Drug for C.O.P.D. Enters Pipeline

It appears that a drug to combat C.O.P.D. is just entering the pipeline here in the United States, as Merck & Co. and Nycomed agreed to jointly market Daxas, a once-daily tablet under assessment to treat patients with chronic obstructive pulmonary disease. In a Monday statement, the companies said they would co-promote the drug, generically known as roflumilast, in Canada and certain European countries. And they signed an agreement under which Merck will distribute the drug in the U.K. as well.

In 2009, closely held Nycomed filed a new drug application for Daxas with the U.S. Food and Drug Administration. On April 23, 2010, Nycomed, Zurich, said that a panel within the European Medicines Agency had urged the agency to approve the drug for marketing in the E.U.

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Multi Generational Homes: Trend Reversal

In 2003, members of Rosa Licea-Mailloux’s family bought an eight-bedroom house in North Grafton. Her household now consists of her parents, husband, two brothers, sister-in-law, aunt, uncle, three cousins, and her own 3-year-old daughter.

Living in a multigeneration household is “partly a cultural thing,’’ said Licea-Mailloux, 33, a Boston attorney whose parents emigrated from Mexico in the 1970s. But the built-in advantages — like having help with child care, or being near her parents as they age — also make living in a large familial nest appealing, offsetting a loss of privacy.

The Licea-Mailloux family’s living arrangement is representative of a marked change in how the American family has organized itself over the past three decades, an evolution brought on by what one observer calls “a perfect storm’’ of demographic, cultural, and economic factors.

A report last month from the Pew Research Center found 49 million Americans, or 16 percent of the population, living in multigeneration households as of 2008, compared with only 28 million in 1980, or 12 percent. The surge reverses a sharp decline between 1940 and 1980, when the percentage of Americans living multigenerationally dropped from one-fourth to less than one-eighth.

The most common arrangement? The head of house living with his or her adult child and grandchild, an arrangement shared by 2.2 million Americans, according to an AARP poll that echoes the trend. An additional 1 million occupy households where the head of house belongs to the so-called sandwich generation, living with both a parent and child in the house.

Both studies offer a variety of reasons for families opting to move in — or back in — together in large numbers, among them a tough job market and rash of home foreclosures, along with the cultural influence in immigrant communities, and a desire to share the care of family members.

“The difference between this boom we’re seeing now and the postwar model is, back then it was almost automatic that grandparents moved in with adult children,’’ said Amy Goyer, who blogs on intergenerational issues for the AARP. “Once people got more mobile, this was much less of a given, though.’’ Today, Goyer said, family members increasingly rely on one another for support, whether it’s because more grandparents have seen their savings shrink during the recession or because more mothers work outside the home and need assistance with child care. “I’ve been hearing both enthusiasm and reluctance’’ from family members who are regrouping this way, she said, “but most focus on the positive side.’’

Even the White House has become a three-generation household, noted Goyer, with President Obama’s mother-in-law moving in last year.

Jane McMahon wasn’t necessarily thinking big picture when she sold her Springfield house in the mid-’90s and moved to Eastham. McMahon, 68, bought a small, two-bedroom Cape cottage, mostly to be near her three adult children. Suffering from a slow-progress form of muscular dystrophy, however, McMahon knew she could not take living independently for granted as the years rolled by and her disability worsened.

Page 2 of 2 --Her son moved in with McMahon not long after, followed by her future daughter-in-law. The high cost of rentals had priced them out of the local housing market and, she said, “they said they’d take care of me if I could give them more space and privacy, so that’s what we did.’’

Five years ago the cottage was torn down and replaced by a two family home that accommodates both McMahon’s physical needs and the couple’s desire for privacy. Last summer McMahon welcomed a granddaughter into the household.

“Now I have assisted living at its best, and they have their own two-story house,’’ McMahon said. “This is the way it used to be’’ — with older, more experienced mothers lending advice to first-time parents. Though unable to handle some child care duties, McMahon helps with laundry, bill paying, and other chores. Having a granddaughter around 24/7, she said, is “the best pain medicine I’ve ever had.’’

Returning closer to family is often the primary concern, said Joann Montepare, director of Lasell College’s Fuss Center for Research on Aging and Intergenerational Studies.

“People want that multilayered piece to their lives,’’ she said. “They’ve lived a distance from their parents; now they have kids of their own and want to live closer.’’

While living with an older parent or two can be challenging, she said, “people are also more open to the benefits of living intergenerationally, and in a rich way.’’

For Debbie Sheehan and her mother, Jan Liehe, it’s taken a concerted effort to face the rougher sides of multigeneration living to make the arrangement go smoothly. Sheehan, 39, lives in a four-bedroom Somerville house with her husband and two young daughters. Liehe, 71, retired from working and left her Ohio home four years ago, intending to help Sheehan with first-time motherhood.

Sheehan anticipated her mother staying around for a few weeks. But a combination of financial need — Social Security checks are Liehe’s sole income — and generational bonding has turned a few weeks into four years.

“The first few months were the honeymoon period, then we went through struggles and tensions,’’ Sheehan recalled. “In terms of privacy, it’s hard enough adjusting to having a spouse around. With a parent, though, there’s always that duality of being a child and a parent at the same time.’’

It took multiple family meetings for roles and responsibilities to become clear, both women said. “We knew we had to deal with this, or one of us would have to move out,’’ Sheehan admitted.

Said Liehe: “I’m very independent and always have been. To slowly lose that has been a challenge. But we’re working it out. And some day I’m sure the kids would love to have their house back.’’

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Baby Boomers In The Role Of Caregiver

Except for the years when my father was serving in World War II, my parents were inseparable during their 54-year marriage. Then, 14 years ago, Dad died at the age of 80 of a brain tumor.

My mother, who was just 73 at the time, was pretty much self-sufficient for about a decade after that. She still played tennis, drove her car, and got together with friends and neighbors, including fellow retirees from her years as a kindergarten teacher who met monthly for lunch. After a few years, Mom had a new romantic partner as well.

Then, about four years ago, my sister and I got “the call.” It was the call to which many baby boomers who have an aging parent can relate. Who makes the call can vary. It can come in many forms -- a phone call, a letter, an e-mail, or even someone making a comment. It is that defining moment, that “wake up call” if you will, the one where you can no longer deny that your parent needs help.

Whether the call is from a physician, a sibling, a spouse or romantic partner, a friend, a neighbor or, in some cases, from the police or even the fire department, it is that call that distinguishes the moment when you go from being an adult child to someone who will now have to be the parent to your parent.

Giving Up the Car
For many of us, the first big change in our parents’ independence occurs when it becomes prudent for him or her to stop driving. (See, “Seniors in More Severe Auto Crashes Than Younger Drivers” which reports on a study conducted at Kansas State that analyzed the driving patterns of those aged 65 and over.

Parents who live in an urban setting, where driving was rarely an issue, may find it has become more difficult for them to take public transportation because of diminished mobility or increased feelings of insecurity around strangers. It is often left to the Boomer to help his or her parents to get around. And that’s just the beginning.

Seek Out Help
If you find yourself becoming your parents’ caregiver, it may be useful to invest some time and money in meeting with an eldercare or geriatric manager or counselor. They can guide your parent or you through the world of senior care that you and your parent or parents are now entering.

Linda A. Ziac, president of the Caregiver Resource Center, has been working in the eldercare field for 35 years. She emphasizes that “no two situations are the same.” Ziac gets calls from adult children who are trying to get things in place but their parent refuses to talk about it, as well as “calls from seniors from 60 to 90 saying that they want to explore help for themselves.”

You can find a local eldercare manager or counselor the same way you would find any trusted professional: ask friends, your own physician, or senior services in your own or your parents’ community for referrals. Then perform due diligence checking out their credentials, testimonials, or websites. Usually there is an initial consultation for a fee and if additional services are requested, you would negotiate with the eldercare specialist what assistance will be needed and what it will cost.

Becoming Your Parents’ Advocate
One of the best gifts you can give to your aging parent or parents is to become their advocate. This is especially important if a parent starts to have a diminished capacity and can no longer deal with such everyday activities as walking, feeding or dressing oneself, making phone calls, or cooking.

As eldercare counselor Ziac points out, there is a big difference between being your parents’ advocate and helping and taking over in a way that makes the parent feel worse. Ziac says, “There has to be a conversation between the senior and the family to honor the wishes of the senior. They can’t just come in and dictate what the right thing is to do.”

