Family resource articles on hiring caregivers and caregiving.

List of Caregiver Articles:
Family Caregiver Survival Tips
Full-Service Agency, Referral Agency or Private Hire?
Home Healthcare Agency or Homecare Agency?
Agency Comparison Checklist (PDF)
Hourly or Live-In Services?
Housekeeping vs. Housecleaning Services
Importance of Respite Care
The Abundant Difference
Helping Seniors Feel Great About Themselves
Mom Insists On Driving
Seniors and Their Diets
Compassion Fatigue
11 Easy Steps to a Safer Bathroom
Grab Bars 101
Helping Family Caregivers
Retired? Now is the Time to Take Charge
The Story Behind “Did She Dance”
Medical Alerts: Are They Worth It?
10 Tips for More Affordable In-Home Care
Paying for Homecare with a Reverse Mortgage
Senior Computer Users Fastest Growing Segment
Dementia

Family Caregiver Survival Tips
Caregiving may be one of the most important roles you will undertake in your lifetime. Typically it is not an easy role, nor is it one for which most of us are prepared. Like most people, you may have questions about how to cope with your care receiver’s illnesses or disability. If you have a job and are juggling several responsibilities or if your family member or friend needs a lot of assistance, you may need help with caregiving, too. Whether you are expecting to become a caregiver or have been thrust into the role overnight, it is useful to know where you can get information and help.

The enactment of the Older Americans Act Amendments of 2000 (Public Law 106-501) established an important new program, the National Family Caregiver Support Program (NFCSP). The program was developed by the Administration on Aging (AoA) of the U.S. Department of Health and Human Services (HHS). It was modeled in large part after successful LTC programs in states such as California, New Jersey, Wisconsin and Pennsylvania and after listening to the needs expressed by hundreds of family caregivers in discussions held across the country.

Caregiver Survival Tips
1. Plan ahead
2. Learn about available resources
3. Take one day at a time
4. Develop contingency plans
5. Accept help
6. Make YOUR health a priority
7. Get enough rest and eat properly
8. Make time for leisure
9. Be good to yourself!
10. Share your feelings with others
(from Dept. of Health and Human Services, Administration on Aging)

Full-Service Agency, Referral Agency or Private Hire?
When making the decision about homecare services, one must decide between these three sources of caregivers. The questions below can help you assess what level of responsibility and risk you may wish to undertake. Basically, a full-service homecare company, such as Abundant Home Care (AHC), is the caregiver’s employer. If you choose to find a caregiver through a referral agency or on your own, you may be assuming the employer’s responsibilities for screening, training, employment taxes, insurance and more.

Some of AHC's present clients discovered their obligations after hiring casual help and discovered they could have AHC assume the employer obligations and responsibilities for not much more than what they'd been paying.

If you have questions regarding employer responsibilities, contact the California Employment Development Department at (916) 657-0529. It is further advised to consult an attorney and your insurance company regarding your risks, rights and responsibilities. Stories abound of workers wanting to collect unemployment wages after a job is ended, and EDD (or IRS) asks who were the most recent employers. With the amount of money changing hands, you and your family don't want to become an "accidental employer."

Who is the employer?
HOMECARE AGENCY:
Caregivers are employed by the homecare company and are paid by the company.
REFERRAL AGENCY:
Depending on the arrangement, you are likely to have the employer responsibilities.
PRIVATE HIRE:
Caregivers are employed by the client or the client’s family.

Who screens the caregiver’s references, performs criminal background checks and tests for TB?
HOMECARE AGENCY:
Usually does this [AHC does].
REFERRAL AGENCY:
Client can ask whether the agency has done this.
PRIVATE HIRE:
Client must screen or else assume the risk of not screening for criminal and TB history.

How is payment made?
HOMECARE AGENCY:
Typically submits an itemized statement, based on the hours authorized and agreed-upon rates [AHC invoices on the 1st and the 15th].
REFERRAL AGENCY:
Client usually pays a combined referral agency fee and caregivers’ wages into a "trust account" of the referral agency, or separately pays the referral fee to the agency and wages to the caregiver. Client and caregiver negotiate wages and raises.
PRIVATE HIRE:
Client pays caregiver directly on a daily or weekly basis. Client and caregiver negotiate wages and raises.

Who is responsible for withholding and paying Federal and State Income Taxes?
HOMECARE AGENCY:
Prepares and files quarterly and annual employer payroll tax returns.
REFERRAL AGENCY:
Client is responsible for preparing and filing quarterly and annual employer payroll tax returns.
PRIVATE HIRE:
Same as referral agency.

Who is responsible for withholding and paying Social Security and Medicare Tax?
HOMECARE AGENCY:
Pays the cost of the employer’s share of these taxes.
REFERRAL AGENCY:
Client pays the cost of the employer’s share of these taxes.
PRIVATE HIRE:
Same as referral agency.

Who is responsible for paying Caregivers’ Workers Compensation, professional and bonding insurance?
HOMECARE AGENCY:
Usually provides and pays for this [AHC does].
REFERRAL AGENCY:
Client, or homeowner where the client resides. Contact homeowner’s insurance carrier for details and coverage limits. Normally, a Workers Compensation extension needs to be added to a homeowners policy in order to cover domestic help.
PRIVATE HIRE:
Same as referral agency.

Who coordinates services, including replacements when caregivers are sick, or need time off?
HOMECARE AGENCY:
Usually does this [AHC does].
REFERRAL AGENCY:
Day-to-day coordination is worked out between the caregiver and the client. A substitute may be available through the agency.
PRIVATE HIRE:
Day-to-day coordination is worked out between the caregiver and the client.

Who resolves problems when they come up?
HOMECARE AGENCY:
Supervisors or case managers usually do this [AHC does].
REFERRAL AGENCY:
Client and caregiver generally need to resolve day-to-day problems themselves.
PRIVATE HIRE:
Same as referral agency.
Adapted with permission from the California Association for Health Services at Home (CAHSAH).

Home Healthcare or Homecare Agency?
Here are the industry-recognized definitions:
HOME HEALTHCARE agencies provide in-home medical services from a licensed professional medical staff, usually registered nurses who can administer medication, provide wound therapy and other medical procedures. Though some healthcare agencies only provide medical services, others can provide personal care services as well, but usually at higher rates than a “homecare” agency.

HOMECARE agencies specialize in in-home, NON-medical personal services, such as companionship, assistance with activities of daily living (ADLs) like cooking, housekeeping, bathing, dressing, grooming and transportation. They can also provide safety monitoring and hygiene maintenance services. Many homecare agencies have experience with Alzheimer’s, dementia, Parkinson’s, stroke and hospice care and can provide the ideal solution for relieving a family caregiver (respite care). Some homecare agencies take an active role in the daily care plan, making sure caregivers are thoroughly trained and following the procedures necessary to assure the best health, safety and emotional well-being of the clients.

When both medical and non-medical services are called for, it can make the most economic sense to acquire services from both types of agencies.

When interviewing either kind of agency, make sure to check the qualifications of all workers and that they are licensed, bonded and insured. Also double-check references and advertised affiliations, such as the Better Business Bureau, to verify they are a company in good standing with the community.

