China's Coming Crisis Of Elder Care

Global Times

As China's one-child policy moves to its next generation, the "4-2-1" problem, namely four grandparents and two parents with only one adult child to look after them, has become a pressing concern for many families.

The one-child policy has severely challenged China's traditional family system. As the old Chinese saying goes, "Raise sons to provide for old age." Under the old system, the younger generation, men in particular, served as the main providers for older family members. This is the logic behind the traditional thinking of having more children, especially boys.

But the one-child policy leaves many families with little choice. Therefore, regardless of gender, the only child faces the challenge of providing for all the aged in the family when time comes. It is like an inverted pyramid – the pointed side has to support all the weight of the whole structure.

However, for many young people in the urban areas, who were born as the only child in the late 1970s or later, the time hasn't come yet. Most of their parents are either working or have social securities and personal savings to support themselves.

Their grandparents are not their problems, since their parents basically take care of the issue by sharing the responsibilities with their brothers and/or sisters and using their own resources.

China hasn't moved to the stage of "4-2-1" yet. The parents of China's first generation of one child are still the main providers now.

Mostly in their late 50s or early 60s, these people are quickly draining their lifetime savings to help their children by buying them apartments, careers, or other things. They stretch themselves to simultaneously care for their children as well as their parents.

But the situation won't last long. With China's living expenses shooting up and the increasing life span of old people, responsibility is going to shift.

Unlike Western countries, which have a developed social support system for the elderly, China is still experimenting with and reforming its public welfare system.

Not everyone in China has social insurance, especially among the rural population. When these social mechanisms fail, the last resort is their only child.

Some young people are acknowledging the challenge ahead of them. It is a daunting task even to imagine how a young couple could support four aged people or more while trying to make ends meet for their own small family.

Many of them can only cross their fingers that their parents won't have any serious illnesses that go beyond the coverage of social insurance or their own personal savings.

Even when the financial needs are not a big concern, how to take care of the other personal and emotional needs of the older generation is going to be a tricky task for these only children.

I am lucky enough to have two siblings, and even then it's hard sometimes to make sure somebody gets home for the Spring Festival with our parents. I can't imagine how bad the situation might be for those one-child families, especially given how scattered across the country many families are.

The living situation is another problem. When parents have aged to the stage where they can't take care of themselves, where to put them becomes a real headache. One can either live with the parents or send them to an old folks home.

But the latter doesn't sound like a good solution as putting parents in a nursing home is totally against Chinese beliefs.

China's elder care industry is also still in the early stage of development, as the Global Times reported yesterday.

My mother joked once that she could go there, but I could tell from her eyes that she didn't mean it.

However, with both sets of parents needing help, young families may face a very awkward situation. It is already very difficult for grown-ups to live with their parents. Living with in-laws could be even worse.

But the worst scenario is to put both sides of the parents under the same roof with the young couple, especially if there is a young grandchild around.

We can only hope that time and reform will solve everything. When the "4-2-1" crunch comes, we must already have a terrific social support system for the aged, no matter where they live or how many children they have.

Human Services Chief: Cuts Hurt Elder Care

News-Telegram

Fitchburg, MA -- People receiving services and others who provide them testified at a forum at Fitchburg State College last night on how cuts to state aid have affected programs.

The forum, moderated by Secretary of Health and Human Services Dr. JudyAnn Bigby, was one of 19 planned across the state seeking input on the upcoming state budget and how to fill a projected $3 billion deficit in fiscal 2011. A panel comprised of Health and Human Services officials also attended.

In a pre-recorded address played at the start of the forum, Gov. Deval Patrick said his administration was going through the budget line by line to find savings while still providing services to the most vulnerable populations in the state. He said his administration was building a budget around community values.

Greg A. Giuliano, incoming executive director of Montachusett Home Care — an agency that provides in-home and community-based services to the elderly — said cuts in state funding have diminished the agency’s ability to provide services.

“It’s important to back up the rhetoric about building a budget around community values,” he said.

He said the agency’s parent organization, Mass. Home Care, which works to keep elders from having to enter nursing homes, has more than 2,000 elderly on a waiting list for services.

The state, he said, impounded $2.5 million that was targeted for staff who go into hospitals and educate people on their rights to community care that can divert them from nursing homes. Additionally, he said, the group-home model that places four elderly people in a ranch house instead of a nursing home has been derailed by the state for two years; and the elder abuse program was cut by $1 million.

He urged the state to restore funding to those areas and not make further cuts.

Suggestions from the audience to fill the state’s deficit to avoid further cuts to services included legalizing marijuana and taxing it to increase revenues, increasing taxes on tobacco products and just generally increasing taxes.

Linda C. Lolly, a personal care assistant for people with mental illnesses, was a proponent of legalizing and taxing marijuana to save in-home services to those she supports.

“I have seen it over and over again that an elderly person can stay in their home when someone comes in and gives them a bath and gets them dressed for the day,” Ms. Lolly, who works for Arcadia Health Care in Worcester, said. “That’s just a few hours instead of having them go into nursing homes that cost thousands of dollars because there is no one else to do it for them.”

Dr. Bigby said the upcoming budget cycle is going to be even more difficult than last year because fiscal 2010 was balanced on $2.1 billion from one-time revenues. Moreover, there is only $561 million left in the state’s stabilization fund, she said, that may be needed in this budget cycle.

The Health and Human Services budget totals $13.7 billion — 51 percent of the state’s overall budget of $27 billion.

Seniors Teach Med Students Finer Points Of Elder Care

UAB Reporter

Lorain Devito is an expert on the elderly. She knows their tendencies, their likes and their dislikes. She knows how strong their will can be. She also knows their fears.

