care, Alzheimer's/Memory Care, incontinence care, and therapeutic services under the direction of a physician. In addition, three nutritious meals are prepared for the residents along with snacks throughout the day, as well as daily activities as required by law. Both private and semi-private rooms are available for residents to choose from. As a result, there are many benefits available when residing in an Assisted Living Home.
Why is an Assisted Living Home unique? An Assisted Living Home provides care in a home setting, and because there is a limit of up to 10 residents in each home, the ratio of caregiver to residents is such that the care provided is very individualized as opposed to larger facilities. Monthly costs for Assisted Living Homes range from $1,500 to $3,000, allowing for an affordable option compared to the cost of nursing home care. Private pay may be the only option currently offered by the majority of Assisted Living Homes. However, the facilities that do accept different payment sources such as ALTCS (Arizona's Medicaid Program referred to as Arizona Long Term Care System), usually require a resident to private pay for a certain period of time before they allow government benefits to begin. Bottom line: Assisted Living Homes are less expensive and provide more individualized care in a home-like setting.
Finally, when living at home is not an option and skilled nursing care is either out of one's budget or not the right option based upon one's level of care, Assisted Living Homes are the affordable alternative senior housing choice.
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By Torey Farnsworth
Exercise Walking For Seniors: Preventing Foot Problems
Exercise has a very important role in the general health and the quality of life of everyone, but especially in seniors. Seniors who walk tend to look younger, sleep more soundly and have fewer visits to the doctor. Walking for 30 to 60 minutes four to six days a week will help improve osteoarthritis and decrease the risk of osteoporosis, heart disease, hypertension, diabetes and obesity. Walking is the top recreational sport for seniors.
Although many seniors may be scared to start an exercise program because they are worried about injury, the health benefits of exercise outweigh the risk of injury. Walking is considered one of the best forms of exercise because it's safe, cheap and easy. Unfortunately, foot problems can prevent seniors from starting or continuing with a walking program. Follow these tips to help avoid foot problems when walking:
1. Choose the right shoe. Make sure the shoe is supportive and bends only at the toes. The shoe should also be stable from side to side. If you can twist the shoe or fold it in half, it is too flexible. The shoe should have enough wiggle room for the toes, yet be snug enough to keep the heel from slipping.
2. Buy shoes in the afternoon. Feet swell during the day and it is better to fit your shoes at this time. The only exception to this rule would be if you always do your walks in the mornings. Make sure your foot is measured at the store to obtain your correct size. Feet change size over time. Most feet lengthen and widen over the years, increasing the shoe size. Don't assume you've always been the same shoe size.
3. Start slowly with an easy pace. Try a short walk of 15 minutes and gradually increase the time each day.
4. If you haven't walked before, make sure you start on a flat, soft surface. A great surface to start on is a level, dirt path. Don't jump into climbing hills until you build some endurance.
5. Warm up before walks. Gentle stretching before and after walking can improve circulation and prevent injury. But, don't over stretch. If you haven't stretched before, be careful not to over do it. This can lead to injury.
6. Avoid walking in bad weather. Cold, wet weather makes surfaces slippery and hard and decreases visibility. Muscles can become tight and the feet can become numb, increasing the chance of injury.
7. Examine your feet after the walk. Look for areas of irritation, red spots, blisters or areas of swelling. Self- treating can turn a minor problem into a major problem. Consult a podiatrist if a problem persists.
8. Avoid cotton socks. The white cotton socks you've been told to wear all these years are not appropriate for exercise walking. Synthetic or wool socks will help wick moisture away from your feet as you walk. This will decrease your chance of fungal infections, excess rubbing or blister formation.
9. Walk in well-lit places. The darker the trail or road, the more difficult it is to see and the higher the chance you will have of tripping, falling or twisting an ankle.
10. Don't walk through pain. As soon as you notice a foot problem, stop walking. If you continue walking with an injury you could be making the problem worse. If you feel it's necessary to continue your exercise program, try using a stationary bike while you give your foot a rest. If a few days of rest does not resolve the problem, see a podiatrist.
