To Stay at Home or Not to Stay at Home

George Shaw 4 copy

– By George Shaw
Most individuals, if given the choice, would prefer to stay in their own home later in life – even as their needs for care progress. There are a number of different home health care options for those who wish to “age in place,” yet depending on the actual level of care that is required, this option can become quite costly – especially if assistance is needed around the clock.

Some of the issues to consider when making the decision to remain at home or move into a senior care facility include cost and location. Proximity to family and other loved ones is certainly a primary factor in making this decision – regardless of whether these individuals will be the actual caregivers.

Certainly, we all enjoy our independence. It is great to be able to do the things that we want to do when we choose to do them. But for some who are getting older, physical mobility and / or cognitive impairments may make it difficult to live an independent lifestyle without the assistance of others.

While in the past, seniors with physical or mental impairments had no other choice but to move to a skilled nursing home, today there are many types of living arrangement options that are available. These can include:

Retirement Communities – As the group of baby boomers who are retiring continues to increase, there are a number of new retirement communities being developed across the country. These living arrangements typically consist of apartments or condos for those who can live independently, and they oftentimes provide amenities such as swimming pools, golf courses, tennis courts, and a myriad of planned social activities.

Assisted Care Living Facilities – Assisted care living facilities are ideal for those who can do most things independently, but they may need some assistance with basic daily activities such as bathing or dressing. These facilities typically consist of apartment type arrangements with a common eating area and planned activities.

Continuing Care Retirement Communities – Continuing Care Retirement Communities, or CCRCs, are a relatively new type of living arrangement for seniors that consist of independent condos, assisted living quarters, and skilled nursing services, whereby the residents may move to different areas as their needs for care progress. These communities are ideal for seniors as they can stay in one area, even if they develop a need for additional assistance. These are also a great option for married couples as both individuals may reside in the same location, even if one needs a higher level of care.

In terms of expenses, in many cases, the cost of care in a facility or at home may be covered under a long-term care insurance policy. Today’s insurance plans have become quite flexible in their payment options for the many different care choices that are now available to seniors.

Lessons We Can Learn from Death

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By Denise Scruggs, Director, Beard Center on Aging and Jen Horsey, Assistant, Beard Center on Aging

Ben Franklin once said, “Nothing is certain except death and taxes.” Neither are things we look forward to, but they are an inevitable part of life.

Death will impact us throughout our lives. We will lose family members, coworkers, friends and acquaintances. Some losses will be easier to bear than others. Some will be expected while others will be a surprise. Many will leave a void in our lives that will be hard to fill.