Devito knows these things because she, too, is elderly. Devito is a resident at Episcopal Place, a Section 202 supportive-housing program that provides seniors and disabled adults with restricted income safe and affordable housing and access to related services in a home-like environment.

She’s a very busy lady. Devito, a diabetic, swims regularly and helps interview potential Episcopal Place residents. She also volunteers for two programs in the School of Medicine — the Senior Mentor Program and the History of Medicine Program — and she meets with medical students to discuss health care.

“I look at this as an opportunity to give back and an opportunity to help the physicians of tomorrow better understand geriatrics,” Devito says.

Both programs have been a part of the School of Medicine and the Division of Gerontology, Geriatrics and Palliative Care for several years and recently received a jolt with a $2 million grant from the Donald W. Reynolds Foundation and a $1 million match from the university. Christine Ritchie, M.D., director of palliative and supportive care, is the principal investigator for the four-year grant, which will improve education for the school’s 875 medical students and for 350 residents, numerous faculty and community physicians.

“Both programs were part of the original grant proposal and are receiving much-needed funding,” says Angela Rothrock, Ph.D., assistant professor in gerontology, geriatrics and palliative care and associate director for the day-to-day operations of the UAB Reynolds Program. “The grant will enable us to change the programs — particularly the Senior Mentor Program — in positive ways. It’s certainly reinvigorated the programs and helped us increase the diversity of our seniors.”

Stan Massie, M.D., associate professor of general internal medicine, oversees the Senior Mentor Program for first-year medical students. Richard Sims, M.D., professor of geriatrics, is the co-director.

Rothrock says Massie and Sims were responsible for starting the program and have kept it going with little funding.

The course is a unique opportunity for first- and second-year medical students to be paired with a senior citizen living in the Greater Birmingham area.

Among the goals of the program:
• Provide students with an opportunity to develop a working relationship with a patient
• Expose students to community-dwelling elders
• Enable students to visit elders outside of UAB
• Provide opportunities for students to practice their interviewing skills
• Make students aware of some of the principles and challenges involved in care of the elderly

Two students are paired with an adult and visit their senior mentors approximately six to seven times in two years.

“There are specific things we want them to learn each visit,” Rothrock says. “One visit might be learning to do history-taking. One might be learning to do a cognitive assessment, a depression scale or a medication review. There are specific clinical skills we want them to learn. But we also want them to learn that all older adults are not sick and frail. There are older, healthy and vibrant adults in our community who they have a lot to learn from.”

Focus on geriatrics

The Donald Reynolds Foundation grant is part of $80 million it gave to UAB and 39 other medical schools to focus student learning on better care for the elderly.

The grant requires internal medicine residents to spend one month in geriatrics training in settings that include acute care for the elderly, a long-term care facility, outpatient clinics and home-care visits. Other programs, including interactive, online training modules and special geriatric training for residents in internal, emergency, family and pediatric medicine, also are in development.

The Senior Mentor Program also will evolve into an interdisciplinary program.

“It won’t just be a medical student working with an older adult, it will also be a nurse, a social worker, a dental and a therapy-based-practice student working in teams,” Rothrock says. “The professionals in training will discuss how to work in an interdisciplinary team to best care for older adults.”

Training in geriatrics, the area of medicine that focuses on diagnosing and treating diseases and problems particular to older adults, is essential for future physicians.

The first Baby Boomers begin turning 65 in 2011, which creates an additional sense of urgency. The Silver Tsunami, or wave of seniors seeking medical care, is expected to increase dramatically during the next decade.

“Given the changing demographics, we’d have to train far more physicians than we are able in order to have enough geriatricians,” Rothrock says. “So even if you’re not a geriatric specialist, you’re going to have to care for older adults. What we can create are geriatric-friendly physicians so that any physician coming out of training is attuned to geriatric needs and able to recognize that caring for older adults requires a different perspective on health care.

“If we don’t train health-care professionals in general to care for older adults, from basic communication skills to very technical clinical skills, they’re not likely to learn it,” Rothrock says. “In the average medical journal you’re learning about outcomes in a 40-year-old white man, and that’s not who’s going to be coming into their clinics.”

Mentors are the teacher

That’s why the mentorship program is so valuable to students. They get an opportunity to begin learning the way seniors live and think.

In fact, Rothrock makes it known when she is recruiting the seniors that they are to make sure they do one specific thing with the students — speak their mind.

“I tell these local residents, ‘You’re the teacher. If you don’t like the way they ask you questions, tell them,” Rothrock says. “This is a collaborative model. The seniors aren’t just guinea pigs. It empowers them and gives them some ownership in the program.”

Devito is more than happy to do that after 14 years without taking charge of her own health. Part of that blame she says is hers, but she also says her physician never pushed her hard for information and never fully educated her on potential outcomes due to her medical issues.

“You go to a doctor because you want answers and direction — at least that’s why you should go,” Devito says. “Geriatrics are not always honest about their health. They think, ‘If I have this problem or that problem and tell the doctor about it, I’m going to wind up in the hospital having surgery.’ Obviously that’s not always the case. I think this program will better prepare these students to treat geriatrics. Because I can assure you, they are going to see patients just like me, who gave very little information and thought they could handle their health on their own. I’m glad I’ve got a doctor now that will ask me questions and tell me what to do.”

Elder Care Survival Key Concern At County Forum

Courier News

Kane County, Il -- Nearly 100 Kane County elder care providers, senior citizens and their advocates discussed federal and state issues relating to elder care during a legislative forum Monday in St. Charles.

