Aging Parent Solutions: New Year's Resolutions for the Long Distance Family Caregiver

Maybe home is where the heart is, but if you are not home and desperately worried about an ailing loved one who lives 2,000 miles away, your anguish can be a ticking time-bomb for your own health and future happiness.

There are lots of common sense strategies that we as long distance caregivers can put into place to make 2008 stress-free for you and your aging parent. According to a study by Metropolitan Life (2005), more than 7 million adult children are caring for their parents long distance. While the internet and cell phones can put us in immediate contact with our loved ones, there is no substitute for the human touch or being able to see with our own eyes that our parents are safe, and well cared for. Long distance caregivers live an average of 304 miles away from their care receivers, according to statistics from the National Coalition on Aging (NCOA).

In Navigating the Journey of Aging Parents: What Care Receivers Want (Routlege 2006), we've included an entire chapter about what the dependent elderly expect from their children who live far away, as well as the concerns that the adult children have about mom and dad not living just down the block. As we venture into a new year our own new year’s resolutions should include a reasonable, updated game plan for long distance caregiving.

Resolutions to insure the well-being and comfort for a relative who lives miles away:

Advance Directives. It’s a new year. Time to revisit the affairs that are in order, or simply get your parent’s affairs in order. Specifically, make sure that the Living Will, Health Care Power of Attorney, and organ donation card (if this is your loved one’s choice) are up to date. Too many families wind up in court at the same time that their ailing family member is dying in a hospital, because nobody checked the advance directives. In some cases, guardianship needs to be established long before a loved one’s dying days.

MOST IMPORTANTLY: KNOW WHERE THESE DOCUMENTS ARE KEPT! Whether it is a safe deposit box, file cabinet, a lawyer’s office or a shoe box under the bed, you should know and should also alert someone who lives close to your parent how to locate these documents. Some elderly individuals choose to tape an envelope to the refrigerator with the living will and durable power of attorney inside. If paramedics are called, they will have the documents in hand in a matter of minutes.

Consider Care Management. Eldercare managers or case managers can be hired to do all kinds of tasks for your parents including scheduling appointments, doing paperwork, hiring housekeeping and even pet care services. Care managers are often considered as “the other daughter” and can serve as a terrific professional liaison between you and your parent. Contact the National Association of Geriatric Care Managers, www.caremanager.org.

Local contacts as back up. It’s time to update that list of local contacts. One adult daughter that we worked with was frantic because her mother’s health care power of attorney had been given to an elderly woman who was now hospitalized with Alzheimer’s disease. Comb through your parent’s social network of neighbors, church folks, and friends to see if there isn’t someone who can frequently visit and give you an update on how your parent is doing. A good source is the Eldercare Locator, www.eldercare.gov. for help in your parent’s community.

Family members. It’s hard to believe that just as your aging parent grows older, so do the grandchildren and nieces and nephews. Maybe one of you nieces or nephews is old enough now to do ‘grandma check-ins’ as a part time job.

Perhaps the situation for your siblings or Godchildren has changed, and they can help with the tasks of taking your parent to appointments.

In town assessments. During your next visit, do a thorough assessment of your parents’ living situation. Is their environment still safe? Are there spills around the stove that could indicate poor eyesight, or lack of recognition about food spilling over?

Do a physical ‘walk around’ with your parent, in their home. Before every flight, the captain or first officer on each commercial flight does a physical ‘walk around’ to make sure that the plane is in ship shape. Are the lights and vents working, etc? Have the conversation with your parent about falling, as the two of you walk through their living room, and into the bedroom. Phrase the question by saying, “When you fall….” not, “If you fall…” One third of all falls with the elderly occur from hazards in the home. As you pass various locations in each room, the question should be, “When you fall over here by the window, how will you get help?” Whether or not you get the best answer to this question, you have started the conversation, and started your parent thinking about the possibilities of a fall. This is also a great time to talk about emergency alert devices.

Telephones. Cell phones and cordless phones can be both a blessing and a hindrance for your parent. Cell phones need to always be charged; and, with a few exceptions, most buttons and displays on cell phones aren’t user friendly for someone with poor eyesight or arthritic hands. Cordless phones work, but are useless if the power goes off. Always have a phone with a cord in the home.