From Wikipedia, the free encyclopedia:
Home care . . . is health care or supportive care provided in the patient's home by healthcare professionals (often referred to as home health care or formal care; in the United States, it is known as skilled care) or by family and friends (also known as caregivers, primary caregiver, or voluntary caregivers who give informal care). Often, the term home care is used to distinguish non-medical care or custodial care, which is care that is provided by persons who are not nurses, doctors, or other licensed medical personnel, whereas the term home health care, refers to care that is provided by licensed personnel.

Hourly or Live-In Services?
Hourly services are best for those situations where just a few services are needed, or at certain times during the day. When getting going in the morning, for instance, or getting ready for bed in the evening. Maybe it’s around mealtime and someone is needed for companionship or driving to a local get-together with a friend. Or maybe they need certain errands or doctors’ appointments set up for a certain time of the week. Hourly caregiving can be set up for one day a week, up to seven days, but the most important consideration is consistency, both for their peace of mind/stability and to increase the chances they’ll have the same caregiver every time. Almost all agencies have a four-hour minimum with two- and three-hour shifts available at a higher rate.

Live-in personal assistants are also available to stay at the home of the client, helping with typical activities of daily living (ADLs), such as safety monitoring, bathing/grooming/dressing/toileting assistance, meal preparation, housekeeping and errands/transportation. Due to recent changes in California labor laws, overtime rates apply to longer shifts using the same caregiver.

Abundant Home Care is well-acquainted with the different and changing needs of elderly clients and would be willing to discuss them with you at the time of assessment, or at any time during the service period. All consultations are free of charge.

Housekeeping vs. Housecleaning Services
Most caregiving agencies provide attendants who perform housekeeping services, which means maintaining the home in a hygienic and tidy manner. “Housekeeping” typically means cleaning up after meals, mopping up spills, laundry of the client’s clothes and linens, and picking up items that might be a hazard to the client’s safety. Occasional vacuuming and dusting may be requested if there's time.

On the other hand, “housecleaning” includes maid-type services and deep-cleaning of the home, such as cleaning floors or windows, moving boxes and furniture, etc. At this time, Abundant Home Care does not provide housecleaning services, but can refer local maid service companies, if desired.

The Importance of Respite Care
Family caregivers need opportunities to spend time away from their loved one in order to maintain their own emotional, mental and physical health. Respite care services allow other caregivers to enjoy brief periods of rest and relief, knowing with confidence that an experienced caregiver is providing for their loved one in their absence.

Over time, caregiving can be a burdensome and tiresome job, especially if you are juggling other responsibilities in your life. If you are a family caregiver, especially if you’re trying to do everything, it is important to heed the advice of others and take care of yourself first. Only when you are feeling healthy and refreshed, can you expect to adequately take care of someone else and their needs, and the sooner you seek help, the better it is for all concerned.

Gathering information about the stresses involved with caregiving is the first step and actively seeking help is the next. There are many helpful websites, including Family Caregiver Alliance and Caring.com, two good places to start researching the needs of family caregivers.

Abundant Home Care has provided respite care services for many families, and it is one of our more rewarding challenges. For one thing, we see family caregivers getting a much needed break. We see adult children dressing up and getting out of the house more, starting to have fun they hadn’t had in a while. We see spouses getting some time alone, or with friends, to enjoy a movie or a book or a hobby, or going shopping by themselves.

Another thing we see, and clients comment on, is a difference in the client’s behavior. “He was apprehensive at first, but my dad is talking more and looking forward to the caregiver visits,” or “My mom seems more upbeat now.” A new, friendly and caring face in the home can sometimes make a big difference.

The Abundant Difference
When looking for an agency that will care for you or a loved one, take the time to check out the others. Ask questions, seek answers, meet the caregivers, and demand the best. We’ve often heard from our clients how different we are from other agencies and we’re proud of that because our main mission is to provide the best possible service to our clients, and in doing so, “raise the bar” of caregiving services in our local area. Elder caregiving is a growing industry and the higher the standards, the better for everyone.

Listening
We are constantly asking clients how things are going, how the service can improve, and we listen. Recently, when asked why a client chose AHC over another well-known agency, she said, “The other place was more interested in telling us about their company than asking what we need. You people listen.” We take however long it takes to get the most complete picture of what a client, and their family, wants and needs.

We Don’t “Drop and Leave”
A number of agencies ask caregivers to show up at new assignments without a proper introduction. Caregiving isn’t the same as maid services where a plug-and-play approach might work, but chemistry between caregivers and clients is paramount and we realize that. And sometimes we may think a certain combination will work, only to find that the chemistry isn’t there. In that case, we gladly switch caregivers.

Good Fortune
We have a range of nationalities working for us and that diversity has taught us how different cultures care for their elders. A number of those cultures have an enormous amount of care and respect and responsibility, and those are the type of caregivers we look for. We get four to five employment inquiries A DAY, but only a few a month are selected. Some are interested in the healthcare field but are more appropriate in a facility environment. Some have the desire but not the experience. Some can’t handle certain aspects of aging. We want employees that are genuinely concerned, compassionate, friendly, sensitive to others’ needs, smart, and can get through the more unpleasant times with a smile.

Training
We take the continuing education of our caregivers seriously. A number of them are Certified Nursing Assistants already, and we provide more training to challenge them further. A 32-page Caregiver Training Manual when they start, paycheck communiques about recent issues, CPR and First Aid classes, all helping our caregivers to be the best in their field.

Fairness
There are a number of factors that go into determining the price for caregiving services and every agency has their own set of parameters. We can only tell you about ours and that is to give our caregivers a competitive wage and benefit package, cover our operating costs, and have enough left over to assure we’ll be here in the future. In our area, our rates are on the low side, figuring that LOW PRICE + GREAT SERVICE = VALUE. That’s how we like to be treated and we want to pass those ethics on through our business.

Caring
Our personalized service speaks for itself, just ask for a list of references and let others confirm this. They’ll tell you of the hospital visits from staff and caregivers, the contact with family members, the 24/7 hotline phone answered by a care manager, not an answering service; the list goes on. For a sampling of kind words about our company, click on the Testimonials page. We are delighted to know our clients on a personal level and train our caregivers to carry out the slogan, “Caring for your family as we would our own.”

Helping Seniors Feel Great About Themselves
One of the aims of senior care is to help them feel good about themselves. It can turn into a serious problem dealing with older people who only feel pity for themselves because of their weakening bodies. They should be reminded that they still have the means to feel great and enjoy life. Here are some tips that can help people feel great in spite of their advancing age.

One of the best ways to keep older people feeling good about themselves is to help them become more active. Most older people feel their lives are dull because they feel there are certain limits to activities that they are capable of doing. These limits may be brought about by lack of activity. It is more common to see older people getting weaker and weaker simply because they do not get involved in some activities that help keep their energy levels up. Giving pointers on how to live a more active lifestyle (of course, with considerations to certain ailments that they may have) will usually be the answer to help the elderly feel great at any age.

