Frequently Asked Questions About Eldercare
A healthcare directive is a document your aging parent signs, giving someone else the power to make health and medical decisions if he or she is unable to speak or make decisions. Everyone needs such a document because we never know when or if we will become incapacitated. If we are in an accident, have a stroke or are in a coma, someone has to be able to decide what we would want done by the doctors and hospital. If we don’t spell out our wishes in a healthcare directive, the decisions are up to doctors who may not know us, or there may be conflicts among our loved ones about what our wishes would have been. Doctors who don’t know what a person wants may keep giving life sustaining measures and using every artificial means at their disposal, even if we are terminal and the treatment won’t change the course of our illness or injury. The most important reason for having a healthcare directive is to be sure that our wishes are honored, even if we can no longer say what we want. A healthcare directive is free, and the form can be obtained from your doctor, hospital, or on the internet. If you need help filling out the form, it can be found at senior centers, from social service agencies, or from an elder law attorney.
The term “legal guardian” has different meanings in different states. I’ll take it to mean that your question applies to the duties of a person who was appointed guardian over an incompetent elder by a court. A guardianship is also called a conservatorship in some places. The guardianship can cover either the aging person’s money, or the person’s safety and welfare, or both. The duties of a guardian, generally speaking, are to oversee the welfare and safety the aging person under guardianship, and to attend to the financial needs of the individual, using his or her assets wisely. A guardian has a legal duty, called a “fiduciary duty”, to act in the best interests of the individual. A guardian has total control over the aging person they are appointed to serve. They can decide how to spend the elder’s money, where the elder will live, what medical care the elder will receive, and how much freedom the elder or aging parent has in his or her life. The powers can be total. An elder under guardianship loses the freedom to make decisions for himself or herself about all important aspects of life. The guardian also has a duty to protect the aging elder from abuse, to keep complete records of all expenditures, and to report regularly to the court which appointed the guardian, as to the elder’s finances and status. The requirements vary somewhat from state to state, but generally, the court decides how often the guardian must return to court to report to the court how money is spent and what the status is of the elder. Being a guardian is a very heavy responsibility. It is formal, public and supervised.
A Do Not Resuscitate Order is a legally binding physician’s order for a senior patient, which is signed by the treating doctor, that no steps will be taken to restart a person’s heart when it stops or to get a person breathing again if the patient stops breathing. A DNR order is normally a result of a person’s healthcare directive, which says that he or she does not want measures to be taken to keep the person alive. The decision to not resuscitate a person must be made by the individual, if competent to do so, or by the person’s agent for healthcare, on a “living will’” or healthcare directive, if the person is not competent to do so. The patient or agent must ask for such an order. The signed DNR order is placed in the patient’s hospital chart. The family of the patient who does not want to be resuscitated often must remind the doctors and staff in a hospital about the order, because the first thing doctors and nurses want to do is to save someone’s life if their patient does stop breathing or their heart ceases to beat. The DNR order only works if the patient or the patient’s family is clear with the doctors about it, and is able to be the patient’s advocate in a setting where it is almost automatic that resuscitation will take place. In other settings, such as hospice care (care designed to keep someone comfortable in their last days for a dignified death, rather than trying to fix or save them during their last days), DNR orders are fully respected without coaching or advocacy by family.
Possibly, depending on your situation. If no one in your family is in disagreement with the arrangement, it is perfectly legal for your mother to pay you for getting care she would otherwise have to pay someone else to provide if you didn’t. The clearest way to handle this is with a caregiver contract between you and your mother, so that your duties and her expectations, as well as the rate of pay you are to receive are spelled out in writing. An elder law attorney can prepare such a contract for you. Be aware that payment of a salary carries with it tax obligations on your part, and contribution for you to Social Security, disability and unemployment insurance on your mother’s part, in the form of deductions from your paycheck. You may need a bookkeeper to advise you. Difficulties sometimes arise with getting paid for care giving, as it may cause conflict with siblings or others in the family who want to inherit the funds your mother is paying for your care taking. Before arranging such compensation, it is wise to seek the advice of an elder law attorney, to be sure there is not a problem with doing so. Such factors as available long-term care insurance, if your mother has such a policy, trying to become eligible for Medicaid, and other factors can complicate the arrangement of your mother paying you for caregiving. Her competence to decide to pay you out of her assets is also a consideration to discuss with the elder law attorney.