Time zones. We worked with an adult daughter named Jean, who lived in London, while her 85 year old mother lived in the United States. Even though Jean told her mother to call on her cell phone, the elderly mom rarely called because of the distance, the cost, and the confusion over the time zones. Jean became so anxious about her mother refusing to call, that she moved back to the U.S. Now Jean’s mother uses the same cell phone number and calls her daughter frequently. The hurdle here was the obstacle in her mother’s mind about placing a transatlantic call.

Know that you are doing your best. No two families are alike, and no two situations are alike. What may have been an emergency crisis for your Aunt Mabel in Omaha may be solved by getting your mom in Chicago to take two aspirin.

Take care of yourself, celebrate each moment, and 2008 will be a Happy New Year!

Dad turns 100 today.

My dad's birthday is today. If my dad had lived past age 92, he would have turned 100 years old today, July 28, 2007. Born in a church manse as the eldest of two boys, - preacher's kids - my dad lived the life, and fought the battles of a PK (preacher's kid).His grammar school didn't have electricity, lighted only by gas lamps. He and his brother, Paul, moved several times with their parents around Chicago and Indiana, establishing Presbyterian Churches along the way.

What dad brought into our lives was free spirited thinking; a strong belief in the Lord Jesus Christ; music; some chaos; a strong sense of community; and a love for my mother, his kids, and our extended family (including our neighbors of 30 years) that was everlasting. He was even athletic in his own way. My dad was a self made individualist who had a unique style of his own. He was anti-establishment with an independent spirit.

Walking was dad's physical sport of choice. Every night after dinner he would grab the dog's leash, and he and (our dog) Mickey would take a walk of about a mile around the neighborhood. Good thing to work off those pounds, because our family liked to eat. Sometimes, he would return from his after-dinner walk with a large pizza - always willing to please! He was also a strong swimmer, and I remember going with him to watch a swim meet sponsored by the local Kiwanis Club, where he was a member. When we arrived he found out that they were one swimmer short for the team, so he sat me down in the stands, put on an extra swim suit someone had in their bag, and joined in.

An entrepreneur at a young age, he and his brother created the Safeway Driving School in the 1940s, a business sponsored by the Chicago Motor Club. One of his great claims to fame was teaching Nancy Reagan how to drive. Many years after the driving school had closed, dad still proudly displayed an autographed picture of Nancy Reagan on his dresser mirror.

Dad had a few other brushes with famous people, too. One day when he was attending naval officer's training school at Harvard during World War II, he and my mother took a walk across campus. They noticed a disheveled old man with long gray hair, walking ahead of them. My dad commented, "That must be one of the town drunks." A man walking just behind my parents heard the comment and replied, "No sir, that disheveled man is Albert Einstein!"

Never one to shy away from an opportunity with celebrity, my dad was the first to go up and greet actor Pat O'Brien when we ran into him one Sunday 40 years ago at Mickelberry's log cabin restaurant on Chicago's south side. My dad quickly ushered my brother, sister, and me up to the actor to be introduced with, "Hello. I'm Stewart McClenahan, and these are my kids." Mr. O'Brien was appearing at Drury Lane Theater just a mile away.

During his Navy days aboard the Westpoint, dad also rubbed shoulders with actor and comedian Red Skelton. When my dad ran the Oxygen Medical Service, one of his clients was Elijah Muhammad, leader of the black separatist religious movement known as the Nation of Islam.

Driving and cars played an integral part in our lives because of my dad. He was proud of his work at the driving school, and taught each of his kids how to drive. Those lessons didn't come without a fair portion of blood, sweat and tears. We had to learn on a three speed, manual transmission car - and take our driver's tests on those cars, too! We didn't pass, or get use of the car unless we could successfully parallel park, facing uphill! I remember my dad telling me during those lessons that by learning the three speed, I would be able to drive any type of vehicle in my life. He was right! He also said that I would be able to learn this with ease, and eventually be 'doing it in my sleep.' Well, maybe not in my sleep, but easily without effort.

