Despite our best efforts to make the holidays a time of pure joy and thankfulness, the fact is for most people I know there is also a fair amount of stress. I can only imagine how that is exacerbated when there is a family member with Alzheimer’s.

The Alzheimer’s Association – Florida Gulf Coast Chapter- has developed 10 Holiday Survival Tips that will help make family gatherings a happy, memorable occasion for all.
 
Tip 1 -  Planning can avoid holiday stress. Individuals who experience the most difficulty with the holiday season are those who have given little thought to the challenges they will encounter. Consider ahead of time what may be expected of you, both socially and emotionally.

• Discuss holiday celebrations with relatives and close friends in advance. 
• Plan to maintain a regular routine while trying to provide a pleasant, meaningful and calm holiday event.
• Celebrate early in the day or have a noon meal rather than a late dinner.

Tip 2 – Take care of yourself (caregiver) Remember, the holidays are opportunities to share time with people you love. Try to make these celebrations easy on yourself and with the person with Alzheimer’s disease so that you may concentrate on enjoying your time together.

• Set limits by telling family and friends that you intend to control stress this holiday season.
• Maintain a positive mental attitude.
• Ask for assistance for you and your loved one.
• Attend an Alzheimer’s Association support group that will allow you discuss ways to overcome holiday stress.
  Prepare to deal with post-holiday letdown. Arrange for in-home care (respite care) so you can enjoy a movie or lunch with a friend and reduce post-holiday stress.

Tip 3 – Prepare the person with Alzheimer’s for the family gathering. Preparing your loved one for the upcoming holiday events can allow both of you to enjoy the warmth of the season.

• Talk about and show photos of family members and friends who will be visiting.
• Have a “quiet” room in case things get too hectic.
• Play familiar music and serve favorite traditional holiday foods.
• Schedule naps, especially if the person usually takes naps.

Tip 4 – Prepare family members and friends. Preparing families and friends with an honest appraisal of the person’s condition can help avoid uncomfortable or harmful situations.

• Familiarize family members and friends with behaviors and condition changes.
• Recommend practical and useful gifts. (See Tip 7)
• Remind family and friends the best way to communicate with a person with dementia. (See Tip 6)

Tip 5 – Involve everyone when selecting activities. Involve everyone in holiday activities including the person with dementia.

• Consider taking walks, icing cookies, telling stories, doing chores, making a memory book or family tree, or keeping a journal.
• To encourage conversation, place magazines, scrapbooks, or photo albums in reach; play music to prompt dancing or other kinds of exercise. 
• Encourage young family members to participate in simple and familiar activities with the person.

Tip 6 – Communicate with success. Alzheimer’s can diminish a person’s ability to communicate. These tips may help you understand each other.

• Be calm and supportive if the person has trouble communicating.
• Speak slowly with a relaxed tone.
• Avoid criticism. For example, when someone forgets a recent conversation, avoid saying, “Don’t you remember?”
• Address the person by name.
• Be patient, flexible, and do not argue with the person with Alzheimer’s

Tip 7 — Smart gift giving.

• Encourage family and friends to give useful, practical gifts for the person such as identification bracelet (available through Medic Alert® + Alzheimer’s Association Safe Return®). Other gifts may include comfortable easy-to-remove clothing, audiotapes of favorite music, videos, and photo albums.
• Advise others not to give gifts such as dangerous tools or instruments, utensils, challenging board games, complicated electronic equipment, or pets.
• If possible, involve the person in giving gifts. For example, someone who once enjoyed cooking may enjoy baking cookies, or buy the gift and allow the person to wrap it.

Tip 8 – Safe environment in the home. Persons with dementia may experience changes in judgment. This behavior may lead to confusion, frustration, or wandering. Consider these tips to reduce the risk of injury and situations that could be confusing to someone with dementia.