The event was sponsored by Kane County Senior Resources, Asbury Gardens, Countryside Care Center, Heritage Woods of Yorkville, and the Northeastern Illinois Area Agency on Aging.

Among challenges discussed were the state of Illinois' lagging Medicare payments to small businesses that provide elder care and services.

Betty Schoenholtz, executive director of Senior Services Associates, said state payments to elder care providers -- many of whom are small-business owners -- have lagged for months because of the state's budget shortages.

"It is of great concern to me what is happening to our (provider) agencies," Schoenholtz said, adding that those funds would help stimulate the economy through purchases made by small businesses. "When the state of Illinois doesn't pay its bills, we can't buy things from small business ... We hope (state legislators) can step up to the plate and resolve these issues."

She also recommended that legislators change state law to require the Illinois Department of Public Health to allocate at least $750,000 into the ombudsman program, or to implement a "bed fee" similar to Ohio's, which requires a $6-per-bed fee to help offset costs to agencies. Schoenholtz also said the elder abuse program is owed $134,000 from the state and that the figure represents one-third the budget for elder abuse cases.

Lucia Jones, executive director of the Northeastern Illinois Area Agency on Aging, also said she is concerned about how the state's budget issues are impacting service providers.

"The providers are all small-business owners," Jones said. "The numbers they serve are going up tremendously, because of the economy ... . There are hundreds and thousands of families in the state of Illinois in need of elder care; and if the ombudsman program is cut, those people will have to go into long-term care."

AARP spokesperson Heather Heppner also provided an update. "We have spent a very long time advocating to prevent cuts to community-based services. We know it is more fiscally responsible to care for individuals in their homes than in institutions," she said. "We have providers who have not been paid this entire fiscal year ... . Senior services need to have a heightened level of priority."

She also noted that AARP endorsed the Affordable Healthcare for America Act.

"On the House bill side, it was not perfect ... but the bottom line is that our health care system in this country is broken, and the things our AARP members have told us are important issues are addressed in that bill," Heppner said. Older adults were at times paying up to seven times more in insurance rates than younger adults, she said, and the health care act would cap age rating at two to one.

Lobbyist Working To Help Senior Citizens

Wicked Local Harvard

Deb Thomson knows all the ins and outs of Beacon Hill’s workings.

As a lobbyist for elder care and health care issues, Thomson spends her days working on behalf of a growing senior population. As a founder of The PASS Group, a legislative and administrative advocacy organization working for non-profit companies, Thomson says taking care of all its citizens is what a country should do to its best ability. Laws can get bogged down with words and requirements, but in the end, they need to serve the people in the best way possible.

For instance, Thomson is working hard for the spouses of those who need long-term care and have to put themselves into poverty to get it. A nursing home resident gets a monthly allowance of $72.80 to cover everything Mass Health does not — shoes, clothes, telephone calls, transportation, books or newspapers, said Thomson. It is a figure she finds ridiculous and wants to see increase, but it is a fight to just have it remain steady.

“This is a perilous time for human services because of all the budget cuts,” she said.

For anyone interested in lobbying work, Thomson says a good way to start is to be an aide to a legislator. A determined group of people can make a difference.

Q How did you get started in your career?

A I am an attorney and for many years, I worked as an elder law attorney and in legal services which serves lower income seniors. Part of that developed into legislative advocacy work where you pass bills and legislation that would benefit programs that elders rely on for income and health care purposes.

Q What got you started in elder services and health care?

A When I was in law school I volunteered in a clinic for elder clients. I worked for the Alzheimer’s Association for five years working on public policy. And then I left there and went into a legislative and administrative advocacy business. I had a great interest in the issues that confront the elderly in our society.

Q It sounds like you must have your ears open to everything.

A Well, I also used to work for Massachusetts law reform [agency] for several years that was devoted to advocacy on behalf of lower income people. There is a whole community out there, of which you may not be familiar, advocates and people who work on behalf of clients in nonprofit organizations trying to improve society. It is a real specialized niche in both the political and legal world.

One thing that surprised me was how small town Boston is in these circles. State government is people who change hats occasionally, so you really develop a network.

But my clients are not big corporations; my clients are advocacy groups, some small healthcare providers, and day programs for seniors. For instance, lately, there have been terrible budget cuts and they have affected most of the state-funded elder programs. There is a wait list now for health care services for elders. Councils on Aging, which rely on funding, have been affected.

Q All the cuts often seem harsh — your work must make you feel good.

A Oh, absolutely. I used to do a lot of individual representation, but this is more durable. You can pass a law that affects a lot of people. An example of the kind of issues I work on, the seniors for many years had Medicare, but no prescription drug coverage. There was a constant tension between keeping Medicare affordable and providing drug coverage.

Several years ago, they implemented something called Medicare Part B which is a drug program. But Massachusetts, at that time, had enacted a state-based program so seniors would have coverage. When the Part B coverage went into effect, prescription advantage filled the gap that Part B would not cover.

Q How does a lobbyist help them?

A It is very difficult to get anywhere without professional help. I was just at the Mass Councils of Aging annual conference talking about advocacy and how to get a bill through or how to affect a budget item. If you are just a regular layperson and you can develop a relationship with a legislator, then sometimes they can help you through the process. If you have a lobbyist it is better. If you are in a coalition of many groups, you can get the attention focused on an issue.

Q Do you sometimes feel like the underdog?

A The groups I work with do not have the wherewithal to make campaign donations. We have to make a case on its merits; we can’t make it on the fact that we made campaign donations. It has to be a compelling issue that affects the constituents of legislators and that gets their attention. Most legislators are interested in elders and their issues.

Q And it is a growing field.

