Aging Parents

I wrote a piece for Forbes on guns and the elderly. I hadn’t realized that so many older people, some with dementia and Alzheimer’s, own guns until I started getting reader comments. What’s an adult child to do if Mom or Dad wants to hold onto their favorite firearm? Even if they’re ready to part with it, where do you take it once it’s out of their house? I thought the National Rifle Association might not like the idea for my post, but I received a letter from them thanking me for the story and letting me know they have a program to dispose of guns. So, if taking them to your local police department doesn’t excite you, you now have another option.

Here’s the post:

5 Things To Know About The Elderly And Guns

According to a Pew Research Center report, 35% of Americans in a recent survey said they have a gun, rifle or pistol in their home. Some of these may belong to your elderly Mom, Dad or Granddad (most often it’s a male) or the aging relatives of someone you know.

Over dinner the other night, my friend told me about the talk she had recently with her 89-year-old father. It wasn’t about driving, as you might think, but about giving up his gun. A loaded gun.

There’s great cause for concern: an older gun owner may have cognitive impairment or dementia, may have diminished eyesight and hearing (raising the risk of mistaking a family member or worker in the home for a bad guy), or may shoot a spouse or themselves. Yet from the older owner’s perspective, the gun may symbolize independence and control in a world where they might otherwise feel powerless.

That might include if he or she is ever in pain or has a terminal illness. A parent might never commit suicide, but still want to know the firearm is there. According to the Centers for Disease Control and Prevention, in 2010, 4,276 people age 65+ committed suicide by firearm and 3,367 people aged 55-64 died that way. The same friend whose dad had a loaded gun said that her parents always joked that if one of them no longer wanted to live, they’d made a murder-suicide pact. She didn’t think they were serious.

What would you do? What should you do? I asked Boston-based geriatric care manager Suzanne Modigliani and Bay Area elder care attorney Michael Hanson for advice. Here’s what they said:

1.  Consider: Is the gun owner competent to keep a weapon? Why did he have it in the first place? To go hunting or protect himself from intruders? Are those same reasons valid today?
2. If the answers to those questions suggest the gun should no longer be in your parent’s home, try to get his permission to remove the gun. Having the support of others, like siblings or a geriatric care manager or attorney, may be more effective than trying to convince him by yourself.
3. If you can’t make headway, your parent has cognitive issues or you think the situation is dangerous, you’ll want to get it out of their house regardless. Call your local police department and ask them what to do. Should you bring it to the station? They may be willing to come to your house and pick up the gun.
4. You can’t just remove a gun from someone else’s house and bring it to yours. In some states, that may be considered larceny. If you want to keep the gun, it will have to be registered in your name. Ask the police for help.
5. A time to be particularly vigilant: when an elder is overcome by grief, such as after the death of a spouse.

Hanson, the elder care lawyer, didn’t realize his father owned a .22-caliber target pistol until he died. Hanson routinely asks clients, who are adult children or their parents, whether there is a firearm in the house. Hanson turned his dad’s pistol in to the police. And yes, he called them ahead of time and made sure it was in a bag “so I didn’t look like I was in Django Unchained!”

Here’s a thought from Jim Reardon, a Brookline, Mass., police firearms instructor: In some police departments, if you don’t want the gun to be destroyed, you can arrange to have a gun dealer purchase the firearm at the police station. Who knows, the gun could be valuable, and even if not you would get some compensation.

There’s always the NRA!

Photo by hey skinny courtesy of Creative Commons

It’s amazing to see how making and playing music helps both those with Alzheimer’s and their family caregivers. For a story I wrote, I interviewed Gabby Giffords’s music therapist. I also watched a chorus in New York made up of dementia patients and their partners, spouses and kids. A moment of normalcy and pleasure–together–in otherwise very difficult lives.

Here’s a piece I wrote for AARP aptly named “The Power of Music”:

Geriatrician Theresa Allison can’t talk with her grandmother. Alzheimer’s disease has left her without the ability to see, converse or recognize her granddaughter. Yet the two are able to interact. Instead of talking, they sing. “I’ve watched her babble nonsense, but then bounce my son on her knee as we sing a folk song she taught me as a child. For 45 seconds, life is completely normal,” says Allison. “Engaging this way is profoundly meaningful.”

