Dear AgingParents Family:

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First, we do have to put ourselves first sometimes.  What’s best for us, best for our own families and our own peace of mind must be a serious consideration.  Sacrificing our sanity for the sake of caregiving is not the best choice. Delegate and find others to help if having too much of the caregiver burden is getting you down.

Second, know our own limitations.  Caring for aging parents can become very time-consuming and emotionally wrenching as we watch our loved ones decline in health.  Trying to bravely go it alone, taking in an ailing parent, or assuming other large, long term chores is not for everyone.  It’s okay to say “no”.  Every adult child is not the same and many are simply unable to do a good job of being a primary caregiver.  Admitting this to ourselves is both healthy and necessary.

Third, forget trying for praise, appreciation or recognition of a caregiving job well done when our parent has dementia.  Our parent’s brain is not functioning normally with dementia.  The cognitive impairment may mean that he or she is unable to appreciate your efforts.  It may mean behavior changes, such as suspicion, accusations and nasty outbursts in your aging parent when that sort of thing didn’t happen before.  Do a good job for your own sake and because it’s right, not because you have to have your parent’s approval.

Fourth, we need to love ourselves for trying.  Our efforts may not always succeed. We may feel doubt about what we’re doing. We may feel guilty that we get mad at an aging parent who is so difficult.  But we keep trying to make life manageable, keep up their quality of life the best we can and go at it with sincere hearts.  We need to tell ourselves that we are brave and valued for forging on in the face of difficulty.  We need to appreciate our own efforts.

Fifth, we need to take breaks.  We get so lost in caregiving, directing others, managing our own jobs, families and problems, we forget how much time we’re putting in. We forget to stop.  This is really important!  To nurture our own bodies and soothe our own spirits is the very thing that gives us the strength to carry on and keep it up.

So, my friends, be very good to yourselves.  Love your own heartfelt work of helping aging parents, especially the most difficult ones.  It takes a strong will to put up with the resistance difficult parents put up.

Mikol and I are with you. We have difficult people in our lives, too.  My Mom was mentally ill and the challenge to my strength and patience was there for years on end.

We are on this journey together.  We can help each other along.

If your aging parent is driving you nuts, let us know about it,  We do like to address your questions.

Until next time,
All the best,

Carolyn Rosenblatt, RN, Attorney and Dr. Mikol Davis

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WATCH THE FILM FOR FREE
Age of Champions is the story of five competitors up to 100 years old who sprint, leap, and swim for gold at the National Senior Olympics. The Washington Post called the film “infectiously inspiring” and theater audiences across the country have fallen in love with its light-hearted take on growing older.

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Even if your loved one is in poor health, you still never think of it. No one plans for a sudden passing.  I’ve just had a shocking awakening.
Our friend, colleague and I were emailing each other about a recent video product we created together.  He had just done some edits and the video was great.  Bruce was the best video producer I’ve ever met. He was an original founder of AgingParents.com, our business. We were on this project for weeks. Four hours after the email, he died of a sudden heart attack. He was my age.

                                               In Memoriam: Bruce Tokars

I am sad and feeling the loss very much.  And I am struggling to imagine what it would be like for my own spouse and kids if I were the one to go so unexpectedly.  I do this blog full of ideas about being prepared for disability or the end of life. And in my work I meet people face to face and help them get ready for their aging parents’ frailties and end of life.  Yet I am sure my kids would not be ready to step up and do the job of winding up all our affairs if I left this life without warning, as Bruce just did.

We always think we have more time.
So, here is my resolve, which I discussed with my husband, Mikol as we try to deal with the loss of our friend and an original founder of AgingParents.com.
We need to prepare our “exit papers”.
We need a hard copy and zip drive with the essentials our kids would need if we were suddenly no longer with them.

Fortunately, we have practiced what we preach in our work. We have let them know what we have, where our investments are and where we keep all records.  We have introduced them to our financial advisor and our tax preparer and they have relationships with both. We’ve taught our daughter about how to handle real estate transactions, as she is interested in them. We have our estate plan and a health care directive.  They know our wishes. It sounds like a lot.

But that is not enough. They need minutiae: account numbers, passwords, access to a great deal of information and a list of all the managers and professionals upon whom we rely to keep our lives and finances in order.  This is detailed stuff. It’s complicated.  These are part of the exit papers.

Is this risky, telling them all our business?  Yes.  If we give them all information, they could possibly take advantage of us if we become infirm and live to be 100. Of they could rip us off if we lost our minds.  I’ll take the chance.  I am certainly not a perfect mother, but I’ve tried hard to raise kids with integrity and values and they’ve definitely got them.  I am willing to trust them to do what is right and to never misuse the trust we place in them.  I know my kids are both honorable human beings and I’m very proud of that.

What if you don’t have kids or your kids don’t happen to be so trustworthy?  If they have a drug or alcohol problem or they’re not good with money?   In that caseI’d give my exit papers to a licensed professional fiduciary or appointed successor trustee and be sure everything that person or institution would need is in the exit papers. I would teach them while I could.

This goes a lot farther than standard estate planning.  It is about the minute details of daily life that our friend Bruce’s widow must now deal with in the midst of her profound grief.  Can she get into the email accounts?  Can she transfer the projects he was working on to the next person in charge?  When it’s my turn to go, I don’t want it to be any harder on my loved ones than it needs to be.  I can at least give them information in advance so they will not struggle to take care of business.

So, my husband, Mikol and I embark upon the Exit Papers Project. It will take the next two weeks or so to get it done.  It’s a matter of copying contacts, things and numbers into a document with explanations about what and where and why.  Then we sit down with the kids, both in their 20′s, and show them what it all means.