Since our family lived on a tight budget, our family cars were always used - never new. In the '70s, my dad was in his glory when his 'new' used car was a Volkswagen Beetle - a far cry from the sedans he had driven all his life. He bought the car from a shirttail relative who only drove it to church on Sundays (or so the story goes), and after he picked the car up, he honked the horn all the way home.

It was my dad's second career move that made a lasting impression with me, and fueled my passion for the eldercare field. After the driving school, dad opened Oxygen Medical Service, a company that delivered medical equipment and supplies to hospitals, nursing homes and private pay clients. I was about six years old and he would take me along on his routes. His clients were happy to see a small child, and the experience gave me an understanding of the lives of the frail elderly. On the way home from his deliveries, we would stop at the A & W Root Beer drive-in and get, what my dad called , "A couple of small RBs." Dad would get a gigantic stein of root beer, and I would have a kid's-size real glass stein.

Dad was a terrific writer and took every opportunity to write to the newspaper editors, the state's attorney, or anybody else he felt needed his opinion. TIME Magazine printed my dad's letter about the atrocities of war when Lord Mountbatten was killed, and a medical publication ran dad's comments about the benefits of brushing your teeth with baking soda. (He used backing soda all his life, and had most of his teeth -gold crowns and all - when he died).

Then there was music. He loved to sing and had the wonderful gift of being able to play the piano by ear. Dad was probably a choir member in every church he attended, and was also a proud member of the Morgan Park Glee Men - a men's chorus on the south side of Chicago. He did his best to keep up with the times, -especially in the musical arena. When Saturday Night Fever and the disco era were in full swing, dad came to me one day and asked if I had heard of The Bee Gees? Of course! He told me he had just heard a song by The Bee Gees on the radio, and immediately sat down at our piano and played, "How Can You Mend a Broken Heart" from memory!

My parents were all about service and giving. When dad taught eighth grade science (his third career) in one of the Chicago suburbs' underprivileged schools, he set up an after-school woodworking program for the kids. Dad would go to a local lumber yard and get the scrap wood donated. In that program the kids -most without dads- built bird houses, wooden boats and kites.

When a family from his school was burned out of their home, dad collected clothing and organized a drive to help the family get back some of what they lost. He was an active member of Kiwanis, volunteered for community programs such as flu shot clinics and election judging. Closer to home, dad helped out some of our neighborhood kids when they had troubles at home. He was also known in our area as Mr. Mack, the "go to guy" if a neighbor needed his car jump- started on a cold winter morning.

Believing in God and living a spiritual life was the foundation for both mom and dad. It was their faith that carried them through the rough hurdles in life. His favorite Bible passage was Romans 8:28 "We know that all good things work together for good for those who love God, who are called according to his purpose."

Dad's love for mom for more than 57 years was never doubted. He died just eight weeks after she did, and we are fairly certain he kept going that last year for her sake. His love of family and for his country were also limitless. One of the hymns that knew by heart was Henry F. Hemi's "Faith of Our Fathers, Living Still." That was my dad -faithful, loving, very much full of life, -and living still our hearts.

Happy 100th birthday, Dad.

Bringing Community into the Long Term Care Picture

Twenty years ago when my grandmother was in her '80s, during those times when she wasn't getting her way, and wanted us to believe that she was momentarily forlorn, she would affectionately tease us with, "Just drop me off at the Imperial." The Imperial was your average, one story nursing home that didn't look very appealing from the outside. We don't know what it looked like, or lacked on the inside, because we never ventured in. My grandmother never did go there, because she died at home after 10 years of stumbling through the fog of Alzheimer's disease. Long term care facilities weren't foreign to me, however, because when I was four years old I used to accompany my dad on his routes to deliver medical equipment to the nursing homes. Sitting in the lobby of various skilled facilities, I saw it all - people in pain, noisy carts being pushed around, unpleasant smells and elderly people. Somewhere along the way, I chose elder care as my vocation.

Fast forward to today, and take a look around at what the world of long term care has to offer. The world 'facility' has been replaced by 'community', for all the right reasons. Having just returned from a wonderful event in Houston at The Plaza, which is the health care center for The Buckingham, a continuing care community, I'm happy to say that this experience was one more affirmation on how the the long term care arena is anticipating the needs of today's elderly.