Is Dad Okay? Depression is the most common of mental conditions which can be treated, but among the aging elderly, it is one of the most overlooked.
Sometimes, it’s because physicians don’t recognize the signs and symptoms. Sometimes it’s because of an overall attitude of society that perhaps feeling low is just part of getting old. The danger in overlooking depression is twofold. First, quality of life that could be improved isn’t, and unnecessary suffering goes on. Second, the alarming fact of elder suicide looms. Depression is both an emotional occurrence and a physical event. The physical component is triggered by brain chemistry, and can be helped. Feeling low doesn’t have to be a permanent part of getting older. There are many aging elders and aging parents who are able to take aging in stride, and accept the many limitations that accompany getting along in years. Aging is frequently marked by losses. Loss of spouses, siblings and friends, as well as losses of physical strength and abilities can lead to sadness. The sadness associated with loss can often be lessened with time. But what if Dad, who lost his wife last year, just doesn’t seem to care about anything anymore? If more than a year has passed since loss of a spouse, and an aging parent still seems unable to move forward, it may to be time to see the doctor for a checkup. If you are able to accompany Dad to the doctor, mention the problem specifically. Loss of enjoyment of things one normally likes is one of the symptoms of depression. Other symptoms include feeling sad for extended periods, loss of appetite, sleeping too much or not enough, eating too much, difficulty making decisions, steady weight loss, or unusual weight gain, irritability, outbursts of temper which are not normal, and withdrawal from friends and family. Depression is one of the most treatable of all mental health problems. Many excellent medications can make a great difference in one’s mood and ability to participate in life. Counseling or talk therapy can also be a great help in managing feelings of loss and grief and in helping an aging parent to get through the grieving process. If Dad is just not getting back to the way he was, and has an alarmingly long, ongoing period of sad mood and other symptoms, encourage him to see his doctor. Plan to go with him to be sure he doesn’t gloss over the problem. Many elders are unaccustomed to talking about their feelings. They may lack the basic vocabulary to describe them. The adult child can offer gentle assistance with this difficult area. If unchecked, depression can become a downward spiral with no end. It can become worse and more miserable for the depressed person as time passes. Addressing depression in an aging parent can lead to relief, and improved quality of life. It is a loving act to suggest that the problem can be improved. It may take the initiative of a son or daughter to get help for Dad, but the effect of help if well worth your effort. (originally published on http://www.50fabulous.com/)
Many caregivers suffer from burnout. While you can’t change your aging parents’ condition, you can do things for yourself. First, I’d recommend a physical exam. Report your symptoms of feeling overwhelmed and anxious. Sometimes a physician will recommend medication to help control the things that make it hard for you to function day to day. Medication is a kind of support, and is worth a try if your doctor thinks it will help. You may need to ask for it. It can certainly help with anxiety. Next, it might make sense for you to have the support of others in your situation. Is there a support group in your area? Can you join an online support group? As an example, the Alzheimer’s Association offers such groups, as does the Family Caregiver Alliance and other, similar organizations. Search for caregiver support groups and try one out. It can be a big relief just to share the everyday burdens with other caregivers who may be feeling as you do. Also, consider respite for yourself. You need and deserve time to “recharge your batteries”. No one has to feel guilty about taking time off. We all need it. Is there someone who can take over for you for a few days off? Can you get away, even if it’s just to turn off the responsibility for a period to rest and not think about your job of caregiving? Periods of rest are essential to doing a good job of caregiving. Maintaining your own mental health in this way will reduce your anxiety and allow you to recover from the sources of your distress, from time to time. Finally, I’m a firm believer in walking as therapy. It’s purposeful exercise, gentle, stress-relieving and it can be your mini-respite work that you can do daily. If you have any mobility problems yourself, there are substitutes just about anyone can use. The point is that some exercise every day, even for 20 minutes, can do a great deal to reduce the anxiety and alleviate the feeling of being overwhelmed. It changes the stress-induced metabolic response your body goes through when you’re feeling uptight. Think about building some form of exercise into your busy schedule. By protecting your own physical and emotional well-being, you will be able to focus better and continue to do your best for your parents.