To raise energy levels, it is important to work the heart and lungs on a daily basis. One way of doing this is by taking regular walks for at least 30 minutes a day. Not only is it important for keeping the heart and lungs strong but regular walking can also help delay the development of such chronic diseases like diabetes, stroke, as well as those that affect the heart and the lungs. (Consult with a doctor first to make sure they are capable of this type of activity.)

In order to feel great, it is also important for seniors to continue building up their muscles. As people get older, gradual muscle loss is experienced, especially to those muscles that aren't used that often. This can contribute to the feelings of weakness and tiredness that they experience as they grow older. Building up the muscles can be as easy as doing simple chair exercises. Working the muscles by using weights while sitting not only helps build up muscles but also increase the metabolism.

Another way to help the elderly feel good about themselves is by keeping them active socially. Keeping up with friends as well as becoming more socially active can help older people feel better about themselves. Being physically as well as socially active can help make senior care more successful by helping older people feel better and enjoy life more.

Mom Insists On Driving by Steve Brooks, AHC
Ten years ago, our aging, yet fiercely independent, mother wanted to drive beyond what we what we felt comfortable. It was only a mile down the road to her favorite cafe and grocery store, but her eyesight, hearing and onset of dementia presented a clear danger to herself and others.

My brother and I thought taking her to lunch in a crowded restaurant would be a good chance to discuss it with her, but we were ill-prepared for her resistance about suggesting she give up her keys. We tried to reason that our sister, who lived nearby, had volunteered to run all her errands, but she only became more angry...and loud. At the end of the meal, though, she reluctantly gave us her keys.

Unknown to us, she had a spare set of keys and was driving again the next day. We gave the subject a rest for a week or so, then decided to disable her car by removing the battery. But the next day she was driving again after calling AAA to “fix” her car. It wasn’t until she was hospitalized with pneumonia that she quit driving for the last time.

Another story is about a friend who mysteriously started getting into solo car accidents. After a doctor determined that he had early onset of Alzheimer’s Disease, the police took away his license. Because of a glitch at DMV, he was able to walk in and procure another one, only to get into yet another accident. Fortunately, nobody was hurt.

There are many elderly drivers out on the road today that clearly shouldn’t be behind the wheel, representing a danger to themselves, their passengers, innocent bystanders, property, insurance rates, etc.

What we’ve learned since those personally scary moments is that the DMV has changed its rulings regarding senior drivers, at least in California:
• Drivers age 70 or older must appear in person to renew their driver’s license. They can’t renew by mail or internet.
• If there’s an unsafe driver report by a law enforcement officer, physician or family member, the senior must submit to a driving test. The DMV’s REQUEST FOR DRIVER REEXAMINATION form can be submitted anonymously by family members.
• Friends and physicians of the elderly driver can provide the most valuable, objective input about quitting driving. Explain the problem to them and try to enlist their help.

Heartfelt regards during a difficult process, Abundant Home Care.

Seniors and Their Diets
As a general rule, a healthy diet for seniors is the samediet that suits most adult eaters. The quantity of intake, however, should be decreased a certain degree because the metabolism of food slows down in older years, and excessive intake of food leads to obesity and health problems. A variety of changes should be made to avoid this.

Sweets and greasy/fatty food are the first foods seniors need to limit. Oil, salt, coffee, tea, alcohol, and synthetic food also need to be controlled. Fluid intake (especially water) should increase. Of course, this is a healthy diet for any age, but seniors can especially benefit from eating this way.

The most frequently encountered problem in senior citizens diets is with digestion. To keep the stomach and bowels working well, adequate amounts of vitamins, minerals, and fiber are needed in the diet. These come from food sources like whole grain breads, cereals, vegetables and fruits. Many foods are now enriched with fiber, so it is especially easy to get all the fiber you need in your diet.

Many senior citizens are worried about mental degradation and fruits and vegetables can prevent this. By eating a diet that includes apples, pears, oranges, prunes, and other fruits, you can greatly positively influence your mental health. Studies have also shown that leafy green vegetables, high in Vitamin E, can slow the rate of cognitive decline in seniors.

Vegetables are usually eaten with salad dressings that are rich in fat. Fat is already known to increase the absorption of vitamin E in the body, meaning a little fat can be a good thing. However, fat should not be taken in excess, especially by seniors, because it is not easy to digest and its accumulation can be the cause of obesity and cardiovascular problems.

If you are worried about your health in later years of life, the best policy is to talk with your doctor. They can provide you with more information about diet and answer concerns you may have. It is important to ask for your doctor's advice before starting any kind of new diet (or changing your current diet) in order to be sure it is best for you and your body.

Health and vitality are important and a healthy diet can help prevent many of the illnesses common among seniors.

Compassion Fatigue by Paula Spencer, Caring.com senior editor
My mom didn’t know she had compassion fatigue, since nobody named for her this extreme caregiving stress back when she was looking after her mother, who was in her 90s and had Alzheimer’s disease. By the end, Mom was dutifully visiting the nursing home day after day for hours, where she’d not only quietly tend my grandmother but also became such a familiar face that she also felt she had to stop and greet half the other residents, visit Gram’s barely-verbal roommate, bring treats to the nursing staff, and so on.

It was compassionate. But it was also taxing. And it added up to compassion fatigue. Compassion fatigue is a recognized stress disorder that often affects people in healthcare. But family caregivers are just as vulnerable. “Grieving by inches” is how compassion fatigue expert Sherri Showalter, a social worker in Tarpon Springs, Florida, describes it.

My mom didn’t stop making the daily visits until her own doctor ordered her not to. As her own health began to suffer, he suggested she cut back the nursing home visits to every other day. She’d known in her heart this was necessary, but it wasn’t until she had official “permission” that she felt okay about putting herself first.

Yet this is exactly the solution to compassion fatigue: stop caregiving – not forever, just for a day. Preferably a whole day.

Turning off your caregiver brain temporarily turns off caregiver stress. (You don’t have to turn off your heart; obviously you still care. But this is about self preservation, and without the calm and energy that come from self nurturing, you simply can’t nurture anybody else very well or very long.)

To find a day-long break from compassion fatigue, Showalter and others suggest:

First, realize what’s happening to you.
Stress sneaks up. We might not feel miserable, but we start to add pounds, sneak extra cigarettes, grouse at the spouse. Caregiving stress strikes not just because the tasks rob our free time and our sleep. It infects our emotions. "Sometimes you can feel like you want to go out and bite the tires on the car because it’s so frustrating," Showalter says. “There’s a lot of grief, on top of guilt because we feel we shouldn’t be grieving for someone who’s still living. Self care is not optional.”

Make the commitment, and recognize excuses as no excuse.
It took my mom a physician’s stamp of approval to give herself a break. Ask yourself what’s stopping you from giving yourself permission to take a break: Guilt? Money? The time involved in setting up replacement care? Those are all legitimate issues, but ultimately they’re self-imposed roadblocks because there’s a way around each of them.

Look close to home.
Can a family member (sibling, partner, aunt, uncle) step in for a day? Even a competent teenager may be able to “grandparent-sit,” and both generations may especially enjoy the change of pace. Ideally, set up a once-a-week system.

