Different Kinds of Sandwiches

Posted on July 24th, 2014

Categories: Caring For Elderly,Gerontology,Helping Seniors,In-Home Care,Senior Care Management

generations of peopleWhen I was in graduate school for Gerontology, we often discussed the “Sandwich Generation”.  The phrase referred to that group of typically middle aged people who find themselves in the role of care giver for their children as well as their aging parents.  The care givers were “sandwiched” in between both generations.

But in my work as a geriatric care manager, I have seen other kinds of sandwiches worth noting.  As society changes, so do the roles of caregivers.

  • For example, early onset of dementia is striking more and more people in middle age.  For some caregivers, this means that they are caring for aging parents, sick spouses, and children all at the same time.  Can you imagine?
  • It is also not uncommon for middle aged people to take on the role of parent to their own grandchildren while still caring for their aging parents.  This is often the case when an adult child is sick in some way and there is no spouse in the picture.
  • Another scenario I have seen is in families with just one adult child amongst siblings.  That child cares for her own children, her own aging parents, and in addition for several aging aunts and uncles.

As society becomes more complex and families follow suit, our definition of “Sandwich Generation” must expand.  After all, different kinds of sandwiches hold varying ingredients!

Finding the right support for caregivers involves honoring the uniqueness of their family situation.

So much of what is best in us is bound up in our love of family…..”  Haniel Long.









Power of Attorney, Medical Directive – What does it all mean?

Posted on July 17th, 2014

Categories: Active Senior Living,Aging Advocacy,Caring For Elderly,Resources

Five wishesAdvocate on Aging Deborah Dolan’s job is to facilitate conversations about care giving between families and loved ones – not control it. She is simply included in order to start and direct discussions, especially when it comes to difficult topics such as legal issues, death and dying. Certain topics are typically more difficult to discuss without a neutral facilitator, such as assigning powers to designated individuals. Deborah stresses to her clients that every caregiver should know the differences between a general power of attorney, and a healthcare power of attorney. Here’s what you need to know when it comes to these powers:

A fiduciary or general power of attorney is in place to handle financial assets including property, money, life insurance, and investments. Whether a person needs to have property sold to pay for their care, have bank accounts changed in any way, the assigned general power of attorney has the same ability to handle all financial transactions that the owner of the asset has. It is important to remember that this power ends with the death of the person granting the power, and the executor of the estate takes over. Deborah sees some clients, who are afraid to designate a power of attorney because they fear losing control over their assets, or that someone will take their money and they won’t have it when they need it. Deborah facilitates these discussions in order to help the elder and their families address these issues before the powers or information is needed and not in crisis. Although Deborah is not an attorney, she is able to refer her clients to attorneys and recommends that an attorney assist in writing this document.

A healthcare power of attorney is usually included in a healthcare directive and designates an individual who, in Deborah’s words, “gives voice to the wishes of how a person wants to live and how he or she wants to die.” This healthcare power of attorney agrees that if the person giving the power becomes ill or incapacitated and is unable to speak, they will honor and direct that person’s care as written to the best of his or her ability. Unlike the financial power of attorney, a healthcare power of attorney and directive does not have to have an attorney involved. There are resources available online which are legally binding and honored when the signature of the person assigning the power is notarized or witnessed by two non-interested parties. Two such forms are Five Wishes and Honoring Choices Minnesota.

There is much to do and many decisions to make when a health crisis occurs. Giving the gift of information needed to carry out personal wishes when you are no longer able to speak for yourself is a gift of love and peace.

Take Me for a Ride: The Importance of Grandchildren

Posted on July 10th, 2014

Categories: Gerontology,Grandparents,Senior Care Management

open book“Take me for a ride in your story”  Edwin Honig

When I first heard these words, it took my breath away.

The words describe my relationship with my grandchildren to a tee.  I hitched a ride in their story, and they wonderfully in mine.

I have attended hockey games and plays galore.  I’ve baked countless batches of my famous chocolate chip cookies.  I snuggled and tickled and read to them for countless hours.  Time spent with them is magical!

As they grow older, I have had to balance my joy with some worry.  My grandchildren will not be spared from sorrow as I would like them to be.  They will have disappointments and failures.

But I will not be mired in such thoughts.  Because they will have happiness and health and success in abundance as well.

I know they are my happiness.  I know I am some of theirs.

I am a part of their story.  They are a part of mine.