The Plaza at The Buckingham, a Greystone community, is a good example of a health care center that stands ready as a resource for the community it serves. There are amenities that used to be unheard of for health care communities; valet service, a nursing staff that will gladly answer your questions when you call, even if your elderly parent isn't a Plaza resident. A swimming pool, beautiful foot paths, fireplaces, and dining rooms that resemble the finest restaurants.

Behind all the niceties is the community connection that is the heart and soul of The Plaza. Its people, both residents and staff, are the true core of the community. Look at some of the success stories. One resident who came to live at The Plaza because of her advanced stages of cancer has regained her hope for a long and healthy life. She has recovered enough to drive her car, and will soon move back home. Dorothy, the director of nursing, is another example of a person who has found her calling at The Plaza. Dorothy was already retired when she heard about The Buckingham opening its doors, and decided that she needed the challenge, and wanted to give back with her time and talents. Several of the team members are also caregivers to their own family members. There is no lack of quality or integrity with this staff.

Since The Buckingham and The Plaza are in the business of making people feel better, they have partnered with several like-minded organizations dedicated to education, research and possible cures for debilitating diseases. Nancy Tucker, the president of CanCare Cancer Support Network, introduced me and gave our audience a wonderful snapshot of statistics and hope regarding cancer survival. Photo at right - Cathy Lightfoot, The Buckingham; Nancy Tucker, CanCare; Cheryl Kuba, Aging Parent Solutions.
She also talked about how health centers can work hand-in-hand with caregivers, and ease the burden for those individuals who are battling cancer.

Health centers aren't for everybody. My octogenarian sailing friend, Reese Paley, talks about long term care communities as, "holding tanks for the truly old and decrepit." If an elderly family member has the physical capabilities and desire to stay in their own home, then that's were they should be. But, if they lack socialization, feel isolated, and need assistance with any segment of their activities of daily living, there are so many desirable care communities that stand ready to help.

Care centers don't have to be the end of the road. Short term stays for rehab, and for recovery are the perfect utilization of care communities. Respite care-short term stays- are one of the greatest gifts around. Use it in three ways;

1. As a trial to see if your elderly parent is comfortable there.
2. For a vacation. Maybe your parent can't ski the Rockies. They can spend a week at a care community. (They won't tell you this- but it's a vacation for them, too!) Or, if you are remodeling your house, use respite care for your relative. Don't subject them to the plaster dust and hammering.
3. As a time-out when you need a break. We could write another article about caregiver stress. Use respite care when you need it, and research it long before you need it.

First and foremost, involve your elderly parent in the decision. Don't encourage them to do anything they don't want to do. Do your homework, and check out the care community with your parent. They already know some of the residents. If possible, have your parent volunteer at the community to become more familiar with their programs. Bring your mom in to the center's spa for an afternoon of mother/daughter manicures and pedicures.

Do your homework. Ask the right questions. In "Navigating the Journey of Aging Parents" I have a full page of questions to ask. Don't be shy. If something is a concern as you tour the community, bring it up. Remember that this community is home to some very precious relatives.

Involve the rest of the family in the new care lifestyle. I've seen kids on their way to the prom, and bridal parties stop at a long term care community to include their grandparents in the special day. Many communities have a program called the Baby Brigade, where young mothers bring their toddlers in for the morning so that the older adults and little ones can bond. A lot of surrogate grandmas are born.

A big part of doing your homework is checking out a care community before you need it. Build the relationship as you go. Just like falling in love, it doesn't happen in one day. You have to educate yourself and the community has to earn your trust.

Be ready. There are some terrific resources out there. Get to know the community in your area. It's a blessing to know that they are there when you need the help.

Take Heart, Dear Friend. My Life Depends on You!

Link


Today is Valentine’s Day, and I am dumbfounded at how I have been neglecting the good health of a dear friend – my Heart!

Three statistics about heart disease are so arresting , that I want you to read them, digest them, and then pass these three important facts on to everyone you know - your email lists, joke lists, buddy lists – and especially to the women in your life;

1. Coronary heart disease is the No. 1 single killer of women
over age 25.
2. One in 2.6 women die from heart disease, compared to one in 30 from breast cancer.
3. Sixty-four percent of women who died suddenly of coronary heart disease had no previous symptoms.