Consider a trade.
Know another family caregiver with whom you can pool time? It doesn't have to be another person involved in eldercare. Caregiving stress and compassion fatigue affect those responsible for young children and disabled people, too.

Look into community services.
Contact your local area agency on aging to learn about resources in your community such as adult day programs (which range from craft lessons to dementia care) and other respite programs (which can include drop-in and day-long programs, even overnight care). Many services are low-cost or free.

Hire an elder companion.
Local agencies can also point you to home health companies that offer this wonderful service: Professionals who will sit and play cards or talk to your loved one, take him or her to lunch or doctor appointments, and otherwise fill the role of attentive, trusted friend for a few hours a week.

Start small.
If you can’t go for a day, go for half a day. Go to lunch and a movie. Just do it, and do it regularly.

Make it a genuine escape.
Ideally, don’t use this time to run a million other errands or to attend a support group where you continue to talk and think about caregiving. Instead, get back in touch with your real self: Eat your favorite foods, do something you truly enjoy, whether alone or with favorite people.

Learn to trust.
No, someone else might not prepare the food or anticipate your loved one’s needs exactly the way you do. Nobody can replace you. But many people can ably substitute for you on an as-needed basis.

Make your escape complete.
Leave a cell number for emergencies, but resist calling in yourself to check on the person. Be selfish in a good way...as in, focused on yourself.

Compassion fatigue is brutal. The goal is to forget caregiving stress awhile in order to recharge. You deserve it. But moreover, so does the person you look after. Think of the time you spend away as a way to improve the time you spend together.

SOURCE: caring.com

11 Easy Steps to a Safer Bathroom
Out of the many rooms in a household, the bathroom can present the most danger, especially to seniors. Burns, cuts and falls can all happen here, with falls causing the most concern. And with the number of hard and sharp surfaces in a narrow space, any fall can be debilitating. There are a number of ways to make the make the bathroom safer, at little or no cost.

1) Because throw rugs can present a trip hazard, they should be removed. In fact, all clutter should be taken from the floor.

2) Grab bars (see the next article on installation) should be installed next to the toilet for getting on and off.

3) A grab bar should be installed at the entrance to the shower or bath and more inside the shower or bath stall.

4) Verify that the hottest temperature coming out of the tap is 120 degrees F.

5) Make sure a Ground Fault Circuit Interrupter (GFCI) is installed near water sources, to eliminate shock hazards if an electrical device falls into the water.

6) Clean up water spills on the floor immediately.

7) Eliminate towel bars that might accidentally be used as a grab bar. Towel bars are installed into sheetrock only and sometimes just a slight tug can dislodge them.

8) Remove glass and ceramic items. If they break, they can cause serious cuts.

9) Install a high-rise, chair height toilet for ease of getting on and off. An alternative is a raised toilet seat.

10) Install non-slip strips to the bottom of the bathtub or shower stall.

Grab Bars 101
Most emergency room visits by seniors are the result of falls, and the most dangerous falls occur in the bathroom because of the combination of narrow spaces, slippery floors and hard surfaces. Grab bars can provide a ready crutch and help reduce the chance of falling. They can also provide assistance getting on and off the toilet and something to hold onto when showering. Towel rods are commonly installed into just drywall and their removal should be considered because of the clear danger to anyone prone to falling.

This article is about basic grab bar placement and installation. There are many complex configurations that can be considered, but 98% of today's bathrooms will benefit from just simple horizontal or vertical grab bars, from 16-36 inches in length. These bars are now available at the big box hardware stores, like the Moen® brand withare attractive, well-designed and available in several finishes.

When installing grab bars, there are certain considerations to make them safe and practical. In the bathroom, they can be placed in several locations and their purpose will help determine the final placement and installation method.

Some rules to follow
• Grab bars in wet locations should have a “peened,” “knurled,” or otherwise-textured finish to increase traction
• The height of horizontal bars are typically 32-36 inches from the finished floor
• The bottom of vertical bars are typically 32 inches from the finished floor
• Both ends of each bar should be securely attached to meet ADA-compliance standards (see below).

When choosing a mounting location, one must also consider aesthetics and what might lie behind the wall, like plumbing, electrical lines or pocket doors.

Typical placement of bathroom bars
• Horizontally-placed next to the toilet
• Vertically-placed just outside the bathtub or shower stall for ingress and egress
• Horizontally-placed inside the bathtub or shower stall
• More bars should be considered if a person is prone to falls

American Disabilities Act (ADA) standards call for grab bars to be securely mounted in order to support a static load of 250 lbs. This means having at least 2 screws at the end of each bar, mounted through the wall surface and at least 1 inch into the supporting substrate behind the wall, normally vertical studs.

If studs aren't available for mounting, here are some other options (other than installing bracing between the studs, which can be costly):
• Wing-Its®
• Moen SecureMount® Anchors
• SnapToggles®

Mounting methods to avoid
• Avoid using screw anchors, standard molly bolts or toggle screws, except for the 3rd screw, with the other 2 screws going into a stud
• Avoid mounting onto tile surfaces without screwing to a solid substrate behind the wall
• Avoid mounting to fiberglass or plastic tub surrounds without pre-existing grab bar bracing (some home builders provide for this, so ask them), or using the product below.

Solid Mount® is a product for use with fiberglass or plastic surrounds that have a gap between them and the drywall, providing the gap is between 7/8" and 2-1/8".

Tips for a secure installation:
• Follow instructions provided with the grab bar and/or mounting hardware.
• Pre-drill holes using the size bit specified in the instructions. Using soap on the screw threads will help screw into older wood.
• Test the final installation by firmly pulling on it.
• In wet locations, use silicone caulking on all screws and behind mounting plates to prevent moisture intrusion in the wall.

Other alternatives to wall-mounted grab bars include the Super-Pole® and the Guardian tub grab bar. The Super-Pole is a floor-to-ceiling grab pole that is often used in the bedroom for assistance getting in and out of bed, or the living room getting in and out of chairs. It can also be used in the bathroom if a mounting surface isn't available for a grab bar, or inside a stall shower. It can also be used for getting on and off the toilet. When installing a Super-Pole in a wet location, make sure silicon caulking is applied to the sleeve joint to prevent water getting into the screw mechanism.

The Guardian tub grab bar grips the side of the bathtub to facilitate getting in and out. Extreme care should be given to installing the Super-Pole and Guardian tub grab bar to make sure they are secure and won’t dislodge in the event of a fall. Test them from time to time by firmly pulling on them.

Helping Family Caregivers by Judie Rappaport, author of Eldercare 911
When a friend, family member, or neighbor accepts the responsibility of caring for an elderly relative or friend, many of us automatically look for a way to help and find we don’t know what kind of assistance to offer. If you have a friend or neighbor who is caring for a parent, grandmother, aunt, or elderly spouse and want to offer your support, begin with these recommendations and let your imagination create others.