Allison, a musicologist as well as physician and assistant professor in the Division of Geriatrics at the University of California, San Francisco, sometimes sings songs with her frightened or confused patients to get them to relax during a physical exam. And she encourages generous doses of music in caregiving, whether the loved one is cognitively intact or has memory loss.

The healing power of music was recognized in ancient Greece; Aristotle and Plato wrote about it. And though the field of music therapy formally debuted in 1950, but has only recently gained many fans, including hospitals, adult day care and senior centers, and nursing homes. Health care professionals often refer patients to music therapists — the country has more than 6,000 music therapists nationally certified through the American Music Therapy Association and they can help you find one in your area. Health workers are also using music to treat a long list of conditions: depression, Tourette’s syndrome, Huntington’s disease, autism, Parkinson’s disease, stroke, brain injury and cardiac disease. It can be part of pain management and cancer treatments.

Now there are probably a lot more than just five caregiving mistakes! But in the process of finding out what they were–and please, add your own–I discovered a cool collaborative model I wanted to share. It’s a concept you’re going to be hearing more about. Concentrate!

Here’s what I wrote in my AARP blog:

Trend alert or rather, trend-to-be alert. I recently heard of a new concept that sounds like a caregiver’s dream: a team of professionals from various disciplines (i.e. legal, financial, caregiving) who specialize in aging issues. Someone on the team steers you to other experts you need — and may not even realize you need. These pros confer to make sure all your bases are covered.

Rod Chamberlin, a financial planner in Irvine, California, has one such team. Besides a financial planner and eldercare lawyer, it includes a senior care placement expert, long-term care specialist, family advocate aka mediator, personal business facilitator (helps Mom cancel subscriptions and insurance, arrange documents, pay bills) and geriatric psychiatrist.

Clients hire whichever specialists they need and pay each separately.

I asked Chamberlin for the most common mistakes his group sees boomers make regarding their parents’ financial, legal, and care decisions. This applies to you, too!

Here are his top five:

1. Becoming vulnerable to scammers and unqualified professionals. “It doesn’t just happen to dumb people,” says Chamberlin. “I’ve seen professionals whose parents were scammed!”
2. Not having proper legal, financial, and healthcare documents. At the least, you need power of attorney, a will and/or trusts and an advanced care directive.
3. Misunderstanding your options for senior care and how to pay for it: assisted living vs. a nursing home vs. memory care. They’re different, as is Medicare and Medicaid. Do you qualify for benefits i.e. a veteran or spouse of a vet may be eligible for paid in-home or long-term care? Some long-term care life insurance policies pay in advance on a death benefit (tax-free cash now), and, in some situations, a reverse mortgage makes sense to help bankroll care costs.
4. Holding inappropriate investments and/or selling investments that trigger unnecessary taxes. A professional can identify the best assets to sell (to pay for care or simply maximize investments) that won’t have a big tax impact.
5. Not taking advantage of tax credits, exemptions, exclusions and deductions. If you qualify, you may be able to claim your parent as a dependent or write off healthcare costs, for instance.

Chamberlin’s model is new; there aren’t many like it — yet. If you can’t find a similar group, then look for a legal or financial pro able to coordinate efforts with other specialists.

(Thanks, adult son, for the blog idea.)

Photo Courtesy of Ponyinarope via Creative Commons

Is  there a doctor in the house? You might as well be one, according to a new AARP study of family caregiver responsibilities. I just blogged about the research and realized how lucky I was that I didn’t have to perform medical tasks with my parents or  mother-in-law. Intravenous feedings? Caregiving is already so complicated emotionally and logistically.

Examine my blog:

Family caregivers: If you’re ever looking for a new career, you might want to consider nursing or medicine. Results from the national survey “Home Alone: Family Caregivers Providing Complex Chronic Care,” released this week, suggest your learning curve may not be very steep.

Yes, family caregivers still perform typical tasks such as bathing, dressing, toileting, eating, shopping and handling finances. But the survey reveals the scope of duties often goes far beyond these responsibilities to include handling wound care, administering intravenous fluids and operating specialized medical equipment. Home dialysis. Suctioning. Ventilators. Scary!

Add to the list uncooperative recipients, inordinate amounts of time required to perform these sophisticated tasks and stress over making mistakes. What’s more, many of the 1,677 caregivers who participated in this joint AARP Public Policy Institute/United Hospital Fund online survey felt they didn’t get enough training or support.