WAKE UP! WAKE UP! WAKE UP! Especially those of us who are providing care for an aging loved one, or are professionals managing the health care of one individual or one hundred. Take care of yourself first, -especially your heart.

In "Navigating the Journey of Aging Parents," and in all my presentations to caregivers and children of aging parents, my mantra continues –Take Care of Yourself First. Caregiver stress leads to heart attacks, hypertension and stokes. In an Evercare study about caregivers in decline, the physical forms of stress for caregivers include increased blood pressure, heart attack scares, arthritis flare-ups, acid reflux, and headaches. Every experienced any of these?

Two different events this week have fueled my fire to take immediate action about good heart health. In recognition of February being named Healthy Heart month by the American Heart Association, this past Sunday on Care Radio News Talk 560 WIND we featured heart health. I interviewed Lynne Braun, PhD., Nurse Practitioner, Preventive Cardiology Center and the Heart Center for Women, Rush University Medical Center, and Holy Messick, Senior Gala Director for the American Heart Association. These two experts shared powerful information with us about how we, as women, can prevent heart disease.

The second event that made heart health top of mind for me was yesterday’s Go Red for Women celebration at Navy Pier. Every single minute of this half day event and luncheon was filled with resources about getting your heart health checked out, diabetes information, healthy cooking demonstrations, keynote speeches and workshops to raise awareness, and how to speak to your physician about your concerns.

Here’s another alarming fact we need to tattoo to our brains:
On average, an American dies of Cardiovascular Disease every 35 seconds.

Know your numbers. You should be talking with your doctor about your heart rate, cholesterol levels, blood pressure and weight. You can figure out your numbers on line by going to www.GoRedForWomen.org, and clicking on the Go Red Heart Check Up tab. Get your heart checked out at least as often as you have your mammograms.

There are three things that can keep heart disease at bay: Avoid tobacco, Become more active, Choose good nutrition. The American Heart Association calls these the ABCs of maintaining a healthy heart.

When I took a little personal family inventory –always passively thinking that heart disease in our family was on the back burner – I had a rude awakening. Dad had quadruple bypass; one uncle had two heart attacks, with one resulting in his death; mom and her three brothers all had pacemakers. Mom also admitted that 30 years earlier she had been given a prescription for nitroglycerin by her doctor for heart problems – and didn’t tell anybody about it at the time. Because we would worry! Twice, I have thought I was having heart attack symptoms, and I know that my sister had a similar scare.

On two different occasions, I have called my sister in-law, and she has told me about just coming in from a funeral of a dear friend in his 50s: good health, a runner, good diet, doesn’t smoke. In both cases, the individuals died of heart attacks. One of the speakers at the Go Red For Women event was also a runner, in good health, good diet, etc., when she survived a heart attack – at age 27!

Here’s an embarrassing piece of self disclosure: During the last few years of our dog, Arthur’s life, my husband and I were overtly more concerned and conscious of Arthur’s heart health, diet and exercise routine – than we were of our own!

It is the motor that drives our body’s circuitry and soul. It is the furnace that fuels our emotions, from moving our hand with a gentle touch, to having us shake with riveting fear. Scared to death? That emotional shock starts in the heart!

With the advancement of medical technology, we have the possibility of getting spare parts –body parts – to help us maintain an active lifestyle. Over the course of our lifetime, we may have a hip replacement, dentures, new corneas, - even fake knees and boobs! I could go on and on. Our friend, Bill, was lucky enough to get a new heart valve –from a cow! But, for the majority of us, we will only get one heart!


My heart – my dear friend, has been with me since the day of conception when God set its rhythm to keep pace with my life’s stride. Our hearts are the last organ to die in our bodies. My human heart will be the pulse of my existence, until it stops with my last breath. The rest of my life begins right now. I can’t think of a more important or timely reason to take care of a dear friend.
Happy Valentine’s Day!

Please visit www.GoRedForWomen.org. or call 1-888-MY-HEART (694-3278).

PS. If you are interested in reading about the connection between your heart and your soul, pick up the book Heart and Soul, or, The Spiritual Heart, both by cardiologist, Dr. Bruno Cortis.