By Christine Dobrowolski
Assisted Living: Tips on How to Choose a Facility
It is easy to be fooled by fancy drapery or expensive furniture that may decorate a care facility. Even though a facility looks high class doesn't always mean the care provided is first class. The following are just a few simple guidelines to follow when selecting either a nursing home or an assisted living facility:
1. Talk with people in the community who are familiar with the facility you are looking at. Get their opinions and feedback.
2. In order to get the feel of the residents and their activity level, tour the facility during meals times, or right before or after a meal. Activity level is usually higher during these times. This will give you a general idea of the atmosphere and the quality of food being served. Great meals are one of the lasting enjoyments our seniors have.
3. Pay attention to the residents in the facility. Do they appear to be happy? Unhappy residents could indicate their needs are not being met properly. Do the caregivers know the residents by name? Is there adequate interaction between caregiver and resident?
4. If you have concerns about the facility, don't be afraid to ask the staff questions and voice any concerns you may have. Did you receive adequate answers? Was the staff professional? Ask the administrator about the staff turnover rate. If it's high, ask for the reasons why.
5. Examine all license and state or county inspection results for the facility. Each facility is required to display these items. A facility with little or no deficiencies is most likely a facility that wants to get the job done right the first time.
6. Research the facility using resources on the internet such as the Nursing Home Compare at www.medicare.gov or view license and enforcement action information with the appropriate state agency.
7. Trust your instinct. If you feel uncomfortable about a facility, there is a reason why. If a second unscheduled visit yields the same uneasy feeling, go with your gut feeling.
Overall, being familiar with a few simple guidelines will help make your selection process much easier. Selecting a care facility for a loved one is a very important decision. The care your loved one receives will ultimately affect their quality of life. In the end, if you cannot see yourself living in a certain facility you're visiting, then chances are you shouldn't place your loved one there either.
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By Torey Farnsworth
Short Trips Can Stimulate Alzheimers Patients
Severe degradation of short-term memory means that my father, an Alzheimer's elder, is seldom interested in movies or books. And, although music used to be a source of enjoyment, he no longer listens with pleasure. Left to his own devices, he sits. . .and sits. . .and sits unless he's sleeping. What to do?
We've found that visually stimulating events often perk our Alzheimer's elder right up. So we've added weekly, sometimes daily, trips, preferably four hours or less in duration, to his routine. These appear to add to his enjoyment of life and stimulate him to the extent that sometimes he'll add spontaneous comments to a conversation, a rare event nowadays.
Here are some of the outings that have added a little oomph to his life (and provided a short break from the daily grind of caregiving):
IMAX
IMAX presentations offer stunning cinematography that grabs and holds attention. The presentations are usually fairly short, about an hour in length, without a complicated story line. He enjoys the 3D effects and has remembered these films for several hours after the fact.
RIDE THE RAILS
A ride on the Dallas Area Rapid Transit rail takes less than three hours when you board at one end of the line and ride round-trip. In between, there are interesting stopovers, such as the West End, where people congregate for restaurants and entertainment. We think he enjoys watching the people as much as the museums and restaurants.
VISIT THE FARMER'S MARKET
Talk about visual stimulation! You couldn't find a place with more going on or more interesting things to see. He loves the market, and, as a bonus, we're able to find really fresh fruits and vegetables and flowers for the garden.
COMMUNITY THEATER
From time to time, community theaters produce old favorites that he still remembers. And the Grandbury Opera produces farces that we can all enjoy together. Trips to small towns like Grandbury that have preserved their history can supply openings to reminisce.
SHOP IN THE GROCERY STORE
If you'd never visited a supermarket, imagine how exciting your first trip would be! It's probably quite similar for our Alzheimer's elder and never fails to amuse him.
VISIT A SHOPPING MALL
Bookstores no longer hold much interest for my father, but walking the mall provides lots of opportunity for people-watching. He doesn't care much for exercise these days, so a trip to the mall provides a built-in excuse for walking.
These particular jaunts might not work for your Alzheimer's elder, but they should fire up your imagination.
By Phyllis Staff, Ph.D.