• Assign a “buddy” to watch out for the person to ensure their comfort.
• Arrange ample space for walking side-by-side, for wheelchairs, and walkers. Keep walking areas clear.
• Consider seating options so the person with Alzheimer’s can best focus on conversation and be least distracted.
• Don’t serve alcohol, which may lead to inappropriate behavior or interactions with medications.
• Accommodate changes in vision. Place contrasting-color rugs in front of doors or steps.  Avoid dark-colored rugs that may appear to be “holes.”
• Limit access to places where injuries occur, such as a kitchen or stairwell. Check temperature of water and food.  Prevent falls by installing metal grab bars; and secure textured stickers to slippery surfaces.
• Create even level of lighting; avoid blinking lights.
• Keep decorations simple; avoid using candies, artificial fruits/vegetables, or other edibles as decorations.
• Supervise in taking medicine.
• Keep emergency phone numbers and a list of medications handy.

Tip 9 — Travel wisely. The following suggestions may ensure a positive traveling experience:

• Never leave the person alone.
• Use familiar modes of transportation and avoid peak travel times.
• Keep plans simple and maintain daily routines as much as possible.
• Allow extra time to avoid the stress of rushing.
• Advise service and hospitality staff that you are traveling with someone with dementia and about the person’s behaviors and special needs.
• Arrange for services, such as wheelchairs, ahead of time.
• Provide identification items such as a Medic Alert® + Alzheimer’s Association Safe Return®) bracelet and clothing labels.

Tip 10 – Reliable sources of support
Families can call the Alzheimer’s Association (Gulf Coast Chapter) at 727-578-2558 or the 24-hour Helpline at  1-800-772-8672 to answer questions about warning signs and to assist persons with dementia  and caregivers.  The national Helpline is 1-800-272-3900. The Helpline will be open all Christmas day and New Year’s Day, as well as year round.

Thanks to Linda Dunkelberger for submitting this guest blog post to Florida Senior Living Advisor. She provided this post on behalf of Visiting Angels, a nationwide network of  senior home care providers that help seniors with everyday tasks, errands, meals, transportation, just to name a few services.  I think these tips are especially important to keep in mind during the holidays, when we are all busy with jam-packed “to-do lists,” in addition to whatever care we must provide to elderly family members.

Caring for aging parents or loved ones carries a lot of responsibility and a range of emotions.  No matter how much love in your heart, carrying the load of caring for your loved one will leave you drained physically, emotionally and possibly financially.  Coping with the stress of senior home care has to be managed or you will not be able to be an effective caregiver.

Managing the stress of senior home care is all about taking charge.  Take charge of your thoughts, your emotions, your schedule, your environment and the way you deal with problems and unexpected situations.  The ultimate goal of coping with the stress of senior home care is to achieve a balanced life. 

How to reduce, prevent, and cope with the stress of senior home care:

• Senior home care requires organization – Organize your time and your schedule.  Write everything down so that you or another family member has reference to phone numbers, doctors, medications, in-home senior care providers, important insurance and financial numbers.
• Start a personal journal- Share your feelings about the stress of senior home care (either in hard copy or an online blog).  Writing down your thoughts will help you to take charge of your emotions. 
• Prioritize your health and well-being.   Nurturing yourself is a necessity, not a luxury.  Healthy ways to relax and recharge:   
   *Go for a walk 
   *Call a good friend 
   *Sweat out the tension with a good workout 
   *Write in your journal 
   *Curl up with a good book 
   *Take a long bath 
   *Eat healthy and exercise regularly 
   *Play with your pet
   *Work in your garden 
   *Listen to music 
   *Savor a cup of warm coffee or tea
• Give yourself a break – Enlist the help of a professional senior home care provider. Senior home care providers such as Visiting Angels can provide daily or weekly help with everyday chores, errands, hygiene, meals or transportation needs, just to name a few.  Senior home care providers can also provide a respite to you with as little as 15 minute notice to avoid unnecessary stress if your schedule needs help.