We hold these truths: Caregiving and Life

Posted on July 3rd, 2014

Categories: Dementia,Grief,Medicare Part A,Prevention,Senior Care Management,Uncategorized

july4th1Happy 4th of July!  It is once again a celebration of the birth of this magnificent country, the United States of America!  While far from perfect, it is a blessing really to live in such a country as ours!

For some reason, this year I have chosen to read again important documents such as the Bill of Rights and the Declaration of Independence with great care.  Not surprisingly, the words are far different in meaning now than when I first gazed at them through the eyes of a child.

The idea that we are endowed by our “Creator with certain unalienable Rights, that among these are Life, Liberty, and the pursuit of Happiness“.

I am a care giver as well as a care manager.  I think about “Life” all the time.

For the elderly, upholding the sanctity of life is wholly enmeshed with what we loosely refer to as the “health care system“.  This system is so very complex and unwieldy that families not familiar with it come to me for support to figure it out.  Their goals are:

  • “Life” for their loved one.
  • Care that supports the “life” of their loved one.
  • Services that support the “life” of their loved one.
  • Medicine that supports the “life” of their loved one.
  • Physicians that support the “life” of their loved one.
  • Hospitals that support the “life” of their loved one.

The one thing I have learned as a care manager that causes me anguish is that access to health care is not equal among all our citizens.  It is an ugly truth that is often batted away by politicians unwilling to look it square in the face.  But I see it day in and day out in the work that I do.

The right to life may sometimes mean the need for health care.  Life is an inalienable right.  Adequate health care is not available to all.  Why has the disconnect become politicized?

Yes the world is far more complex than in 1776.  But the message is not.

Do we really hold these truths as self evident?  Do we really?



Senior Patient Beware: Credit Cards and Health Care

Posted on June 26th, 2014

Categories: Aging Advocacy,Caring For Elderly,Gerontology,Health Insurance,Healthcare Advocacy,Helping Seniors,Medical,scams,Senior Care Management

credit card fraudLast week I went to see a health care specialist after a referral by my primary care physician.  No big deal.  Or so I thought.  The specialist I saw was professional and knowledgeable and took care of my medical problem flawlessly.

But it was his financial policy that I took issue with.  I was required to submit a credit card and to agree to allow him to charge that credit card $250 per month after my health insurance claim was paid.  Unfettered access to my credit card!  I also had to leave a $100 balance before he would treat me (even though I had no deductible).  I balked at this requirement.  I told his office assistant that I am north of 50 years of age and had never run into this kind of financial policy before.  To which she responded that it is “done all the time”.  I hemmed and hawed before I finally acquiesced because I only needed one treatment and because I have the capacity to monitor the situation.  No one will take advantage of me!

I asked for a copy of their financial policy, however, and took it home.  It has gnawed at me ever since.  I can only think of the many elders that I care for and love.  Many of whom are just so vulnerable to financial exploitation due to illness, memory issues, or simply their age.

I have perused the internet to find out more information about such policies.  Sadly, I encountered even more nefarious health care credit card tactics.

The Consumer Financial Protection Bureau (CFPB ) in December 2013 posted an online article about deceptive health care credit card practices.  Doctor and Dentist offices were actually enrolling patients into credit cards that patients assumed were interest free.  In reality, the credit cards were accruing high interest rates the whole time and patients didn’t see the interest charges until the promotional period ended.  Fortunately, the CFPB in this case ordered the credit card company to refund $34.1 million back to consumers that had been harmed by this practice.

So it is that I am compelled to ring the warning bell for caregivers of the elderly that there are new concerns over senior finances.  Sadly, they stem from people that our elderly loved ones trust almost implicitly.  Their physicians.

I understand the need for physicians to get paid.  But there’s got to be a better way!

What say you?


My Cup Runneth Over – Can You Help me Catch the Drips?

Posted on June 19th, 2014

Categories: Aging Advocacy,Caring For Elderly,Gerontology,Helping Seniors,Senior Care Management


Nothing makes one feel so strong as a call for help” Pope Paul VI.

If you are a caregiver, my guess is you probably like to help.  Helping is what we do.  We definitely provide care for our aging loved ones.  That is our priority and how we define ourselves in the care giving role.

But, if you really take a look at your life, I’ll bet you care for a whole lot more than your elders.  Think about your neighbors.  I bet you do kind things for them.  Do you occasionally shovel their snow or mow their lawn when they are sick or injured?