Even if the final decision about what your parent wants to do is up to him or her, you can still help by doing some research. For example, if your parent has vision challenges such as macular degeneration, you can explore if there are free services for the visually impaired in your community. Volunteers may be available to read to your parent on a regular basis for one to two hours a week.

As long as your parent is still self-sufficient and able to get to the programs and participate in activities, or has a caregiver to help out as needed, you can explore senior centers in your parents’ community to see what she or he might want to participate in.

Getting a Geriatric Assessment
If you suspect that your parent has Alzheimer’s or another kind of dementia, you might want to get a detailed geriatric assessment through a hospital or a neurologist. This will give you a starting point of how your parent is currently functioning as well as suggestions about what medical or social services your parent would benefit from. One such program is run by the Center for Healthy Aging at Greenwich Hospital in Greenwich, Connecticut.

The assessment is conducted by the Geriatric Health Team which consists of a geriatrician, who is a physician, board certified in geriatric medicine, a geriatric nurse practitioner, a pharmacist, a gerontologist, and a social services liaison. (Your parent would first be seen and evaluated by an internist who would make the determination that your parent should be referred to a neurologist or geriatric assessment center.)

Housing and Caregiver Considerations
Author Mike Campbell has spent more than 18 years in the senior housing and care industry including visiting hundreds of nursing homes or assistant living residences on behalf of his former employers. He also comes to this topic from a personal perspective. Campbell and his siblings, all of whom live in Ohio, and his mother, who is 81 and living in Florida, are deciding where she should live since her second husband died. (Campbell’s father died suddenly at age 57 of a heart attack.)

In his book, When Mom and Dad Need Help, Campbell identifies nine basic housing options that seniors and their Boomer children need to consider:

(1) parents moving in and living with you;
(2) adult day services, a community-based option, with your parent still living in their same home;
(3) home care services, while still in the same home;
(4) moving to an independent community with supportive services;
(5) assisted living communities;
(6) stand-alone Alzheimer’s dementia communities;
(7) nursing care facilities;
(8) Continuing Care Retirement Communities (CCRCs)which offer all of these levels of care on one single campus; and
(9) hospice, the final option.

Campbell says there are pluses and minuses for each option. One concern is cost but another key factor is the staff. According to Campbell, “You want to have “adequate staff and adequate training.”

In assisted living and nursing care residences, the recommended maximum staff to resident ratio varies depending upon the shift. For the morning (7 a.m. to 3 p.m.) shift, Campbell suggests that the maximum assisted living ratio should be 10 residents to one direct care staff. In a nursing home, Campbell’s maximum recommended ratio is 5 direct care staff to one resident.

In addition to finding out the staffing ratio, you and your parent will also want to tour any residences that your parent is considering. Here are some questions you want answered:

• What is the ambiance of the residence?
• Are activity rooms in use?
• What is the dining area like?
• Is the food up to the standards that you and your parent were expecting?
• What will this residential option cost?
• Are there any additional fees beyond the daily room rate and meal charges that you should know about such as charges for various types of assistance, from administering medications to escorting to meals or activities, as well as any one-time or recurring activity fees?
• How long is the lease and what, if anything is the obligation for payment of the monthly rent if there is an extended hospitalization or death that requires breaking the lease?
• How friendly are the staff and fellow residents?
• Is there an emergency system in place if your parent falls and can’t get to the phone such as pull cords in the apartments that connect to the front desk or to 911?

Legal Issues
Hopefully your parents will have already taken care of the major legal issues such as having an irrevocable or revocable trust, a will, a durable power of attorney, and a health care directive. (See “A Legal Wake Up Call for Boomers” for a discussion of these key legal concerns.) You should look at these legal and estate issues from your parents’ perspective. It may be helpful to consult with the family attorney or an elder care attorney on these matters.

As Carolyn L. Rosenblatt, who was a nurse for 10 years, a lawyer for 30 years, and who is now an elder care advisor and author of The Boomer’s Guide to Aging Parents, says, “Everyone needs to have a durable power of attorney for finances and a health care directive for health.”

Everyone Ages Differently, On Their Own Timetable
At the assisted living residence where Mom now lives, there is a petite healthy woman who is 103 years old. Everyone points to that woman as a role model of aging. On the one hand, it is very comforting to know that someone could be 103 and still be in excellent shape, walking on her own, and needing minimal assistance with everyday self-care.

But, on the other hand, it is a false standard by which all others are compared. For one thing I have learned most about aging is that there is a very wide disparity in how or when someone loses their mobility, develops dementia, suffers from chronic pain, arthritis, or contracts life threatening diseases like heart disease or cancer. Therefore, it’s important to keep the focus on the abilities and challenges of each senior rather than making him or her feel unfairly compared to someone else who seems to be faring much better even at a more advanced chronological age.

I have also learned that seniors deal with the changes they are going through in unique ways. Some become very angry and resentful, looking back at the way things were; others are accepting and positive. Excessive and ongoing depression and sadness in seniors, however, is not necessarily a normal part of aging; it is treatable. If your parent is showing signs of chronic depression, seek out a geriatric social worker or counselor, psychologist, or psychiatrist for help. (See “Depression Not a Normal Part of Aging” by Fred Cicetti).

Meeting Your Aging Parents’ New Relationships
As your parents’ life changes, they may also be forming new friendships or even romantic relationships, which may be an adjustment for you. For example, 49-year-old Brenda, whose mother died suddenly in 2008 after 51 years of marriage, said it was a challenge dealing with a new stepmother for her and her siblings.

“It wasn’t a few weeks before my father was looking for a new wife,” said Brenda, “and he was quite open about his desires, even before my mother’s funeral. He did not want to be alone and he was going to make sure that was not the case for the rest of his life. Within five months, he was online dating, and he quickly found someone who looked exactly like my mother. It was comforting and disturbing all at the same time. Within 17 months, he was remarried. All has gone well with the marriage, however a couple of my siblings have had great difficulty with the transition to having a stepmother.”

Health Care Issues
Coping with the myriad of healthcare issues is a large part of the aging process and can take a lot of time and attention. Although some parents will be fit and self-sufficient even into their 90s or beyond, others will have one or more health concerns that require your time.

With the advancement in medicine today, conditions that seemed a part of aging that just had to be endured are now treatable even if not curable. For example, there are medications that internists can prescribe for incontinence; urologists may even have additional treatment suggestions including surgical procedures, to minimize or eliminate this as a health care issue. Research advances in treating any number of age-related health care problems, such as macular degeneration, dementia, arthritis, depression, or hearing loss. You may also want to find local or even out-of-state experts who can help.

How Are They Going to Pay?
As elder care advisor and lawyer Rosenblatt points out, “One of the biggest problems we have as Boomers is that many parents did not plan on living this long and have outlived their money.” That leaves the question, how is your parent going to pay for their care?

You may want to hire an elder care attorney or specialist with whom you can have a family meeting to weigh the various options. If your parents got long term care insurance in their 50s or 60s, that is one possible option; if they are already in their 70s or 80s or older, it is probably too late to buy such insurance. Since your parents are over 65, they will have Medicare, but Medicare may not pick up all the healthcare expenses.

Your parent might want to look into the feasibility of buying “gap” insurance which covers some or all of the difference between what healthcare costs are reimbursed by Medicare and the actual costs. (Because of the recently-passed health care reform bill, you may want to check with an elder care expert about what is changing for senior healthcare.)

If your parent needs to go into a nursing home, or if you need a nurse to care for your parent in his or her home, you might want to find out if your parent is eligible for Medicaid to cover some or all of the costs. Since this is an extensive requirement and application process that varies from state to state, you might want to hire an elder care attorney to help your parent with this.

Acceptance and Perspective
Recently I asked my mother, who now needs continual care since she has mobility, vision, and memory issues, if her situation is hard on her. “No,” she answered, much to my surprise. “That’s good to hear,” I replied with relief. Then she continued, with absolute clarity and certainty, “It makes me feel loved.”

I learned so much in that exchange with my mother. I was looking at her situation as an outsider rather than as the one who has resigned herself to the walking and memory challenges that are part of my mother’s new world. I also did not understand that she views her situation from a very different perspective than I do. I am a “young” 61-year-old. My mother’s world is now mostly made up of other seniors with physical and mental challenges of their own who are in their 70s, 80s, 90s, and beyond.

Caring For Ourselves
We Boomers also have to remember that it’s okay to turn to other family members, romantic partners, friends, or even local support groups if we need help in our caregiver role. (See “Managing the Stress: Tips for the Caregiver” at the AARP website.

