The holidays bring families together, and the season should be as merry as possible for everyone. But, we all know holiday stress is a fact of life — and it can be especially tough on older adults.

Here are ways to help ensure your elderly loved ones have smooth, enjoyable holiday season:

• If their home will be used for gatherings, look for ways to manage the heightened activity. Kids and dogs running about can be over-stimulating and stressful, so make sure parents supervise them.
• Respectfully honor that Grandma might be particular about which casserole dishes can be used, or help Grandpa put fragile treasures out of reach of young children.
• Is your elderly loved one quiet and withdrawn? If hearing loss is a factor, check hearing-aid adjustments in support of increased opportunities for conversation.
• Draw older adults into activities by assigning simple tasks. If dementia is causing your seniors to be withdrawn, get family members to involve them in “memory lane” conversations that take advantage of long-term memory. What was Grandma and Grandpa’s first Christmas or Hanukah together like? Are there cherished ornaments or holiday vacations to reminisce about? Did they weather any scary snowstorms?
• Be on the look out for holiday criminals who may call, email, or come to the door of your elderly loved one who they expect to be an easy victim. If Grandpa talks about a recent purchase that doesn’t quite make sense, stop, listen, and ask probing questions.
• Relatives and friends who don’t see older relatives regularly might observe something new. Look for opportunities to have conversations that might start with, “How do you think Grandpa is doing these days?” You might find that an elderly relative will reveal things suddenly to someone they don’t see much. When dementia is present, out-of-town friends and family may need to be warned to help avoid embarrassing moments.
• Check in with your loved ones to find out how they’re doing in the face of such a flurry of activity. You might be able to set up a room for resting so Grandma can nap or otherwise get quiet time. Don’t be afraid to put a sign on the door that lets others know a room is off-limits for a time.

Source:

http://seniorliving.about.com/od/grandparents/a/happy_holidays.htm

What kinds of training does a caregiver get before taking care of seniors?

Not all agencies require the extensive training that Pinnacle does.

According to Karin Malkowski Stende, trainer/human resources associate, Pinnacle requires “very intensive, 30-plus hours of classroom and on-site training that new staff are expected to complete during their initial two weeks of employment.”

“The state requires 30 hours of training within the first 60 days of employment,” says Stende. “We believe that our two-week training model exceeds that requirement and allows us to better equip our new staff with the knowledge and expertise they will need in order to be of maximum service to the consumer.”

The Pinnacle curriculum includes training on:

• The Vulnerable Adult/Maltreatment of Minors Act (which mandates reporting of actual or suspected abuse/maltreatment of vulnerable adults and/or minors)
• Rule 40 (which regulates the use of controlled procedures)
• Medication administration
• Home health aide competency
• Basic dementia training (which includes communication skills and working with challenging behaviors)
• CPR and first aid from American Red Cross-certified instructors
• Boundaries
• Vehicle safety
• Funding and waivers
• HIPAA
• Alternative intervention, and
• Pinnacle Services company history, mission, and core values.

New staff also gets intensive on-site orientation that includes medical equipment training, as well as completing risk management post-tests.

“All of our trainings are designed to give our new staff the confidence and competence they need so they can provide consumers with services of the highest quality — one of our company’s core values,” says Stende.

The recent stretch of hot weather in Minnesota had everyone looking for relief. And aging adults are more likely to experience the effects of hot weather than younger adults. Physically, older adults cannot adjust to significant changes in temperature the way younger adults can.

What’s more, prescription drugs can also reduce the body’s ability to adjust to temperature changes.

The effects of too much heat
Watch for these symptoms of heat stroke:

• An extremely high body temperature (above 103°F)
• Red, hot, and dry skin (no sweating)
• Rapid, strong pulse
• Throbbing headache
• Dizziness
• Nausea

If you suspect heat stroke, call 911 or summon medical personnel immediately.