1. Call and ask the caregiver how the patient AND the caregiver are feeling. Most people ask only about the ill person, forgetting that it’s equally important to care for the caregiver. Studies show those caring for an elderly parent or relative suffer higher levels of stress, anxiety, and illnesses than non-caregivers. You can help add comfort to the harsh emotional and physical burdens of the daily caregiving routine by a simple act of recognition-remembering to ask the caregiver, “How are you holding up?”

2. If you have to leave a voice-mail message, don’t ask the caregiver or ill person to “call me back.” Caregivers are usually overwhelmed with daily chores and responsibilities. Asking for a call back just adds another obligation to their “to do” list. Instead, say, “Don't worry about calling me back. Just know I’m thinking of you and I’ll call you back another time. If you need a shoulder, or just want to vent, I’m here for you.” Instead of adding another item to the caregiver’s long “to do” list, you’ve sent a message of friendship and compassion. Remember, you’ve made a promise, so be sure and call back within a day or two.

3. Your time may be the most practical and valued gift of all. Let the caregiver know you’re going to the grocery store on Tuesday and offer to pick up her groceries while you’re there. Be sure and get a list and ask if specific brands are important. Ditto for dry cleaning, prescriptions, or other errands. When you prepare dinner for yourself or your family, it takes very little time to cook extra portions, freeze them and drop off a bag of dinners as often as you can.

4. If you’re comfortable sitting with the patient for a few hours, offer your time so the caregiver can leave the house and take a break. Be frank about you will do and what you don’t want to do: You may be comfortable reading to the patient, or watching TV with them, but uncomfortable feeding or toileting them. Explain your feelings, saying, “Pat, I want this to work out well so I can offer to help again. I’m happy to sit with your mom, read to her, or watch TV with her, but I’m too uncomfortable to help with any hands-on assistance. I’d also like to be sure I can reach you if I have a problem. Is that okay with you?”

5. Resist the urge to tell the caregiver horror stories about your cousin or friend’s aunt who went through the same or a similar illness. Third or fourth hand medical stories, particularly those told by lay people, are rarely accurate. We all react to medical problems differently. Your cousin might have had an adverse reaction to a medication that someone else tolerates without incident. Or, your friend’s aunt may have hallucinated after she took an over-the-counter product that millions of other people found beneficial without incident. Don’t add fear and dread to the caregiver’s already considerable worries.

6. Recognize that when illness strikes, family members or caregivers may be so overwhelmed that they cannot help themselves or their loved ones. At those times, they need an advocate. You can provide emotional and practical help by helping them find one. Log on to the Internet and find out what resources are available for the caregiver and patient. Look for treatments, medical centers, support groups, general information, medical trials, time saving tips, caregiver bulletin boards and advice from illness-related groups, then print the information out and give or send it to the caregiver. If you find information you believe is particularly important, highlight it. If the caregiver doesn’t use it, don’t press the subject, just let it go and feel good about yourself for trying to help.

7. Say something encouraging or warming. You don’t have to reach for what to say, the answer is all around you. Medical science is now reaping the reward of decades of research and is continually blessing us with new and better treatments, sometimes cures that enable patients to manage many medical problems while maintaining a satisfactory quality of life. So tell your friend to have hope for the future, because tomorrow or the next day, the doctor might call - as he did for my sister a few months ago - and say, “We’ve got something new for you. Come on in.” And when my sister met with the specialist, the “new, improved” medication worked for her and improved her life dramatically. Never give up. My sister had been waiting for ten years.

8. Finally, be available to listen. Caregivers often feel bewildered, overburdened, afraid, and alone. Learn to sit still and listen. Remember this isn’t about you and your experiences or beliefs. This is about the caregiver you’re there to help. Aside from an accurate diagnosis and medical treatment, nothing is as important as a trusted friend who will take the time to listen to fears and innermost thoughts. Don’t pass judgment by trying to change the caregiver’s grief, fear, anger, or guilt - you can’t feel them or understand them from their perspective and it’s unlikely you have the training to suggest how the caregiver should or shouldn’t feel.

A caregiver friend of mine recently said, “I’m not so much stunned about today as I am about the future. Oh my God. What he’s been through and what he’ll go through. One of the things that keeps me going is what you told me years ago about new treatments being available every day.” They are. Be a friend. Practice sharing HOPE.

SOURCE: ezinearticles.com

Retired?
Now is the Time to Take Charge by Claude Sancartier
Time is passing. It just doesn’t last as long as we would like it to last. Although it may seem like just yesterday you were raising your children, those years have passed, you are retired, and now your kids are raising their own children. But, before you let any more time slip pass, start thinking of your future.

Although you can not to go back and adjust time, implementing changes in your diet, your exercise, your mental and financial health will allow you to find the necessary tools to excel in the years to come. One thing is certain, if you take charge now without wasting any more time, you will be able to make a big difference in the quality in your future.

The good news is, most of the damage that you’ve done to your body can be reversed if you take action rapidly and are dedicated to making it happen. With just a few minutes of care to your lifestyle every day, you can get back some of the shape you have possibly lost. Don’t think it has to go on forever. You are retired and you don’t have to live a life that’s super “clean” and yes, you can make mistakes, eat that fatty hamburger and still watch reality television if it makes you happy. All you have to remember is to do certain things in moderation.

Here are a few important issues you should look at and may want to consider changing.

• Diet ... are you eating healthy?
• Attitude ... are you happy with yourself?
• Finances ... are you satisfied with the amount of money you have and will need in the future?
• Physical Fitness ... are you in shape? Exercise minimizes future health problems and is a quick way to improve attitude.
• Lifestyle ... are you satisfied? What changes would you like to make?

Now is the time to take charge of your life. Don’t count on time as an ally because it won’t wait for you.

SOURCE: ezinearticles.com

“Did She Dance?”...
The story behind the song
This is a touching story about how singer/songwriter, Kristi Cawley, came up with the lyrics and music to her song, “Did She Dance?”, and how she came to grips with Alzheimer’s Disease on a personal level.

Listen to the song and read the story.

Medical Alerts and Personal Security Devices:
Are They Worth It? by Jessie Penn
Do you, or a loved one, live alone or have medical needs? Senior citizens, especially, are at risk because they often live alone.

Sometimes being aware of your surroundings and medical needs just isn’t enough in today’s world. Medical emergencies and threatening encounters can happen while traveling, shopping, jogging, walking and even relaxing in our own homes.

Medical alarm devices give seniors the freedom and ability to live independently where they are most comfortable – in their own homes. Medical alarm and monitoring devices not only offer you peace of mind, but can save your life.

Tips for choosing a medical and security device
1. Be wary of companies requiring pre-payment. Some advertise no long-term contracts but require a 3-month minimum service period. Always demand to know your obligations.

2. Prices vary between $25 and $45 a month, but low pricing shouldn’t be your only criteria for selecting a company or product. And don’t pay over-priced monthly fees just because you ‘think’ you recognize the product name or it has a celebrity endorsement.

3. Insist on a 30-day money back trial period. This will give you the opportunity to try the system without monetary obligation.

4. Use a company that monitors its own system! Only companies that monitor their own system can review emergency calls on a daily basis, to achieve critical self-evaluations.