It Will Never Happen To Me!
I try hard to make time for Mom by visiting her regularly and calling often. I like to think that I won’t be so dependent on my children when I am that age. Not me! I jokingly tell my sons, who are now ages 20 and 24, that when their father and I are in our late 80s, we’ll be traveling around the world in a hot air balloon, joyfully independent and healthy.

However, deep down inside I can hear a little voice telling me that my mother and every other senior dealing with the tough physical and mental challenges of growing old probably had that same dream and hope when they were my age. It is a reminder to live our dreams as fully as possible while we still can because aging and all that entails is happening to all of us.

For more information contact Senior Solutions at (954) 456-8984 or toll free at 1-800-213-3524

Smoking & Depression: A Deadly Duo

If you are an incessant smoker, you probably know when you’re feeling down and depressed. Depression in a smoker is usually characterized by doubled amount of cigarette sticks consumed in a day. For ages, our health care community has been trying to solve this very alarming mystery: does depression cause smoking or is it the other way around?.. These two, even if taken separately, indeed can cause major health problems, even trigger underlying ones especially in seniors whose body’s defenses are weaker. The medical community believes that if they are able to pinpoint which of the two comes first, they will be able to decrease the number of casualties for both cases.

Even if a strong link has been established between the two, it doesn’t really prove that one existed as a direct result of the other. In fact, there are quite a number of people who tried smoking for the first time not because they were depressed–just go ask a teenager! The same way as people who began smoking don’t automatically fall into depression. According to a survey done to establish connection between the two, a person who smoke is most likely to reach for a cigarette stick when depressed because of the calming effect a stick has, and because the feeling of depression doesn’t usually go away that easily—and the calming effect of a cigarette stick is all but temporary—he or she will surely consume another stick, in an attempt to somehow alleviate the bad feeling. In a way, depression doubles your cigarette consumption but it was never proven to be the cause of smoking. At present , experts believe that the best treatment for a person who is addicted to smoking and at the same time, experiences depression is to undergo treatment for both, either specialized treatment or separate courses.

It is also wise for the senior to recognize the signs. There are two major points to remember, smoking is an addiction and depression is a disorder. The soonest you recognize these and actually accept your condition—enough to get you to a specialist, the earlier you are saving your life from potentially health risks brought about by smoking and depression.

Nicotine dependence is notably marked by your inability to stop smoking, even in situations you know you are not allowed to. When a senior attempts to stop, he or she will experience withdrawal symptoms like cigarette cravings, restlessness and irritability, dry cough and even flu-like symptoms. On the other hand, depression symptoms are mostly emotional which extends to physical symptoms. Emotional symptoms are severe sadness, feeling worthless and sometimes even guilt, and loss of interest while physical symptoms are fatigue, lack of energy, and sleeping difficulties.

For more information contact Senior Solutions at (954) 456-8984 or toll free at 1-800-213-3524

PELOSI: GOP Used Fear 2 Fight Healthcare Reform

Pelosi: GOP used fear to turn elderly against health care bill

House Speaker Nancy Pelosi said Monday that Republicans used a ‘campaign of fear’ to get senior citizens to oppose health care reform.
(CNN) – Republicans used a "campaign of fear" based on false information to get senior citizens to oppose health care reform, House Speaker Nancy Pelosi said Monday.

In response to questions at a news conference in her home district in San Francisco, California, Pelosi accused Republicans of spreading misinformation against Democratic health care legislation backed by President Barack Obama, who made the issue his top domestic priority.

"There was a campaign of fear that was launched (at senior citizens) as soon as the president was elected," Pelosi said.

The reform plan includes cutting the costs of Medicare, the government-run health plan for seniors, by about $500 billion.


During months of debate on the health care bill signed into law last week by Obama, Republicans repeatedly said it was impossible to cut Medicare costs by such a large amount without reducing benefits.

Obama and Democrats say the Medicare cuts involve eliminating wasteful spending and fraud.

On Monday, Pelosi called the Medicare cost reductions "essential" to health care reform, and said Republican claims the bill would cut benefits for the elderly are "truly false."

Polls show the American public remains sharply divided over the health care issue. Pelosi said she believes polls in coming months will show more support for the bill as the public learns more about it.

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Extraordinary People of the Senior Kind ~

RETURNS IN THE FALL ~

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Senior Suicides ~ Swept Under The Rug

By every measure, Don Langland was a pillar of Pequot Lakes. He was a devoted family man who never cursed. He was a master craftsman who constructed beautiful homes and cabinets. He was a religious man who salvaged wood from a church fire and built an altar, baptismal font and pulpit.
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When Langland bade his wife of 56 years goodbye as she headed off to Bible study one night last spring, no one had a clue what he intended to do. Langland, 79, took his glasses off eyes that no longer saw well enough to make perfect cuts. He took his wedding ring off a hand that was losing the coordination required to frame buildings. He retrieved a shotgun from a locked safety vault he had built, shuffled into his back yard on the crutch he needed to support an increasingly unsteady body, duct-taped his weapon to his crutch so his aim would be true and shot himself.
Langland's death stunned the community he served. It devastated the unsuspecting family he loved. And it became one more data point in a state and national trend that gets very little notice -- suicide among the elderly.

Statistics show that the highest suicide rate in Minnesota since 1990 is for white men over 75. Among all Minnesotans who attempt suicide, people over 60 are nearly six times more likely than the rest of the population to succeed in killing themselves. In 2008, that translated into 111 senior suicides in 264 attempts.
Experts disagree about why the American public pays so little attention to suicide among its oldest citizens. But most of those who deal with the issue agree on one thing: If nothing changes, the number of seniors taking their own lives will grow large as baby boomers swell the ranks of the elderly to record levels.
"The story hasn't been told because the larger community doesn't think there is a story," said Atashi Acharya, mental health services director for Volunteers of America of Minnesota. "We have an expendable sense of the elderly."

Recently, a group of elderly Hmong women asked Acharya to speak to them about "loss and grief." To her surprise and concern, almost all talked about taking their own lives. Doctors and other health care providers say such revelations make an urgent case for better diagnosis and treatment of mental illness among seniors, because mental illness is a precursor to roughly four in five suicides. Still, myths about the elderly get in the way.

"There's an old maxim," state epidemiologist Jon Roesler said. "'A young man may die. An old man must die.' Suicide is the second leading cause of death in young people. It isn't even in the top 10 for those over 65."

Right-to-die debate

In 2008, a total of 593 Minnesotans killed themselves, the largest annual toll in the state's history, although not the highest rate because of population growth. Overall, nearly five times more Minnesotans took their own lives in 2008 than were murdered, more than twice the national average. Within these figures, elderly suicide constitutes a complex public health problem. Loss of control that accompanies aging can complicate people's view of elderly suicides. "Some people call suicide a hate crime," said Dr. Steve Miles, a medical ethicist at the University of Minnesota, who also specializes in treating senior citizens. Still, Miles acknowledges that certain cases of elderly suicide "are hard to condemn."
Acharya's husband chose to stop eating after dementia and his body's failure left him bedridden with no hope of recovery. She acceded to his wish. "I was doing a suicide prevention talk in St. Cloud when he was dying by choice," she said.
For many who work with the elderly, the ability to choose rationally makes the most difference in the morally conflicted right-to-die debate. Minnesota has no right-to-die law. Miles calls right-to-die practitioner Jack Kevorkian "a serial killer." Yet Miles admits that "there is some evidence that altruism is equal to pain in driving these decisions. In that sense, [elderly] suicide becomes a way to protect the family."

