What to Do When Being the Caregiver Is Not an Option

Not everyone has the resources and stamina to take on the role, and it's OK

By Phyllis Quinlan for Next Avenue

Daughter holding her father's hand.

Credit: Thinkstock

There are 66 million unpaid adult family caregivers in America — 29 percent of the adult U.S. population — providing care to someone who is ill, disabled or aged, according to the National Alliance for Caregiving and AARP. Female caregivers outnumber their male counterparts two to one. In 2012, female family caregivers, on average, were 48 years old, lived alone,and provided about 25 hours of care per week.



As anyone who has done it knows, caregiving is rarely a sprint. It is most often a marathon of planning, adjusting, attending and doing. Not everyone is capable of staying in the race.



When You Cannot Be the Caregiver



What happens when being a caregiver is not an option? What do you do when your own health, personal and career commitments or relationship with the person in need of care leave little room for you to take on the added responsibility that comes with the role?



Many struggle with this relentless internal conflict and the onslaught of negative emotions that often result in a profound sense of isolation. The comments and judgment from outsiders add to your confusion and perhaps toxic sense of self.



What is called for at this crossroad is self-compassion. Surprised? You thought that I was going to suggest that you listen to your harsh self-criticism and dig down deep to find a way to be available and accommodating. Actually, I want you to honor your sense of personal limits and not make a commitment when committing to just one more thing could invite undue hardship or risk your health and well-being.



Ending Negative Messages



Just what is self-compassion? It is responding to yourself (and your situation) with kindness rather than criticism. It is stopping the loop of derogatory self-talk that often takes on the tone we imagine we would hear from some authority figure in our life. It is the extension of kindness, care, warmth and understanding toward oneself when we are faced with the reality of our human shortcomings, inadequacies, or perceived failures.



Self-compassion is not self-pity and does not mean perpetuating a sense of being a victim. It offers you the sense of objectivity and control earned by being an adult. Self-compassion is giving yourself the time and space to make a choice that honors your needs as well as the needs of others. Individuals who are self-compassionate are more likely to learn and grow from the challenges in their lives.



Self-compassion provides the foundation for developing personal resilience. It helps us to maintain a healthy perspective when we are bombarded by those on the periphery of the decision. They are those who are all too often unwilling to lend a hand but are free with judgments and rhetoric designed to manipulate you into thinking that you’re the best or only person who can do the caring when others cannot.



So my recommendation is to stay strong.  Honor your understanding of what is best. Do not make a noble sacrifice by ignoring what you intuitively know is right, wrong, healthy or destructive. Respond to the challenge of caregiving with critical thinking rather than judgment clouded by emotion. Put your own oxygen mask on first.



Where to Go for Help

  • Share the Care Organization: sharethecare.org. A not-for-profit organization that trains groups to create care circles for an individual.

  • Veterans Benefits Administration: www.benefits.va.gov/benefits/. Site contains information that can connect the vet to benefits and services.

  • Nursing Home Compare: medicare.gov. Site designed to help you shop for the best long-term services in your area.

  • Care Navigators: https://www.healthcare.gov/glossary/navigator/. Helps consumers look for health coverage options through the marketplace, including completing eligibility and enrollment forms. These individuals and organizations are required to be unbiased. Their services are free to consumers.


© Twin Cities Public Television – 2016. All rights reserved.

 

Not Your Mother’s Retirement Home

New communities put music or other creative pursuits at the center

By Beth Baker for Next Avenue


 


Jerry Myroup jams with musicians.


Caption: Jerry Myroup wants to spend his retirement doing what he loves: jamming with like-minded musicians.


 


Every year, Jerry Myroup travels to Jamaica with his wife to rock out to the band Little Feat. They like the fan appreciation resort weekends so much that they started wondering how they could live like this all the time, for the rest of their lives. Could they actually rock till they drop?


 


“It all began as a joke,” Myroup says. But that funny thought sparked some serious conversation. “We thought this is just perfect— people who like to be around each other, a lot of them are musicians. When we get older, how will we be around the music that we want to hear?” The answer: create a retirement community where rock and roll lovers can grow old together called — what else? — Rock Til You Drop.


 


Rock Till You Drop: Home Sweet Home


 


Myroup, who plays guitar and drums, jams with a band called the Old Farts, lives in northwest Indiana and plans to retire in five years, has put up a website to gauge interest in the idea.


 


“We had a lot of interest, but the problem is getting people to put up money for a vision,” he says. Still, about 20 people so far are onboard. Now they just need to find a place to live the dream of a co-housing community for aging rockers.