Coping with the stress of senior home care is the only possible way to be an effective caregiver to your loved ones.  Your mental and physical health must take priority or you will not be able to manage what needs to be done.  Take advantage of these tips.  Organize yourself, express yourself, nurture yourself and help yourself by arranging for assistance with a senior home care provider.

We celebrated my father’s 85th birthday yesterday.

As I sat there watching him enjoy his dinner and laughing at the antics of his grandchildren, I couldn’t help but smile at how much he has mellowed with age. When I was younger, he was tough. Really tough. Opinionated. Obstinate. Prone to cynicism. As a teenager,  when I would ask for permission to go out with my friends, he would randomly say no. When I would ask why, his response would be, “Because I said so.” End of discussion.  Now I see a softer side to him; he laughs more, even cries occasionally (particularly when my daughters play the violin for him). And he’s definitely much easier on waitresses and other service personnel than he used to be.

So I had to wonder, is there any scientific proof to what I have experienced with him – that personalities can mellow with age. I came across this report from a few years ago from the Journal of Neuroscience. The study suggests that elderly people may be better at perceiving happiness and worse at perceiving fear, which researchers say supports the idea that people do mellow with age.
 
In the study, volunteers were asked to pick out the pictures showing fear and happiness from others showing anger, disgust and sadness. As they viewed these images their brain activity was monitored using functional magnetic  resonance imaging (fMRI). Results indicated that older people more accurately spot happy expressions while teenagers are better at identifying fearful expressions.

An anthropologist from Rutgers University explains that there may be an evolutionary advantage to mellowing with age. Helen Fisher says, “I don’t think it’s just about going to your grave feeling happier about life.” She says our hunter-gatherer ancestors may have benefited from the presence of happier elders with a calm approach to settling disputes within groups. “There would have been a tremendous advantage to have older people in the group with an optimistic view,” she adds.

All I know is that it makes my time with dear old Dad much more enjoyable. Happy Birthday Dad.

I suppose I shouldn’t have been surprised by this sentence in a recent report by the Federal Government. The sentence reads, “In addition, the most poorly performing homes tended to be chain affiliated and for-profit and have more beds and residents.”  The report, by the General Accounting Office, is a lengthy document about the quality of our nation’s nursing homes. To see it in print – from the federal government – that “chain affiliated and for-profit” nursing homes tend to be the ones offering the poorest care to residents only reaffirms what I have long suspected, and what I have heard from many of you who write to share your personal experiences of loved ones in senior living facilities. Time and time again, I hear that the best care tends to come from a personal connection between caregiver and resident.

And here is another interesting finding – the most poorly performing homes are distributed UNEVENLY across the states, with eight states having no such homes and ten others have from 21 to 52 such homes. Where do you find the 52 worst nursing homes? According to the GAO, that’s in Indiana. Florida has 16 that make the list, a relatively low number considering there are 664 nursing homes in my Florida Senior Living Advisor database. But we don’t do as well as another popular retirement location – Arizona has just 4 homes on the list.

According to GAO’s estimate, of the 16,000 nursing homes in the US, four percent – or 580 – could be considered the most poorly performing. If you want to understand more about the GAO’s research and conclusions, you can read the summary and recommendations, or even review the entire report. But be patient – it is 57 pages long! (The map showing numbers of poorly performing homes in each state is on page 15.)

In the past year, I’ve seen first-hand how devastating a fall can be to an elderly person. My 84-year-old father has fallen twice in his independent living apartment. The first time, he was on the floor for about 36 hours before he was found; the second time, he was down for about five hours. He has been very lucky – he has recovered fully from both incidents, with no long-term effects. In fact, I think his two artificial hips have actually been a blessing in these  falls – his right hip did dislocate both times, but doctors were able to pop it back into place; had this been his natural hip, it likely would have broken, leading to a much more difficult recovery.