Don Langland had watched dementia devastate his mother, said Langland's wife, Shirley. Doctors at the Department of Veterans Affairs had tried three separate antidepressants on her husband. But he continued to have embarrassing bouts of confusion that made life unbearable for a high school dropout who once carried the equivalent of blueprints in his head.
"Not being able to work or plan in his mind, Don was finding it more convenient to sit in a chair with the TV going full blast," Shirley Langland said. "For a real active man, I felt sorry for him, because that was not his life."
Most of Langland's family longs for a way he could have died peacefully. Yet not a member would have driven him to a doctor for an assisted suicide had the option existed.
"I'm angry at God," said Langland's daughter, Laura Hofius. "Maybe I'm angry at myself. I'm having a difficult time even praying."
Those affected by suicide typically respond with confusion, angst, isolation and resentment, said Dan Reidenberg, director of Bloomington-based Suicide Awareness Voices of Education.
Langland's family also felt "shunned."
Teri Knight knew that her mother, Chicky Dague, had battled depression her whole adult life. But Dague was healthy in every other way and had a family history of longevity. So Knight, a former Twin Cities radio personality, never expected her mom to take her own life at age 71.
Dague asphyxiated herself sitting in a running car in her garage. She had her hair done and laid her head on a pillow covered with a silk case. Dague knew that Knight would be the one who found her. So Dague baked lemon poppy seed muffins, her daughter's favorite, and left them in the kitchen.
"It took awhile to forgive her," Knight said. "Six months after she died, I saw her picture on the mantel, picked it up and threw it across the room."
Signs are easy to miss
Education is key to confronting senior suicide, experts say. Job one is understanding mental illness. "We are wired for survival," Reidenberg said. "We are not wired to take ourselves out. That's the indication of a brain being very sick."

Even if you're looking, diagnosing mental illness may not be a slam dunk. University of Minnesota Medical School Prof. Jim Pacala specializes in treating the elderly. "I had a white man in his 80s come in," Pacala said. "I was treating him for several chronic problems. He was having some pain issues. I was adjusting the meds to control the pain. I knew he was frustrated. I told him, 'Make these changes, and I want to see you in a week.' He said, 'OK.' He went home and killed himself two hours later. It was just devastating. You wrack your brain, thinking, 'How can I miss this?' The behavior didn't suggest suicide. I think I missed the depression. I blew it."
Pacala's medical practice instituted a mandatory depression screening. Acharya says it isn't just depression. "Depression has almost become a designer mental illness," she said. "Seniors can have almost every illness."
The stigma of mental illness bothers senior citizens more than younger people, experts say. The elderly don't want to admit to medical problems that earlier generations often considered weaknesses or character flaws. Nor do seniors want to admit to conditions that could rob them of the ability to live independently.
"You've got things that don't move on to the table easily," Miles said. "The loss of sexuality, incontinence, the loss of intimacy in nursing homes, impending death. If doctors can't or won't talk about those issues, they can't tap the reservoir behind a suicidal act."
And then, there are the inevitable pain, grief and loss that come with aging. The percentage of elderly Americans in assisted living and nursing homes skyrockets between the ages of 65 and 75, Pacala said.
"In your 60s, you develop diseases that make you sick, but don't kill you for a long time," he explained.
Finding ways to delay or eliminate debilitating sickness will shrink the elderly suicide rate, Pacala predicted. So will finding ways to get old people interacting regularly with young people, he said.
Added Miles: "Antidepressants are only 20 percent of the solution. The rest is sleep, exercise and finding friends."
Throw in talk therapy and pain management and you may have found a way to reconnect senior citizens with hope.

Several years ago, a patient named Helen came to Miles for pills to kill herself. Arthritis had left her in pain. Depression had caused her to withdraw from everyone at her assisted-living facility. Instead of a lethal injection, Miles gave Helen narcotic painkillers and antidepressants. When she arrived for a follow-up visit three weeks later with her hair done, Miles suggested that she start taking meals in the cafeteria instead of alone in her room.

"Nine months later, she had a massive stroke and died," Miles said. "Two weeks later, I got this box. I opened it without reading the card and ashes spread all over the clinic."

The card was from Helen. The box held her ashes. Miles swept them up, took them home and used them to fertilize an azalea in his front yard.

"That is Helen," he said pointing to a plant. "And every year she says hi."

For more information contact Senior Solutions at (954) 456-8984 or toll free at 1-800-213-3524

Popular Vacations for Active Seniors

Most Popular Vacations for Active Seniors

Where is the active senior heading for vacation? The choices have never been more numerous. While there are many vacation destinations that only a few years ago were unheard of, other vacation spots have updated in order to become more attractive to seniors.

Overall, seniors today are healthier and more active than ever before. Visiting new places and experiencing new activities is possible for many of today’s seniors. Of course, relaxation is still of prime importance, which is why all-inclusive vacations are still popular.

All-inclusive vacations are great for active seniors for a variety of reasons. Because everything is included in the price, including airfare and meals, it is easy for the senior to plan and budget for the trip. Many all-inclusive vacations allow the vacationer to choose from a variety of activities as well. This means that the active senior can choose to play tennis or golf, ride bicycles or scuba dive, while other participants partake in spa activities or shopping. In the past, choices in all-inclusive vacations could be restrictive, but today, it is unlikely that the senior will be forced to participate in an activity that does not interest them.

All-inclusive vacations are available on resorts or cruises, in all areas of the world. If you are interested in a particular area, it is very likely that there is an all-inclusive vacation to that spot. What to know before scheduling an all-inclusive vacation? Be sure that you understand what all is included in the vacation. While it may be necessary for you to pay airfare from a smaller city where you live to a travel hub in a large city, if there are a variety of “extras” or optional expenses, it should raise a red flag that perhaps this particular all-inclusive vacation is perhaps not the best vacation for you.

Another popular choice for active seniors is a volunteer vacation. A volunteer vacation allows you to visit a different part of the world, learn about the culture, and help others, while still reserving time for relaxation and recreation. Activities for volunteer vacations run the gamut from counting bird eggs to helping children learn to read. There are options in the United States as well as many foreign countries. Don’t think that you don’t have skills that are needed. While some volunteers find opportunities to work in the field they were in prior to retirement, there are many opportunities for volunteers with no specialized training.

How to choose the right volunteer vacation for you? It is important to do volunteer work that you are interested in. If you aren’t an animal lover, counting turtle eggs probably will not interest you that much, even if it is on a beautiful beach. Of course, this does not mean that you should only volunteer for a charity that you are already familiar with. If the work piques your curiosity, and sounds intriguing to you, it will probably be a good vacation. The volunteer work is only one part of the vacation.

How will you spend your off hours? Although some volunteer vacations are in extremely poor areas with no amenities, it is possible to find a volunteer vacation that allows you to work part of the day, and spend the rest of the day relaxing on the beach, hiking in the woods or enjoying excellent meals. If you have a strong opinion about what you need for a successful vacation, such as a certain level of accommodations or food preferences, it is important to speak with the vacation company early in your trip planning, to make sure that it is possible. The most important thing that you can do to ensure you have a good time on your volunteer vacation is to speak with others who have completed these vacations and ask if they feel that the company accurately represented the vacation to them.

Learning vacations are another popular choice with seniors. These vacations are a terrific idea for seniors who have not been intellectually stimulated since retiring from the workforce. A learning vacation typically devotes several hours a day to honing a particular skill, and the remainder of the time exploring the countryside, taking part in spa treatments, or relaxing on your own. The things that you can learn on these vacations are limitless; you can take cooking classes in France, horseback riding lessons in Ireland, or language lessons in Spain. Lessons are available for all experience levels, from the rank beginner to the expert looking to hone their skills.

What should senior citizens look for in a learning vacation? Again, speak with past customers of the company you plan to use. If others were satisfied with their experience, and would go on another vacation with the same company, that is a pretty strong testimonial. Also, consider what the recreational options are for the trip. It is easy to think that you will be so involved in the learning process that you will not have time to go sight-seeing, but these vacations are specifically designed to provide amble down time, and if you don’t have a plan for how to spend it, you may find yourself painfully bored. An experienced learning vacation company will know exactly what recreational activities are perfect for seniors and are available in each area. Formulate a plan about how to spend your day, taking into account your interests and activity level, take plenty of pictures and have a great time!

For more information contact Senior Solutions at (954) 456-8984 or toll free at 1-800-213-3524

Seniors Save on Car Insurance

Just because a person is getting up there in years and they may have just recently sold the old roadster for a minivan, there is no reason to accuse a person of being "elderly." I have known many a person in their 70's, 80's and 90's and never once did I dare suggest that their sight, hearing and overall driving skills were perhaps not as good as it used to be. Even when it perhaps was.

The mere suggestion of such a thing sends most sane-minded individuals into a mental tizzy full of flashing lights spiraling downward into an ever growing dark. The reason why so many older Americans don't like to talk about getting older as it relates to driving is because they don't like to think about their time with the freedoms of the automobile being finite. Yes, just like they said in Driver's Education Class when you were 16, "driving is a privilege and not a right."