How To Find Affordable Senior Housing
A few years ago Miranda M. became a widow. After a short time her grandson (her only available relative) persuaded her to move across several states to be closer to him.
He located a nice retirement apartment where meals, housekeeping, and transportation are provided. By using her small Social Security income, and funds left by her loving husband, Miranda was just able to afford her rent and basic living expenses.
She didn't much like taking all her meals in the community dining room, so she continued to fix some of them in her own kitchen.
She reluctantly accepted the help of housekeeping for the heavy cleaning. But, as she said, "I need to keep busy. If I can't make my own bed and dust around I feel like a useless slug. I intend to keep doing for myself just as long as I can get up out of this chair."
But for one unforeseen disaster, Miranda and I never would have met, and she would have happily lived on in her sunny apartment.
You see, disaster struck because Miranda lived too long.
Both she and her grandson had counted on Miranda dying before her 85th birthday. It made perfect sense, they thought, as her family was not generally long-lived.
Her sister and brothers had all passed away at relatively young ages, as had her parents. Miranda figured she would be long gone before her money ran out.
There was only enough left to cover two more months in the retirement apartment when Miranda's grandson called me.
What was she to do?
Her monthly income of under $900 wasn't enough to pay for rent, utilities, food, and her medications in the least expensive apartment he could find. He asked me to find her a place in a Medicaid nursing home.
Well, Miranda certainly wasn't nursing home material.
There was nothing wrong with her mind. She could fix her own meals, and she could keep up her apartment (with a little muscle help). She really had no medical needs, and wouldn't have qualified for Medicaid and nursing home care even if she had wanted to.
Which she certainly didn't.
Her only real problem was lack of money (and a grandson who wasn't any better at planning ahead than she was).
After talking with her doctor and the manager of her apartment to confirm that she really was capable, I set out to try to find a "Section 202" apartment.
Section 202 housing - named after the section of the federal legislation authorizing it - is rental housing specifically for people over the age of 62 who have incomes under 50 percent of the area median income.
According to HUD, the U.S. Department of Housing and Urban Development, the average Section 202 resident is a woman in her 70s with an annual income of less than $10,000.
Section 202 residences are built and run by private, non-profit groups who have received loan incentives from HUD. HUD is not involved in day to day operations. Rents are calculated according to income, and rental assistance funds pay whatever balance remains.
Luckily for them, Miranda and her grandson live in a large metropolitan area. There are always more options in a larger town. But somewhere between 20 and 25 percent of Section 202 funds have been set aside for use in non- metropolitan areas, so these apartments aren't only found in big cities.
Hunting for a Section 202 apartment can be labor-intensive. When an apartment becomes available it rarely stays empty long. Often there are lengthy waiting lists.
The first piece of business was to telephone every apartment complex on the Section 202 list (see below for the web address to get a list). I verified that they were still participating in the program, and asked whether they had any vacancies.
Frankly, I didn't expect a "yes" to the vacancy question, but it never hurts to ask.
Lo and behold, and miraculously for Miranda, there actually was a vacancy in an older building near downtown. Because it's not in the pretty suburbs it isn't as popular as some of the others. For our purposes, it was a palace and a kingdom all in one. Beggars couldn't be choosers!
If there hadn't been a vacancy, Miranda and her grandson would have had to visit each apartment complex and place her name on every waiting list. Sometimes the wait can be as long as 2 years or more, so I don't advocate waiting as long as Miranda did.
Along with her application form, Miranda was required to give the apartment manager proof of her income (a Social Security statement or a pay stub). She was asked about previous landlords who could vouch to her suitability as a tenant. She was asked to provide copies of her pharmacy bills, as those expenses are taken into account when the rent is calculated. This particular apartment manager also wanted a statement from her doctor that she was truly independent.
If she had planned on visiting multiple places, Miranda would have taken along several photocopies of all her information so she could leave it everywhere she applied.
This is where having someone to come along is invaluable. The job can be overwhelming and exhausting for an older person.
