I’ve just been talking to colleagues here in Marin County about helping to educate our community about anxiety, a problem that affects so many.  Here is some information we’ve gathered to put on our local Psychological Association site to help everyone get a better understanding about anxiety.

Anxiety, according to the American Psychological Association, is  an emotion that creates feelings of tension, worry, and increased blood pressure.

Does this sound familiar?  Many adult children caring for aging loved ones feel that tension and worry.  They may also have penetrating, recurring thoughts. These recurring thoughts and worries can arise from day to day activities or specific events. Anxiety can physically manifest itself in symptoms like sweating, rapid heartbeat, dizziness, and trembling.

When these symptoms are extreme, a person might feel that she is suffering from a heart attack. Psychologists might call the more pronounced forms of anxiety a disorder that needs care and treatment. Those suffering from the more severe form of anxiety may find it challenging to accomplish even the simplest of tasks for fear that something bad may happen to them or the possibility that something might go wrong. They have trouble staying in the moment or living for now.   They  focus on the “what if” scenarios. They complain that they can’t turn off racing thoughts through the mind that evoke a sense of panic. Besides the negative emotional toll on the mind that anxiety can take, the physical residual effects are detrimental as well.  Symptoms might include weight loss, weight gain, hair loss, and stomach discomfort, back or other pain.
Excessive, irrational fear and dread are hallmarks of a problem that can benefit greatly from treatment.  The good news is that there are many good treatment options for anxiety. One treatment option that clinical psychologists offer is called cognitive behavioral therapy. This technique helps a person change the connection between specific thoughts and their irrational fear and dread. The ability to self-monitor one’s own  thoughts can help the person gain control over their emotions. This directly aids in stopping the perpetuation of anxiety or depressive feelings.

In addition, psychologists help people learn breathing and relaxation techniques that can be used to eliminate, manage and assuage anxiety. In some cases especially when anxiety has been present in a patient’s life for many years, medications maybe the best way to provide rapid relieve of emotional symptoms.  Newer anti-depressive mediations called selective serotonin reuptake inhibitors (SSRI’s) are often used as a first line of defense in the treatment of anxiety disorders. People often report experiencing less anxiety and improved mood from taking these medications within two to four weeks.

It is critical to understand that medications do not cure anxiety or anxiety depressive disorders.  Professional treatment (“psychotherapy”) is needed to develop new coping methods, along with a deeper understanding of the complex workings of one’s mind. Once a person learns the techniques, successful alternative action strategies can assure and sustain ongoing changes for the better.

The heavy pressures of caring for aging parents in declining health, the rising demands on one’s time and the sadness of seeing a parent get worse over time can make anyone anxious. If the symptoms you are feeling are getting in the way of doing what you need to do in your life, don’t wait to get professional help. The problem is likely to only get worse over time.

Anxiety is often irrational and cannot be treated logically. Many people do not truly understand anxiety disorder, and think they can just will themselves to be cured. Or maybe the anxiety symptoms will just magically go away if they try to no longer think about them. Most people can’t cure themselves. There is no need to suffer when help from a professional can relieve the emotional pain.  If these symptoms sound like what you are feeling, reach out.  You can find a professional to help you through your local Mental Health Association or your insurance provider.  Low cost services are available in many counties for those who do not have insurance or who are low income.

We care about each of you and hope you will take good care of yourself.  If your aging parent worries are getting you down and you need advice and support, contact us for a complimentary strategy session at AgingParents.com.

Until next time,
Carolyn Rosenblatt, and Dr. Mikol Davis
AgingParents.com

by

By Carolyn L. Rosenblatt, R.N., B.S.N., Attorney

When it comes to elders, most of us don’t think of romance. For some reason, our culture seems to entirely dismiss the concept that older people, divorced or widowed, might fall in love again. But they do. Ask anyone who works in a senior community, assisted living, or other kind of elder-focused living group. Romance blossoms there, as spontaneously and intensely as anywhere else. Our bodies may age, but our emotions are ageless.

Put a group of men and women together in the same place, and over time, attractions will form, relationships will grow and romance may thrive. And how do their adult children react to this? Sometimes, they are supportive and even pleased that Granny has found a new man. She won’t be lonely anymore. But not surprisingly, there is often outright resistance to elder romance in senior communities, coming from the kids.

They’re worried about one thing: their potential inheritance. Demands that the elders stop, interference, and other punitive actions are brought on by the adult children. Do they have a right to stop Granny from consorting with her new guy? Probably not. Unless Granny is mentally incompetent and someone is taking advantage of her impaired mind, she has the legal right to keep company with anyone she pleases. After all, this is a free country, even in a retirement community or a nursing home.

The legal issue is an interesting one. Elders do decline with age, and sometimes mental capacity to give consent to anything, particularly romance, is not entirely clear. However, despite elder care facilities’ focus on “elder rights” no bill of resident rights posted on the wall is likely to say “you have the right to be romantic if you feel like it, provided you can find a willing partner”. Assuming two competent and consenting elders choose to have a romance, should anyone stop them?

When I was a young nurse’s aide in a nursing home, I remember wheeling an elderly lady to the dining room for lunch my first day on the job. “No, not there!” she insisted, as I tried to put her at an empty table. She showed me just where she had to sit, at a different table. The reason became clear a moment later. Her guy, also in a wheelchair, was wheeled over next to her, and the two proceeded to hold hands.

“There’s no one I’d rather sit next to than you,” he said loudly, as he was hard of hearing. She responded, flirting, and demurely returned the comment. She was hard of hearing, too, so their conversation was overheard by everyone nearby. The flirtation continued every day. He told her she was so good looking. I thought it was a crack-up, and also very sweet. They each had someone to look forward to seeing at mealtime and their lives were a little brighter. Elder romance? Why not?

by

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:

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 non threatening – 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.)

by

First

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

by

                                               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

by

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

by

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

by

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.

by