Tips for preventing heat-related illnesses
Here are tips to safeguard your health during the hot weather:

• Drink more fluids. It’s very important to keep hydrated. Don’t wait until you’re thirsty to drink. Warning: If your physician limits the amount of fluid you drink or has you on water pills, check with him on how much you should drink while the weather is hot.Avoid drinking liquids that contain alcohol or large amounts of sugar. These types of liquids make you lose more body fluid.
• Stay indoors and, if possible, stay in an air-conditioned room. If your home does not have air conditioning, visit a shopping mall or public library. You can also contact your local health department to find out if there are any heat-relief shelters in your area.
• Electric fans may offer some comfort. However, when the temperature reaches the high 90s, fans will not prevent heat-related illness. Taking a cool shower or bath, or spending time in an air-conditioned place is a much better way to cool off.
• Wear clothing that is lightweight, light-colored, and loose-fitting.
• Visit adults at risk twice a day or more. Watch them for signs of heat exhaustion or heat stroke.

SOURCE: elderparenthelp.com

As defined by the courts, a guardian is someone appointed to make decisions about health care, living arrangements and other personal issues for a protected person.

A conservator is appointed to make financial decisions such as entering into contracts, paying bills and investing assets for a protected person.

How much power do they have over an individual’s life?
Their powers are broad, but not absolute. According to the Minnesota attorney general’s office, they may use their authority only as necessary to provide care and services for the protected person. The court should ensure that decisions are not overly restrictive of the protected person’s rights.

The Legislature recently passed a Bill of Rights for Wards and Protected Persons (statute 524.5-120). Find it here:

http://www.mncourts.gov/Documents/4/Public/Probate/Bill_Of_Rights_For_Wards_And_Protected_Persons.pdf

Find more information about guardians and conservators at:
www.tinyurl.com/mrzfp8

Source: Minneapolis Star Tribune

A new national survey shows this sluggish economy is definitely impacting people with disabilities here and across the country.

As reported recently by KARE-11 News, the Arc Legislative Action Center of the United States conducted a survey that found some startling facts. Forty-six percent of parents said they have more caregiving responsibilities than they can handle. One out of five families said one parent has had to quit working to help take care of their disabled child.

“We’re not supporting families like we used to,” said Steve Larson of The Arc of Minnesota. The Arc Minnesota says the change has nothing to do with people’s feelings toward those with disabilities and everything to do with budgets. Federal cuts to Medicaid would make the current problems even worse.

The Arc is calling on people to join their movement to promote and protect the rights of people with disabilities. You can sign up by going to www.thearc.org/joinwithus.

See the KARE-11 News story at:

http://www.kare11.com/news/article/927068/14/Families-dealing-with-disabilities-hit-hard-by-economy

When was the last time you had a break from taking care of your elderly parents? Can’t remember? Then it’s been too long.

Let’s face it. Even though you love Mom and Dad dearly and believe taking care of them is the right thing to do, sometimes it wears you down. You haven’t had time for yourself in a while. Your family is getting tired of frozen pizza or mac n’ cheese out of a box.

You’re doing your best, but between getting Dad or Mom washed and dressed every day, rehab and doctor appointments, and laundry, grocery shopping, cooking and cleaning, you’re struggling to keep up.

There aren’t enough hours in the day.

If your best friend were in this situation, you’d say, “You’re stressed out and running yourself ragged. You need to get some respite care—have someone else come in for an afternoon or two every week to take care of your Dad—you need a break.” You’d really believe your advice and encourage your friend to call for help.

But why is it different when it’s you?

When your friends and family ask how you’re doing and encourage you to take a break, you say, “No, I’m fine. We’re managing. Really.” But what you’d really love is to have an afternoon to yourself, to do nothing, take a nap, catch up on your own chores, or meet a friend for lunch.

Instead, you tell yourself, “Having a stranger come in would be too upsetting to Dad” or “Mom never got a break when she was raising me. Why should I need a break?” But don’t forget, your parents had babysitters for you. And you were fine. You might even have looked forward to seeing the babysitter. Had fun with the babysitter. Your elderly parent will be fine, too.