If she hadn't found this affordable place, Miranda probably would have had to move in with her grandson (NOT a happy thought for either of them), or find a little private room to rent in someone's home, or try to find someone looking for a roommate. I was ready to try whatever it took to keep her off the street.
Because time was short Miranda had to take what was available. She has since put her name on the waiting list at two other apartments that are a little nicer and closer to her grandson. The great thing about Section 202 apartments is that you can move whenever and wherever you wish - depending of course on the terms of the lease you have signed.
To locate a directory of Section 202 housing in your state, go to http://www.hud.gov/directory Choose your state in the upper right corner. From that point on you might have to search around a little for "renting," because the information seems to be in different places on the state pages.
If you want to talk with someone in a HUD office, click on the web address below for a directory of offices: http://www.hud.gov/directory/ascdir3.cfm
If you, or someone you care for, is over 62 and on a limited income, Section 202 housing can be a lifesaver. It's very important to plan ahead, though, because these apartments are popular.
If you have concerns about finances becoming a problem in the future, start NOW to investigate your options. There's nothing more frightening than outliving your savings - - ask Miranda.
By Molly Shomer, LMSW
10 Tips to Keep a Family Caregiver from Losing Their Mind
Caring full time for a loved one can be a challenging task, and it takes a special person to get the job done right. Patience and compassion are the two top qualities a caregiver must possess in order to be successful. Caring for someone who suffers from Alzheimer's disease or other forms of dementia can be an uphill battle at times. This requires planning on behalf of the caregiver in order to keep from burning out. The following are useful tips on how to remain a hardworking caregiver while maintaining your sanity:
1. Maintain hobbies or interests. Find time to do the things you enjoy. You'll find that life outside of care giving has a lot to offer. By taking the time to enjoy your interests, you'll feel motivated to keep caring for your loved one.
2. Join a support group. There are many online and community support groups that offer assistance and a place where you can express your frustrations and concerns. You can find support groups at your local Alzheimer's Association or other organizations.
3. Respite Services. Take advantage of respite help made available by local nursing homes or assisted living facilities. Sometimes getting away for a short weekend helps rejuvenate your soul.
4. Get plenty of exercise. Even if walking the dog on a daily basis is all you have time for, every bit of physical activity helps reduce stress.
5. Just say "No". Be aware of your limits and don't be afraid to say "no" when feel you can't take on the extra responsibility outside of your care giving duties. You'll thank yourself in the end.
6. Keep a journal. It's important to express yourself. Keep track of your thoughts and your goals. It also helps to read and ponder past entries to see how far you've come.
7. Maintain a healthy diet. Don't skip meals and don't consume foods that may cause irritability such as caffeine. You need all the brain power you can get, and by maintaining healthy eating habits, you'll be a better caregiver and a healthier person as a result.
8. Have a support system in place. It's important to have family members available for respite care. It's equally important to connect with friends that you're able to communicate your feelings with.
9. Take frequent breaks. It is important to prevent both physical and emotional burn-out. Take frequent breaks with the help of your support system and community services such as hospice and home health care agencies.
10. Become an educated caregiver. It's important to understand the disease or condition your loved one is faced with. Having an awareness of the techniques and strategies designed solely for specific diseases will make your care giving experience less stressful. Be aware of the community services available as well as the benefits through Medicare.
By Torey Farnsworth
Scaling Down (almost) Painlessly
Moving to a smaller house or apartment in a retirement community almost always involves a certain degree of trauma, both for the elder who's moving and for family members. However, by planning ahead you can reduce the discomfort involved and turn what might well become a nightmare into a pleasant event.
Begin by Planning for the Move
Where is the elder moving? Go to the actual house or apartment with tape measure, pad and pencil and write down measurements. Floor space is important, but don't forget about ceilings. Many elders own large pieces of furniture that may not fit into rooms with low ceilings. Your work here will determine which pieces can move with your elder.
And while you're at the actual location, talk to several other elders who already live there. What is their life style? Do they go outside the property on frequent trips? How do they dress? Casual lifestyles will require an entirely different style of dress than more formal ones.