If you are willing to face the reality that we are indeed mortal, consider your own Exit Papers Project.  It might be the smartest, most caring and safest thing for your family.
And of course, we’ll have to update it every year.
I’m okay with that.  It’s an act of love.

Until next time,
Carolyn Rosenblatt
AgingParents.com

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Howard, 92, loves women.  He has dementia and is legally blind.  He likes to give women checks when they tell him their sob stories about needing money.  He has one daughter, Missy, who is aghast at his conduct.

After her mother died, Missy felt obligated to try to keep Dad from throwing away all his money.  He would use up everything in the checking account and then use credit cards to the max. He got into debt. Missy warned him and warned him, but he just didn’t get it.  She had no legal authority to stop him from his stupid decisions about money.

He  got a housekeeper, Flossie, recommended by the manager of his building.  Flossie didn’t have much money, and needed to get her car fixed.  She hit up Howard and wrote herself a large check from his account, which she had him sign.

When Missy confronted him about giving Flossie money, he lashed out and tried to hit her.  He had a history of violence and Missy was fearful as well as very angry.  Dad had given away cash to five other women before Flossie!

Finally, Missy was able to get the checkbook away from dad and no one else could write checks for this blind man to sign.  He was now out of money.  She had not taken legal steps to do this before he was broke. Not smart.

Flossie decided she was “in love” with Howard.  She assured his daughter that she just wanted to be with him but they weren’t going to get married. Then Howard took a fall, was hospitalized and soon after, went to a nursing home.  Flossie kept hanging around. One day, she went down to City Hall and got a marriage license. She never told Missy. She found an officiant for marrying them and had the ceremony right there in the nursing home.

Missy was beyond furious.  She had reported Flossie to Adult Protective Services. The worker told her that Howard was “entitled to his folly”. She thought that was just plain stupid. She was advised that she could go to court and get a guardianship over her Dad. But, he had no money left and it seemed pointless by then. It was going to cost thousands of dollars too.

She sought advice at AgingParents.com.  Mediation of the dispute with Flossie was suggested.  Missy and Flossie both agreed to talk over the problem.

Missy wanted to have the marriage annulled.  She wanted Flossie to be able to visit Howard, as he did seem to like her company and he was lonely.  Missy and her  husband had a suspicious and mistrusting relationship with Flossie, but in a way she was actually helping them by keeping Howard company while they were at work. Flossie didn’t want an annulment. She liked the idea of being married. Apparently, she didn’t consider Howard’s credit card debt. She just wanted to get something from Howard, like his Social Security survivor’s benefits.

The dispute was mediated without involving lawyers or the court. Missy proposed that she would allow Flossie to continue to visit Howard as she wanted.  But, she was to refrain from discussing money and would report to Missy. When Missy asked Flossie if she was going to pay her Dad’s credit card bills, Flossie blanched.  Suddenly, she seemed a lot more interested in the annulment.

She agreed to Missy’s conditions. A deal was worked out between them with the mediator’s help. Flossie agreed not to tell Howard about the annulment. He had been declared incompetent long before, and would forget what it meant anyway.  Flossie agreed to the legal annulment.  In exchange, Missy and her husband agreed to attend a “marriage” ceremony between Flossie and Howard at Missy’s home, without any paperwork, without it being legally recognized, and Howard would be none the wiser.  Flossie could play married, without any legal consequences good or bad.  Howard would still have Flossie’s companionship and Missy was okay with that.

The resolution gave everyone at least some of what they wanted.  Before it got as far as it did, however, Missy might have tried other options.

By the second or third time a woman had ripped Howard off, she might have worked on persuading him to give her a Durable Power of Attorney for finances.  She could have moved funds out of his checking account and stopped the ripoffs by his “girlfriends”.  He eventually did sign one, but it was too late to keep his funds in the bank when he did.

She also could have gone to court for that guardianship.   His doctors were cooperative in declaring him incompetent to handle money.  Guardianship was a last resort, but it would have protected him.  He ended up on Medicaid, in a 3 bed room in a mediocre nursing home.  He will likely stay there for the rest of his days. Guess that’s how it works when one is “entitled to his folly”.

I’m hoping that anyone with an aging parent who is like Howard will look ahead.  Sometimes, your aging parent makes a string of stupid decisions and you can’t stop them. But sometimes you can stop the folly before it’s too late.  If you don’t know what to do, seek some outside advice.

Until next time,

Carolyn Rosenblatt

AgingParents.com

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As a nurse and attorney, I can tell you I was so uncomfortable reading about the nurse who refused to give CPR to the dying resident in the seniors’ community where she worked. I got a sick feeling in my stomach.  But there is a lot to this story.

I believe there should be exceptions in non health care residences for emergencies like the one involving this senior, Lorraine Bayless.  A nurse who is on scene should be able to do what any trained lay person can do:  administer CPR when someone stops breathing.

The press reports that there was no Do Not Resuscitate (DNR) direction in place.  Ms. Bayliss’s family believed that she wanted “to die naturally and without any kind of life prolonging intervention” as they told the Associated Press. Glemwood Garden’s policy about what the nurse should do in an emergency was sufficiently unclear that  owner Brookdale’s public statement was to the effect that the nurse had “misinterpreted the company’s guidelines.”  What those guidelines were is not certain.

We have legal documents that allow anyone to make quite clear what they want in an emergency such as stopping breathing.  There is a DNR statement or order. There is an advance health care directive to guide others if the person in no longer conscious or competent.  There is a newer document called Physician’s Orders for Life Sustaining Treatment (POLST) in some states, also called Medical Orders for Life Sustaining Treatment (MOLST).  A doctor signs it and it’s posted appropriately. It allows others to be comfortable following the person’s wishes, even if the wishes say don’t keep me alive.