Consider the alternative.

Still struggling with the idea? Feel too guilty about wanting a break? Then consider the alternative. If you get too stressed out, you’re likely to be frustrated and irritable with your parents. How is that better? Similarly, if you’re stressed and exhausted, you’re more likely to get sick. Then who will be taking care of your parent? Somebody else.

Plan for the long run.

When you’re immersed in the situation, it’s hard to step back and think, “Can I keep this up for another six months? Two years?” But when the pace isn’t sustainable—either emotionally or physically—you need to reconsider your plan to go it alone. Building in some regular respite care—from a friend, a church member, a companion or home health aide isn’t an act of selfishness. It’s an act of love and responsibility. You are planning how to take care of your elderly parent long-term. Taking breaks will help you go the distance.

To learn more about how respite care works, visit the HelpGuide. For ideas about where to find respite care resources, check out local home care services online or visit the MN Home Care Association for a list of services.

Can you imagine a time when your elderly parent might find bill-paying overwhelming? Or make more and more mistakes with the checking account? Or simply prefer not to deal with the hassle of selling the house or a car? If so, it would be good to talk with your Mom or Dad about choosing someone to be a durable power of attorney—either you or someone else. The following points will give you a good working understanding of the role of a power of attorney.

1. A “Power of Attorney” manages financial assets. He or she does not make healthcare decisions. For that, you need a person to be a healthcare proxy (also called medical power of attorney or healthcare power of attorney). A power of attorney might pay bills, buy or sell a house or car, begin or end a contract on behalf of the person who’s given him or her the power. The arrangement can be short-term—while your Mom is touring Europe—or long-term—you take over paying bills for your Dad at his request.
2. The key players in a power of attorney arrangement are the person requesting the help (called the “principal”) and the person providing the help (called the “attorney-in-fact” or sometime, the “agent”). The attorney-in-fact doesn’t need to be an attorney at all. But he or she should be a trustworthy person close to the principal.
3. The principal can still make legal decisions, but the attorney-in-fact acts as a deputy –carrying out the principal’s wishes.
4. A general power of attorney has limited powers, and the principal decides what the powers will be. If the principal becomes incapacitated (i.e. unable to make decisions and handle financial and legal matters), the general power of attorney loses all powers.
5. A durable power of attorney is someone who can make financial and legal decisions if the principal becomes incapacitated (unable to make decisions and handle financial and legal matters). A durable power of attorney is in effect until the principal dies. However, a durable power of attorney has to be established before the principal become incapacitated. But the duties don’t have to be activated until your parent clearly needs you to do them. Once your parent is no longer competent to understand the legal issues, he or she won’t be allowed to assign a durable power of attorney. Instead, you may need to pursue guardianship through the courts – a more lengthy and complicated process.
6. It’s best to visit a lawyer to set up a power of attorney. The lawyer will ensure the agreement is detailed enough. Together you, the lawyer, and your parent will determine the list of duties to be performed, when they should begin, how long they should last. Using a lawyer ensures the principal’s rights are protected and that the agreement is legally sound.

A durable power of attorney is what you’ll need to handle your parent’s legal and financial affairs if he or she becomes incompetent. The best time to arrange for a durable power of attorney is beforeit’s needed, while your parent is still competent. For more information, check out these resources:Federal Office of Personnel Management, Minnesota Board on Aging’s ElderCare Rights Alliance presentation, or Senior Health at About.com.

If you’re shopping for home health care, the types of licenses sounds like a crazy alphabet soup—A, B, C, F. What does it all mean? What class of service is right for you? And what about Medicare certification? Here’s a guide to Minnesota home care licenses.