I recently lost my mom after she became terminally ill and passed away at home under hospice care. It seems like only yesterday that I talked with her and held her hand. I already miss her and know that these feelings will not go away for a long time, if ever.
While with my mom, I had many opportunities to ponder life and death. Here are a just a few things that I was reminded of during this time:
 Having faith is important, especially at the end of life. Believing in “God” or a higher power brings comfort. It reminds us that life is everlasting and suggests that we will reconnect with our loved ones in death. As a person goes through the final stages of death, he or she often “talks with” loved ones who are already deceased. I saw this with both my mom and my father-in- law. While my mom’s health continued to decline after her conversation with late family members , my father-in-law miraculously recovered from a near death experience when his late twin brother would not “open a door” for him.
 Sometimes we forget how important our family and friends are to us. We often go through life assuming that the people we care about will always be there. In reality, they may not be. Death and terminal illness can come at anytime and without warning. It can leave us with unfinished business and regret for the things we never had time to say or do with our loved ones. To prevent this from happening, stay connected. Spend time with those you care about the most. Be free with your “I love you’s and your hugs. Most importantly, take time to create new memories that will last forever. You will be glad that you did.
 Saying “good-by” is difficult to do. Whether someone dies suddenly or after a long illness, it’s still a surprise. It is still hard to let them go. We are never prepared. Even if we know that death will end their pain and suffering, it’s hard to accept.
 Our loved ones are always with us, both in life and in death. Although, not with us physically, our loved ones will remain alive in our thoughts and memories. Photographs, videos, and personal possessions left behind, as well as time spent reminiscing about our loved one will keep them close to us.
 Life goes on around us while we face death or a terminal illness. It is surreal to go to work, to church, and to the grocery store while we are grieving. Although we are feeling sad, anxious or stressed, life is going on normally for most of those around us. It is during these times that we may begin to feel isolated or alone. We may question our faith. Despite this, we need to reach out to others for help and support, while sharing our thoughts and feelings.
 We are never alone during a terminal illness or death. Although we may feel isolated in our grief, there are many people available to help us. They’re waiting to help, but don’t know how. We need to let these friends, family members, church members, and colleagues know what we need while being open to their assistance. We also need to accept help from professionals who provide hospice, home health, support groups, and other assistance.
 We need to take care of ourselves as we face the loss of a loved one. Although we may feel guilty doing something good for ourselves while a loved one is struggling to stay alive, it is still important to do it. We need a break from the stress and responsibility. We need a good night’s sleep and a balanced diet. If we don’t take care of ourselves, we will not be there for our loved ones when they need us the most.
 It is important to make end-of-life decisions ahead of time. It takes the pressure off family while ensuring that decisions are carried out the way we want them to be. It also removes the potential guilt our loved ones may experience in the event they have to make a decision to take us off life support. So share your preferences with your children and spouse, and seek to understand theirs.

Finally, remember that we are never guaranteed tomorrow. We should live each day as if it is our last. By doing this we will be better equipped to cope with death and dying- whether it is our own or that of a loved one.

Who Gets Grandma After the Divorce?

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Who from my family will step up and care for me as I grow older? That is a question a lot of baby boomers are asking themselves. Because the prospects are scary.
In a study reported in Long-Term Care Magazine, divorce and remarriage is changing the role of adult children in caring for aging parents and the quality of family relationships is often trumping genetic ties argues a researcher from the University of Missouri.
Lawrence Ganong, a professor and co-chair at the university’s Department of Human Development and Family Studies, found that relationship quality, a history of mutual help and resource availability influence decisions about who cares for parents and stepparents.
Ganong said: “How close family members are to each other, how much they have been helped by them in the past and what hardships caregiving might place on family members are important factors when people consider caring for older kin.”
Ganong and his research team presented study participants with hypothetical caregiving scenarios involving an aging parent or stepparent and a child or stepchild. Participants then responded to questions about their perceptions of who should provide care.
The majority of participants said biological factors are relevant in caregiving decisions, but they do not automatically require adult children to help older relatives.
“Based on what happens before, during and after marital transitions, family members may change what they think their responsibilities are regarding helping and providing care to kin,” Ganong said. “As a society that relies on families to provide much of the care for older adults, we need to better understand the effects of changes in families due to divorce and remarriage.”
Ganong recommended that middle-aged adults have honest conversations with parents and stepparents about expectations for caregiving and other types of assistance before needs arise.
Ganong’s study, “Who Gets Custody of Grandma After the Divorce? How Marital Transitions Affect Family Caregiving Responsibilities,” was funded by the National Institute on Aging.
So now I am praying that my stepson, whose mom I am divorced from, will stay married to my lovely daughter-in-law!

The Ripple Effect of the Economy on LTC

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nursing home

A recent Kaiser Health News article illuminated the Catch 22 seniors are in – wanting to sell their home to be able to afford assisted living and of course not being able to because the market is in the tank.

According to Kaiser, experts say thousands of seniors remain unable to move into senior housing because they can’t sell their homes quickly enough or for the price they need.

And that adds to caregiver pressure to either fund that care or take mom or dad into their homes. Not ideal situations in either case. Just ask my sister. Mom just moved in with her after a series of hospital and rehabilitation stints. Mom had no real estate to sell but has money in the bank, which she does not want to part with to pay an assisted living. That too is generational because the WW2 seniors feel some obligation to leave money to their kids. Despite our assurances that we don’t want or need it. (Maybe speaking personally here.)