This uncomfortable, ethically questionable, confusing scene over Ms. Bayliss’ end of life did not have to happen the way it did.  If you don’t want to be in that kind of situation, you need to be responsible for deciding what you want and communicating it to those who will have to act on your behalf.

Either you want emergency intervention or you don’t. If you are very clear that you do not want to be resuscitated when you stop breathing, let the people where you live know what you want and put it in writing. Post it in a prominent place and give it to the administrator of any seniors residence you choose as your home. If you have clear statement that you don’t want resuscitation and you stop breathing, no one should call 911.  Paramedics will attempt CPR every time. CPR is definitely life prolonging intervention.  The legal documents mentioned above allow you to spell out  under what circumstances you want to be kept alive. It is not always so straightforward as stopping breathing, or a sudden event.

We’re in a society that is generally phobic about death, much more than many other cultures in the world. Death in many other places is accepted as the natural end of life and people don’t spend as much time avoiding the very idea.  In our culture, we seem to think it’s optional.  We don’t like the idea of planning for the end.

Perhaps Lorraine Bayless has left us all with an important wake up call.  Independent and assisted living senior residences need clear written policies about resuscitation of residents. If nurses happen to be working there, they should not be frozen in place when a resident collapses and CPR can be administered by someone, including themselves.  Residents should be required to spell out their end of life wishes and emergency instructions and these should be available to those in charge.  And each of us needs to face the reality that no one gets out of here alive.  We need to think it out, write it out, and do our loved ones and those who help us the decency of making our wishes clear to them.  If a person wants no resuscitation, we have to accept the idea that we don’t have to “do something” if they stop breathing.

As we’re  in the elder and family consulting business, I made sure my husband Mikol and  our kids know about my own wishes.  I’m pretty sure  that when it’s my time to kick the bucket, they’ll let me kick it and get out of the way.  It’s not so bad to exit the way Lorraine did, fast,  and probably without pain.  Her family says she had it her way.

What would your way look like?

Until next time,

Carolyn Rosenblatt

AgingParents.com

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Learn how a son in Pennsylvania was ordered by a court to pay his mother’s $93,000 nursing home bill.

After his mom was injured and went to the hospital, she spend some time in a nursing home.

She then was discharged and left the U.S.  The nursing home sued the son to pay the outstanding bill.

In this quick video, learn three things you can do to prevent this kind of nightmare from happening to you.

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When Nice Aging Parents Start Behaving Badly

A person who never said a bad word curses at you, or someone else.  Old Dad gets combative. Mom seems so irritable.  They can’t remember that you were coming when you showed up. What the heck is going on, you wonder.

If your parent is forgetting to pay bills, or forgets that you visited yesterday, it’s a huge red flag for you.  Most of us dismiss this at first. They’re just getting old. Or, getting forgetful is “normal”, you tell yourself.  You rush in to take care of things.  You offer to help. You are met with nasty resistance.

As time goes by, your parent is making more and more mistakes, the memory problems are getting worse and you now know leaving her to her own devices is dangerous.  She thinks she’s just fine.  Should you step in and get her all upset?  Should you just let her do whatever she wants? After all, she’s your mother.

The answer is “no”, you can’t just let a parent with significant memory problems go on as if nothing were wrong, even if she gets upset with you. At some point, the adult child who loves a parent must step in.  You may end up setting limits, making new rules, or taking over certain decisions.  This is not easy for most people. We are so accustomed to our parent making her own decisions, that to dare to tell her what to do is very uncomfortable.

Some people call this “switching roles” or “parenting your parent”.  What it means is that your job, one you’ve never done before, is to be sure your parent is safe and cared for, just as your parent once did for you.  The problem is, your parent is not going to grow up, become more mature and eventually appreciate your efforts.  So where does that leave you?

For most adult children who must learn this new job of safety monitor, it leaves you with a fair amount of stress and anxiety.  Some adult children still feel intimidated by an imperious aging parent, even one who is infirm, demented or unable to care for herself independently.  It takes some doing to face this and cope, but it can be done.

Here are five strategies to cope with switching roles and learning to manage your rebellious or difficult aging parent who doesn’t want you to take over anything.

1.  Make peace with the reality of your parent’s aging.  It isn’t going away. It isn’t going to get easier.  With dementia, memory loss and other conditions, behavior of an aging person can change dramatically.  The judgment your parent once had may be very damaged. It can’t be fixed.  Your parent needs your help. Accept that this may be hard for you.

2. Start to collect information as soon as your parent demonstrates those red flags, those signs of trouble you’ve been denying, or she has.  Does she have legal documents, such as durable power of attorney, trust and healthcare proxy? Where are they? When were they last updated?  You may need to take over on any one of them some day.  Find out about parent’s income, bank accounts and where their records are kept. It’s essential.

3.  If your parent is dangerous with her habitual activities such as driving, paying bills or buying groceries, step in.  Make rules. Learn a strategy for getting Mom to give up the car keys.  Gently insist on helping with bill payment.  Offer to hire someone to help keep groceries in the house or offer to do this chore if you live in the area.

4.  Do not expect your parent to accept logical arguments about why you need to help out.  It’s not about logic for her.  It’s about fear of losing control.  Acknowledge this with her and respect the feeling. And as you would with a teenager, do what is needed to keep her safe, even if she doesn’t like it.

5. Avoid being reactive when your parent gets upset with your “rules” or the limits you set.  You need not engage in an argument.  ”Let’s not fuss about this” is a perfectly acceptable response.  Then keep on doing what you need to do. Trying to explain why you need to keep a parent safe is unnecessary. She may forget the explanation anyway.  Keep your focus on safety and quality of life. Get past the fact that you don’t like telling Mom what to do.