How about your kids? Did you think when they were growing up that some day all the cares they required would be gone?  Did you envision your reward would be sitting on the front porch in a rocker reading stories to blissfully happy grandchildren?

Did you see your career as this beautiful arc that would send you toward a well deserved retirement at the dutiful age of 65?

If you did, you are not alone!  But it turns out that life is never how we envisioned it when we were young. We are still helping.  Everyone still needs us.

And that is OK because it is often sweeter and more gratifying to have it that way.  Better really than we could ever have imagined!

But the contentment can sour quickly when there are too many demands on our resources.  Sometimes the opportunities to care can overtax the precious resources we have.  Often when this occurs, we take from our health, our security, our sanity to keep giving to others.  If this continues for very long, we become sick and unable to give anything to anyone!

As care givers, we are not good care takers!  It is just so natural for us to say yes I can help!  Saying yes I need help is unnatural; even impossible for us to imagine.

I am like you.  I will continue to help my parents, husband, children, grandchildren, friends and neighbors.  We are who we are.

But when my cup runneth over with the needs of others, I have to ask for help.  There, I said it.  I sometimes need help.

I remind myself that I receive more than I give when I have helped another person.  It is why I became a care manager and gerontologist.  It is why I have chosen the care giving role in my family.

I am also reminded that when I reach out for help, I give another person the opportunity to give to me so that they may receive their own reward through giving.

So for all you care givers out there:  don’t be afraid to ask for help.  Share the joy of not only giving help to but also receiving help from others.

My cup runneth over!







Looking After Dear Old Dad!

Posted on June 12th, 2014

Categories: Active Senior Living,Aging Advocacy,Caring For Elderly,Dementia,depression,Gerontology,Healthcare Advocacy,Helping Seniors,holidays,Medical,Mental Health and Seniors,Senior Care Management

HappyFathersDayThis Sunday is Father’s Day and a good time to reflect on men’s health.  Men, just like women, exhibit more health problems with age.  But men are less likely to discuss any health issues or to see a physician for help.  Thus it is often left to their care giving spouses or children to monitor any signs or symptoms of ailing health.

So what should we as care givers be looking out for in our older guys?

  • Heart Disease and High Blood Pressure:  Risk factors include smoking, stress, poor diet, being overweight, family history and sedentary lifestyle
  • Prostate Problems:  Symptoms may include urinary difficulty and erectile dysfunction; embarrassing but important topics to discuss
  • Diabetes:  Symptoms include frequent urination and thirst.  Diabetes is a devastating disease that wreaks havoc on nerves , blood vessels and eyesight.
  • Depression:  More than just “the blues”, depression is thought to be a chemical imbalance in the brain that effects both body and mind functioning.  Depression and its cousin anxiety, respond well to medication and/or cognitive behavioral therapies.
  • Memory Problems:  More than just forgetfulness, symptoms may include, getting lost in familiar areas, irritability or depression, difficulty sleeping, problems with movement, misplacing things, repetition of stories, and inability to follow simple directions.  Often these symptoms are well advanced before a caregiver realizes they are related to memory issues.
  • Cancer:  Bladder and lung cancers are two of the most common cancers in older men.  Lung cancer is the leading cancer killer in men.  Smoking is overall the most significant risk for lung cancer.  Symptoms of bladder cancer are similar to those in diabetes as well as prostate problems.  However, blood in the urine is a key symptom and one that should be evaluated immediately.

Talking with our older men about the above issues may be difficult.  After all, men have a tendency not to share this information and are less likely to go to a doctor for treatment.  If we are lucky, our senior guys will tell us about what ails them.  If not, we as caregivers have to become sleuths when caring for our elderly men.  Sometimes the best clues are the nonverbal ones.

Just some things to think about as we celebrate these wonderful men in our lives.

Happy Father’s Day!

Show Me a Hero

Posted on June 5th, 2014

Categories: Caring For Elderly,Gerontology,Helping Seniors,Senior Care Management

heroShow me a hero and I will write you a tragedy”  F. Scott Fitzgerald.

I come across heroes every day.  They go about their day quietly.  To look at them superficially, you would never know.  But once you deign to scratch the surface, heroism abounds!