Mediation is a way to resolve disputes by discussion and negotiation, using the help of a neutral person, the mediator. It is usually voluntary. Disputing parties agree to use mediation to avoid continued conflict, to avoid or end lawsuits by settlement of the dispute, or to “clear the air” of ongoing disagreement which has reached the point of stalemate.
Who can use Mediation? Anyone who wishes to resolve a disagreement or conflict by meeting, talking, and accepting the guidance of a mediator can use mediation. It requires a willingness to come together in a neutral place and spend the time working to get the dispute resolved. It also takes a willingness to listen to the other party or parties to the disagreement, and to make some compromises or agreements with them.
I am fighting with my brother about caring for mom. What can I do?
Many families experience conflict over what to do for an aging loved one. Some fight over who is doing the most work. Some argue and criticize the choices and work one sibling is doing for an aging parent. Others are in a constant state of disagreement over where their elder should live, or who should take care of the elder. All of these areas of conflict can be successfully addressed. If the family is unable to resolve their own disputes by talking them over in the family, it may be time to consider an outside source of help: elder mediation. This is a process in which people who have a dispute choose an outside neutral person to work with them to air their differences and make a guided effort towards agreements. The parties sit down with the mediatior, who is a trained professional, to negotiate solutions to the problems that are causing distress among them. Sometimes, the process only takes two or three hours. If there are mulitple issues, the parties to dispute, may need to have two or more sessions with the mediator. The mediator does not tell the parties what to do, or decide the solutions for them. Rather, a mediator helps people to see things from a different point of view, and to reach their own negotiated agreements. Mediation can save untold grief and stress, and can prevent things from boiling over into lawsuits and destructive actions by one family member against another. At AgingParents.com, we work as co-mediators to help familes in dispute. We can also help you to find a mediator in your area.
Many families experience conflict over what to do for an aging loved one. Some fight over who is doing the most work. Some argue and criticize the choices and work one sibling is doing for an aging parent. Others are in a constant state of disagreement over where their elder should live, or who should take care of the elder. All of these areas of conflict can be successfully addressed. If the family is unable to resolve their own disputes by talking them over in the family, it may be time to consider an outside source of help: elder mediation. This is a process in which people who have a dispute choose an outside neutral person to work with them to air their differences and make a guided effort towards agreements. The parties sit down with the mediatior, who is a trained professional, to negotiate solutions to the problems that are causing distress among them. Sometimes, the process only takes two or three hours. If there are mulitple issues, the parties to dispute, may need to have two or more sessions with the mediator. The mediator does not tell the parties what to do, or decide the solutions for them. Rather, a mediator helps people to see things from a different point of view, and to reach their own negotiated agreements. Mediation can save untold grief and stress, and can prevent things from boiling over into lawsuits and destructive actions by one family member against another. At AgingParents.com, we work as co-mediators to help familes in dispute. We can also help you to find a mediator in your area.
Arbitration is a process somewhat like a trial. A neutral party, the arbitrator, sits and listens to the facts and evidence presented by both sides or all sides to a dispute, considers the law, and makes a decision as to what the outcome of the dispute is going to be. The power to decide the outcome is entirely in the hands of one person: the arbitrator. The arbitrator can take the place of judge and jury in making a decision about a conflict. The parties to the conflict can only present the facts and evidence. They do not have any choice about what the arbitrator decides. They leave the decision up to the arbitrator. Courts can use arbitrations as a way to lighten the load on the courts. Parties to a dispute can agree to arbitration, or a judge can assign a matter to arbitration. Arbitrations take place outside the courts. Mediations also take place outside the courts, but they are not “ordered” by judges. Mediation is chosen by the parties to a dispute as a way to try to resolve it informally, through guided discussion. The mediator does not decide what is going to happen. How the dispute turns out is up to the parties, with the help of the mediator urging them, and guiding them toward settlement. Mediation involves choices. Arbitration does not. Mediation can be creative, and can go in any direction. Arbitration goes in the direction of presenting evidence before an arbitrator, and the parties do not control what happens with the arbitrator’s decision. Arbitration is usually binding if it is the result of a requirement to use arbitration, such as a contract. Mediation, on the other hand may or may not resolve a dispute. No result is forced on the parties, and no one decides how the conflict will turn out except the parties to the dispute.