If you are struggling with any of this, you are not alone.  Millions of adult children are facing this role reversal with aging parents.  If you find yourself at your wits’ end, help is here.  We give advice, work with you and your siblings, help you come up with a clear plan about what to do, and help you nip disagreements in the bud. You get a huge benefit and a great head start with relatively little expert advice from us. Click here for a quick, complimentary strategy session. We offer ongoing coaching too!

Until next time,

Carolyn Rosenblatt and Mikol Davis

AgingParents.com

****P.S.  We are always here to help you get through the challenges of aging.

Please let us help you help the ones you love.

We are offering a free strategy session to our readers, just click HERE.

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Have you had to deal with this?

Suppose you’ve done all that, and the fight rages on.  Anger flares. You’re frustrated.  It’s time to get help. Consider mediation, a smart way to resolve disputes without any courts or lawyers.  Here’s a 4 minute video we produced to illustrate the process.http://vimeo.com/ 11534608  We do family mediation by phone, Skype, Skype video and in person.  We’re here to help. Contact us at AgingParents.com

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Thoughts On Turning 65

65! Yikes!  Isn’t that when you’re OLD?

I looked in the mirror and I didn’t see an old person, so maybe it’s a myth.   I definitely didn’t see a young person though.

I had lunch with my daughter and she asked me if I feel 65. I said, “yes and no”.  The “yes’ part is that life experience teaches us quite a lot. I’m very happy about that.  I have more confidence as a 65 year old human being than I ever could have had as a young person.  There can be no substitute for decades of dealing with and solving problems, of survival through hard things, of seeing our own progress in striving to get better at something.  When we can make it through all that, we are “seasoned”. I rather like being seasoned.  It certainly feels a lot better than being anxious, fearful that we won’t make it, unsure of our skills, or pressured to climb whatever ladder is before us. I’ll take seasoned any day.

The “no” part is that my image of 65 from the distortion of youth’s prism was that feeling 65 would be about feeling old.  About slowing down or being less interested in having fun and adventure.  We know that’s not true! , I’m happy to report that  I’m having more fun than ever at this point.  I work because I want to work, doing things I feel satisfied doing.  I am using all those years of experience in nursing and in practicing law combined in an effort to be useful to people whose elders and parents are failing in their health.  Their stories aren’t fun, but I like being able to help them solve their problems.

I am one of the lucky ones in excellent health at 65 and I am grateful every day for this.  One thing a nurse can learn from working with thousands of patients and clients is to appreciate all we have in the body and mind that works. One spends a lot of days facing folks with body parts or minds that don’t work. You get perspective that way.  A friend or classmate dies suddenly.  You get perespective that way, too.

If I can take a walk on a beautiful day, it’s a gift.  Every body part works fine.  And going beyond a casual walk, I can jog, bike and run, sometimes all in the same event (triathlon).  Never mind that in my county’s triathlon three months ago I was the oldest woman registered to complete the event.  I can just celebrate being able to do it at all.  And I do celebrate. With carrot cake.

I am among the millions of Boomers who have recently reached this milestone or who will do so soon.  We are glad and sad about some things.  We are already experiencing the loss of dear friends.  It sobers us.

I also think it’s a time to celebrate a lot of things.  I think about the political power we have as a group. I think about how we have changed society and will continue to do so, just because there are so many of us.  I think about how we, as a generation are changing the concept of aging.  I love it.

So, if you, too are a Boomer, celebrate with me. Raise a glass to a different and evolving idea of aging.  Toast to the beauty of experience and being wiser than we were at 20.  Find your joy in showing the younger generation that we know how to live these years in a meaningful way. We already changed the world when we were young. Now we can change it again as we get into the next phase of our seasoned lives.  We can share life’s lessons with others. We can set an example of being responsible. We understand that we must savor the moment. We can have a wonderful time appreciating what we are and all we have.  Let the beauty of this time of life shine on.

Until next time,
Carolyn Rosenblatt
AgingParents.com

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Carolyn & Mikol, Our Favorite Aging Parents

Well Carolyn and I are happy to tell you that we successfully finished the 5K race in Golden Gate Park last Sunday. We both finished 17th in our over 60 year old age group.

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Read it all the way through! It’s a good laugh! AND really quite true!!

A good laugh for people in the over 60 group !!!

When I bought my Blackberry, I thought about the 30-year business I ran with 1,800 employees, all without a cell phone that plays music, takes videos, pictures and communicates with Facebook and Twitter. I signed up under duress for Twitter and Facebook, so my seven kids, their spouses, 13 grand kids and 2 great grand kids could communicate with me in the modern way. I figured I could handle something as simple as Twitter with only 140 characters of space.

That was before one of my grandkids hooked me up for Tweeter, Tweetree, Twhirl, Twitterfon, Tweetie and Twittererific Tweetdeck, Twitpix and something that sends every message to my cell phone and every other program within the texting World.

My phone was beeping every three minutes with the details of everything except the bowel movements of the entire next generation. I am not ready to live like this. I keep my cell phone in the garage in my golf bag.

The kids bought me a GPS for my last birthday because they say I get lost every now and then going over to the grocery store or library. I keep that in a box under my tool bench with the Blue tooth [it's red] phone I am supposed to use when I drive. I wore it once and was standing in line at Barnes and Noble talking to my wife and everyone in the nearest 50 yards was glaring at me. I had to take my hearing aid out to use it, and I got a little loud.

I mean the GPS looked pretty smart on my dash board, but the lady inside that gadget was the most annoying, rudest person I had run into in a long time. Every 10 minutes, she would sarcastically say, “Re-calculating.” You would think that she could be nicer. It was like she could barely tolerate me. She would let go with a deep sigh and then tell me to make a U-turn at the next light. Then if I made a right turn instead. Well, it was not a good relationship..
When I get really lost now, I call my wife and tell her the name of the cross streets and while she is starting to develop the same tone as Gypsy, the GPS lady, at least she loves me.