People are therefore also entering assisted living at an older age and needing more acute services. And frankly many assisted living residents might be better off in a nursing home.

Kaiser reports that nationally, the occupancy rate for CCRCs fell from 94.4 percent in the first quarter of 2007 to 89.5 percent in the first quarter of this year, according to the National Investment Center for the Seniors Housing & Care Industry (NIC), a senior housing trade group. Meanwhile, occupancy rates for assisted-living facilities fell from 90.6 percent to 88.4 percent, and for independent-living facilities from 92.7 percent to 87.7 percent.

Interesting Solutions

So some enterprising providers are feeling compelled to enter the real estate business in a manner of speaking. Some facilities are buying people’s houses, freezing prices and offering move-in discounts.

Others are encouraging some seniors to share their living units.

Other CCRCs are letting people move if they promise that they’ll pay the entrance fees once their houses sell.

Since 2008, Brookdale Senior Living has signed contracts with seniors promising to buy their houses at a pre-determined price, based on an independent appraisal, within eight months, if they can’t sell them. Brookdale has entered into about 400 of these deals, but has had to buy fewer than 100 homes, most of which have been resold.

Another contributing factor and consequence is that seniors have a hard time grasping the depleted market value of their homes. And when they do and finally sell, they often buy into living arrangements that may not be best suited to their medical and other needs. In Florida alone it is estimated there are 400,000 seniors with dementia living on their own at home, with few or no services.

Nursing Home Impact

The housing slump also is affecting seniors who own a home and need to move into a nursing home. That’s because states require single seniors to exhaust nearly all their assets, including their home equity, to qualify for Medicaid. Federal Medicaid rules allow states to exempt the home from consideration in the financial eligibility test if the family is making a good-faith effort to sell, but not all states do. Depending on which state they live in, these seniors may not qualify for Medicaid if they can’t sell the home.

So you have read some of the interesting solutions. What are you doing to offset the slumping recovery and attract new residents?

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Source: Kaiser Health News

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Techniques for Facing One’s Fears

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facing fear

To get what we want out of life we need to acknowledge and experience fear. We need to courageously step out of our “comfort zone” and face our fears head on.  Here are a few questions to help you get started in facing your fears. Take a few minutes and answer these questions. Put it in writing so you can look back on it later.

  • What do I fear? Make a list of the things you are afraid of and of the things you are afraid to do. Identify the fear(s) that are holding you back in life and limiting your success. By identifying what we fear, we are taking the first step to conquering it.
  • What are my strengths? List the strengths you can draw upon to help you master your fear. For example, “I am strong”. “I have handled my fear of ______ and it turned out ok. List as many as you can. If you are willing to be temporarily scared as you face your fears, note this as a strength.
  • Who can help me? We don’t have to face our fears alone. Ask for help or morale support. Talk to someone who does what you fear the most or someone who will walk thru it with you. Remember that everyone experiences fear in life, others are just handling it differently. Seek support from others who will encourage you. Find a cheerleader.
  • What is the worse thing that can happen? Look at the “what if’s”. What if I did X and things did not work out, then Y would happen. Try to look at these worst case scenarios realistically without allowing your mind to build up unrealistic situations that will never happen.  By looking at the worse case realistic scenarios, you can prepare for them in advance. At the same time, don’t dwell on past failures. Draw on what you have done right and what has worked in the past.
  • How can I minimize my risks? For each “What if?” consider the potential outcomes and identify what you can do to eliminate or at least decrease the possibility of this worse case scenario from occurring. Doing this is very liberating and puts you in control of the situation. Knowledge is power. The more you know about your fear, your risks, the obstacles, and what to do, the more control you gain over the situation and your fear.
  • What are the steps I can take to face my fear? Instead of eating a whole pie, we eat it one piece and one bite at a time. We need to use this strategy as we face our fear.  Refrain from taking one big leap or eating the entire pie in one bite. Break it down into doable steps and enjoy your success in the smaller bites.
  • Why am I doing this? Look at your reasons for facing your fear? Is it to open the door to new opportunities? Is it to inspire you to do other things? Is it to improve the quality of your life? This will serve as a reminder as to why facing your fear is a priority in your life.
  • What good can come out of facing my fear? What are the best things that could happen if you face your fear? How will it change your life? What opportunities can occur as you open this door? Visualize success and the good things that come out of facing your fear. Fantasize about how life will be after you overcome your fear. Focus on the positive outcomes. For example, if you fear public speaking, take time out to shut your eyes and visualize yourself doing a stellar job when addressing a group. Use this to replace the mental image you previously had of getting up in front of a group and failing.

