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It’s important for caregivers to understand that the incontinence is more than just inconvenient. Associated health problems can occur and potentially turn serious, such as skin rashes and urinary tract infections. And incontinence is even known to increase the chances of falls and injuries. Further, the need for long-term care often arises; one study found that urinary incontinence is second only to dementia among reasons for admission to long-term care.

Here are several ways to help those suffering urinary incontinence:

• Establish a restroom routine and be diligent and patient. Try to get the person to go to the bathroom every two hours during waking hours. This can lead to a degree of bladder “retraining.”
• Consult a health care professional with experience training the patient in pelvic-floor strengthening exercises (such as Kegel exercises).
• Consult a doctor, who may determine if prescribing a medication called an antimuscarinic is appropriate. These can help with the different types of urinary incontinence: overactive bladder and urge incontinence.
• Ensure the person avoids stimulants in the evening, such as caffeine, as well as liquids before bedtime.
• Simplify the person’s wardrobe — pants with elastic waistbands offer great convenience.
• Keep a close eye on nonverbal signals that the patient needs to use the restroom. These include facial expressions, distraction, and pulling at clothes.
• Realize the person may have been hiding their incontinence and suffering longer than you’re aware of. This can result in a longer time period required for managing the incontinence, and if the patient has become more socially isolated and less likely to leave home, the incontinence may have been the primary reason.
• Know that surgery may be an option for patients who do not respond to conservative methods as described above.

Sources:

http://www.bmj.com/content/341/bmj.c3835.full

http://www.caregivershome.com/community/askexpert_full.cfm?UID=90

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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.

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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.

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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.

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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.

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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.

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You can see your parents’ point. Having in-home help invades their privacy and threatens their independence. You wouldn’t welcome those changes either. But sometimes hiring in-home help is the only way your parents can safely continue to live in their home. Here are three tips for smoothing the transition:

1. If your parents are both living together in their own home, suggest that the less needy parent would benefit from outside help, even though they both need it. For example, tell Dad, whose health is worse, “Keeping up with everything is tiring Mom out. Maybe we should get someone in to clean and shop for groceries.” Because he cares about her, Dad is more likely to agree to get her outside help (Obviously, get Mom onboard with the plan first). Once a caregiver is in the door, hopefully your parents will see the value of the service and come to trust the caregiver. Then your parents will be more open to accepting additional assistance as the need arises.

2. If your parent lives alone or with you, your focus can be that the assistance will benefit you. For example, explain to Mom that having an aide assist her in the bathroom will relieve you of worry while you are at work. You won’t have to be concerned that she will fall and lie there for hours. Often a parent will place the child’s welfare ahead of his or her own.

3. If your parent is really resistant to the idea of a caregiver even though it is clearly needed, enlist the help of a trusted professional such as a physician, pastor, or family friend in the medical profession. Emotions can run high in families, and sometimes an objective outsider can break the impasse.

These discussions can be frustrating. Try not to take your parent’s resistance personally. Remember that he or she feels vulnerable and a bit powerless, and may also be mourning the loss of his or her independence. More than likely you would feel exactly the same.  Be patient, persistent and stress that you want your parent to remain at home as long as possible, but accepting help is the key. For additional suggestions about making this transition, visit www.agingcare.com/Caregiver-Support/ or www.mnaging.org/advisor/caregiver.htm.

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1. Is the agency is accredited by a national organizations such as the Joint Commission on Accreditation of Health Care Organizations (JCAHO) or Commission on Accreditation of Rehabilitation Facilities (CARF)? These certifications tell you that the agency conforms to national industry standards. There is always comfort in dealing with an organization that has proven its worth to its peers.

2. Is the agency Medicare-certified? As the name implies, if you want Medicare to pay for the services, the agency must be Medicare-certified. However, be aware there are some complications associated with Medicare’s coverage of home health services (see “Surprise! Medicare Doesn’t Pay for Most Home Healthcare”). Many high-quality home healthcare agencies are not Medicare-certified. Instead, their clientele pays for the services directly or their private insurance covers it.

3. Can the agency provide references from former clients? By talking to former clients, you can get a good sense for whether or not the staff is caring and respectful. Family members can tell you all the reassuring (or alarming) details.

4. What experience and training do Home Health Aides (HHAs) have? How about Homemakers? All Home Health Aides need to be trained, competency-tested and supervised by an R.N. However, the level of training required may vary depending on what type of license the agency has. For example, agencies with a Minnesota Class C license require their HHAs to be Certified Nursing Assistants (also called Certified Nursing Aides, Nursing Assistant –Certified, or Nursing Assistant-Registered).

But Minnesota agencies with a Class A license don’t require their HHAs to be Certified Nurse Assistants. Instead, they provide some training for their HHAs. Whether or not the agency employs Certified Nursing Assistants, their training should include home safety practices as well as training in caring for and communicating with elderly people.

Homemakers and Companions should have driving safety training as well as first aid, home safety training, and experience working with elderly people. Answering these questions will help you establish the agency’s professionalism.

5. Does the agency do criminal background check on ALL of the employees? In addition, the in-home staff should be bonded and the agency should have malpractice insurance.

If you have any concerns about an agency’s practices, contact the Minnesota Office of Ombudsman for Long-term Care. They can answer questions and investigate if necessary. The Minnesota Board on Aging can also provide information.

6. Is there a care plan? Is it updated regularly for the HHA? Before a HHA starts helping your parent, an R.N. should assess Dad or Mom. Then the family and the R.N. will discuss what care is needed, and the nurse will write a care plan for the HHA to follow. If your parent’s needs change, the care plan will be updated.

7. How closely are the HHAs and Homemakers supervised? HHAs can only be supervised and directed by an R.N. Homemakers are usually supervised by the agency’s program manager. However, any time you have questions or concerns, you should contact the agency, and the appropriate person should call you within 24 hours.

By law, you and your parent should also be given a copy and explanation of the Minnesota Home Care Bill of Rights, so you know what to expect. In addition, the R.N. supervising your HHA will visit in 14 days to check on progress and then every 14 to 60 days after that, depending on what tasks the HHA performs. The nurse can also change the care plan by phone if need be.

Knowing how to evaluate home health care agencies will help you find the best services for your loved one.

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