To be perfectly frank, I am still trying to learn how to use the cordless phones in our house. We have had them for 4 years, but I still haven’t figured out how I can lose three phones all at once and have to run around digging under chair cushions and checking bathrooms and the dirty laundry baskets when the phone rings.

The world is just getting too complex for me. They even mess me up every time I go to the grocery store. You would think they could settle on something themselves but this sudden “Paper or Plastic?” every time I check out just knocks me for a loop I bought some of those cloth reusable bags to avoid looking confused, but I never remember to take them with me.

Now I toss it back to them. When they ask me, “Paper or Plastic?” I just say, “Doesn’t matter to me. I am bi-sacksual.” Then it’s their turn to stare at me with a blank look. I was recently asked if I tweet. I answered, No, but I do fart a lot.”

P.S. I know some of you are not over 60. I sent it to you to allow you to forward it to those who are.
We senior citizens don’t need any more gadgets. The TV remote and the garage door remote are about all we can handle.

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In a small county in central California, an 86 year old retired firefighter was sentenced to two days in jail and probation for assisting his wife to commit suicide.

The Tribune News in San Luis Obispo reported the story with little detail, but did report that George Taylor was convicted of aiding and abetting the suicide, after the couple had long ago agreed to a suicide pact.  They had been married since 1947, and apparently had this agreement to die together.  Only George somehow failed in his own attempt.

One odd part of the story was why they chose to try to carry out their pact together at that particular time. Neither was suffering from a terminal illness, and they were financially secure.  They had adult children.  According to the report, they agreed with the philosophy of Dr. Jack Kevorkian, an advocate of physician-assisted suicide.

What Does the Light Sentence Mean?

Mr. Taylor had already served the two day jail sentence, so essentially, the consequence of the event was probation for him, and living with his failed attempt to keep the pact with his wife.  He was ordered to get counseling.

The court’s light sentence may reflect an underlying philosophy that elderly people do have a right to die, even if assisted by a loved one.  The result would probably have been very different if George had been a younger person.

Is our society evolving in its attitude toward elder suicide?  It is clearly an emotionally laden area, with sharp differences in personal, religious and moral beliefs.  Do we, as a society have a right to insist that someone who does not want to live must do so?  If a loved one begged you to help him or her die, would you be able to do it?  Would you be able to refuse, particularly if the person were suffering?

A Personal Story of a Suicidal Client

My only personal experience with this issue was in representing a client who was in the later stages of multiple sclerosis. She was wheelchair bound, paralyzed and had the use of only one arm.  She was able to do some things for herself, but depended on a caregiver to help with all activities of her daily life.  Her case had nothing to do with her disease, and it was resolved.  Before she received her settlement, she asked me to find her a lawyer who would come to her apartment and draw up a will to specify who would receive her settlement funds. I did so.

She said that she would not be here any longer by the time her settlement came in.  She gave me specific instructions as to how to distribute the settlement funds to her loved ones.  She said that she was losing the ability to use her arm and that she soon would be unable to eat or drink by herself. She had decided long before that when she reached that point, she did not want to live any longer. Her time had come.

Although I suggested counseling, speaking to her clergy person and the suicide hotline, she was adamant that she had done all that already and her mind was made up.  I felt sad, conflicted and yet resigned to do as she asked. I complied with her wishes, as my lawyerly duty required that I do.

I learned shortly afterwards that she had indeed committed suicide.  No more was said about it by anyone.  I mailed the checks to the person who was the executor of her estate and the file was closed.

For a long time afterwards, I thought about it.  I believed that she did have the right to do what she wanted to do but I could not escape the feeling of sadness, my own tears, and  somehow wanting her to feel that her life was worth living.  The matter was under her control and no one had to decide whether to help her.  She chose to exit before she lost that control.

Perhaps George Taylor and his wife also wanted to make their choices before losing control.  Perhaps some change was going on that others did not know about and that was what prompted them to act when they did.  We won’t know the answers.  What we do know is that end of life issues remain controversial in our society.  We confront our feelings about them in our own hearts.  In the meantime, the idea to live each day as if it were your only day is a good one to embrace.

Until next time,

Carolyn Rosenblatt

AgingParents.com

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“How To Help A Dangerous Older Driver
Give Up The Keys For Good”

There comes a time in every elder’s life that driving is no longer safe for anyone on the road. Whether you’ve already had “the talk” – which may not have gone as planned – or, are just starting to approach this subject with your aging parent, then you are no stranger to how difficult a situation this can be.

What most people don’t realize is that there’s one single underlying dilemma that can make the subject of driving much more emotionally charged than other issues you may face with your aging parent, and I talk about it here:

So what is an adult child to do?

Simple. Get educated and learn the ropes of dealing with your dangerous older driver before disaster strikes and it’s too late.

That’s why I tackle this issue in explicit detail for an entire chapter…

…giving you the upper hand with your dangerous older driver…

…and resolving your conflicts before they start.