A It is going to be interesting because I don’t think the government at the state or federal level is prepared to deal with the needs of baby boomers. People are getting older and saving less. The person who has pension benefits now is a rare bird.

Actually seniors take the worst hit for long-term care. Because nursing homes are not covered by Medicare, except for a very short period of care. People end up spending all but $2,000 of their assets in order to qualify for long-term care. You have to impoverish yourself to get there.

Q Elder care is not always at the forefront.

A Right. There is private long-term care insurance, but there are many problems with it. One is that it is too expensive for many people and many people wait too long until they are sick to buy it and then it is too late.

Q Is that the one thing you would like to see changed the most?

A Adequate coverage for long-term care is right up there. I guess the other thing I would like to see is better state coverage of community-based care. Again it is a question of money.

But people who live alone and are isolated really need those services.

Q How do you lobby?

A One of the important things we do is educate. We educate the legislators about the issues we care about. We educate the public about the issues we care about and we try to, at the same time, we are educating them about the importance of these issues we try to get them to advocate on their behalf.

Q So it changes all the time?

A It does. And it is fascinating. You never know quite what to expect.

Waiting Lists Lengthening For Elder Care Services

Somerville Journal - Somerville, MA

There are more than 2,000 households across the state that have a disabled elderly person who is not receiving home care support.

According to Mass Home Care, which represents the 27 agencies that operate the home care program locally, the waiting list to get into home care has reached 2,002 people. This includes both the basic home care program (1,593 people waiting) and the Enhanced Community Options Program (409 waiting).

Mass Home Care projects that budget cuts enacted by the General Court and the governor will result in as many as 5,000 to 6,000 seniors waiting to get home care by the close of the fiscal year June 30.

“Families will be struggling to figure out how to take care of mom or dad this Thanksgiving,” said Mass Home Care executive director Al Norman, who said the 2010 fiscal year will go down as the worst on record for cuts since the home care program began in 1974. “The irony is that nursing home doors are wide open in most parts of the state, but the door to home care is closed.”

Norman said community programs like home care are a wise investment for the state, because home care has helped drive down institutional services by 20 percent since the year 2000, and two people can be helped at home for the cost of one nursing home placement. The state’s Medicaid program is required to provide care to the disabled in the “least restrictive setting appropriate to their needs,” but Mass Home Care said the community programs are some of the first to be cut.

Along with home care cuts, the administration has recently slashed rates to the adult foster care program — a residential alternative to nursing homes — and reduced access to the personal care attendant program. The group adult foster care program has also been pared back. Cuts to these three community services total $11 million. The home care cuts totaled more than $16 million, for a total of at least $27 million in lost services.

“It will take us years to get back what we have lost,” said Norman. “We are hurting some of the most vulnerable people in the commonwealth. These are people who will show up sooner or later in our institutions, costing the taxpayers much more in the long-term. Not only is this policy forcing people to be unnecessarily segregated from their community, but it’s fiscally short-sighted.”

While these programs are struggling for every penny, the commonwealth provides $1.2 billion in corporate excise tax breaks.

Podcasts Feature Advice For Senior Community Management

Earth Times

"Best Practices in Senior Care Management" podcast series from Horst Construction discusses trends and challenges facing CEOs, CFOs and executive administrators of senior living communities. Four episodes are now online, focusing on lending and financial issues and the new Five Star rating system for senior housing.

Lancaster, PA (PRWEB) December 6, 2009 -- A series of thought-provoking podcasts developed expressly for CEOs, CFOs, executive administrators and other top decision makers of senior living communities by Best Practices in Senior Care Management and sponsored by Horst Construction is available on iTunes or accessed as an XML feed at http://horstconstruction.com/podcast.asp.

Titled "Best Practices in Senior Care Management," the four-episode podcast series provides ideas, processes and new information from leading thinkers and doers in the field of senior care. Topics such as new regulations, financial measures and management, marketing ideas for increasing occupancy, and operations and planning are part of the podcast curriculum.

In the first two episodes, Steve Jeffrey, regional director of Ziegler Finance, reviews first quarter 2009 results and the present state of lending and then addresses the near-future of financing and acquisitions in the senior care industry. The final episodes are a two-part discussion on the Five Star rating system for senior care facilities in the U.S. Ron Barth, CEO of PANPHA, the largest trade association representing nonprofit providers of housing and health-related service options to Pennsylvania's elderly, and Pennsylvania Secretary of Aging, Mike Hall, debate the benefits of a nationwide rating system for senior care.

The information in the "Best Practices in Senior Care Management" podcasts was originally presented at the Horst Senior Living Conference in April. The 2010 conference is scheduled for April 8 at the Lancaster Country Club in Lancaster, PA. Keynote speaker is Jim Moore, president of Moore Diversified Services, a leading national consultant to the senior housing industry. More information on the 9th annual half-day conference is available by calling 717-581-9981.

Choosing Appropriate Senior Care

Evansville Courier & Press

One of life's landmarks is choosing a nursing home. It should be carefully thought out, but typically the decision is made when a loved one is about to be discharged from a hospital, often with hours notice. Even on that deadline it's possible to make a good choice.

Lee Bowman, medical reporter for Scripps Howard News Service, talked to many top experts on nursing homes to come up with some guidance.

They recommend starting with the U.S. Centers for Medicaid and Medicare Services' Nursing Home Compare, a database that ranks 15,700 nursing facilities on a star system, from one star — "much below average" — to five stars — "much above average." Around 12 to 13 percent of nursing homes have the top rating; slightly more than 20 percent the lowest.