Gather Supplies and Contact Helpers
Having all the supplies you will need in one place will speed your task. You'll want a number of storage bins; five or six should be sufficient to hold sorted items. Plastic bags can be used for discarded belongings and as a container for articles to be donated to charities. Packing boxes and supplies such as padding materials and wide sealing tape are must-haves. Labels and dark marking pens are essential to ensure that boxes go to their intended location.
While you're in the gathering stage, begin to contact helpers you'll need. Among these may be:
estate sale professionals
certified appraisers
moving companies
house cleaners
repair specialists (electricians, plumbers, carpenters, painters)
Ask friends, relatives, and senior real estate specialists for recommendations. Also, check with the Better Business Bureau to ascertain whether problems have been reported about particular companies or individuals.
Approach Your Task One Room at a Time
Who should help? The elder and one family member should assume responsibility for sorting all items and some packing. Do not include everyone in the family if you want to make the job quick and easy because distractions increase in geometric proportion to the number of persons doing the sorting.
Sort all the items in one single room at once, beginning and ending in the kitchen. Why start there? Because kitchens in small houses and apartments typically are short on storage space, and the elder needs time and experience to determine which items are true necessities, and which may never be used. If you reduce kitchen items to a bare minimum at the beginning, your elder can determine what's needed and what's not by living with them ahead of time. After living with fewer items, your elder may find that items once thought essential may not be needed. Complete work in the kitchen at the very end of your tasks.
Even though you intend to stay in only one room, distractions will occur. Resist them by stacking items that belong in another room at the door. A bin or box placed just inside the door can contain all the items that have homes elsewhere.
Make your motto One Thing at a Time; One Time for each Thing. Once you've picked up an item, decide then and there what its fate should be. Place it in one of the bins you've labeled:
Discards
Donations
Distribution to Relatives
Keepers
Uncertainties
Large collections of books may require their own bins. You might have bins for Collectors' editions, books to be stored, books to be sold to book dealers.
When you have finished categorizing all the items in the room, start the packing process. Items in the Uncertainties bin can be packed for storage.
If an unbreakable item is to be moved only a short distance, don't waste time on elaborate packing and padding. Items like crystal and china, however, require excellent packing, regardless of the distance they will be moved. If you can't do a great job, leave packing fragile items to professionals.
Mark boxes as you go.
Mark boxes as you go.
Mark boxes as you go.
Nothing is more frustrating than finding that you've shipped your elder's bed linens to Aunt Minnie and kept a silver salver you meant to send your nephew.
Don't try to do everything at once. Do only one room on any given day, and take the time to enjoy reminiscing as you sort items.
This is also the perfect time to have a certified appraiser come in to appraise items that may be of significant value. Very expensive items may be auctioned at an auction house such as Christy's or Sotheby's. Less expensive items can be sold to local antiques dealers. By having an idea of their value before going to dealers, you reduce the chance that dealers can scam you.
You could also consider selling items through an on-line auction. If you do so, remember that you will be responsible for shipping items and ensuring their condition to successful bidders.
Distribute Items to the Intended Recipients
Schedule a single day for distribution of items. In-town relatives can come to pick up items intended for them; they may also be helpful by taking bags to charities, books to resellers, boxes to storage, and trash to dumps.
Use this day for shipping as well. Small items can be shipped via UPS or FedEx; large pieces of furniture and antiques may require special handling by movers. Once you've finished distribution, you should have a considerably reduced pile of boxes and furniture. These boxes should contain only items to be moved to the elder's new residence or to storage. Remaining items should be those to be sold in an estate sale.
Move the Elder to His New Residence
Will the mover actually show up on time? Will the mover actually show up at all? Increase the probability of a good outcome for the move by contacting the mover to confirm arrangement a week ahead and the day before the actual move is scheduled. Of course, missed appointments may still occur, but if you've checked out the company with the Better Business Bureau and reminded the company of your appointment, the chances are good that the move will go as planned.
Accompany your elder to his new residence and help him with the moving-in process. Even if not all boxes can be emptied in a single day, he will feel more comfortable if a few items that are meaningful to him are unpacked and placed where he can find them.