 


“We found that trying to find a location that is suitable for most people is a little difficult when you’re all over the country,” said Myroup. But the rocking pre-retirees have narrowed down their parameters. The goal is to find property that is affordable in an area with a low cost of living; within an hour of an international airport; near a good hospital, cultural venues and a college campus; and, surprise, surprise, marijuana tolerant. The top states the group is considering: North Carolina, Tennessee, California, Oregon and Arizona.


 


They might buy an RV park. The way Myroup sees it, there are a couple of advantages to that: “It gives us the ability to have people who want to live in tiny houses — a lot of people don’t have a lot of money saved up, especially if they’re musicians and artists. It also gives us an avenue to have people come in, see what we’re doing and stay a couple weeks in their RVs.”


 


Visitors will be welcomed. “You never know who’s going to stop by and that’s the whole premise of Rock Til You Drop,” he says. “You have the ability to play and jam without having to get in your car. It works out good for everybody.”


 


Getting Creative About Creating Community


 


Lydia Manning thinks Myroup is onto something with his co-housing scheme, and not just because she likes to jam, too. As a gerontologist with Concordia University in Chicago, Manning studies resilience and aging. The founding members of Rock Til You Drop are the subjects of her latest research project.


 


“I’m interviewing them, asking what does it mean to you, how are you conceptualizing it, how does it shape your imagined aging, how are you going about planning for it,” she says. “I do think these types of communities are going to be gaining in popularity. I think you’ll see a trend of people wanting to craft space, rather than just pick a place and go. The marketplace is going to have to change in terms of our options for people.”


 


There’s a good reason for that to happen: A growing body of research suggests that creativity and artistic expression contribute to healthy aging. Creativity is linked to decreased stress, better cognitive health, self-acceptance and a sense of purpose. Gay Hanna, executive director of the National Center for Creative Aging, observes that “art is spiritual and it’s community building.”

 


Co-housing with like-minded people, of course, only makes it easier to pursue your interests. “Aging in place and age-friendly communities are going to make it more conducive for these informal groupings of artists and interest groups to form,” Hanna says.


 


Putting Art at the Heart


 


Emilie Parker, 64, is already doing it. She’s a sculptor and painter; her husband is a scriptwriter. “Fun for me is doing art and being around artists,” she says. “When I think of what I want to do with my life, artist co-housing is perfect. I don’t want to be alone, I want to be with my friends, and I want privacy, too. I want to share art every single day. I don’t want to have to go somewhere or do something to make it happen.”


 


That’s why Parker founded Louisville Artists Cohousing near Boulder, Colo. Together with eight other painters, musicians and fabric artists, she and her husband are looking for property on which to build 24 homes. Although a majority of the core group is over 50, the community will be multigenerational.


 


Like all co-housing, it will have private households and a large common area where people can dine together and watch movies or exercise. In addition, Louisville Artists Cohousing will have art-making spaces in the common area and each household will have room for a home studio.


 


The group hopes to find property that is zoned residential and commercial, in order to build an additional 6,000-square-feet of studio space where outside artists could hold exhibitions and teach classes. The fees for using the space would help defray building costs.


 


Although members are not required to be artists, they should be art-loving. “The things that I value will be the same things that my neighbors value,” says Parker. “Community is a good thing for everybody — you get to take advantage of everybody’s skills and talents — it’s a healthier way to live.”


 


© Twin Cities Public Television – 2016. All rights reserved.

PRR Resident Contributes to Community with Educational Programs and Research

Dr. Michael WallachBy Harry Glazer



What does someone do if he is blessed with a sharp mind and finds himself, due to medical conditions, living in a nursing home?



If you’re someone like Michael Wallach, you find many ways to continue to challenge yourself intellectually and to contribute to your new home.



Michael, who moved into the Parker at River Road home in the winter of 2012/2013, has a doctorate in cell biology. He did his graduate studies at the University of Pennsylvania, and his dissertation research at the Wistar Institute. Michael remained at the Wistar for a number of years as a staff scientist after receiving his doctorate.



Upon arriving at Parker, Michael soon sized up his surroundings and saw an opportunity to enhance the activities offered by the recreation department. He met with recreation department leaders and proposed to give monthly talks on thought-provoking topics. They took him up on his offer and Michael has been on the speakers’ circuit ever since.



Since December 2013, Michael has presented dozens of talks in the nursing home and in the Adult Day program. His most popular talk was one given in the winter titled “Searching for Santa Claus,” a historical look at the origins of the much beloved character and an effort to prove that Santa Claus really does exist. He has also spoken about the destruction of Pompeii, World War II Navajo code talkers, the Monuments Men (during the same war), NASA’s Kepler Space Telescope and the search for earthlike planets, how birds are living dinosaurs, the Water Tribunal of Velencia, Spain – a 1000 year old court — and a wide variety of other topics.