…and probably, saving lives…

I reveal everything, including:

• How to assess an elder’s driving capabilities without them ever knowing! (Hint – This trick alone can avoid hours of long, painful arguments with your aging loved one.)
• A new (and caring) approach to driving restrictions – so delicately and effective – that slashes your risk of an argument in half!
• A quick start-up tip for hiring licensed professionals to objectively evaluate your elder’s driving needs – so easy to use – you’ll blast through confusing “qualification barriers” fast and know exactly who to call… right from the start!
• How to determine the best (and safest) time for your elder to drive! (Hint – This simple secret gets right-to-the-point…and makes restricting your elder driver 10 times easier!
• How to slowly limit your elder’s driving habits so they don’t feel angry, isolated or alone!
• How to safely (and easily) increase driving observation of your elders (among family members) before it interferes with your daily life…even if you live across the country!
• The 7 “secret” aging symptoms proven to botch driving performance…and how to spot these life-threatening “red flags” fast! (Note – This process is incredibly efficient, once you know what to look for…)
• How to properly select a family “agent” to assist with your elder’s transportation!
• How to safely plan for what happens to loved ones with dementia (especially Alzheimer’s) when assessing an elder’s driving habits…and how to detect subtle warning signs – even during the confusing “early to middle stages” – that most people miss! (Hint – This incredibly gray area becomes much easier to understand…once you have a timeline in mind.)
• Relax, knowing you won’t have to “wait until there’s an accident” to realize your elder can no longer drive and experience peace of mind before it’s too late!
• What little-known sign to look for that uncovers driving incompetence…even if you’re never with the elder on the road! (Hint – This has nothing to do with your parent physically…but you’ll be shocked to discover how obvious – and alarming – this indicator really is.)
• The Top-3 best times to talk to your elders about their driving disabilities in a natural – and totally nonthreatenin – manner…steering you clear of potential anger and resentment thwarting your good intentions!
• How to seamlessly communicate respect for your elder’s struggle to give up driving for good…and how to support them along the way!
• How to find low-cost driving services locally, so that your elder won’t be without a ride! (Note – There are services available in many communities, if you know who to call)
• The SINGLE most important thing you can do to communicate with your elder without upsetting them…and the worst sin you could ever commit – an unforgivable act that can destroy your relationship!
• How to determine the best living situation for an isolated elder if transportation isn’t available…and what else these options provide that most people unknowingly ignore!
• Power Struggles Exposed: How to handle an elder who absolutely refuses to give up driving with this straightforward, 5-Level, step-by-step approach to resolving conflict with your difficult elder for good!
• How to prevent “ganging up” on your parent when involving a 3rd party, and pave the path of least resistance so your conversation flows smoothly…even if they’ve always felt threatened before!
• How to find the right professional mediator if things get ugly! (Hint – This is what I do professionally and I uncover lots of “insider” secrets I know…saving you from what may be one of the most heart-breaking conflicts of your life.)
• The correct way to conduct a family intervention! This hyper-touchy subject can be an explosive nightmare if not handled properly…but you’ll be ready to handle it with confidence, once you learn how it’s done!
• The 3 most dishonest acts committed by an adult child that – while attempting to help – can inflict trust-shattering emotional damage in their elder’s heart…and how to prevent this from happening to YOU!
• How to effectively use legal means – as a last resort – while drastically reducing blame, guilt or confrontation! This technique can be your lifeline, helping you NOT be stonewalled when all else has failed and you fear for Mom or Dad’s immediate safety!
• A last stop legal tactic that gives you full legal control over your parent – if Mom or Dad becomes a serious danger to themselves and others …giving you a secret security plan that very few people really consider. (Note – This topic is explained in critical detail – for 3 pages – to prepare you for this “worst case scenario”…before things get out of control.)

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This is a season of so many mixed feelings.  We are happy to have the holidays and at the same time sad about the recent tragedies.

We keep being reminded of how fragile life is.

We keep seeing sad and sobering events around us, and involving us.  At the same time we are also reminded of peace, family, and celebration. It feels like a contradiction sometimes.  I believe we can choose our focus and look at what we do have more than what we don’t have.

For us, my mother in law Alice, age 90, will get on a plane by herself and come for a visit. That’s amazing in itself. How many of our parents are no longer here? How many aging parents can’t be a part of the party, as they are too ill? Our kids, both in their 20′s still have a grandma to share this time with them. My husband still has a Mom to pick up at the airport and escort to the events of family togetherness.  I still have someone to honor at our table as the oldest person there. Our kids are nearby, safe, healthy, and they want to be with us. This time is precious for us all.

We can work on overcoming the darkness we see around us with little light-giving things.

A way to cope with tragic things around us is with these little things.  We can still feel joy, gratitude, and hope that our world will do better.  We are in each other’s  presence this week, visiting, catching up on the family news, eating, enjoying some entertainment.   Gratitude for the good we still have is our path to healing from the shock of any trauma.

Little things are like expressing appreciation for what we have to share and the people who are able to join us. Thank them for coming.  Thank them for anything they do or say that you like. Toast their presence.  Remember the happy things from the past and speak about those.  Concentrate on how to just enjoy right now. Turn off the news.  Listen to beautiful and energizing music.  It is being in the now that helps us keep going.

I just want to hug everyone and not let go. I speak to my fear to quiet it. I don’t want to lose anyone. But of course, duty calls.  The shopping, cooking and cleaning we do to make a gathering good. The tasks, the chores are still there. I concentrate on the food preparation and the laundry and I philosophize.  The mundane has its own rhythm and it is peaceful and restorative.  As I fold and scrub, I think of those whose lives are so sad right now, and I send them loving thoughts.

We are alive, we have loved ones, we are able to celebrate.  So, hold your own loved ones close.  Don’t waste a moment.  For just a bit, be fully present where you are.  Savor all you have.
Mikol and I wish each of you a time of peace and of appreciation and all the love you can give and receive.  May you find a way to laugh, to have fun, and to bring the gift of a smile to someone’s else’s face.

Until next time,

Carolyn Rosenblatt and Mikol Davis,

AgingParents.com

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We’ve been asking ourselves this question.

Alice

Would Mom be better off in a different community?

My mother in law Alice, is now 90.  She lives alone in a 2700 square foot home that she enjoys. It’s in a retirement community with lots of amenities. But, you have to drive everywhere.