Hold an Estate Sale
Once the movers have left the premises, the estate sale professionals should come in to evaluate and price items for the estate sale. Give them a key to the house, and then get out of their way. If you have chosen well, these professionals can do a great job of pricing items to sell and clearing the house of whatever remains. They will take a percentage of the sale receipts as compensation.
The days of the sale are good days to keep your elder busy elsewhere. A tearful elder does nothing to help sales.
Schedule a professional cleaning service to clean the house once the estate sale is over. When that has been completed to your satisfaction, turn the keys over to your senior real estate professional and give yourself a big pat on the back. You're done!
By Phyllis Staff, Ph.D.
Stair Lift Buying Guide
There is no doubt that having a stair lift in your home can dramatically improve your quality of life. If you are starting to find that climbing the stairs is becoming a hazardous experience, or just hard work, then a stair lift could be the answer. Another solution could be to move to a single storey residence. However, this can be expensive and stressful, and many people are reluctant to leave a house that they have spent many years turning into a home.
Once you start considering the possibility of having a stair lift, you begin to delve into what can be a highly technical area. However sure you are of what you want, I strongly recommend that you take professional advice from someone with experience in this field. In most areas, informed advice is available from community occupational therapists (OT's). You will also need to make contact with a company who specialises in installing stair lifts. I would advise that you contact at least 3 companies because there can be a huge difference in price and quality. Unfortunately, as the populations average age increases, more and more unscrupulous traders have entered the market and you need to make sure that you are not being ripped off.
If possible visit a demonstration centre and try a stair lift yourself. A stair lift is not the answer for everyone. For example, if you are confined to a wheelchair, then a lift that goes through the floor would probably be the best option.
The technology involved in stair lifts has improved dramatically in recent years. A stair lift can be installed on 99% of stair cases these days. But remember, not all stair lift companies are equal, some are using technology that is several years old. My advice is to research as many products as you can and to get as many quotations as you can. Knowledge is power after all, and with a few sensible precautions before purchase, you can ensure that you buy the right lift for your needs for the right price.
Remember : Always get more than one quote and make sure that the products are 'like for like'
Try a manufacturer and a local supplier to get a price comparison.
Ask your local authority or Occupational Therapist who they prefer to use.
If possible have another family member or an O/T present.
Ask about maintenance costs, will they still look after your lift even if you don't sign up to an expensive contract? A reputable company will service your lift regardless.
Are the company approved suppliers? If not, they will struggle to obtain spare parts and their engineers will not be trained by the manufacturer.
An independent supplier can tell you about a range of different stair lifts without bias to one manufacturer.
Exercise caution if the salesman is pushing you to buy that day. Many salesmen start with a high price and discount to close a sale. A reputable company will quote the best price from the start.
If possible try a lift out in a Disabled Living Centre showroom. A stair lift is not suitable for everyone.
Do as much research as possible, there are many companies in this industry who sell at highly inflated prices.
By Christian Dunnage
Caregiving Across The Miles-Tips for Successful Long Distance Caregiving
Caring for a parent or a loved one is a difficult job. Your duties as a caregiver become increasingly difficult as the miles increase between you and your loved one. The following are a few helpful tips in order to plan ahead in the event your loved one needs your help, as well as ideas on how to become a successful caregiver once your caregiving duties begin.
1. Have a discussion with your loved one. Years before the need for caregiving arises, discuss ideas and thoughts with your loved one. Discuss with them their thoughts on possibilities of relocation, assisted living or nursing home care, and end of life arrangements. Make sure all of their legal and financial needs have been met. Talking with your loved one ahead of time will make them more comfortable with the idea of needing help down the road.
2. Design a "Family Plan of Action". Before the need arises, get the family together and discuss responsibilities and divide them up accordingly. Devise a plan to keep in contact with those members who may be out of state by frequent phone calls, emails or set up a private chat room on the internet for family discussions. Investigate costs for care and travel expenses. Design contingency plans in the event that funds run out, level of care increases, and availability of family is limited.