Recently, Michael branched out and has begun giving “Travel to” talks, complete with a number of eye-catching Google Earth images, to highlight the attractions of exotic cities and countries across the world. His first two talks, “Travel to – Israel” and “Travel to – Transylvania,” were very well received. These virtual tours are now part of the monthly recreation calendar. 



While presenting the talks and going about the homes, Michael has identified other opportunities where he can apply his skills and make valuable contributions.



He has made co-presentations on a range of medical topics, as part of the monthly “Parker Rounds” talks held by Parker’s medical director Dr. David Howarth. He has also spoken with small groups of Dr. Howarth’s medical residents and students, focusing on the molecular biology of certain conditions and diseases to complement Dr. Howarth’s talks on the clinical aspects. They are currently working on a new set of presentations for the nursing staff, medical residents, and medical students.



He got to talking with the Senior Director of Nursing, Michael Yannotta, and he learned about Mr. Yannotta’s interest in investigating the impact of sensitivity – between staff members, staff and residents, and management and staff – on the quality of care at Parker. Michael got to work on a literature search on the topic and identified 125 references in peer reviewed journals that touched on this topic. He is currently developing a questionnaire that Parker will use to better understand how staff views issues of sensitivity.  Michael foresees that his research project will give Parker a knowledge base on this topic, which can be consulted as a resource when leaders consider assessing or revising policy and procedures.



“Michael Wallach has made so many delightful contributions here that, frankly, I’ve lost count of all the great things he’s done and is doing for us!” said Carol Burt, Senior Administrator of Parker’s homes on River Road and Landing Lane. “He’s a high-quality researcher and a skilled speaker with many interests, who is eager to engage with our staff and our residents. We are so grateful that he devotes himself to these pursuits and carries through with such professional skill – they’ve made a major difference in our homes.”

Look Ahead and Plan the Future You’d Prefer

By Roberto Muñiz 


President & CEO



Roberto MuñizThere is a statistic that I hear often and I’m sure you have heard it as well – 70% of people over the age of 65 can expect to use some form of long-term care during their lives. Many people make the assumption that this means nursing home care for an extended period of time – but it does not.


 


Long-term care includes a wide range of services, care and support that many people may need at some point in their lives, and very often for a limited period of time – think rehab after knee or hip replacement surgery. 


 


Along with skilled services like rehab, assistance is also available for personal tasks of everyday life, like bathing, dressing or preparing meals. Other support might include help with housework, medication management, transportation or shopping services. It’s important to know what services are available and to think about how, if you need them, you will pay for them if they are not covered by Medicare or other health care coverage. 


 


Just like any other life event, whether marriage, buying a house, having a child, paying for college (and the list goes on) planning for your future can be an exciting prospect. 


 


With the holiday season around the corner, now is an opportunity to talk with your family and friends about how and where you want to grow older. Take a few index cards and jot down these questions, along with some others that are important to you, and at your next gathering, have everyone take a turn at answering a question. You might be surprised at the answers!


  • Do I want to live in a walk-able community, close to restaurants, entertainment, health care and services or can I count on accessible transportation if I am unable or don’t want to drive at some point?

  • Am I happy in my own home, and am I willing to have help brought in, when and if I need it? Or would I rather live in a community where services are close by and sometimes included?

  • Am I willing to use and can I pay for available services, like home grocery delivery, cleaning and handyman services that will make it easier to stay in my own home longer?

  • Are there any modifications I can make that will make my house more user-friendly as I get older and should I think about having those upgrades done now?

  • Where will my friends and family be living? It’s all about relationships and it’s important to stay in touch with people you enjoy – whether by car, train, plane or technology! 

  • Think about whether your family, friends or neighbors can play a role (paid and unpaid) in providing support if needed, whether a ride to medical appointments or the big spring clean-up in the garden.


These are just a few things to think about, but I urge you, do start thinking about them. By letting your family and friends know how and where you want to age, and learning about the resources available to help you, you can start planning for the future you envision for yourself.


 

How to Visit Your Aging Parent the Right Way

Taking a different approach can make things better for both of you


By Emily Gurnon for Next Avenue


 


Young woman and older woman sitting on a park bench


Credit: Thinkstock


 


Katherine Arnup, a retired professor at Carleton University in Ottawa, Canada, and now life coach, got an education in caregiving when her sister and parents got sick. She later became a hospice volunteer. 