But the star system can be slightly misleading. In a study of the CMS database, Scripps Howard came up with a few general principles to help read between the ratings:

— Homes run by nonprofits, about two-thirds of all, generally score better than those run by for-profits and tend to have more nursing staff per patient.

— Homes with more than 100 beds tend to get lower scores in all categories.

Experts recommend finding a nursing home close to the patient's home because it's easier for family and friends to visit. He recommends meeting the home administrator and making several visits at different times to talk to staff and inspect public areas. Look for longevity among the key caregivers. If more than 25 percent of staff are recent hires, it can be a worrisome sign.

Plan early. Choosing a nursing home is difficult, but knowing the patient's preferences improves chances that the decision will be the right one.

Senior Care Across The Miles

The Bend Bulletin

Our society has become increasingly mobile in the past few decades.

Kids move away from home and don’t come back. Parents retire to another state. Family members shift from place to place, looking for work, going to school, building their lives.

Often, adult children end up living some distance from their aging parents. While this leads to increased travel and decreased time spent together, it has another consequence as well. Distance makes it harder to help when a parent is in need. As a result, many adults are finding themselves playing the role of long-distance caregiver.

Raeann Hamon, a professor of family science and gerontology at Messiah College in Pennsylvania, says long-distance caregiving is absolutely a trend that is likely to increase.

“Certainly, as the baby boomers and their parents age, we can expect a large jump in the number of families dealing with such caring across miles.”

These adult children face challenges of trying to find the right role to play, staying involved while not becoming overly burdened.

Starting off

Nancy Turk co-owns Visiting Angels, a local service that connects in-home professional caregivers to older individuals. She says about half their clients have relatives in another region or state. They have been contacted by family members in Alaska, California and Australia who want to hire help for a local relative. Typically, Turk says, a family member realizes they need to step in after visiting. “They are shocked to see the condition their grandparents or parents are living in.”

These relatives, often adult children, believe their parents are doing fine, but the reality is somewhat different. They might find rotten food or dog feces. “It’s traumatic for the kids.”

Turk says oftentimes the family members feel guilty and then hire staff to come in and assist, particularly in cases in which the parents don’t want to leave their own home.

Marion Somers, a geriatric care manager and author of “Elder Care Made Easier,” suggests adult children think about what they can and cannot do. She encourages them to set limits and to delegate. “You have to be honest about your time and resources.” She thinks of it this way: It’s like being on an airplane when passengers are supposed to put on their own air masks first before helping anyone else.

“You have to be organized, you have to prioritize, you have to delegate,” Somers said.

Challenges

Trying to assist a relative living far away can be quite complicated. Hamon says many adult children feel guilty about not being able to help more, while also feel angry about the imposition and feel anxious about future needs. She says many individuals feel guilt because of the “norm of reciprocity.”

“There’s the notion that you should be good to those who have been good to you,” Hamon said.

Figuring out when to visit and to allot resources — both financial and time — is another big issue. Sometimes, resources are better spent hiring someone to help than flying out to visit for a week. Somers point out that a $600 plane ticket could be used to hire someone to come in once a week to help out for a couple weeks or more.

Robert Sachs knows about this challenge from both sides. He has been a caregiver working with adult children who live in another state. And he has been the son, living far from his dying father. His experiences are chronicled in his book “Perfect Endings.”

“We’ve created this kind of quandary for ourselves.”

When Sachs worked in a hospice in New Mexico, he saw many negative reactions from staff to adult children living far away. He says staff members frequently looked on these individuals negatively, thinking, “If you really cared, you would live here and be here all the time.”

Sachs felt these assumptions were unfair. That said, he recognized why it happened. Sometimes, the professional caregiver felt as if the relatives living away were serving as armchair quarterbacks, questioning decisions and making recommendations without really knowing the situation.

Sachs says relatives’ top priority should be to develop a relationship with the primary professional caregivers.

Hamon says it’s also not good to assume an older parent will naturally move to where adult children live. She believes part of it is generational because many older individuals have lived in one place for many years. They can also be entrenched in the community and have social support. “To ask them to move, it’s a challenge.”

Practical steps

Hamon suggests adult children start regular rituals and routines, for instance calling once a week at the same time and day.

Somers agrees, saying, “The voice tells so much. Most older people don’t have the energy to fake it.”

When the son or daughter does visit, they need to really get to know the area. Hamon suggests they learn about the neighborhood and meet the neighbors. Who does the older relative have regular contact with? She suggests the child hand out his or her phone number and ask for theirs. Then if neighbors see anything of concern, they will know who to call. She also thinks adult children should try to assess their parents’ needs, such as help with household tasks, personal care and transportation.

Somers suggests adult children take a “look at the house or apartment with fresh eyes.” What is the lighting like? How is it at night? Are any light bulbs burned out? How easy is the bathroom to navigate? Are there any throw rugs? What about the outside, including the garage and porch? She strongly encourages installing grab bars in bathrooms, putting in sensor lights outside and getting rid of all throw rugs. Somers also believes all kitchen items should be at eye level. She says to banish footstools. She will hire a neighborhood kid to mow the lawn or shovel snow. She also encourages family members to get in touch with the parents’ church, if applicable. Getting the grocery store to deliver is another good option.

Hiring help can bring relief. Turk says many adult children appreciate being able to talk with someone who serves as their eyes and ears.

Turk says sometimes the older individuals may resist outside help, saying, “We don’t need it; we’re fine.” They see help as a sign of the end. Sometimes, however, they “respond better to someone who is not a loved one,” said Turk. With family, older individuals may feel more comfortable saying no or getting angry.