3. Gather emergency contact information. Make a list of important emergency numbers such as out of town family members, family friends, physicians, attorneys, clergy, etc. To help preserve this list in the event of an emergency, place this list in a zip lock bag and store it in your loved one's freezer where they keep their ice cubes. Place a magnet on their refrigerator with a note as to the location of this list.
4. Gather important documents. Locate important documents such as social security card, Medicare and/or health insurance cards, legal documents such as living trusts, wills, and powers of attorney, all financial statements including life insurance information and real estate deeds. Inform the family regarding the location of these documents. Keep copies of powers of attorney in the event you need to make health care or financial decisions from a distance.
5. Organize and set up a network. Contact relatives, friends and neighbors who live close by your loved one. Ask them to routinely stop by and visit your loved one, and ask them to contact you if they observe anything out of the ordinary. Find out about community programs that provide services such as meals or transportation, and get them involved. Consider hiring a geriatric care manager to help coordinate the care.
6. Make the most of your visits. Schedule and attend physician appointments with your loved one when you are in town, and keep yourself informed with your loved one's diagnosis. Meet with members of your network, and ask them detailed questions about their interaction with your loved one.
7. Keep a journal. Take detailed notes of your loved one's care such as their progress, medications, changes in level of care, recent injuries, personality changes, etc. A journal will help keep the family organized, as well as provide helpful information for the physician or other caregivers who might be involved in your loved one's care.
8. Be observant. Be aware of changes in your loved one's personality, their appearance such as lack of grooming or soiled clothing. Verify that the mail is being opened and the bills are being paid. Set up a consistent schedule for communicating with your loved one, and pay attention to what they're "not" saying. Remember, your loved one doesn't want to give up their independence, and they may not always tell you the truth.
9. Re-evaluate the situation. Assess your loved one's situation and don't be afraid to make adjustments as the circumstances change. Don't hesitate asking for help from other family members, and investigate the potential for placement in a care facility or hiring a full time live-in caregiver if the family and physician deems necessary.
10. Care for the caregiver. Don't allow yourself to get to the point that you experience burn-out. Get help from other family members, as well as take time for yourself. Maintain a healthy diet and exercise daily. When caregiving becomes too much for the family, and the level of care is beyond your immediate resources, seek out other options. Don't let your guilt get in the way of providing the best care for your loved one, even if a care facility or full time caregiver must provide that care instead of you.
Above all, remember to allow your loved one to remain involved in the decision making process for as long as their decisions do not negatively impact their health or safety. Remember to discuss your concerns with their care in a sensitive manner. Your loved one deserves to be treated with dignity and respect. Be realistic about the situation, and in addition to looking out for your loved one's care, remember to look out for your own as well.
By Torey L. Farnsworth, CSA
5 Myths You Should Know Before Choosing Elder Care
Myths associated with selecting quality nursing home care suggest quick and easy ways to identify quality care. In fact, relying on these myths can lead to disastrous results. I have identified a few of the most common myths in hopes of helping you avoid some of the problems commonly found in many nursing homes.
1. The Smell Test
You've heard it repeatedly: "The best way to determine the quality of care a nursing home provides is to be alert to bad odors when you visit the home."
It seldom, if ever, works. Why? Nursing home administrators have heard the very same advice. As a result, they are particularly sensitive to unpleasant odors in any area that might receive visitors. Almost all will do their best to remove offensive odors as quickly as possible, even when it means avoiding their primary responsibility to their residents.
2. The Personal Recommendation
Recently, I heard a guest on a radio talk show state that the very best way to find great nursing home care is to get recommendations from a friend. Like other myths, there is a grain of truth here, but you must check whether your friend has had extensive interactions with the nursing home recommended. Often that is not the case.
Last weekend I dealt with an emergency call from Jim, a friend who had placed his mother in a nursing home recommended by a friend. Although she was recuperating from a stroke, no nurse or aide checked on her condition for more than 14 hours. Jim discovered her in the morning with many cuts and bruises, her bedsheets soaked in blood. He was astonished that anyone would recommend such a poor care facility.
"My friend said her grandmother was in this particular nursing home," he reported. "So, I thought it would be good care."