She is a bit isolated unless she gets in the car.
Fortunately, she is still able to drive. She cares for herself independently.  But we’ve noticed some changes in how she handles problems lately. It’s harder for her.  When a pipe breaks, she gets very impatient with the repairs. It’s harder to bring in the groceries from the car. Maintenance takes time she doesn’t want to spend .  Her knees are a problem at it’s harder to walk any distance.

My husband, Mikol, partner with me at AgingParents.com, is a wonderful son. He calls Mom every day.  He talks to me about his concerns.  One of them is that Mom living alone in her house is getting to be a problem and he thinks it’s time to introduce the idea of a smaller place with more help available.

He’s a psychologist and very skilled at making suggestions in a tactful way.  So, here’s what he did.

First, the research.  He looked on the net for all the assisted living facilities in Mom’s area. He knows what she likes and what she doesn’t.  He narrowed the search to two places.  He told Mom he was coming for a visit to help her with a few things she needed. She was thrilled.  He got on a  plane and made his visit with the agenda in mind that he wanted to take her to see the places he though could work for her.  Meanwhile, he did the minor repairs and computer maintenance she needed done.
When he gently introduced the idea of giving up the house, he did it in a kind and loving way. She didn’t balk.  Alice is a very practical woman. She knows it’s hard to live alone in a big house as she ages and that it makes sense to think about alternatives.  We’re very lucky that way. Some parents will tell you to take flying leap if you even mention this.  Mikol told her about his research and suggested that they go see a couple of places. She said, “Let’s go”.
She took the tours and decided that one of them was better than the other.  She weighed the pros and cons.  This all has had some time to sink in now, a few weeks later.  No one has pressured her or told her she should move.  She has arrived at that conclusion all by herself.  When I talked to her, she told me all about the spot she picked out and said she had made the decision that she’s going to do this.
There are lots of details to work out.  We’ll help her of course.  She can take a lot of her things and it will feel familiar with them around her, even in a new setting. Alice has chosen to go to what is called a “continuing care retirement community”.  That means they have independent living  in apartments (that’s what she’ll do), assisted living in different apartments and skilled nursing beds in another part of the campus.
She will be in a community with many other widows like herself and it is likely that she will benefit from the increased social contacts. In many ways, Alice is an ideal candidate for this setting. She reaches out to others often, likes to socialize and works at making friends.  The benefits are numerous.  One doesn’t have to dine alone.  There are organized card games, outings, entertainment and events.  Yet, if she doesn’t feel like doing any of them, she can be in a nice apartment where someone will bring what she needs. If she stops driving, she will have access to transportation without having to work at it.
Her friends, her doctor and her family all think it’s a good idea. This provides the support and encouragement she needs to give up a home full of happy memories that she shared with Dad for many years.  It is not going to be easy for her.  She is courageous enough to face that, bless her.
Mikol and I realize that this is a marker. She’s aging and will need more help in the future.  Having her in a secure place with  that help nearby will give us greater peace of mind about her safety and her happiness as well.  I think Alice is going to have a gang of new friends soon.  There are men there, too, though very outnumbered by the women. But you never know.  Maybe a new guy could surface in her life.

Keeping our fingers crossed.
Until next time,
Carolyn Rosenblatt
AgingParents.com

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Some of our Congressional leaders are vehement about it.  Some disagree.  Everyone seems to get that we need to fix our debt problem by reducing government spending on something. But what?

For those who are extremists about cutting government spending on Medicare, consider this: we taxpayers are getting ripped off by the Medicare program.  To me, the solution is not in cutting how much we pay doctors and other providers of healthcare.  It’s about enforcing the protections that exist to stop fraud.  

We can’t protect ourselves against fraud without spending money to do it.  It’s rather like law enforcement.  You don’t reduce crime rates by cutting out police officer jobs.  With state budget cuts, we tried that, remember?  Don’t know about you, but crime rates rose right away when that took place in my area.

Consider the Office of the Inspector General’s report, issued this month, revealing that skilled nursing facilities (SNFs) committed widespread fraud, or errors, to the tune of $1.5 billion worth of inappropriate Medicare payments in 2009. That doesn’t even count how much Medicaid fraud is also included in those same claims, but it’s likely that Medicaid picked up part of the tab for a significant proportion of them.

The OIG’s report made six specific recommendations to the Centers for Medicare and Medicaid Services (CMS), the entity which is responsible for overseeing these programs.  CMS agreed with all of the recommendations.  OK, here’s the rub.

If CMS is going to expand review of SNF claims, how will it do that without more inspectors and improving how it does inspections?  Knowledgeable and trained inspectors go through millions of claims, comparing the data against past history, averages, and other digital information that will alert them to unusual activity in billing.  Clearly that takes person power.  That means contractors at work.

Every single recommendation the OIG made will likely require more contractors to do more, not just more efficiency in the existing workers, to effectively carry out.  If we had enough inspectors to adequately monitor the claims billing activity in nursing homes, I seriously doubt that we would have a $1.5 billion problem there.  The overall amount Medicare paid out in SNF services in 2012 was $32.2 billion.  That needs a lot of monitoring.  We can’t fix fraud by cutting benefits to the elder and disabled people who need them.

CMS uses  Medicare Administrative Contractors, and Recovery Audit Contractors among others, to safeguard the program’s billing.  Who thinks we need to cut out those contractors to reduce fraud?

We also need to prosecute the fraudulent billers in these facilities. In 2012, CMS reduced payments to SNFs by approximately $3.9 billion.   As skilled nursing facility reimbursements have decreased from either Medicaid or Medicare, they’ve found a handy way to make up for the diminished revenue:  bill for things that don’t actually happen.  Add billing for some therapy visits that didn’t take place.  Make the therapy continue with the older person, even if it isn’t doing a bit of good anymore, just to get the revenue.