Class A License – Issued to professional home care agencies. A Class A agency provides care in your home—whether it’s a house/apartment or a residential facility. Agencies with a Class A license may offer a full spectrum of services from nursing and physical/speech/occupational/respiratory therapy to medical social services and supplies. Many Class A agencies provide a menu of the most requested and essential services: nurses, home health aides, homemakers, companions, and medical social services or care management services. The agency employs and manages the staff and checks their qualifications.

Class B License – Issued to paraprofessional agencies. A Class B agency provides home health aides and homemaking and/or companion services in your home—whether it’s a house/apartment or a residential facility. Class B agencies do not offer nursing or any of the various therapies mentioned above. For many families, that’s all they need. The agency employs and manages the staff and checks their qualifications.

Class C License – Issued to an individual. With a Class C license, a Certified Nursing Assistant (CNA) can provide home health aide services under the supervision of an R.N. It’s up to the CNA/home health aide to establish a relationship with a supervising R.N. A home health aide can also provide personal care assistance or homemaking services. Personal care assistance includes help with bathing and dressing as well as some housekeeping tasks. However, personal care assistants do not help with anything medical like taking blood pressures or supervising medications. Homemakers do cooking, cleaning, and shopping, but they do not do personal care. Personal care assistants and homemakers need to be registered with the state, but they are not licensed.

If you choose a person with a Class C license, you are hiring and supervising him or her directly. You are responsible for checking credentials and background. You will arrange for coverage if the person you hire is sick or his or her car won’t start.

Class F License – Issued to assisted living facilities. Agencies with a Class F license provide care in a residential facility/assisted living setting. Sometimes these facilities are referred to as Housing with Services (HWS). People with a Class F license do not come to individual homes. With a Class F license, the organization may provide the full range of services mentioned under Class A. Or they may offer a more limited selection of services.

Medicare Certification – If an agency accepts Medicare payments, it must meet the federal government’s requirements in order to be certified. However, if an agency does not accept Medicare payment, it doesn’t have to be Medicare-certified. If an agency is Medicare-certified it must also have a Class A home care license, but a Class A agency is not required to be Medicare-certified. In other words, lack of Medicare-certification is no reflection on the quality of the care—it strictly relates to the forms of payment accepted.

To learn about home care licensing in more detail, consult the Minnesota Department of Health or visit the Minnesota Board on Aging.

Does Dad have a mysterious new scrape on his car? Did Mom run over a curb in the parking lot because she just didn’t see it? While one mishap doesn’t mean it’s time to stop driving (after all, middle-aged drivers do these same things, too), if you see a pattern of accidents, poor judgment, and decreasing skills, it’s time to make a change.

Asking Your Elderly Parent to Stop Driving Can be Hard on Both of You

You’re worried about your parent’s safety and that of other drivers and pedestrians. But to your parent, giving up the keys means giving up independence and becoming beholden on someone else—very hard for someone who’s always been self-reliant. For an elderly person, it’s a major loss. Think how you would feel if you had to ask for a ride every time you wanted to get groceries, go to the library, or visit a friend. Plus, you’d have to wait until the errand or visit fits into someone else’s schedule. For your parent, the end of driving signals the end of an era of being independent and competent.

Your parent may also feel angry, frustrated or humiliated—as if he or she is being treated like a child. And yet, can you live with the possibility that your parent could miss a stop sign or get flustered and plow into another driver, hurting everyone involved? The approach you take depends on the level of impairment. Here are several options.

Intermediate Steps – Limit Driving Instead of Eliminating It

Sometimes your parent doesn’t need to stop driving altogether, just make some adjustments. Aging Parents and Elder Care.com recommends these changes.

• Avoid driving at night and, if possible, at dawn or dusk.
• Drive only to familiar locations like the grocery store, church and hair salon.
• Avoid driving to places far away from home.
• Avoid expressways (freeways) and rush hour traffic.
• Leave plenty of time to get to the destination.
• Don’t drive alone.

How to Get Your Parent to Stop Driving

If your parent has dementia or has repeatedly shown bad judgment such as not gauging the speed of oncoming traffic, drifting from lane to lane, or disregarding traffic signals, you need to get him or her off the road.