So there is the ugliest truth of all—one day you may no longer have a license to drive and will have to ask people for rides. That is never a pleasant realization, as it is a means to define one's own mortality. But what can senior citizens in the here and now do to try and save money? We all know Medicare and Medicaid don't pay as much as they used to and once you set a fixed income it is that way for life. Here are five great ways for seniors to save on their car insurance.

Take a Senior Citizen Driving Education Class—Many car insurance companies offer special classes that help teach senior citizens what danger signs to look out for in terms of issues like driving at night. The class usually gives practical solutions to challenges that may face senior citizen drivers every day. And just by taking a one- or two-day course, you could get a serious car insurance discount!

Ask for a Senior Discount—At still other car insurance companies all you have to do to get a discount is mention your age. Some may ask to see a driver's license but only because you still look so young.
Bundle Insurance Policies Together—As many senior citizens own their own homes, property or boats, it is always wise for them bundle all of their insurance policies with one company. Add in a life insurance policy and you have the recipe for one very happy agent and one seriously discounted bill.

Only Buy the Insurance Coverage You Need If You Aren't Driving as Much—Many senior citizens, due to retirement or bad night vision, don't drive their cars as frequently as their younger peers in America. So if you really don't think you need that certain all-encompassing coverage plan since you only drive 1,500 miles a year then by all means say no.

Buy the Right Car for You and Your Body—Safe, well-built and affordable cars with easy ingress and egress and great crash test ratings generally cost less to insure. You see, that minivan you bought really is paying dividends. And you can actually get out of it without wrenching your back again.


For more information contact Senior Solutions at (954) 456-8984 or toll free at 1-800-213-3524

Long Term Care Insurance Examined

Planning For Your Long-Term Care Needs

Preretirees and retirees are still feeling the economic pinch. With individuals' assets still trying to recover from market downturns, planning for the costs associated with long-term care is increasingly important.

According to the 2009 MetLife Long-Term Care IQ Survey, fewer than half (45 percent) of those surveyed were aware that one in five American households care for an adult family member or loved one. A majority of respondents were also unaware that most long-term care services are received at home, and a small minority (9 percent) of respondents are taking action to protect themselves from potentially significant long-term care expenses with long-term care insurance. The need for long-term care can happen at any time, not just when an individual ages.

The misconceptions surrounding long-term care can have costly implications in the future. According to the 2009 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and Home Care Costs, the national average annual rate for home health aides increased 5 percent, to $27,300 per year in 2009, and the costs for a semiprivate room in a nursing home increased to $72,270 per year in 2009.

These statistics are startling when you consider the chances that as longevity increases, so might the risk that individuals will suffer a major health event requiring long-term care. According to the December 2009 data from the U.S. Bureau of Economic Analysis, national savings rates are low. The average American is not likely to have money readily available to cover the tens of thousands of dollars it can cost each year for long-term care, according to the MetLife study. As a result, the average American could find the retirement savings they worked so hard for quickly eroded.

Long-term care insurance (LTCI) is one way that individuals can help protect themselves and their loved ones against the financial impact of long-term care. Unfortunately, many consumers do not fully understand the need to prepare for such an expense and are unable to identify the types of insurance programs that will pay for long-term care.

About LTCI

LTCI is designed to help pay for long-term care services if an individual needs them. Depending on the type of policy and coverage selected, this insurance can provide coverage for care in various settings, including an individual's home, adult day care center, assisted living facility and nursing home.

Long-term care can also have emotional costs that are more difficult to calculate, especially when it comes to the impact on family members. The responsibility of caring for an aging spouse or parent can create stress for the entire family. In the case of multiple children caring for a parent, it is not uncommon for one child to take the lead role in providing care. This tends to impact the family dynamic and has the potential to create tension in relationships among siblings, between parents and children and, in some cases, the grandchildren. One solution to this is getting private care. While such care can alleviate the stress on a family, it comes at a cost, which can be covered by long-term care insurance.

When To Start

There is no time like the present for establishing a plan to help protect yourself and your family against the cost of long-term care services. Consider the following about long-term care insurance:

• Age is a factor in determining LTCI premiums--the younger someone is when he or she purchases LTCI, the lower his or her premium can be.

• LTCI can give peace of mind, ensuring you won't become a financial or emotional burden on your loved ones.

• You spend your life saving for retirement, and LTCI is a key way to help protect those savings if you need long-term care at some point in your life.

• Everyone strives to lead a long and healthy life, but living longer can increase your chances of needing long-term care services--make sure you are able to enjoy your long life with the proper protection.

It is important for individuals to not only consider their own future care needs but that of their spouse or significant other. While a healthy spouse may be able to provide some level of care without any outside support, providing care over an extended period can take a toll. At some point, the spouse may not be able to provide the necessary care or may also need long-term care.

In addition, individuals should consider the future care needs of their parents. LTCI can help alleviate the financial and physical burden of caring for aging parents while at the same time raising children yourself.

It is important to purchase LTCI from a company that is stable and financially sound and that also has a history of providing this type of insurance. Individuals may not need to use the benefits from their LTCI policy for 10 to 20 years or more after purchasing it, so it is essential that they have confidence that the company they purchase from will be there for them in the future.

To learn more about long-term care insurance, speak with an insurance agent or financial adviser.

For more information contact Senior Solutions at (954) 456-8984 or toll free at 1-800-213-3524

Alzheimer's Patients Respond to Books

Many Alzheimer’s Patients Find Comfort in Books
By MILT FREUDENHEIM

Familiar music can engage those with Alzheimer’s when almost nothing else can, researchers have shown. Now it appears that books written for these patients may have a similar effect.

Researchers have found in a number of studies that reading can improve a patient’s quality of life. The meanings of written sentences can be understood by — and prompt cogent responses from — even those who have difficulty handling verbal exchanges.

Caregivers may be surprised to learn that reading ability is not always destroyed by Alzheimer’s. “All of my research demonstrates that people who were literate maintain their ability to read until the end stages of dementia,” said Michelle S. Bourgeois, a professor of speech and hearing science at Ohio State University.

At the earlier stages of Alzheimer’s disease, many literate patients may still enjoy reading books themselves, said Dr. Barry Reisberg, a professor of psychiatry and director of the Fisher Alzheimer’s program at New York University. Large-type reading materials can be used to assist later-stage Alzheimer’s patients to continue reading.

Even at later stages of the disease, many patients are engaged by books read to them. Lydia Burdick, a businesswoman in New York, was able to get her mother to respond by reading to her even at a relatively late stage of Alzheimer’s disease, although it had long been hard to get through to her.

One afternoon she persuaded her mother to read a sentence — “I love to feel the sunshine on my face” — and asked, “How does the sun feel?”

“Warm,” her mother said, and both women smiled.

Ms. Burdick went on to write three books for caregivers to read aloud to, or with, “memory-challenged” adults.

Books published for children and young adults may be easy to read, but they can be off-putting for people with Alzheimer’s. “If they see something as being childish, you have lost them,” Dr. Reisberg said.

The illustrations in Ms. Burdick’s books are based on realistic watercolors of white-haired men and women and their families, created by artist Jane Freeman, a friend of Ms. Burdick. The messages are clear and upbeat. “In November, I am thankful for so many things,” she writes. “In December, I celebrate the holidays. Let’s sing a song.”

“It is not just reading anything,” Ms. Burdick said. “It has to be personally relevant to the person, and the size of the print has to be big enough for them to see it.” Suggestions for starting a conversation and appropriate songs for each page are listed at the end of two of the books.

“I used to buy children’s books with big pictures, big words, about animals for my mother, who has advanced dementia,” said Jill Eikenberry, a New York-based actress. “Now to be able to have a book with pictures and words with somebody her age sitting on a chair enjoying the sunset — it’s a really inspired idea.”

Dr. Peter V. Rabins, director of geriatric psychiatric programs at Johns Hopkins School of Medicine, said, “Anything that helps make it easier for people to interact produces benefits in both directions — the family member with the disease and the caregiver. It gives the person with the disease a chance to interact with grandkids or younger children,” he said. “It’s positive both ways.”

For more information contact Senior Solutions at (954) 456-8984 or toll free at 1-800-213-3524

Trouble Swallowing? Read This

When the Meal Won’t Go Down
By PAULA SPAN
When an older person regularly gags or chokes in the middle of a meal, it’s obvious that there’s a problem. But what of the more subtle symptoms of trouble while eating?

Say your father gets a runny nose or weepy eyes during meals, or clears his throat repeatedly, or develops a voice that sounds kind of gargle-y. Perhaps your mother takes forever to down a few bites or appears to lose interest in eating altogether. We’re less apt to recognize those signs, but they can be tip-offs to swallowing problems.