5. Ask about the training process for operators. When every second matters, you need qualified staff.

6. Ask if the company has 24/7 monitoring service. Unfortunately, many alert providers have limited customer service hours.

7. How long have they been in business? Experience and longevity are extremely important, after all, it is emergency assistance for you that is dependent upon their service.

8. Does the system include repair and maintenance?

9. Does the system self-test weekly? Checks to verify that your system is connected and functioning is very important.

10. Does the alert provider offer Senior Discounts on the monthly fee?

An alert system is like having a friend with you at all times, all it takes is a push of a button. . With most systems, you can talk and listen from ANYWHERE in your home. The base station can be located in your bedroom and if you fall in the other end of the house, the alarm company can still hear you, and you can hear them.

If you can’t speak or respond to the operator, emergency medical or police personnel will be dispatched to assist you. In the meantime, the operator will keep talking to you so you know they haven’t closed the connection.

SOURCE: ezinearticles.com

10 Tips for More Affordable In-Home Care by Steve Brooks, Abundant Home Care
According to a 2009 study by Genworth Financial, the median annual cost in the San Francisco Bay Area for in-home non-medical services is $52,624, based on 44 hours per week. The cost from a Medicare-certified (home health) agency would be $217,360 and the cost of a private room in a nursing home would be $102,018.

People are often alarmed about the cost of in-home services today and wonder how they can possibly afford it. There ARE alternatives out there to help. First, it pays to have an agency handle the caregiver employment, no matter what the source of payment. Whether it’s a two-hour shift or 24/7 live-in care, a full-service agency provides several advantages that you won’t get from hiring directly or a referral agency...for not that much more. For one thing, a full-service agency provides a pool of caregivers to select from because chemistry is so important in personal care, and there’s a ready back-up should a caregiver call in sick or need time off.

Then there’s the employment issue. As a responsible corporate citizen, a reputable agency won’t pay “under the table” and will contribute towards the employees’ federal and state taxes and Social Security. In order to retain the best employees and their families, the agency will also provide employee benefits like medical insurance and paid time off. Reputable agencies also provide Workers Compensation insurance so the client won’t have the financial risk should a caregiver get injured on the job, and bonding insurance to cover caregiver theft and fraud (which rarely happens when an agency performs criminal background checks on its employees). All this takes money, of course, and different agencies have their own way to compensate for it, so be sure to ask what the starting rates are, and whether the above features are in place.

Even though hiring a caregiving agency can be cheaper than placing someone into a nursing home, sometimes the money still isn’t available. Medicare doesn’t cover non-medical care and Long-Term Care insurance may not be in place, so what is a family to do in today’s economy? Here’s a list of solutions for you to consider:

1) Negotiate the rate. An agency can often find better ways to suit your budget. For instance, caregivers are sometimes willing to accept less pay which would translate into a lower fee.

2) Sometimes a cutback in hours can provide an almost-equal level of care. Avoid agencies that continually “suggest” that more hours are needed.

3) Talk to your doctor. Sometimes they know of less expensive resources for non-medical care.

4) Call your place of worship. The office sometimes knows volunteers willing to help seniors in the community.

5) Ask family and friends. Maybe someone is available for a couple hours a week to help out.

6) Visit your local senior center. Workers there can be a wealth of information on senior care.

7) Seek out government resources. Agencies like In-Home Support Services (IHSS) can provide funds to pay for, or at least supplement, non-medical caregiving services.

8) Seek out non-profit resources. For instance, Family Caregiver Alliance (www.caregiver.org) provides grants to those needing respite (family caregiver relief) care.

9) If medical care AND personal care is needed, have two different agencies handle the needs in order to save costs.

10) Consider the available assets. Some seniors have considerable equity in their home, for instance, and reverse mortgage have benefited many. Consult with your local banker to find out more.

In the end, though, a reliable and cheerful caregiver can be worth every penny.

Paying for Homecare with a Reverse Mortgage
(by Jim Carley, Reverse Mortgage Consultant)
Even if you’re already familiar with reverse mortgages, you may have questions or concerns about the process and the options. The information below is designed to give you a brief overview.

Definition A reverse mortgage allows older adults access to the equity in their home to pay for home care needs and living expenses while allowing them to live in their home and maintain their independence.

Eligibility Homeowners age 62 or older who live in the home as their principal residence are eligible. If there is a conventional mortgage, the property owner may still be eligible. In that case, the reverse mortgage would be used first to pay off the existing mortgage(s).

Maintaining ownership Borrowers always retain ownership of their home. They can continue to live in it as long as they want, and the loan doesn’t have to be repaid until they leave or sell the home. They are responsible for paying property taxes and homeowner’s insurance, and making any property repairs.

Loan amount The amount of the loan depends on: homeowner’s age, type of reverse mortgage, current interest rates, Federal Housing Administration’s FHA) lending limits for the area, appraised value of the home, and amount of equity in the home.

Receiving the money Borrowers can receive the cash from a reverse mortgage in a lump sum, a monthly cash advance, a line of credit, or a combination of these options.

Use of the money Usually seniors get a reverse mortgage to allow them to continue living in their home and to remain independent. Reverse mortgages can help pay necessary home care, medical care, or other living expenses.

Monthly payments There are no required monthly mortgage payments. Unlike traditional forward mortgages, with a reverse mortgage, the bank pays the borrower. That’s why it’s called a Reverse Mortgage. The homeowner is still responsible for paying home insurance premiums and property taxes, as well as ongoing maintenance

Repaying the loan Loan repayment is due when the last surviving spouse passes away or leaves the home permanently. The loan can be repaid through sale of the house, or the home can be refinanced with a conventional loan.

Lender limitations Reverse mortgages are non-recourse loans, which means that the property alone is security for repayment of the loan. If the sales price is less than the loan balance, the lender must accept the sale proceeds as sufficient payment and cannot seek to recover additional repayment from the borrowers’ income, other assets, or heirs. Of course, if the sale price exceeds the loan balance, the amount in excess of the loan belongs to the borrowers or their heirs.

Tax implications The money from a reverse mortgage is generally tax-free. Laws differ in each state, so it’s a good idea to consult with a tax advisor.

Government benefits Funds from a reverse mortgage generally do not affect regular Social Security or Medicare benefits. However, needs-based benefits, such as Medicaid and Supplemental Security Income (SSI), could be impacted. Contact a tax professional about your relative’s particular situation.

Interest rates Most reverse mortgages have variable rates tied to a financial index and will vary according to market conditions. MetLife offers both fixed-rate and variable loans.

Refinancing Reverse mortgages can be refinanced. This option can be advantageous if the home increases in value, making more equity available.

Other fees Beyond interest charges, most reverse mortgages have an origination fee, closing costs, a mortgage insurance premium, and a monthly servicing fee. These fees can be included in the loan amount. The costs are added to the principal and paid with interest when the loan becomes due.

Benefits versus a home equity loan Unlike a home equity loan, a reverse mortgage does not require monthly mortgage payments. It also can never be stopped or frozen by the lender. And the borrower can never be foreclosed on as long as they pay their property tax and insurance.