Most often, if you live to old age, chances are you are a hero.  You have suffered loss of loved ones, loss of robust health, loss of independence and sometimes even loss of faith.  But you have prevailed in life nevertheless.  You are indeed a hero.

If you commit to care for an elderly loved one, you are a hero.  You forfeit your time, your emotions, and sometimes your own health to provide good care.  Yes indeed, that makes you a hero.

Our culture admittedly idolizes celebrities and athletes.  But we would be misguided to automatically assign to them the status of hero.  Celebrity and heroism are not the same.

As a care manager for the elderly, I want to recognize the heroism of family care givers as well as those whose chosen profession is care giving.  Care giving requires self sacrifice and bravery.

Show me a hero and I’ll show you a care giver!

Everyday courage has few witnesses.  But yours is no less noble because no drum beats for you and no crowds shout your name”  Robert Louis Stevenson.




Seven Summer Tips for Seniors

Posted on May 29th, 2014

Categories: Active Senior Living,Aging Advocacy,Caring For Elderly,Dementia

elderly woman with hatThis week we celebrated Memorial Day.  A solemn day to be sure. Hopefully you were able to reflect as I did on the sacrifices of our soldiers and the greatness of our country.  I do this by hanging the American flag outside my door.  This ritual also signals to me the onset of summer with all the promises it holds.

If you are new to my blog, you may not know that I am a caregiver for my elderly parents as well as my husband who suffers from early onset dementia. Frontotemporal dementia to be exact.  I am also a gerontologist and care manager for other elderly clients.

Now that summer is upon us, I think about what this new season means for all those entrusted in my care.   Each season holds different concerns for the elderly.

Here are seven tips for seniors to be aware of this summer!

  • Push those fluids!  Sounds simple, but heat and dehydration result in many a trip to the emergency room.  Elderly folks are more susceptible to temperature changes coupled with a reduced ability to conserve water. This combination can be disastrous!
  • Apply sunscreen liberally!  Older skin is thinner and more delicate.  Some medications can accelerate sunburn, be sure to check! Stay in shade when possible and wear protective clothing!
  • Eat a healthy diet!  When it is hot, sometimes the tendency is not to eat.  But healthy eating helps maintain the sense of well being, plus it aids in  hydration.
  • Screen for skin cancer!  Conduct both a self examination as well as make an appointment for a screening by your physician.  Especially if you see any changes in skin.
  • Avoid bug bites!  The best way to avoid complications from insect bites is to not get bitten!  Using insect repellents and wearing long sleeved shirts and pants goes along way in preventing bites.
  • Be extra careful when driving!  Summer is the season when most car accidents occur for many reasons.  Summer vacations, schools not in sessions and road construction to name just a few.
  • Beware of food borne illnesses: foods that are left out on a warm day can quickly grow bacteria and other toxic substances.  Be sure to put away foods right after serving to avoid getting sick!

With a little common sense and some extra TLC, your senior can safely get out and enjoy these summer days.

We’d love to know what tips you have to make the summer more enjoyable.  Please share your ideas!



May is Older Americans Month

Posted on May 22nd, 2014

Categories: Aging Advocacy,Caring For Elderly,Gerontology,Healthcare Advocacy,Helping Seniors

Older Americans MonthMay is Older Americans Month.  It is a time to focus on all things that contribute to the health, welfare, and quality of life for elders in our society.  As a geriatric care manager, I have often focused on big projects and presentations in the month of May.  All of which were designed to highlight the needs of aging Americans as well as share progress made in the area of gerontology.

Earlier this month a friend and I were talking about little things we could do (and have done) that enrich the lives of elderly folks but take just a minute or two.  Helping bag groceries at the store.  Sitting down to chat with someone at the mall.  Bringing a pot of chicken noodle soup to a neighbor on a cold winter day.  Shoveling snow.  Mowing a lawn.  Driving an elder to a doctor appointment.  My friend even brings her dog to the assistant living facility to visit her mom.  Instead of heading right to her mom’s apartment, she tarries in the lobby to let all the dog lovers visit her dog first.

Honoring an older American is so easy to do when you think about it.  Sure, it is wonderful to follow all of the new research and know that better technology in health care is making strides to improve aging on a global scale.  But if your one simple act of kindness can brighten the day for just one elder, than you have celebrated Older Americans Month in a most sacred way.

As we approach the Memorial Day weekend, remember especially our older veterans and the sacrifices they made for this country!



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