The sad reality is that falls are one of the most common causes of accidental death in the elderly. A series this week in the Minneapolis Star-Tribune aims to raise awareness of the prevalence of falls in Minnesota nursing homes; I have to believe this is a similar problem nationwide, and not just in nursing homes but in assisted living facilities, independent living communities and private homes. In her commentary on the series, Star-Tribune editor and senior vice-president Nancy Barnes writes, “I urge our readers not to look away, despite the distressing nature of these stories. Nothing is more certain in life than death; we can only hope that we will be allowed the gift of dignity. In many of these stories, that is simply not the case.”

The investigative article is long and, at times, difficult to read. But it is important. Worth sharing. As one doctor quoted in the  article states, “”I think if you asked a person on the street, not one of them would know that if you take the frequency of falling and the consequences of falling, it’s as big a problem as heart attacks and strokes.” My father was one of the lucky ones. For many elderly people, a single fall can trigger a rapid decline in health. I hope you will take a few minutes to read this article. And I hope you’ll share your thoughts by leaving a comment.

I remember when my father was trying to select a Florida senior living facility. The process was frustrating (which is in part why I created Florida Senior Living Advisor) and tiring – driving around from one senior facility to the next, trying to keep track of the different features, costs, options, etc. By the time he had made his decision, we were both a bit worn down and just ready to be done with it. In actuality, that was the time we probably should have been at our sharpest – focused on reading every bit of fine print before he signed on the dotted lines. Yes, we did read over the pages and pages of paperwork very closely; but I’m not confident that we truly scrutinized every point, and we certainly didn’t have it independently reviewed by an attorney.

Thus far, my father has not had any issues, and (knock on wood) I don’t foresee any in his future. But when I came across this article from The Washington Post about contracts at continuing care retirement communities, I figured it was worth sharing. It makes reference to a specific CCRC in Northern Virginia, but the concepts are universal.

Scrutinize any contract to avoid nasty surprises at continuing care community

By David S. Hilzenrath

If you are considering moving to a continuing care retirement community, you would do well to consult a lawyer and read the fine print of any contract to determine whether the potential benefits outweigh the risks. A “Residence and Care Agreement” for Ashby Ponds, an Erickson community in Ashburn, illustrates some of the trade-offs the decision could entail.

You might be drawn to Ashby Ponds by the potential to avoid another disruptive move when you are least able to cope with it, but there is no guarantee you would be able to move to an assisted-living or nursing facility on the same campus — even when those facilities are completed. If the assisted-living and nursing home beds at Ashby Ponds are full, management could arrange for you to go elsewhere.

Some delay in building those facilities is routine at Erickson developments, said Ronald E. Walker, chairman of a nonprofit group associated with Erickson campuses. Though Ashby Ponds opened in September 2008, the assisted-living and skilled-nursing portions were not expected to open until the end of 2011 or the beginning of 2012, according to a May report from the community’s management.)

The deposit you post to move in does not limit the amount you could be required to pay on a monthly basis; management can raise the monthly fees. In addition, the fees can go up as you move from one level of care to the next. At Erickson communities, the average monthly fees range from $1,750 for singles in independent living to $5,178 in assisted living and $307 per day — as much as $9,517 per month — in the nursing homes, Erickson spokesman Mel Tansill said.

Management can decide to transfer you to a higher level of care. If you refuse to go, management can kick you out and hold on to your deposit until 60 days after it finds a new tenant. To gain admission to the community, you have to pass financial and medical reviews. If you marry a nonresident, your new spouse would have to pass such a review before being allowed to move in.

To reassure management that you have the ability to pay expenses, you must agree not to give away any assets that would bring your net worth below a minimum requirement. Evan H. Farr, a Fairfax lawyer who specializes in issues facing the elderly, recommends putting any extra assets in an asset protection trust before you move in.

Unlike a real estate investment, the deposit you post to enter the community does not grow as property values rise. But it can shrink as property values fall. If it takes management a long time to replace you, you may be offered the option of accepting a smaller payout so that management can in effect cut the price of admission for the next tenant to occupy your apartment.