As you face your fears, take time out regularly to focus on the good things going on in your life.  Pat yourself on the back for the things you have already accomplished. Develop a habit of turning off negative thoughts and focusing on the positives.

Take one step at a time. Use baby steps. It may take longer, but it creates momentum and builds our self confidence along the way. At the same time, refrain from procrastination. The longer you take to act, the more time you have to talk yourself out of it and the more time you have to imagine things going wrong.

Using your experiences and wisdom, and these simple guidelines can help you put fear into perspective and change your life. It has mine. I have faced my fear of public speaking, of success, of failure, cancer and of death, as well as many other fears forgotten along the way.  Life is too short to waste it on being scared. Our time is limited so we should spend our time enjoying it to the fullest.

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Facing Fear

Denise Scruggs is the Director, Beard Center on Aging at Lynchburg College

Fear

Fear

Roller coasters. Going to the dentist. Horror movies. Becoming old and discarded. Death. Failure. Loneliness. Public speaking. Cancer. Perfection. All of these have a common link and that is the tendency to create fear in many people.

While we all experience fear, it is personal. What one person fears, another person thrives on. Successful people feel the fear and don’t let it keep them from doing what they want to do or have to do. Some people hide their fears and appear fearless while others are more open about them. Many face their fears head on while others ignore them and let them guide their lives.

Some things we fear last a lifetime, while others occur at different periods in our lives. As a child we may fear our first day at school or getting up in the classroom to present a paper. In mid-life, our fear of failure in our careers or fear of not finding a partner may be more acute. As we move into later life, we may fear death more strongly as it appears more imminent. We may fear that our money will run out before we die. We may also fear becoming frail or ill.

Fearing the loss of our independence is a common fear among older adults. While it is one that needs to be faced head-on, we tend to become stubborn, uncommunicative, and unwilling to seek help or advice from family, friends and professionals. We hide the fact we are becoming more frail or forgetful. We keep our head in the sand and hope that our situation will go away. Unfortunately, it usually doesn’t and we, in essence, create the situation we feared the most.

Fear manifests itself in many different ways.  It may appear as procrastination or inaction as we fail to make important decisions or act on situations. It may be an over-reaction to a situation that has occurred when we felt frustrated that we did not face a problem effectively.  It may even appear as expressions of anger, aggression and criticism toward others who are able to do the things we fear the most. We feel inadequate when we compare ourselves to them.

Fear is natural. Fear is powerful.  By causing us to feel anxious and nervous, or even sad, it is also uncomfortable. Fear influences the choices we make and how we live our lives. It can energize us or paralyze us while affecting our personal life, our relationships, and our future. It clouds our reasoning and can prevent us from living life to the fullest or being the best that we can be.

Many fears are self created. They are created in our mind when there is really nothing to fear. It is like the infamous “monster under our bed” we feared as a child, when in reality it was not there.

At the same time, fear can be positive. It can keep us from taking risks that are too dangerous. For example, when coming head-to-head with a big bear in the woods, fear reminds us to proceed cautiously. It prevents us from walking up to the bear and petting him on the head. It gives us the adrenaline we need, if we need to run away.

(To Be Continued  “Techniques for Facing One’s Fears”)