For further admiration of family caregivers, check out these critical survey findings:

• 78 percent managed medication, including intravenous feedings, as well as injections. Nearly half dispensed five to nine prescription medications daily and 65 percent also took one to four over-the-counter pills.
• Almost half, or 46 percent, performed medical/nursing tasks for those with multiple chronic physical and cognitive issues.
• 53 percent who had medical/nursing responsibilities also coordinated care—more than double the rate of those who predominately gave personal care.
• More than half who did complex nursing/medical tasks said there was no one else to do it or insurance wouldn’t pay for a professional.
• The majority managing five or more nursing/medical duties believed their help allowed a family member to stay out of a nursing home. While caregivers felt that they were doing something important, more than half felt depressed or hopeless and more than one-third reported being in fair or poor health.
• 47 percent had no training for managing the medications, with more than 60 percent saying they learned how to manage at least some of the medications themselves.

Okay readers. What kinds of caregiving duties do you do? Which do you consider the hardest and why? Do you have any strategies to make your job easier? Let’s get the conversation going!

Photo courtesy of cakencookiebakr via Creative Commons

I always knew I lived in a cool, progressive place, but Brookline, Mass, the closest town to Boston, just went up another notch for me.

It not only attracts an international community (world-class hospitals and brainy universities everywhere), but now has the distinction of being the first dementia-friendly community in the country.

The initiative “It Takes A Village” finds ways for those with dementia and their caregivers to enjoy cultural offerings around town, include other residents who want to attend, change people’s attitudes towardAlzheimer’s, and trigger memories of long ago.

The concept is spearheaded by the non-profit ARTZ (Artists for Alzheimer’s) and bankrolled with a grant from the local Brookline Community Foundation. It has brought together public and cultural institutions, civic and business leaders, and citizens.

Between March and this August, there will be 16 events, every other week for 60-90 minutes. These include:

• An interactive story telling program at an independent bookstore
• An art program at the Brookline Art Center
• A music performance with musicians and those with dementia at the Brookline Music School
• An outdoor concert on the grounds of the Frederick Law Olmsted National Historic Site. Olmsted was a world-famous landscape architect and park-maker
• A discussion on politics at the home where John F. Kennedy was born
• A film program at the 1920’s, Art Deco Coolidge Theatre (profiled in AARP)
• Yoga in a studio
• A talk about antique cars at the Larz Anderson Auto Museum

A recent program at the car museum, entitled “On the Road,” steered the conversation from what they were seeing to their own memories—their first car, going to drive-ins in their parents’ cars, and their own travels.

Since this is Boston, college students volunteer and also participate. “The idea is to destigmatize dementia in the community so that it just becomes something people have, like cancer or HIV, that they live with, but it doesn’t define them,” says ARTZ Creative Director Sean Caulfield. “What we don’t want to do is warehouse people and keep them isolated, but rather, inside the community circle.”

Caregivers get to meet one another and find educational opportunities for family members. The adult child I know of two parents with dementia moved them to Brookline so they could participate in these events.

Want to make your town dementia-friendly?

1. Figure out what is available in your community. A culinary institute? A college? A community center? A public library? A movie theatre?
2. Start a coalition of people caring for those with dementia
3. Talk to local, civic and business leaders, non-profit foundations, community activists, and cultural institutions.

Wahoo, eldercare has arrived! The latest federal survey, which tracks how much time people spent per day working, performing household tasks, engaging in leisure activities, and taking care of children in 2011, has a new category: Eldercare.

This entry into the annual American Time Use Survey (ATUS), put out by the Bureau of Labor Statistics, reflects the deepening responsibilities Americans age 15+ have for providing unpaid care to someone over age 65–perhaps a parent, spouse, relative or friend.

And just wait: Nearly 10,000 people a day in the United States will turn 65 in the U.S. for the next 20 years. As the 78 million baby boomers age, those number of hours are going to escalate big time.

Eldercare covers a lot of turf, from helping with meals and medication to grooming to transportation to companionship. Or really, anything else that needs to be done.

The ATUS is weighty information used in federal economic, health and safety, and family/worklife balance research, as well as for international comparisons. The inclusion of eldercare is significant. For laymen, it provides insight into how Americans spend time, what they do, and with whom. The study further propels momentum for coming up with solutions and policies to ease the burden of family caregivers.