Adult children need concrete information should anything go wrong. This includes a list of their parents’ doctors, medications, insurance information and more. Knowing what they are allergic to, past surgeries, medical issues and what vitamins and over-the-counter items they take are also good ideas.

Not all parents expect their children to be there to provide physical care for them, says Hamon. “Most expect their children to be emotionally supportive.” That is the most important piece. And the good news, according to Hamon, is being a good listener and offering support “is something that’s a bit easier to do at a distance.”

Using The Internet To Transform Elder Care

Wicked Local Concord

Concord resident Jim Reynolds last month opened Caring Companion Connections, a home services agency that adds a 21st century twist to in-home elder care.

CCC’s caregivers, known as Companions, use smartphones, such as BlackBerrys, to upload photos, activity logs and daily reports to a Web portal tied into a landline at the client’s location and viewable by loved ones in other cities or towns.

Reynolds has hired Debbie Bier as district director of the Concord office. She is responsible for day-to-day operations of Caring Companion Connections, which covers Metrowest, a 45-minute radius around Concord by Reynolds’ definition.

He also plans to open offices in the Falmouth area, which would cover the Cape and South Shore, and on the North Shore around Salem or Gloucester. But Reynolds, whose family operates large non-medical home care agencies in Florida and Kansas, expects Caring Companion Connections will grow beyond Massachusetts.


Tell me about your business.

This is a family business, me and my family. We provide flexible, reliable homecare services to elders who want to remain in their homes as long as they can and stay independent rather than move into a nursing home. My dad started this business 17 years ago, but we have added in as new a feature here in Concord, a Web communications portal, which is unique in the industry. And this allows family members, especially adult children who are far away, to log on at work, or during the day from home, or on a business trip, wherever they are and see the status, to get a window into the living room, of what’s going on at the parents’ house. They know when we log in. They know the activities, meals and medication reminders. That kind of thing.

Why is the Web communications portal so important?

That’s important because typically, in this industry, that information is kept on a logbook on the kitchen table, and it’s useful if you’re standing at the kitchen table. The problem is that in most families the person who needs the information is not at the kitchen table — they’re usually in another city. If their loved one gets ill, or is not taking medications or having trouble moving — any information that needs to be noted — the information doesn’t get where it needs to be as quickly as it should. And even then, only one person has it and you wind up with a range of telephone calls and e-mails and voicemails. So this provides one place, that’s instantaneous, that everyone can go for access to the same information and make decisions and take actions as quickly as possible. Or, even, if no action is required, simply to know that everything’s OK.
Can you talk about who your clients are and what kind of care they require?

There’s a particular phrase in this industry, activities of daily living, or ADLs, and those can range from things like trips to the grocery store to help getting to doctor’s visits to medication reminders and meal separation to more personal things like help with grooming, or help in the bathroom. If someone has limited mobility, and can’t move easily, we can help. If someone has lost use of a limb because of a stroke we can help. If someone is a risk to walk because of dementia, we can help. Typically, the clients are someone in their retirement years, most of them live alone and it’s important for these people to live where they want to live, a place that is familiar, where they have often lived for decades. Statistics bare out that people who live where they want to live have much better healthy, happy retirement years, and people who are involuntarily moved do poorly medically and have much more depression and report being less happy.

The Modern Dilemma Of Elder Care: The Sandwich Generation

New Jersey Newsroom

More than 25% of American families are involved in elder/parent care at some level. Today, the baby boomers are the "heart" of the sandwich generation.

To understand the significance of the Sandwich Generation, one needs to realize that the Sandwich Generation is THE largest segment of our population.

Who are these sandwich generationers?

Traditional sandwich: those sandwiched between aging parents who need care and/or help and their own children

Club sandwich: those in their 50s or 60s, sandwiched between aging parents, adult children and grandchildren. OR those in their 30s and 40s, with young children, aging parents and aging grandparents. (Term was coined by Carol Abaya)

Open Faced: anyone else involved in elder care. (Term coined by Carol Abaya)

Statistics further demonstrate the importance of understanding the sandwich generation scenario:

$34 billion a year are lost in employee productivity because of elder care responsibilities. More productivity is lost from elder/parent care responsibilities than from child care.

The cost to industry to replace experienced workers who leave their jobs to take care of a sick loved one is more than $7 billion a year.

Of full time employees who are caregivers, today 52% are men and 48% are women. This is a dramatic shift in the caregiver picture because of the high rate of divorce and family being geographically scattered.

77% of caregivers report they work less effectively.

More employees develop health problems from the stress of elder care than from child care.

While the sandwich generation is the largest segment of our population, those over 85 make up the fastest growing segment.

All of these statistics clearly show the undefinable challenges for adult children.

If you are a sandwich generationer, know you are not alone. In order to keep the stress level of sandwich generationers managable, there are a number of important elements that must be understood. These will be addressed in future columns.

A key sandwich generation responsibility is to enable and empower a parent to live as independently as possible as long as possible given true physical and mental capabilities. A sandwich generationer should NEVER take over control of a parent's life and should do as little as necessary to maintain an elder's safe environment and health.

Acknowledge and accept the fact that everyone's emotions will be on a roller coaster forever. As soon as a sandwich generationer thinks things have calmed down, a plunge is inevitable.

No sandwich generationer should do everything alone for an aging parent. This leads down the road to a sandwich generation physical and mental breakdown. Help from other family members and community resources should be identified and used.

Legal, financial and quality of life elements MUST be addressed BEFORE a crisis. If a person (regardless of age) does not protect himself or herself by executing key legal documents, a court can appoint a complete stranger to take over finances, medical decisions, and lifestyle decisions.

Spiritual elements are also important in an elder's everyday life and especially in relation to dying.