For further questions, contact Jim Carley, Reverse Mortgage Consultant at 925-407-5727.

Senior Computer Users Fastest Growing Segment
Abundant Home Care helps seniors stay in their homes while keeping them connected to other people and activities. One helpful method to achieve this has been through the use of computers. Rather than encourage passive activities, such as watching TV, the computer’s interactive nature provides stimulus and socialization opportunities. There is still some resistance to learning a new method of communication, but to offset having to learn a few new words, computers get easier to set up and learn (and cheaper, too) with each passing year. Computer users are no longer required to study a manual or be a computer whiz to “get online.”

A 2009 Nielsen Ratings study shows that more seniors than ever are getting their first computer to take advantage of the internet. Part of the influence comes from younger family members, but the biggest factor is the availability of online resources geared to senior users. The Nielsen study ranks the following top 10 online activities by users 65+:

1) Emailing
2) Viewing/printing maps
3) Checking weather
4) Viewing/paying bills and checking bank statements
5) Viewing/posting photos
6) Reading general news
7) Researching healthcare
8) Planning leisure travel trips
9) Planning meals, searching recipes
10) Reading business/financial news

At the top of the list is emailing. For instance, Abundant Home Care has a client who came home from a rehab facility after suffering a stroke. Speech was difficult, if not impossible, and she had lost use of her right hand. Communication was a struggle. On top of that, she wanted to talk to her 92-year-old brother in southern California to personally let him know she was OK. Her children got them both computers and now they’re happily emailing each other on a daily basis.

There are more uses for the internet than you can imagine. Hundreds, if not thousands, of websites exist to explore any topic, most at no no cost. For instance, if a person interested in gardening uses the Google search engine to look for “gardening website,” it will reveal an intimidating tens of thousands of entries, but sticking to the first five to ten websites will keep the user from getting overwhelmed. The top one, GardenWeb.com, has a community of 1000s of users, articles and directories of everything about gardening.

Some other popular internet activities for seniors include:
Playing online games (be warned, games can be just as addictive to seniors as they are to teenagers!).
Viewing videos (YouTube.com has replaced Funniest Home Videos!).
Reconnecting with family and friends (Classmates.com and Reunion.com are the top two sites).
Social networking (sites geared to mature users tend to be less superficial and have a more grounded community).
Listening to music (Pandora.com is a genre-specific radio station controlled by the user).
The list goes on...

Dementia (From the past Employee Newsletters)

THIS SET OF ARTICLES is about the progressive condition dementia, common with a number of our clients. Because it is often age-related, the chances of it showing up increases every day. The more we know about the signs and effects of dementia the better we can care for our clients and make sure other healthcare providers are kept informed about their condition.

This first part in the series will be an introduction to what dementia is, and then discussing the three different stages of dementia in future newsletters.

We’ll be discussing the signs of each stage and the behaviors you should be making a mental note of. When they start happening on a regular basis, and it hasn’t been noted before, it is important to bring them up. A note should be made in the logbook, a call into the office, and a mention to the family or healthcare provider.

We’ll also discuss different techniques for dealing with these new behaviors and provide tips that have worked for other caregivers. And if you have tips for the rest of us, please share them!

Introduction
Senile dementia is defined as the set of symptoms caused by changes in a person's aging brain. In November 2000, the National Institute on Aging (USA) estimated that up to 50% of Americans aged 85 years or more may have Alzheimer’s Disease, which is responsible for 60-70% of dementia occurrences. Another 20-30% is caused by vascular diseases "multi-infarct dementia" or "mini-strokes." As people live longer, dementia is becoming an even larger health problem.

Unless a person has been diagnosed as having Alzheimer’s or the other diseases listed below, we should simply refer to their condition as dementia. Other dementia diseases you may have heard of include Lewy Bodies, Parkinson’s Disease, Vascular Dementia, and Frontotemporal Dementia. Dementia can also be caused by certain vitamin deficiencies and other medical conditions.

There can be minor differences in the symptoms brought about by the different diseases, but for the most part, dementia symptoms fall into three categories:
• Recent memory loss
• Language difficulty
• Lack of judgment

Lumping together the symptoms into those three categories is simplistic, but we’ll go into how they show up in the different stages of dementia.

There’s a saying, “When you’ve met one person with Alzheimer’s Disease, you’ve met one person with Alzheimer’s Disease.” In other words, every case will be different and you can’t expect the same reaction between two people having similar symptoms. Caring for someone with dementia calls for patience, alertness, creativity, and above all, a caring heart.

The three primary stages of dementia
Mild: The early stages may be hard to detect but just remember that because of the advancing age of most of our clients, symptoms can start showing up at any time. Be understanding and patient and above all, don’t berate the person. Start noting the symptoms. It is especially important to bring up to healthcare providers since people best respond to certain kinds of medication at this time, rather than later.

Moderate: As symptoms worsen, care needs increase when the person suffers further detachment from reality. Their brain isn’t what it used to be and it is our job to help them cope in their daily lives. This stage can be a time of intense frustration as they feel their reality slipping away and they may lash out in combative ways towards those closest to them. Because of the increased challenges, it is important for caregivers to get the care *they* need during this stage.

Severe: Requiring the most care, often aided by heavy medication and possible transfer to an advanced-care facility designed just for this difficult stage.

MILD DEMENTIA

When signs of dementia start showing up, it is important to contact the person’s doctor who can accurately diagnose the condition and take appropriate steps. The physician might request a diagnostic workup, including a complete physicial and neurological exam. This can help determine the stage and cause of any dementia present. The tests can also rule out other causes of memory loss like head trauma, infection or vitamin deficiency.

Early diagnosis is important so that drugs approved for dementia have the most beneficial impact. Slowing down the changes of the brain can mean a higher quality of life for a longer time.

It’s important to remember that we all have occasional lapses in memory, but it becomes problematic when it starts happening on a regular basis and affecting a person’s quality of life.

Warning signs of Mild Dementia
Changes in memory and other thinking skills are the most reliable way to track the different dementia stages. What happens is, recent (short-term) memories are normally stored in our brain long enough to become long-term memories, but with dementia, there’s a short circuit that causes a short-term memory to be deleted. Over time, these episodes will occur more frequently.

During the Early-Mild stage, a person might forget appointments or other important meetings and may start leaving more notes for themselves as reminders. They may forget to take medications or double up on dosages.

In the Mid-Mild stage, memory lapses increase. They may write notes to themselves, but forget writing them. They begin to say less in phone conversations. They start to get lost, even on familiar routes. They often forget to take medications. They may start to forget to bathe and take care of simple grooming tasks. They repeat questions or stories more often. They may become depressed when they feel life as they once knew it slipping away from them...something “doesn’t feel right.” At this stage, the person may still be wanting to drive, but because of the need to manage the various and changing environmental conditions, driving with dementia presents an obvious threat to themselves and others.

In the Late-Mild stage, speech problems may start showing up as they forget common words and start making them up. Instead of calling a pen by its name, they may call it a “thingamajig” or a “pencil stick,” or referring to a broom as "that thing for sweeping." They continually forget important appointments and frequently repeat questions and stories. They may also start getting moodier than normal and blame others for their own mistakes.