Here are the survey headlines:

• No surprise to some: 56% of the 39.8 million eldercare providers were women. Note that the male/female gap is getting smaller. The age 45-54 demographic provided the most eldercare (23%), followed by ages 55-64 (22%), then age 65+ (16%).
• Surprise: A spouse or domestic partner provided just 4% of eldercare, while 42% cared for a parent, 20% for a grandparent, 20% for another relative and one out of four for a non-relative.
• On average, 24% took care of at least one person 65+ every day, for an average 3.1 hours; 23% helped several times a week, 20% once a week; 20% several times a month; and around 11% once a month.
• 85% of care came from someone who did not live with the recipient.
• 69% cared for just one person.
• Oh, boy! 23% of providers also had one or more kids at home under age 18. Can you say “sandwich”?
• One out of six people in the U.S., or 16% of the civilian noninstitutional population ages 15+, spent time helping elders.
• More than 60% of care for an older person came from someone age 45+; one-sixth by a person age 65+.

Which statistics did you find most interesting? My pick: Very few recipients live with providers. What is your eldercare situation?

Last week  the Department of Labor (DOL) released a guide on the Family and Medical Leave Act (FMLA) that working family caregivers may find invaluable. The step-by-step, easy-to-read resource outlines who is eligible for FMLA, how employees can apply for and take leave and their rights to keep their job when they’re ready to return to work.

FMLA allows workers to take up to 12 weeks of unpaid leave for, among other reasons, caregiving for loved ones who are ill.

FMLA derives from a simple idea: An employee who is sick or needs to care for an ill family member, should not have to fear losing his or her job. Hundreds of pages of rules and regulations have been written to clarify this idea, resulting in both employees and employers struggling to understand their rights and obligations. It’s complicated, which makes the federal guide a delightful find.

Of particular interest to caregivers is the section in the guide defining the rights of caregivers, including parents caring for children or their parents and grandparents caring for their adult children or grandkids. The regulations apply to all families, regardless of sexual orientation.

Caregiver: You may be surprised by the rights you have and the protections available to you under the federal statute. That is, if you qualify. In order to be eligible for FMLA:

1. Your employer must be required to provide the leave. In general, larger companies, with 50 or more workers, are covered.
2. You must have worked long enough for that covered employer, which is generally at least 12 months and 1,250 hours during that period. Part-time employees who meet these standards are ordinarily eligible.
3. You must have a reason that qualifies. It includes having a “serious health condition,” that is, being under the care of a physician, or needing the time to care for a family member with a serious health condition.

The Employee’s Guide to the Family and Medical Leave Act makes it clear that adult children caring for their parents, and grandparents responsible for their grandchildren, are eligible for FMLA, as is a husband or wife caring for a spouse.

A child includes a biological, adopted, foster or step child, or a child for whom the person acts “in loco parentis.” For example, an employee with no biological or legal relationship to a child who is nevertheless responsible for that child’s day-to-day care and financial support, is “in loco parentis” to that child, making them eligible for FMLA where a serious health condition exists. Easy-to-follow flow charts make eligibility understandable.

If you meet these guidelines, your next step is to apply for the leave. The handbook lays out what you must do to apply, what your employer needs from you to verify the need for the leave, and what your boss’ obligations are to grant you that time off.

Use the guide to understand your rights. It may not cover all the fine points, but it’s a good place to start and you don’t have to be a lawyer or policy expert to understand it!

For more information on FMLA, head over to the DOL website.

The mental and physical stress of caregiving is well-documented. We know that it can be exhausting, expensive, and overwhelming. But did you also know it can also enhance your well-being and keep you physically active–and alive?

In my weekly blog for AARP I discuss two recent studies that point to the positives of caregiving: one out of the Sloan Center on Aging & Work at Boston College, the other from Boston University School of Public Health. Take a look!

Good 'Ole Fashioned Contact!

Who says the Internet is the only way to go? Loved the idea that isolated and harried caregivers of parents and spouses who couldn’t/wouldn’t leave the house could pick up the phone and get support from others in their situation and from experts.

Real live voices! Some have continued conversations off line. My latest AARP blog offers a line on this caregiving concept and highlights two programs.

Now, here’s a novel idea. The Global Ageing Network reports plans to build a mock 1950s village in Switzerland where advanced stage Alzheimer’s patients would live. Professional caregivers will wear 1950s garb. IAHSA titles the piece Dementiaville.

What do you think?

Photo by Trace Meek via Creative Commons