"How often does your friend visit her grandmother?" I asked him.
"I didn't think to ask," he responded.
"And did you check the latest survey for that nursing home?"
"No," he answered. "I thought a personal recommendation was all I needed."
Jim's mother is now back in an area hospital. No one knows yet how much damage this experience caused to her recovery.
3. You Get What You Pay For
Nowhere is this statement less applicable than in nursing home care. In fact, I'd replace it with another shibboleth -- "Buyer Beware." Our own research, encompassing more than 6000 nursing homes and more than 100 assisted living facilities shows no relationship between cost and quality of care. You may find quality care in an expensive facility, or you may not! Similarly, the fact that a facility is low-cost does not indicate whether you'll get poor, average, or quality care. You have to do your homework. Relying on price as the sole indicator of quality care can lead to disastrous results.
4. Adequate Staffing Equals Quality Care
A recent report by the Senate's Special Committee on Aging indicated that quality care for a single nursing home resident requires more than three hours each day of nursing and nursing aide time. However, statistical analysis of the latest federal database on nursing home deficiencies indicates no relationship between quality of care and staffing levels. This finding is consistent with a number of university studies.
What should you look for, then, in nursing home staffing levels?
There is a level below which nursing homes are so understaffed that quality care can not be provided. I'd suggest that you not consider any home providing a level less than two hours per day per resident. For levels greater than this, I'd focus not on the number of hours available for care but on the motivation of staff available to provide care. Those who are motivated to care for the elderly will do so. Those who are motivated only by a paycheck will probably provide shoddy care regardless of their numbers.
5. A Well-Known Chain Will Provide the Best Care
This is another myth that can lead to tragedy. Sometimes, well- known companies do provide top-quality care. In other instances, however, a quick review of newspapers and magazines will show you other companies with long records of legal troubles stemming from accusations of neglect and abuse. One such company has been sued simultaneously by several states' attorneys general.
How will you know? The company is not likely to tell you, so you won't know unless you take the time to look into the company's historical performance.
There you have it -- 5 myths exploded!
What does work? There is no substitute for your own personal investigation. With a little research, with personal visits to nursing homes before you sign anything, you can avoid many of the difficulties that have come to those who relied on such myths.
By Phyllis Staff. Phyllis Staff, Ph.D.
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Stair Lifts - Straight and Curved Rails
There are two types of stairlift. Straight and curved. The first is designed for straight stairs. The footrest of the lift will normally stop level with the top stair. It may be possible to use a straight stairlift on some configurations of curved stairs.
The second, and generally far more expensive type, is a 'made to measure' or 'curved track stairlift' which can travel around bends on the stairs and can be made to run on to the landing. Prices vary according to the length of the stairs, the number of bends and the complexity of the bends.
It is worth noting that although far more expensive, the resale value is negligible, as the rail is made to measure and can only be re-installed on an identical staircase.
Curved track stairlifts can be fitted on either side of the stairs, the layout of your staircase will determine which is most suitable. If you need a curved track stairlift you will need to pay a deposit to the company that you are dealing with. This will normally be about 30% of the cost of the lift. The deposit is required because the company are committing themselves to building a stairlift rail that will only fit into your house. You should not have to pay a large deposit if you order a standard straight lift as these can usually be adapted to suit another staircase.
In certain circumstances it is possible to fit a straight stairlift on stairs that have a turn at the top. For example if you have a straight run of stairs with three steps winding onto the landing. Or a straight flight and a quarter landing with two more steps, a folding platform stairlift could be the solution. A straight stairlift is installed with extended legs, so the footrest stops in line with the landing. A solid wooden platform is then built around the footrest of the lift. This platform can then be used to walk safely onto the landing. The platform is hinged so that it can be folded back against the wall to enable other people in the house to use the stairs.
It is also possible to have a powered platform so the user doesn't have to bend to raise it. Please note that the folding platform option is not suitable for everyone. If you are prone to dizzy spells or feinting or if you have very poor mobility this is not a viable option. Seek independent advice.
By Christian Dunnage