Swallowing, I’m learning, is a surprisingly intricate business, involving a number of neurological signals, physical processes and coordinated timing. We unthinkingly do it hundreds of times a day, yet “we don’t know how complicated it is until things go wrong,” said Janet Brown of the American Speech-Language-Hearing Association.

How often is that? The prevalence of swallowing disorders, medically known as dysphagia, varies from about 15 percent of elders living independently to more than 40 percent of those in assisted living and nursing homes, estimated a 2002 editorial in The Journal of Rehabilitation Research and Development by Dr. JoAnne Robbins, a professor of medicine at the University of Wisconsin.

Sometimes swallowing problems are related to illnesses like Parkinson’s, stroke, heart failure or pulmonary disease. Sometimes people simply get dehydrated and don’t produce enough saliva. Even the decreased sense of smell that can accompany aging or dementia can be a factor.

“If you can’t smell food, then there’s no signal to the body and the saliva won’t be triggered,” said Dr. Joel Herskowitz, a pediatric neurologist in Framingham, Mass. (He and his wife Roya Sayadi, a speech pathologist, will self-publish a guidebook this summer called “Swallow Safely.”)

Then there are the multiple drugs that most older people take (this is becoming a persistent theme here, isn’t it?). “Medication is a major cause in reducing the moisture in the body, and it affects the way our muscles respond,” Dr. Sayadi pointed out. Drugs from antihistamines to antipsychotics can interfere with swallowing.

When people can’t swallow properly, they’re at risk — not only from the immediate threat of choking on food, but also from the longer-term hazard of pneumonia caused by aspirating liquids, food particles and bacteria into the lungs. And it’s no surprise that those who can’t swallow risk becoming malnourished.

Speech pathologists — or speech-language pathologists, as they prefer to call themselves these days — have an arsenal of techniques and adaptations to address such problems. They may recommend physical maneuvers, like doing exercises that strengthen the tongue and pharynx muscles, or adjusting the position of one’s chin when swallowing. They may suggest modifying one’s diet with thickened liquids or puréed foods.

The variety of swallowing issues and treatments is too wide for a single blog post, but let me recommend the information on the American Speech-Language-Hearing Association Web site.

And Dr. Herskowitz and Dr. Sayadi have come up with another useful tool. They’ve drafted a letter that a caregiver — or patient — can print out, fill in and bring to a doctor’s appointment. It includes not only a variety of symptoms that might indicate trouble, but also a list of medications someone’s taking, and family contact information.

“People are observing things at home,” Dr. Herskowitz said. “This allows them to record what they’re seeing, whether it’s unexplained weight loss or frequent throat-clearing or a change in voice, and put the information in the hands of a primary care physician. Then the doctor can arrange for assessment and referral, and prevent a small problem from becoming more serious.”

For more information contact Senior Solutions at (954) 456-8984 or toll free at 1-800-213-3524

Extraordinary People of the Senior Kind ~

RETURNS IN THE FALL ~

For more information contact Senior Solutions at (954) 456-8984 or toll free at 1-800-213-3524

Adult Day Care: We Really Need It

Adult Day Programs: A Reprieve for Families and the Elderly
By PAULA SPAN
The other morning, I stopped by Senior Care, an adult day program near my home in Montclair, N.J. Things were hopping, as usual.

In one room, a self-defense instructor was showing participants how to throw a would-be mugger off balance. “I want you to put the cane around my leg and pull,” he urged — and one by one, with a few self-conscious giggles, his elderly students did. “Pull hard. Just like that! One more time.”

A few doors down, a dozen people were drawing with pastels in the crafts room. The walkers in the Mile Around Club were beginning their third circuit along the building’s hallways. In the dining room, meanwhile, workers were setting up a hot meat loaf lunch.

Though almost 4,000 such programs around the country serve older adults who are frail, isolated, chronically ill or demented, I still think these adult day centers constitute one of the better-kept secrets in elder care.

People who might otherwise sit home alone with the remote, or who might move into a facility because they can’t stay home alone, instead spend several days a week being active, social, stimulated, well nourished and — at health-oriented adult day programs like this one — monitored by nurses. At the end of the day, though, the participants go home to familiar surroundings, and the centers often provide the vans that take them there.

The programs don’t come cheap, at a national average of $67 a day [pdf], but they’re dramatically less expensive than moving into assisted living or hiring home care.

I’ve heard heartfelt testimonials to their importance from weary family members trying to keep their ailing relatives out of nursing homes while also struggling to hold onto their own jobs.

“It gives me peace of mind,” said one woman whose 85-year-old mother with Parkinson’s disease goes to Senior Care three days a week. Adult day programs, the research shows, reduces caregivers’ stress. They also suffer less depression and anger, and report greater overall well-being. (Some key findings from researchers at Penn State are here [pdf].)

What’s been less clear is what adult day services do for the people who attend. A team at the University of California, San Francisco, Institute on Aging, which took the somewhat novel approach of asking the participants themselves, recently published a study in The Gerontologist showing significant benefits. “Their quality of life improved dramatically,” said the lead researcher, Eva Schmitt, now associate director of the Aging Brain Center at Hebrew SeniorLife in greater Boston.

The researchers measured how participants assessed their health and social functioning when they first enrolled in programs around the Bay Area, then again six months later and a year later, compared with a control group.

Because participants typically have multiple chronic conditions, Dr. Schmitt said, “We can’t necessarily assume their health will improve over time.” Instead, this study of 57 people (average age: 77) focused on how well people thought they coped with their limitations and whether their quality of life improved despite them.

The answer from participants, who attended at least two days a week, was clear. “They felt the impact of their dysfunctions, physical and emotional, was lower when they attended adult day,” Dr. Schmitt said. (Some other aspects of their lives were not affected.) “In the control group, people actually felt the impact of their problems on their lives increased.”

It’s a small but important study — and a timely one. Adult day programs across the country rely heavily on funding from county, state and federal governments, and on grants from local charities and social service agencies. At the nonprofit Senior Care in Montclair, for instance, nearly 70 percent of participants receive some kind of financial assistance.

All these funding sources are shrinking as government revenues and private endowments plummet. Adult day centers in many states are limiting attendance days or cutting enrollment; a few have closed their doors altogether. Senior Care, running a deficit, first tried to sell the airy facility it built just five years ago. That didn’t happen, so the program is being acquired by a for-profit health care company.

“About 20 percent of the seniors we care for will have to find alternative sources of financial aid,” said Emma Justice, Senior Care’s beleaguered marketing director.

Dr. Schmitt said, “I hope very acutely that our findings will help convince lawmakers not to make big cuts in adult day services.”

Well, that would be nice. A couple of years ago, adult day directors probably would have said their biggest problem was letting families know that they existed, that they could accommodate old people (and sometimes, younger disabled adults) with many kinds of physical and cognitive problems, and that they could often come up with grants to lower the costs.

Now, despite mounting evidence that they help those on both sides of the caregiving equation, they’re just trying to stay afloat.

For more information contact Senior Solutions at (954) 456-8984 or toll free at 1-800-213-3524

Healthly Lifestyle in Middle Age Helps Seniors

Tackling obesity, high blood pressure and high cholesterol in middle age is likely to help stave off dementia in later life, say health and ageing experts.

Writing today in an editorial in BMJ Clinical Evidence Dr Tom Russ and Professor John Starr, from the University of Edinburgh say tackling common risk factors for cardiovascular disease and diabetes could cut an individual’s risk of developing dementia by about 20%.

The most important areas to address are increasing levels of exercise across all age groups, and keeping obesity, blood pressure, and cholesterol levels under control in middle age. And of course these measures will also have positive effects on heart disease, diabetes, and stroke.

"Modifying these risk factors early enough in life to have an effect is everybody’s business," they write. "Primary and secondary healthcare professionals, health promotion bodies, the voluntary sector and even employers will have to play a part for a national reduction in dementia incidence to occur."

An alternative to rolling out these prevention initiatives population-wide is to specifically target people at high risk of dementia. However, they warn that there remains no preventative strategy proven to reduce the risk of developing dementia or to slow progression.

Dementia will continue to be a condition that demands attention and resources in the coming years but, with adequate funding and urgent health promotion and preventative endeavours, it can be hoped that care-providers will not be taxed beyond their limits, they conclude.