The Importance of Being Prepared
Story from the Sun Sentinel

If you help care for an elderly parent — or will do so in the future — it's smart to plan ahead for an emergency room visit.

More than 7 million emergency hospital visits each year involve patients 65 and older. A rushed visit to the hospital can be difficult and stressful, and caretakers will be called upon to answer lots of on-the-spot questions related to medical care and payment.

Fortunately, planning ahead can save a world of headache. Even simple things help a lot.

"I usually bring enough Diet Pepsi and snacks to last six hours, since that's how long I am waiting with my mom or dad until they're admitted," said Ann Blanchard, founder and president of HandiRecords.com, which sells low-priced organizer notebooks for medical information. "And some Sudoku or crossword puzzles, since I'm too stressed to concentrate on a novel."

To help, the American College of Emergency Physicians recommends:

Fill out a medical history form (ahead of time): Go to EmergencyCareForYou.org to obtain a form that you and your parent's physicians can complete. On the form you will list what medications your parent is taking, allergies, as well as past and current medical conditions. Bring this form to the emergency department and give to the emergency physician. Also keep track and make sure your parent is taking medications correctly.

Anticipate admission: Bring a change of clothes and some personal items in case your parent is admitted to the hospital. You can always leave them in the car.

Know physician contacts: Do you know all the names of the doctors your parents see? You should. Take some time now and find out their names, contact information, why your mother or father sees them and how long they have been patients. Write it down and hand it to the doctor or nurse in the emergency department. If you are traveling, have copies of the most recent doctor summary and a copy of an EKG if it is abnormal.

Convey parent's state of mind: You know your parent better than the doctor. If he or she seems confused, explain to the physician what "normal" behavior is like. If the doctor is talking to you, make sure you are talking to your parent. The doctors may have to run tests, conduct an examination or admit your parent to the hospital. Keep the conversation open with your parent.

Consider living wills: A difficult issue to discuss, but end-of-life planning is important nonetheless. Do your parents have living wills, and do you know what their wishes are if their conditions become critical? If not, find out now.

Report on recent surgeries: Keep track of surgeries, especially those involving implanted devices such as hip replacements, or pacemakers.

Simplify insurance information: Have a single sheet of paper with insurance and identification information.

Bring reading materials: Make sure you have a book, magazine or a newspaper to read while you are waiting for results or to see a physician. Bring a laptop so you can check your e-mail or do work. Having something to do that will make the time pass more quickly and help keep your stress level in check, too.

For information about elderly emergency care, go to emergencycareforyou.org.

Book Review - "My Mother, Your Mother"

'My Mother, Your Mother' speaks to many baby boomers who find themselves caring for their parents

Date published: 4/27/2008

THIS BOOK will literal- ly speak volumes to many baby boomers who find themselves helping aging parents through their late-life journey. Geriatrician Dr. Dennis McCullough recommends a new approach to elder care, "Slow Medicine," and his thoughtful observations bring a glimmer of hope to an often bleak scenario.

He focuses on the fastest growing group of elders, those over 80, and notes that there is a "looming tsunami of elder care needs."

McCullough laments the fast, often aggressive pace of American medicine, and points out the incongruity of a diagnosis-based, cure-focused approach to someone who is dying simply because they are old and at the end of their life. He points out the difference between disease and illness. He questions the unlimited use of tests and procedures for elders, and advocates a gentle approach that assesses the patient's mental state, remaining abilities, family situation and quality of life.

Read Entire Review

NY Nursing Homes Fill Gaps Left by Hospitals

As New York hospitals experience budget cutbacks and shortages, nursing home operators find themselves picking up some of the slack - caring for people who, though they may not really need a full-time nursing home, are not able to live independently in their own homes.

This role is actually the need we try to fulfill on a long term basis at an Adult Foster Care facility such as Kelso House AFC.


By E.B. SOLOMONT
Staff Reporter of the Sun


As New York hospitals wrestle with cutbacks and budget constraints, nursing homes are finding a new role in treating patients who are well enough to be sent home but need additional care.

In a departure from their traditional role, nursing homes statewide in recent years have seen an influx of patients seeking short-term, rehabilitative care, as cash-strapped hospitals treat and discharge patients as quickly as possible. With increasing turnover rates at nursing homes, a number of facilities citywide are responding to the demand, taking on costly renovation projects that shrink the number of long-term beds but add space devoted to short-term care. Last week, the Margaret Tietz Nursing and Rehabilitation Center in Queens broke ground on a $3 million expansion of its rehabilitation space, part of a $14 million top-to-bottom renovation of the facility.

Go to Full Article

District Councillors Shoot Down Nursing Home

From the Midhurst and Petworth Observer

This story about a proposed nursing home in Nyewood, UK, shows that the same obstacles and issues surrounding elder care are present throughout the civilized world. What I found remarkable about this article was the fact that there was so much community support for the project, and yet the city planners found the project to be counter to their designs and went so far as to comment on the aesthetic devaluation of the neighborhood a nursing home would engender.

What lot of Sods!


Nyewood nursing home turned down despite strong village backing

NYEWOOD villagers have lost their fight for a 32-bedroom nursing home which was planned on the former station yard site.
Last week Chichester district councillors (CDC) threw out the plans at a special application referral meeting.

It was called because their colleagues on the north area development control committee in February defied their officers' recommendation and said they wanted to see the plan go ahead.

As this decision went against the council's planning policy it was taken to the special referral committee for a final ruling.

More than 40 villagers turned out when Harting Parish councillors held a special public meeting to hear their views earlier this year.

And members of the north area development control committee were told there was 'universal approval' for the scheme among villagers.