Today is the first annual World Pneumonia Day. Nearly 100 health organizations worldwide have come together to call on governments to take action to address this deadly disease. This awareness campaign is focused on pneumonia in children; and rightly so since pneumonia kills more than two million kids worldwide every year, making it the leading killer of young children.

Let’s not forget, however, that the elderly are the second most-affected segment of our population when it comes to pneumonia. Community Acquired Pneumonia (CAP) causes about 500,000 hospitalizations in those older than 65 yearly in the US and is the 5th leading cause of death in people over 65.  Nursing Home Acquired Pneumonia (NHAP) is one of the most common causes of infection in chronic care facilities and is one of the most significant infection-related causes of mortality in such facilities.

The Centers for Disease Control reports that last year 60% of adults 65 and over received a pneumococcal vaccination, sometimes called PPV. The good news is that if you get the pneumonia shot at age 65 or older, you should be protected from the most common type of bacterial pneumonia for the rest of your life, and Medicare will pay for it. According to the CDC, seniors age 65 and older should consider getting vaccinated against pneumonia as well as the seasonal flu, because they are at risk for developing the two infections at the same time.

So if you have an elderly family member, particularly one living in a senior living facility, find out if they have  received a pneumonia vaccine. Some, such as my somewhat stubborn elderly father, may refuse to get the shot. But it is an important issue to raise with the individual and his or her doctor.

If an elderly family member suffers from hearing loss, here is something you need to know: Florida Telecommunications Relay, Inc., (FTRI) will provide specialized phone equipment for them at no cost. FTRI is a statewide non-profit organization that provides this equipment as mandated by the Florida Legislature. The program is funded by an 11 cent surchage on all landlines in Florida. And these phones can be used in private residences, or in Florida nursing homes, Florida assisted living facilities, and Florida continuing care retirement communities.

And now FTRI has added a cordless amplified phone to its mix of available equipment. The Clarity W425 Pro amplifies incoming sounds up to 45 db.

Clarity W425 Pro cordless amplified phone

Permanent Florida residents who are certified as having a hearing loss can easily obtain the W425 Pro by completing an application and visiting one of FTRI’s 22 conveniently located distribution centers throughout the state.  For more information, call FTRI at 1-800-222-3448 or visit www.ftri.org. 

“FTRI aims to provide individuals with hearing loss a telephone solution like the Clarity W425 Pro,” said James Forstall, FTRI’s executive director.  “The majority of the people we serve are senior citizens and the Clarity W425 Pro is a device that may assist them with communicating with others on the telephone.”

 FTRI estimates that nearly three million Floridians experience some degree of hearing loss. Along with amplification technology, the W425 Pro contains large backlit numbers, a bright visual ringer, and is hearing aid compatible. 

 “FTRI is an outstanding program which helps so many people throughout Florida,” said Carsten Trads, president of Clarity.  “Hearing loss is a serious, yet often overlooked issue.  Many people are not aware that solutions like amplified telephones even exist.  Thanks to FTRI, hopefully more people in Florida will take the necessary steps to address their hearing loss and consider using amplified telephones.” 

FTRI also offers equipment for Florida residents who are deaf,  blind or speech impaired. Many other states have similar free programs.  Visit the Telecommunications Equipment Distribution Program  Association to learn more.

Sunday, October 18, life threw me a curve. My elderly father fell in his Florida senior living apartment and dislocated his hip. That triggered a series of events – a trip to the ER to have it put back in place, his release that same night to come stay with me, a second hip dislocation followed by a  second re-location. Then six nights in the hospital to run tests,etc.  He is now back in his Florida continuing care retirement community apartment and gradually re-gaining his strength. So I thought I would share the top ten things I learned in this last week of helping my father recover from this fall:

1 – At any age, life can change in an instant.
2 – Healthcare workers are just like the general population – some are nice, some are not so nice; some are highly skilled, some are mediocre; some genuinely care, some are just doing a job. We shouldn’t make them “God-like,” nor should we start with the mindset they are all incompetent (like my dad is prone to do).
3 – Communication is critical when in the hospital – both from the patient to staff and from the staff to patient. I find nothing puts me, and my father, more at ease then feeling like the medical staff is keeping us up-to-date on his situation; and nothing was more frustrating then having to walk around begging someone to tell us what is going on.
4 – Nothing happens fast in the hospital. Patience is key.
5 – You must be an advocate for yourself, or for your loved one if you are their caregiver. Ask questions, ask for clarification, ask to see test results, ask “What would you do if this was your father?” Don’t be afraid to push a little. I had to call my father’s nurse to say “He would really like to shave, can you help him do that?” and “He has been lying in bed all day, can someone please get him up to walk the halls?” The squeaky wheel gets the grease.
6 – The whole experience of being hospitalized can be confusing and frightening, particularly for the elderly. In my elderly father’s case, anything outside of his normal daily routine causes some confusion. So suddenly being in a hospital, with no familiar faces, a different schedule for meals, none of his personal effects, etc., left him confused and a bit angry. I had to remind myself that his anger was just an expression of his confusion and frustration at the situation and at having to rely on everyone else.
7 – When caring for an elderly family member, remember to care for yourself too. It has taken me a long time to embrace this concept. When my father had a similar fall last year, and was hospitalized for a couple of weeks, I was constantly wracked with guilt if I was not by his bedside 24/7. I have finally learned that is not necessary for him , and not healthy for me. And actually I have found that by taking breaks, I have helped him re-gain confidence that he can do things for himself.
8 – Health insurance & Medicare rules are confusing and can sometimes be an overriding factor in determining care.
9 – When dealing with a variety of care providers (physical therapists, home health, rehab facilities, etc), don’t lose sight of the fact that they are all in business and that factors in to their recommendations.
10 – Getting old is not for sissies (credit goes to my husband for that one).

I remember the first time I saw a “Silver Alert” – it was posted on a highway message board in Orlando last December. The message said “Silver Alert” and also gave a description of a vehicle. I wondered out loud, “What is a silver alert?” And my 9-year-old daughter replied, “Mom, maybe it’s like an Amber Alert only for old people.” Bingo. We then proceeded to discuss what a great idea it was to create this type of alert program.

Florida’s Silver Alert system has now entered its second year, and state leaders are praising its success. The Silver Alert Plan is a standardized system to aid local law enforcement in finding people age 60 and older with documented dementia who have wandered or driven off. The plan calls for the broadcast of important information via the media and highway message signs to enlist citizens in the search for an endangered senior.  In addition, in August 2009, the Florida Department of Elder Affairs introduced a new capability that enables the general public to sign up to receive free Silver Alert e-mail messages. To sign up, visit www.elderaffairs.state.fl.us/index.php.

“Over the last year, law enforcement has drawn upon this program many times,” said Florida Department of Law Enforcement Commissioner Gerald Bailey. “Silver Alerts activate an army of citizens to assist law enforcement. The more people involved with the search, the better the chances of finding the missing senior in a timely manner.”

To date, 115 Silver Alerts have been issued – 110 individuals were located safely, with 18 of those recoveries attributed directly to the Silver Alert.

“I’m pleased and proud of the way this program has worked as a safety net for some of our most vulnerable citizens,” said Florida Governor Charlie Crist. “I thank our citizens for paying attention to the Silver Alerts, and for doing their part to call in the information law enforcement needs to safely locate these seniors.”

“Not only is Silver Alert a safety net for missing elders, it is also a security blanket for their loved ones who can take comfort in knowing that they aren’t alone in their search,” said Elder Affairs Secretary E. Douglas Beach.

“Silver Alerts make more people aware that an elder is missing, and that’s a tremendous help to everyone.”

The Silver Alert program was modeled after the Amber Alert system, which spreads the word about missing children.

To learn more about the Florida Silver Alert Plan, visit http://www.fdle.state.fl.us/. To report a missing elderly person, call 911.