For more information contact Senior Solutions at (954) 456-8984 or toll free at 1-800-213-3524

Senior Humor - Terrible Jokes To Make You Smile

OK - They may be terrible, but they're actually funny !!!!

The Nursing Home

At the Nursing Home a man took his elderly father to a nursing home to check it out. He sat his father down on a sofa in the main aisle way and went to talk with the administrators.
The old man started to tilt slowly toward the left. A Doctor came by and said, "Let me help you." The Doctor piled several pillows on the left side of the old man so he would stay upright.
The older man started to tilt slowly to the right. An orderly noticed and put several more pillows on his right side to keep him upright.
The old man started to lean forward when a nurse came by and piled several pillows in front of him. About this time, the son returned.
"Well, Dad, isn't this a nice place."
The old man replied, "I guess it's ok, but they won't let me fart."

Old Man and the Young Wife

You see this young lad walks out of a store and sees an elderly man sitting on a bench crying. This young lad walks over to the man to check to see if he is O.k.!
Young Lad: Sir, are you Okay?
Old Man: Yes, it's my birthday today (and he is still crying)
Young Lad: Wow, it's a special day for you.
Old Man.: Yes it is. I'm 82 today (and still crying.)
Young Lad: Even better, you look great for your age.
Old Man: Thank you, and I just got married (and he is still crying.)
Young Lad: Married!! Gee, that's great! 82 and married, wow! You've got a whole new life ahead of you.
Old Man: I married a 25 year old.
Young Lad: Holly Molly!! Even better.
Old Man: We have sex every day! (he's till crying)
Young Lad: I don't even have sex everyday, you lucky person you.
Old Man: Yes, I am, and I've forgotten where I lived.

Three Elderly Men

Three elderly men are talking about their aches, pains and bodily functions. The seventy-year old man says, "I have this problem. I wake up every morning at seven and it takes me twenty minutes to tinkle."
The eighty-year old man says, "My case is worse. I get up at eight and I sit there and grunt and groan for half an hour before I finally have a BM."
The ninety-year old says, "At seven I pee like a horse, at eight I flop like a cow."
"So what's your problem?" ask the others.
"I don't wake up until nine."

Growing Old

There is this guy who really takes care of his body, he lifts weights and jogs five miles every day. One morning he looks into the mirror and admires his body. he noticed that he is really sun-tanned all over, except his penis, and he decides to do something about it. He goes to the beach, strips completely and buries himself in the sand, except for his penis sticking out of the sand.
Two little old ladies are strolling along the beach and one looks down and says "There is no justice in this world".
The other lady says, "What do you mean?"
The first lady says, "Look at that". When I was 10 Years old I was afraid of it. When I was 20, I was curious about it. When I was 30, I enjoyed it. When I was 40, I asked for it. When I was 50, I paid for it. When I was 60, I prayed for it. When I was 70, I forgot about it. And now that I'm 80, the damn things are growing wild!

The Hunting Lodge

One night, at the lodge of a hunting club, two new members were being introduced to other members and shown around. The man leading them around said, "See that old man asleep in the chair by the fireplace? He is our oldest member and can tell you some hunting stories you'll never forget." They awakened the old man and asked him to tell them a hunting story.
"Well, I remember back in 1944, we went on a lion hunting exposition in Africa. We were on foot and hunted for three days without seeing a thing. On the fourth day, I was so tired I had to rest my feet. I found a fallen tree, so I laid my gun down, propped my head on the tree, and fell asleep. I don't know how long I was asleep when I was awakened by a noise in the bushes. I was reaching for my gun when the biggest lion I ever seen jumped out of the bushes at me like this, ROOOAAAAARRRRRRRRRRRRRR!!!!!!!!!!!....... I tell you, I just shit my pants."
The young men looked astonished and one of them said, "I don't blame you, I would have shit my pants too if a lion jumped out at me."
The old man shook his head and said, "No, no, not then, just now when I said ROOOAAAAARRRRRRRRRRRRRR!!!!!!!!!!!"

Not That FarSally

A difficult independent 75 year old, liked sitting by the park feeding the pigeons. One day she brought with her a whole bun of fresh bread just to feed her daily company. Little by little, pinch-by-pinch, she fed each pigeon with joy. She sat there without being noticed by anyone in our rich suburban neighborhood.
Then suddenly a man in his early 40's rained on my mom's parade by telling her that she shouldn't throw away good food on a bunch of pigeons that can find food anywhere... when there are a lot of people starving in Africa, says the stranger.
Then my mother said in crazed anger and without hesitation, "Well, hell, I can't throw that far!"

For more information contact Senior Solutions at (954) 456-8984 or toll free at 1-800-213-3524

The Reality of Facility Placement for Seniors

It always makes me sad to hear the families of an elder say Mom made me promise to never put her in a nursing home. That is simply a promise that most families today cannot keep. If a caring son or daughter finds that they have to break that promise, they may feel guilty for the rest of their lives. Mom probably asked for that promise because the nursing homes she remembers were dark, institutional places which would be considered substandard in America today. Todays family structure and the financial challenges of elder care, make facility living a very common choice. When an elder shows signs of not being able to perform the basic activities of daily living, families or concerned professionals must step in. It is actually against most state laws for a professional to be aware of an elder in trouble without taking some reasonable action to secure their safety. There are many indicators that an elder is no longer safe at home alone. The basic litmus test is to ask yourself is: Could this person save him or herself if their home were on fire? Would they be able to call 911 and communicate their exact location? If left alone for any period of time are they at risk for physical abuse or financial exploitation? Do they have the skills and resources to meet their daily hygiene and nutritional needs? The answer is NO for many American elders who live home alone.

Independence vs. Isolation

Many of my elderly clients who were trying so hard to maintain their independence by living alone at home actually maintained nothing more than an isolated existence punctuated by the occasionally call or visit from friends and family. This type of isolation was also coupled with medication errors or abuse, self neglect and unsanitary housekeeping. A person living in this situation will often bloom like a flower in the right retirement facility environment. It is amazing what three hot meals a days, social interaction, clean sheets and regular administration of medications can do for a persons mind, body and spirit. A person who lives alone is more likely to fall and lay alone on the floor for days without being found. A person, who lives alone may make poor choices such as keeping, (or worse,) spoiled food in the refrigerator. If a person lives alone, there are many signs of illness that no one will notice during sporadic short visits. Medical appointments may be missed and prescriptions left unfilled. Many people feel that they are honoring their aging loved one by letting them live alone, even though all the tell tale signs of self neglect are apparent. There is no honor or dignity in being found on the floor after one has laid in their own excrement for three days. Unfortunately, many families will wait for this type of incident before insisting on either home health care or facility placement. If an elder is physically or verbally abusive to family and care givers, they are much more likely to be left alone to make their own decisions, regardless of how dysfunctional their situation may be. Elders with difficult personalities are many times more likely to be abused by caregivers. They need more supervision, not less.

American Family Dynamics and the Pressures of Todays World

I hear people say Americans dont take care of their elders like other countries do. Well that is not my experience. The adult children who consult with Geriatric Care Manager or other eldercare professionals are very concerned about their parents. They love them and they want the best care their money can buy. Thats the clincher: what their money can buy. In America, caregivers, maids, etc,, are expensive. Perhaps in another country where slave labor is commonplace, people can afford plenty of care. But in this country it costs $12.00 per hour (or more) for a home health aide. At eight hours per day, that is $96.00 per day. That is $2,880 per month or $34,560 per year more than the average working American earns per year. The average woman gets a social security check of less than $500.00 per month. Do the math and you will soon see that unless you are wealthy, many people cannot afford to keep their elders in their own home with a part time caregiver or even in their childrens home with a caregiver.

Now couple this financial problem with another very real problem. Most middle income women in their fifties, who are caring for their elderly parents, are also trying to hold down a job, help their young-adult children and maintain a marriage. If a middle income woman stops working to care for her parents, she and her husband either cannot pay their bills or they must significantly reduce their standard of living. I know a few husbands who are fifty-something and feel they have worked too hard and too long to have their dreams of retirement evaporate because someone elses needs are suddenly more important than their own. Now that Americans have come to grips with the concept that it takes two incomes to live well in this country, they are more determined than ever to have a retirement. Paying $35,000 per year for a caregiver can take a huge chunk out of the retirement savings. Frankly, most people couldnt afford to do it even if they wanted to. Because most Americans net worth is in the equity of their home, selling the family home is the most common way to finance elder care services. If the family home sells for $100,000.00 and the average cost of an Assisted Living Residence is $36,000.00 per year, an elder can afford to live in that Assisted Living for 2.7 years. Coincidently, the average amount of time a person lives in an Assisted Living before moving on to a nursing home is 2.5 years.