What caregivers can do for Mild Dementia
It’s important for caregivers to communicate behavior changes to the person’s doctor, and to keep an open dialog with healthcare providers.

Be empathetic of what the person is going through. Begin to accept that their brain is changing and most likely will not be the same again. It is our job to help them through this sometimes difficult process.

Helping them means doing for them those things they once could do themselves. Keeping track of and driving them to appointments. Cooking and housekeeping for them. Handling medications and financial needs. Working with the family to make sure they’re not driving. Above all, try to be patient and not berate them for something out of their control. When emotions escalate, count to ten or remove yourself from the room. And have someone to talk to. It’s not easy.

MODERATE DEMENTIA

As in the Mild stage of dementia, the Moderate stage can be further broken down into Early-Moderate, Mid-Moderate and Late-Moderate. Active involvement in the person’s everyday life is more important during this stage, from communication with the healthcare providers to assistance with their Activities of Daily Living (ADLs). It may be a good idea to suggest the services of a Geriatric Care Manager or social worker in order to plan for the person’s future.

Signs of Moderate Dementia
In the Early-Moderate stage, the person has more difficulty with short-term memory. They may be able to talk about the past, but not recent events. Even if it’s an important event, they may not remember it, with the possible exception if there’s an emotional attachment to it – they may remember a happy holiday gathering for days afterward. The person may need help choosing what to wear or selecting from a menu. They have problems counting money. They may repeat simple behaviors over and over. If they’re still driving at this stage, they will probably start having accidents, if they haven’t already. They may start to “wander,” leaving the house and forgetting how to get back.

In the Mid-Moderate stage of dementia, they may start focusing on childhood memories more than the present. They are more likely than not to forget about medication. They may forget who just visited them, even commenting, “they never visit” about someone who just did. They may ask, “Where are we?” or “What should I be doing?” They may not recognize their house. They may not be able to tell the difference between public and private behavior (disinhibition). Paranoia may exhibit itself and they start worrying about finances to the point of taking cash out of their bank accounts without telling others. They may forget to eat and they may start soiling themselves.

In the Late-Moderate stage, they sometimes can’t identify friends or grandchildren. They may confuse distant memories with recent, thinking they should be at work or school. They tend to worry about unfinished business more, worrying that their young children are safe, or blaming a long-passed spouse for infidelity. They may lash out at those caring for them. Disinhibition may become more of a problem with sexually-charged situations. Sleep will likely be restless with frequent nightmares.

What caregivers can do for Moderate Dementia
Once dementia has been diagnosed, it would be prudent to also consult with an attorney to discuss Power of Attorney (if the person isn’t married) and different health directives that carry out the wishes of the person.

At this stage, it is more important to seek outside help because it will probably become too much for one person to handle. In some ways, it is more difficult than caring for a child 24/7. Seek out agencies with adult daycare programs that have fun activities and can give family caregivers a break. Inform friends and neighbors of the situation so they can be on guard should the person leave the house by themselves.

Moderate dementia calls for help with all ADLs: personal hygiene/grooming, dressing/undressing, feeding, transfers/ambulation and toileting.

Steps should be undertaken to protect physical safety: grab bars installed in the bathroom, door alarms installed to keep from wandering, knobs removed from the stove, knives and other sharp instruments locked away.

Emotionally-charged situations call for a certain amount of creativity. Try distraction, stepping back or just playing along. Avoid asking questions which may frustate them. Identify yourself and others when greeting them to give them a hint to who you are. Remember that trying to reason with the person won’t have the same impact that it may have once had.

SEVERE DEMENTIA

As in the Mild and Moderate stages of dementia, the Severe stage can be further broken down into Early-Severe, Mid-Severe and Late-Severe. During this most difficult stage it is important to realize that more advanced care is needed to help the person achieve the best quality of life possible.

Signs of Severe Dementia
In the Early-Severe stage, the person will have extreme difficulty with short-term memory. They will most likely have difficulty describing past events, with facts becoming confused and scrambled. They may start forgetting faces of those closest to them, like children and spouses, possibly asking, “Who are you?” They may have violent episodes attacking others.

In the Mid-Severe stage of dementia, they will most likely need help with urinary and fecal incontinence. Language continues to degrade to the point of nonsensical utterances. Because of the loss of most memory, difficulty communicating and loss of self-awareness, the only reality the person may know is the present.

In the Late-Severe stage, they may not communicate at all with words, but only with utterances and slow gestures. Generalized rigidity is common. With the loss of physical motor skills, they are most likely bed-bound, and completely urinary and fecal incontinent. Their eyes may be vacant stares.

What caregivers can do for Severe Dementia
It will take concious effort to change your behavior around the person with severe dementia. Rationalization won’t help and you should continually seek out tips for creating comfort for the person.

Living in the present in this stage also applies to the safety of the person. Performing a Home Safety Check (AHC provides this free of charge) can point out problem areas like kitchens and bathrooms. Because of decreased mobility, trip hazards become an increasing problem. Make sure that hot water temperature is at a safe level, 120 degrees, hot enough to destroy bacteria, but not too hot to scald a person if the bath water is left running.

Hygiene is important as the person becomes more neglectful. With incontinence, a watchful eye (and nose) is important to keep the body and linens clean. Use gloves and dispose of them properly. A tightly sealed hamper and frequent laundry may become necessary.

Be careful for your own safety, as well. The person with late-moderate or severe dementia may become combative without warning or provocation, using objects as weapons or grabbing and biting. Keep knives and other sharp objects out of reach and keep an eye on anything that can be picked up and thrown. A cane is often a ready object to strike others. Be alert when in close quarters with the person where they may grab hair or bite an arm. If a violent episode occurs, don’t try to restrain them or reason with them, rather back away to defuse the situation, letting them calm down by themselves when they see that you don't pose a threat.

Focus on creating emotional comfort by treating the person with dignity, affection, and security. That will have the most impact to help influence their mood and behavior.

More on care for persons with dementia
Because of the intensity of care that may be required, it is often difficult for one family member to provide it 24/7. If friends or family wish to provide these services it is important for them to be aware not only of the demented person’s needs, but also of their own needs. It is not uncommon for a spouse or children to feel that they have an impossible choice between being overwhelmed (trying to provide all the care), or feeling they are betraying their relative (by sending them to a nursing home). This often leads to the care provider becoming exhausted. Because of this it would be helpful to investigate local resources to help the care provider.

Ask the person's doctor or contact the senior services department of the local hospital what resources are available for respite care, adult daycare centers, adult foster care, Meals on Wheels, or a local Geriatric Care Manager. The best care for dementia requires teamwork.

Providing caregiver services for the elderly in the following areas: Walnut Creek, Concord, Pleasant Hill, Antioch, Brentwood, Summerset, Martinez and Rossmoor. Contra Costa in home care services are also provided in Lafayette, Moraga and Orinda. Home care options available in San Ramon, Danville, Alamo, Diablo, Clayton, California. Contact us today for rates and to set up a free, in-home assessment.