1. Enlist your parent’s doctor’s help. Often an elderly person will listen to a doctor, whereas the same advice is harder to take from a child, even a middle-aged one.

2. Make it easy for your parent to get where he or she needs to go.

• Enlist help from friends, relatives, and neighbors to provide a solution that precludes discussion. For example, you could say, “Mom, Aunt Susan will pick you up for the birthday party” and “Dad, what day do you want to go grocery shopping this week?” By letting parents know they can still get places, it’s easier for them to accept the new regime.

3. Research the transportation options for your parent. Find out what’s available –public transit, community shuttles, taxis, or senior transit services. Offer to ride the bus with Dad or take a taxi ride with Mom so your parent will feel more confident.

4. Emphasize the benefits of not driving—less expense and hassle. According AAA figures cited by medicinenet.com, the average cost of owning and running a car is about $6,420 a year. So, by giving up driving, your parent might have as much as $123 a week to use for taxis, buses, or to buy gas for friends and relatives who drive.

5. If all else fails . . . if you parent disregards the doctor’s order to stop driving, you can anonymously request that the Minnesota Department of Public Safety Driver and Vehicle Services Division evaluate your parent. They will evaluate your parent’s driving skills and ask your parent to surrender the license if the skills are up to par.

If your parent has dementia and doesn’t remember he or she shouldn’t drive, hide the keys or disable the car.

Although it’s hard to see your parent’s abilities changing, you have a responsibility to keep your parent and others safe. Often elders realize their skills are slipping, but they’re hoping no one will notice, so it’s a relief to no longer have to keep up a front.

If you or your elderly parents are weighing the pros and cons of getting home health care services or moving to an assisted living facility, the costs are not as different as you might expect—see the comparison below. For most people, the decision is very personal: would you be happier living at home and having the personal services come to you? Or would you prefer to move to a facility where meals are included, personal services are available, but the living space is usually smaller than your current home? Since the costs are not that different, the decision comes down to quality of life questions.

Two Views of the Cost of Assisted Living in Minnesota

According to MetLife

In 2009, assisted living costs in Minneapolis-St. Paul ranged from $1,251 per month to $3,450. Interestingly, Rochester-area assisted living rates were considerably higher: from $2,138 per month to $5,500 per month.

Annual assisted living costs could be from $15,048 per year to $41,400 per year for the Twin Cities area and from $25,656 per year to $66,000 per year in the Rochester area.

These figures assume a one-bedroom apartment, at least two meals per day, housekeeping services, and personal care assistance.

(Figures are taken from The 2009 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and Home Care Costs http://www.metlife.com/assets/cao/mmi/publications/studies/mmi-market-survey-nursing-home-assisted-living.pdf , accessed 10/22/10.)

According to Long-Term Care Insurance Planners

The average annual rate for assisted living in Minnesota is $25,090.20, a considerably more optimistic view (http://www.long-term-care-insurance-planners.com/Minnesota-long-term-care-insurance/Minnesota-nursing-homes.html, accessed 10/22/10).

Two Views of the Cost of Home Health Care in Minnesota

According to MetLife

In 2009, the rates for Home Health Aides (HHA) from a licensed agency averaged $29/hour in Minnesota. Assuming 4 hours per day of care ($29 x 4 = $116 per day) for 365 days per year the average annual cost of a Home Health Aide would be $42,340 ($116 x 365 = $42,340).

For 5 hours of care per day for 5 days per week, the cost would be $37,700 ($29/hour x 5 hours/day = $145; $145 x 5 days per week = $725. $725 x 52 = $37,700).

According to Long-Term Care Insurance Planners

Again, the Long-Term Care Insurance Planners estimate optimistically and concluded a Home Health Aide would cost $30,680. This assumes 5 hours of care per day for 5 days per week.

Assisted living includes rent and meals, while home health care allows you to stay in your own home.