None of us can forecast the future, but you can use the time you spend with elders at this time of year to gather information that will help you all prepare for whatever is ahead. Holiday visits may be the only time you see some family members, and a lot can happen in a year. Here are some ideas for how you can capture – directly or indirectly – the information that’s available.
Holidays can be a good time to talk about what people see happening in the coming years, as NPR and other news outlets have discussed. (www.npr.org/sections/health-shots/2017/11/22/564988607/this-thanksgiving-carve-out-time-to-talk-about-end-of-life-wishes) These conversations are often difficult to start, but there are some excellent resources available to help get the ball rolling, such as:
- The Conversation Project theconversationproject.org
- Five Wishes agingwithdignity.org
- Hello (formerly “My Gift of Grace”) commonpractice.com
Even if you can’t find time to have the full conversation, you may be able to set the stage and continue the dialog later by email or phone.
Look at your elders, really look at them.
- Has their appearance changed: weight gain or loss, height, posture?
- Are they caring for themselves, bathing, shaving, styling their hair? If they are using a lot of perfume or cologne, could they be trying to cover up the fact that they are not bathing regularly or have become incontinent?
- Are they getting around normally, or do they get out of breath quickly, limp, shuffle, or hold on to furniture or walls for support?
- Are they dressing like they have in the past, or do they stay in their robe most of the day?
- Do they have visible bumps, cuts or bruises?
Look at the home for changes in housekeeping and maintenance.
- Are there burned out light bulbs? Is the sink dirty or clogged? Has the oven or other appliance stopped working?
- Does the house smell damp, moldy, unclean?
- Have they been accumulating papers, objects or animals?
- Is there unopened mail?
- Are valuable items missing?
- If the yard is usually tidy, is it a mess?
- Is there damage to the car, garage, or area around the driveway?
- Does the refrigerator hold uneaten, spoiled food, or odd things (like keys or a hairbrush)? What is in the kitchen cupboards?
- Have lights, water or other utilities been shut off due to non-payment?
Any of these factors can signal an important change in your elder’s situation. So what do you do if you see something that concerns you?
Treat your elder like the adult he or she is. Everyone is presumed to have capacity to make their own decisions; as a practical matter, trying to impose a solution will make everything more difficult.
- What does your elder want: where to live, what activities to do, what kind of medical care if they get seriously injured or ill?
- Find out what arrangements they have already made: do they have a will, power of attorney for financial matters, healthcare?
- Review overall financial picture (SSI, pension, IRA/401k, VA benefits, investments, insurance, real estate, other assets, liabilities, expenses) with appropriate professionals and update cash flow projections. If resources are limited, find out whether the elder is eligible for benefits like Medi-Cal, Food Stamps, free or low-cost transportation.
- Identify the support system: family, friends, church, fraternal organizations or others who may be able to provide care, money, housing, transportation, companionship, or other services.
- Every community in the U.S. has an Area Agency on Aging (AAA) that publishes a resource guide that includes information on health services, care facilities, housing, nutrition programs, activities, Adult Day Care, respite care resources, long term care, mental health care, transportation, veterans’ services, and organizations that serve the elderly and family caregivers.
- County Bar Associations provide low-cost referrals to attorneys who handle estate planning and can provide benefits advice. They can often connect you to accountants and other financial professionals. A Senior Legal Services program may offer free or low-cost advice and services.
- Identify your elder’s health care providers.
- Consider getting a comprehensive assessment by an eldercare professional. An assessment should include a review of health issues, family and other support systems, finances, personal care and homemaking needs, transportation, etc. The assessment should lead to a care plan that identifies specific needs and resources. Some Area Agencies on Aging provide assessments at no charge; in some areas, a visiting nurse service can provide an assessment, paid for by Medicare, if ordered by a doctor. Professional care managers also provide this service for a fee.
- Consider consulting with a professional Geriatric Care Manager (GCM), especially if you are a long-distance caregiver. GCM’s can evaluate needs, identify resources, coordinate medical care and support services, monitor changes, and manage crisis situations. A good GCM knows benefit programs, the local medical community, care givers, and resources.
- The good news: the right GCM can be a literal life-saver for the elder and for the family. Sometimes people listen and cooperate with a professional better than with family members.
- The other news: GCM services can be very costly, and some GCM’s tend to over-extend their role. It may be worth investing in a consultation to establish a relationship, but postponing further services until specific needs arise.
- Even if your elder is resistant to the very idea of support services, nothing stops you from scoping out the local situation while you are there.
So – enjoy the holidays for all of the opportunities they offer.