Many adult children, who do have the desire and financial means to bring their elders to live with them, still cannot. They cannot because the medical or psychological needs of the elder are beyond their capacity to manage. For example, if Grandma is sweet and docile by day, but sundowns or grows agitated as evening falls, this poses a difficult problem for the caring family. When some people experience dementia or other medical issues, they may stay awake all night. They sometimes wander out of doors or rummage through drawers and closets. This behavior will keep the whole family awake at night. If a working family cannot sleep at night, this situation will become intolerable very quickly. Some adult children have been raised by violent, aggressive parents who are now violent aggressive elders. Children who have been raised under these conditions need not feel obligated to bring their parents to live with them, despite the pressure they may get from outsiders who do not know the real story.

Elders and their families who are trying to make difficult choices about elder care benefit from a professional assessment from a geriatric specialist. Professional care managers can offer an objective opinion based on a clinical evaluation of the physical and cognitive status of the elder. Physicians, hospital case managers, facility admissions coordinators and social workers can also offer advice about appropriate placement of an elder or even suggest how to set up services in the home to best meet the elders needs.

Home Health Care Stay Home without Being Alone

At the very least, any elder living alone should have a medical alert system. This is a necklace or wrist band with a panic button that can be pushed in case of emergency. If the button is pushed a dispatch center receives the signal and makes and attempt to communicate with the elder through a speaker placed in the home. If the elder needs help or does not respond to attempts to communicate, emergency services will be dispatched to the home. Many services will also contact friends and family to notify them that assistance is needed. A good candidate for this device is one WHO DOES NOT have memory loss as memory loss makes it difficult to learn to operate new appliances.

There are two basic types of home health care services: Medicare and Private Duty:

Medicare Home Health is free but can only be accessed if ordered a physician. Medicare will only authorize the free home health services if specific events have happened such as a recent hospitalization lasting three or more days, or a recent change in health status, etc. Medicare will send a Registered Nurse to evaluate the elder and that nurse decides if other professionals such as physical therapists, social workers, dieticians, etc. should perform evaluations. Each professional will determine what services they will render and for how long. Medicare services are temporary in nature and are not offered on a full time basis. The average visit by the nurse, aide and therapist is less than one hour each. Even Medicare home health aides only stay long enough to bathe and dress the patient.

Private Duty Home Health can be arranged on a full time, part time or live- in basis. Many Long Term Care Insurance policies will pay for home health care. The amount of care one can get and the duration of the services varies depending upon which policy they purchased. If someone does not have insurance, they must pay out of pocket (or private pay) for any services. Typically a private home care agency will offer services at a minimum of four hours per day. Typical eight hour shifts are 7am-3pm, 3pm-11pm and 11pm 7am. Many elders complain that an agency sends them a different caregiver each day. In order to avoid having the same aide, that as much as possible, order care every day for at least eight hours. This will allow the agency to schedule the same person for all your shifts. Because labor laws do apply and the agency would have to pay overtime for time which exceeds 40 hours per week, you will most likely have at least two to three caregivers on a full time case. The average hourly rate is $14.00 per hour. A live-in will cost about $150.00 per day. A live-in lives in your home and drives your car (or theirs for a mileage fee) and you are expected to feed them as well, even if you go out to dinner. By law, a live- in is entitled to two hours per day of free time. They can do what ever they like, including leaving the house during their break. If this arrangement will not work for your situation, consider hiring an aide around the clock. Around the clock care is typically delivered in two twelve hour shifts which are done by two different caregivers.

One aide comes to the home from 8am until 8pm and is relieved by the second caregiver at 8pm until 8am. Around the clock care can be delivered in many schedule formats. A live- in is expected to have their own private bedroom and bathroom although many agencies are flexible on this issue. The live- in is expected to be awake all day and have at least 7 hours of sleep at night. If the elder does not sleep at night, a live- in arrangement will not work. One option is to have the live in ($150/day) plus hire a caregiver to come to the house and stay up all night with the elder ($14.00. hour for eight nighttime hours). This costs $112 + $150= $262.00 per day. The only other alternative is to have around- the- clock care which will cost $14.00/hr X 24 hr=$336/day. Adding the eight hour night shift to the live in, saves about $3,000 per month. The Veterans Aid and Attendance Pension is available to qualified veterans who need a caregiver in their home on a regular basis.

Types of Adult Housing and Facilities:

Independent Living Facilities usually offer small apartments with some meals included in the price. A person who lives in an Independent Living Facility is expected to manage their daily care needs on their own, but the staff would readily recognize if needs increased and assist the resident in obtaining the needed help. Some facilities have extra care services available for additional charge to help the resident age in place. Others may ask a resident to move out if their needs exceed the scope of that particular facility. Limited transportation is usually provided although many residents are still driving when they enter an Independent Living Facility. These facilities may cost anywhere from less than $1,000 per month to over $5,000 per month depending upon the luxury amenities and location.

Assisted Living Facilities usually offer hotel size rooms with the option to share a room or pay extra for a private room. Three meals and snacks are usually provided as part of the price. Residents are expected to need some assistance with their daily care needs. Medication administration is strictly supervised. The State laws dictate who can live in an Assisted Living. The State does not want Assisted Living facilities to house nursing home candidates or Nursing Homes to admit people who could function just as well in an Assisted Living Facility. Assisted Living residents must be able to walk and transfer ( from bed to chair or chair to standing) with the assistance of only one other person. An Assisted Living resident can be left alone in their room for two hours or more. Nurses aides are on duty around the clock. Registered nurses or Licensed Practical Nurses are on duty at least during the daytime. Many medical services may make rounds and visit residents at least monthly. It is not uncommon for an Assisted Living resident to never have to leave the building for a medical or beauty appointment. Prices may range from under $1200/month to over $8,000/ month, once again depending upon the amenities. Medicaid has a program called the Medicaid Waiver which can pay part of the cost of the Assisted Living. However, funds have been historically limited and waiting lists can be long. The Veteran Aide and Attendance Pension is designed to financially assist qualified veterans who need the services of an Assisted Living facility

Dementia Specific Facilities are designed especially for the memory impaired resident. The building, floorplan, furnishings, dcor, activity program and even the lighting have been scientifically engineered to enhance the lifestyle of residents with dementia. Many Assisted Living Facilities and Nursing Homes offer a dementia program or dementia unit, but there are entire facilities which specialize in this unique population. Dementia Specific Facilities can be either Assisted Living Facilities or Nursing Homes. They are secure in order to prevent residents from wandering off the property and getting hurt or lost. The price for this extra level of care is usually about $1,000 to $2,000 more per month than a non-specialty building.

Nursing Homes are State regulated and are inspected at least annually. A person who needs a nursing home generally cannot live safely in an Assisted Living environment. A typical resident is either wheelchair bound or bed bound. Those who can walk around freely may need the nursing home environment because they need constant medical supervision. The medical component of this environment is similar to a hospital or hospice setting. The emphasis is on rehabilitation or custodial care rather than socialization and activities. The ICP Medicaid Program (institutional care program) will pay for the room, board and medical costs of those residents who meet the financial and medical criteria. It is possible to plan in advance to help an elder meet these strict criterion.

Financial Realities

Keeping an elder at home with a caregiver can be the most expensive option of all. Many families feel keeping their loved one in the comfort of their own home is priceless. If a paid caregiver cost $14.00/hour, eight hours per day is equal to $2,880.00 per month. Around the clock care exceeds $10,000 per month. Independent Living Facilities cost an average of $2,300.00/ month and provide no personal assistance. Assisted Living Facilities range from about $2,500/month to $5,000/month and provide limited care. A Nursing Home (without ICP Medicaid assistance) can cost from 5,000.00 to $7,000.00 per month and will provide total care.

Anyone considering hiring home health or moving an elder into a care facility of any type should have their elders current needs assessed by a qualified professional who can ascertain the elders current medical/psychological and financial needs and anticipate future needs/solutions. With careful, realistic planning, caring for an elder does not have to be a financial or emotional nightmare. Making the right choices for you and the elder you care about is easier when you enlist the help of people who know the eldercare community and all that it has to offer.

For more information contact Senior Solutions at (954) 456-8984 or toll free at 1-800-213-3524