Applicant Bill Richardson said it would use a brownfield site, get rid of an unsightly builder's yard and enhance the whole area.

Harting and Elsted district councillor Andrew Shaxson also spoke out strongly in favour of the development.

But at the referral committee last week officers reported that 'given the remoteness of the site, the very limited nature of public transport in the area and the lack of local services and facilities, the proposal would be contrary to the aims and objectives of a range of planning policies governing sustainable development'.

They said it would also have a serious and detrimental impact on the appearance of the Area of Outstanding Natural Beauty (AONB) and would impact in an 'overbearing' and 'unneighbourly' way on nearby homes.

The committee voted to reject the plans on the grounds they would be an unsustainable form of development and would be harmful to the AONB and residential amenities.

Shortage in Senior Housing

By Patricia Breakey - Delhi News Bureau

A crisis is looming in housing for the rising population of senior citizens, with a shortage of beds available for those who are no longer able to live alone but don't require nursing-home care.
Adult foster care homes can be a perfect solution for people who need temporary or long-term non-medical residential care, but there aren't enough of them to meet the growing demand, Susan Aikens, Delaware County deputy commissioner, said Tuesday.

"We are actively recruiting for adult foster care homes," Aikens said. "Right now, we have five homes with 26 beds in Delaware County and we get 4 to 5 requests a month."
Recent closures of adult homes in Delaware County, both voluntary and involuntary, left about 100 people without a home. Of those, only 16 were able to remain in the county because there were no other spaces available.

Read Entire Article

As Population Grows Older, Geriatricians Grow Scarce

Officials, Schools Prod Doctors to Focus on Elderly Care

Mary Boland, 91, can consider herself fortunate. In 2006, the chronically ill former teacher from Cincinnati had a narrow brush with death when she came down with pneumonia. Within minutes, Boland's personal physician, Gregg Warshaw, was called.

"She was weak, confused and breathing abnormally," Warshaw recalls. "Her blood oxygen level was low, and she was suffering a low-grade fever."
In the elderly, pneumonia is often fatal. But instead of rushing Boland to the nearest hospital, as many family doctors might have done, Warshaw, a geriatrician, stabilized the condition and put his patient on antibiotics.

"Luckily, the pneumonia wasn't grave enough to warrant hospitalization," Warshaw says.
Geriatricians have provided specialized care to the elderly for decades, and until recently their numbers have been growing. But despite countless attempts to convince the medical profession and the public of their worth, the number of practicing geriatricians in the United States -- about 7,000 -- is falling seriously behind needed levels.

While the U.S. population age 55 and older is growing rapidly, according to a 2005 census report, the number of medical school grads going into geriatrics has been slow to keep up.

According to one estimate, the nation's teaching hospitals are producing one or two geriatricians for every nine cardiologists or orthopedic surgeons.

Read Entire Story Here

Long Term Care Aims to Feel More Like Home

We found the following article useful in that it depicts many of the same philosophies we hold regarding senior and elder care in a home setting.

By Kay Brookshire, news@knoxvillebiz.com
Monday, March 17, 2008

A nursing home in Jefferson County and a Knoxville architectural firm are in the forefront of a reform movement aimed at taking long-term care out of institutionalized settings.

Jefferson County Nursing Home is adding three long-term care facilities slightly larger than traditional homes, each with private bedrooms and baths arranged around a hearth room, and a large dining table where residents and staff can gather for meals. The homes are designed to offer elders vibrant communities, with sun-filled rooms and a garden to explore, rather than institutions with long halls and sterile environments.

Read the Entire Article Here

What makes a Green House?

• Architecture: Resembles nearby housing, ranging from single-family homes to high-rise apartment buildings. Private bedrooms and bathrooms, open hearth, dining and kitchen areas, ceiling lifts and fenced yard. Materials and design emphasize home-like setting.
• Staffing: caregivers provide personal care, meal planning and preparation, light housekeeping, and laundry. A guide serves as a coach and supervisor and might serve one or more homes. Nurses enter and work in the homes much like they would in a home health care setting.
• Interior design: Residents may bring some of their own furniture and accessories. A large dining table seats staff and residents together for meals. Bedrooms open to the central hearth area.
• Size: Intentionally small, housing 6-10 people in 6,000-7,000 square feet.
• Lifestyle: Less scheduled, more privacy and more control of their daily activities than a traditional setting.
• Relationships: Social interaction is key, and friendship between caregivers and residents is encouraged. Families, children, pets and volunteers are welcome guests.

Is Crisis Looming for Elder Care in Hawaii?

Crisis coming in elder care, AARP warns
Residents pessimistic about health care in state

The number of people age 65 and older in Hawaii is expected to grow by 86 percent between now and 2030.

So says a survey by AARP Hawaii, which urges prompt action to avoid a crisis in long-term care for seniors.

"If nothing is done in the very near future, like right now, to begin addressing these issues in a substantive, systematic way, we're going to find ourselves with an essentially insolvable problem," said Bruce Bottorff, AARP Hawaii associate state director.

AARP Hawaii is urging the Legislature to pass Senate Bill 3255 with $250,000 to create a commission that would determine resources needed to meet long-term care policy goals.

Read Full Story Here

Having "that talk" -- Sooner Rather than Later

January 26th, 2008

I picked up a recent post from a site called bloglongtermcare.com. The author addresses the often prickly subject of procrastination. Specifically — children waiting and avoiding discussion of what to do about aging parents who are becoming increasingly unable to live on their own.

A highly regarded book on just this subject is available from Amazon and many other online sources. It is called, The Parent Care Conversation. Read amazon customer reviews.