OIG study found that the standardized method SNFs use to rate the resident’s condition and how serious is the need for care was misreported for 47% of all claims.  The more seriously the SNF rates the resident, the more money it gets each day. We can’t make these analyses and ferret out the misreporting without investing in the process.

These are complicated analyses.  It takes a degree of skill to derive useful data from millions of Medicare claims. No one can put this on autopilot and get the information we need to stop the ripoff.  We need to beef up and increase efficiency in the way we inspect billing, audit SNFs and prosecute violators.  Some of them will still get away with fraud, there is no doubt, but we can at least aim for a major reduction in the amount of it.

The way I see it, we need to put financial resources into addressing Medicare fraud.  Investing in whatever we need, whether it is efficiency experts, better computer monitoring programs or devising programs to increase the effectiveness of existing inspection methods, we need to do it.  If it saves us any part of the billion and half dollars we wasted in 2009 it will surely be worth it.  When it comes to cutting government spending on healthcare, we don’t want to be penny wise and pound foolish.

And for those so eager and insistent on slashing benefits to the frail elders on both Medicare and Medicaid who desperately need the help, I challenge you to tell us what the alternative is for someone 90 years old with complex medical issues who lives on Social Security.  How are they to get care? Some have no family. Some have a spouse as old as they are and almost as frail.  Some have incompetent family who would neglect them.  There is nothing we have to care for these people other than public benefits.  I have personally taken care of some of them myself in my nursing days.  Gets me rabid on the subject, I’m afraid. Do tell us what other options besides Medicare and Medicaid they have to receive basic and decent care. What, exactly is the plan for cutting these benefits to the elderly and disabled poor?  ”Job creators,” I await your answer.

Until next time,

Carolyn Rosenblatt,

AgingParents.com

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Sometimes, there’s just no substitute for a face to face visit.  Adult children may be getting a wake-up call this season when  you visit aging parents.  Little things you can’t learn in a phone call can come to light.

Their health may be a concern because you see visible changes on your visit, such as weight loss or the appearance of neglect.  Their cognitive skills may be a worry because you notice that they are having trouble tracking the conversation.  Or the memory loss you chalked up to “just getting old” is now a significant problem.  Sometimes, they just look frail.

What to do?

My colleague who markets for a large assisted living facility says inquiries and visits to see the place are way up at this time of year.  No wonder.  Adult children who live out of their parents’ area want to know what to do if there is a “next step” needed. That makes sense.   The problem with that is, you’ll likely face parental resistance.  They don’t like change and especially don’t like the idea of giving up the family home.  Approaching the subject requires finesse and respect.  Get professional advice if this entire area overwhelms you.  If you plan what to say and when to say it, you will do better than moving ahead without thinking too much about it.

A visit to your parents during this time of year is an opportunity.  If you don’t see them every day, use the visit as a reason to take stock.  Take your cues from what you see to take action. Here are five essentials you need to know.

1.  Do they have legal documents, such as a durable power of attorney for finances, and a health care directive (“living will’?).  If they dont’ have them, perhaps you can help get them going. One can prepare them without an attorney if you are comfortable with this, and the documents themselves are free.  One day, you may be very glad you did get these in order .  If your parents do have them, learn where they are stored.  It can help to get a copy for yourself, especially if you are named as the “agent” on one or both of these documents.

2. Are there any plans for managing at home with help if they need it?  If grocery shopping, cooking, or bathing is getting difficult, it’s time to consider who could help and how to arrange for help at home.  How to finance the help must be discussed.

3.   If you are worried about their isolation being at home without help and without social contacts check out suitable alternative living situations.  Do your research and visit a few prospects.  It may get the conversation going about necessary change.

4.  If paying bills on time and keeping track of finances is an issue, find out if your parent is willing to accept your help with managing the money.  Offer to take over the responsibility.  Perhaps you can get your parent’s permission to open an online account and automate the bill paying task with your oversight or help.

5.  Learn what to do if a health emergency arises.  You’ll need to keep a record of your parents doctors, medications, diagnoses, and day to day health management.  This can save you from panic when the time comes.  It’s just about inevitable with aging parents that some health crisis is going to come up sooner or later.  And this is where the discussion needs to happen about end of life wishes.  Prepare yourself by being sure of what your parents want with the legal document (#1, above) you will need.

Holidays can be so busy, it may be easier to just overlook any danger signs you see with aging parents.  Here’s hoping you won’t overlook anything.  Take a deep breath, prepare yourself to face these responsibilities and lead the way.  As your parents continue to age, you will feel much greater confidence when you are prepared.  And as I tell my husband, the work of being prepared good modeling for our own kids.  I want them to have it easy and know just what to do when it’s our turn to be the aging and maybe frail parents.  According to our 20-something kids, we’re already the aging parents!

Until next time,

Carolyn Rosenblatt

AgingParents.com

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Working people frequently ask retired people what
they do to make their days interesting.
Well, for example, the other day, Judith my wife and I went into town and visited a shop.

When we came out, there was a cop writing out a parking ticket.

We went up to him and I said, ‘Come on, man,
how about giving a senior citizen a break?’
He ignored us and continued writing the ticket.
I called him an a–hole . He glared at me and started
writing another ticket for having worn-out tires.

So Judith called him a s–t head. He finished the
second ticket and put it on the windshield with the first.
Then he started writing more tickets.
This went on for about 20 minutes.
The more we abused him, the more tickets he wrote.

Just then our bus arrived, and we got on it
and went home.

We try to have a little fun each day now that we’re retired.

It’s important at our age.

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