 



 


Arnup writes about the importance of being “being present” when you visit an aging parent. The following is excerpted from one of the book’s chapters.


 


Settle In, Look Around


 


When you arrive to visit your parents, take the time to get settled. It might help to take a few deep intentional breaths before you open the door to their house or apartment.


 


Once inside, resist the urge to start blathering on and on just to fill the void, or to cover up your discomfort or nervousness. Listen. Observe. How does the house or apartment look? What changes do you notice since your last visit? Is your father wearing clothes with obvious stains? Are there a week’s worth of papers stacked up beside his chair? What might this mean? Is it typical? Might it be a hazard?


 


Not Your House


 


Because of our discomfort, we often fall into the habit of cleaning up, putting things “back in their place,” or throwing things out that we consider to be garbage or recycling. These actions are likely to cause unnecessary frustration and confusion for your parents. They know where everything is now, and you’re only disrupting that order.


 


Sometimes it’s hard to remember that it’s their house, not yours. I’m not suggesting you ignore signs of distress or mental confusion. But you would do well to respect the fact that you’re still a visitor in someone else’s house.


 


Silence Is OK


 


When I was visiting my father, I used to sit down on the loveseat next to his chair, set down my bag, and start drinking the Starbucks coffee I’d bought on the way. Usually I’d ask him an open-ended question like “How are you doing?” and then take the time to listen to his response.


 


It’s fine if you both sit in silence for a while. Nothing bad will happen. Chances are your parent enjoys just having you there, even if he doesn’t seem to notice or drops off to sleep. (Yes, this used to drive me wild!) Bring a book to read or a pad of paper to make lists.


 


Though it made me crazy when my father watched TV (turned up loud because he was nearly deaf and frequently “forgot” to wear his hearing aids) near the end of his life, barely seeming to notice that I was there, still I knew that he appreciated my coming to see him. I won’t say that I enjoyed watching curling or golf – it was like watching paint dry, as my father used to say about getting his blood transfusions! Still, now, when I’m at a bar and golf or curling comes on the TV, I find myself watching, as if somehow honoring my Dad.


 


Stop Multi-Tasking


 


Increasingly, neurological research demonstrates that the much-vaunted practice of multi-tasking is, in fact, a bust. Our brains, it seems, are not equipped to do more than one thing at a time, especially if focus is required. The good news is that being with aging parents demands that we slow down and stop multi-tasking in order to be with our parents where they are.


 


“I don’t do that with my parents,” you may be protesting. “When I come for a visit, I’m really present.”


 


Are you? Maybe, but I’m willing to bet that you check your email stealthily on your smartphone (or not so stealthily) while your father is reporting his latest symptoms or your mother is telling you about a fall she had while standing on the counter to reach the top shelf in the kitchen. We have all done this, and missed the importance of the story and the essential details.


 


No Drive-By Visits


 


After my partner’s parents moved to Vermont to be closer to her, she developed the habit of adding two or three drive-by visits to their condo into her weekly routine. She would listen to their stories (briefly) and pick up the list of chores they needed her to perform.


 


While she assured me that they enjoyed these visits, I wasn’t so sure. I knew that I didn’t like it when she made what amounted to drive-by phone calls to me. (You know what I mean – the sort of activities you engage in so you can check things off on your to-do list!)


 


I knew that my father always took some time to get comfortable with my presence before he would tell the stories he had saved up for me. Because his life moved at a pace much slower than mine, he found the process of my coming and going required an adjustment that was hardly worth the effort if I just raced in and out.


 


Find Ways to Engage


 


When my father was dying, my eldest sister used to ask me, “What do you do all day when you visit Dad?” She found herself bored and uncomfortable after just a few minutes, wanting to get up and do something, or even head back on the road.


 


I will admit I often felt that way with my mother, who was not able to carry on much of a conversation because of her aphasia. Even then I knew instinctively that, if I didn’t slow down, I would only frustrate her as I’d begin completing her sentences before she had a chance to say them.


 


Whether it’s because of poor hearing, weak eyesight, cognitive damage, or other health issue, elderly parents move more slowly. If you are to have enjoyable and meaningful visits with your parents, you need to dial it back to their speed.


 


Find ways to engage with your parents. Perhaps you could watch a television show or a DVD together. If you can bring yourself to pay attention, you might even enjoy yourself!


 


© Twin Cities Public Television – 2015. All rights reserved.

Recrafting a Life After a Stroke

A survivor and his wife offer advice for coping


By George H. Schofield, Ph.D. for Next Avenue


 


Bob and Sue Seiter


 


At 71, Bob Seiter was an active guy. After retiring from Kaiser Aluminum, where he worked in sales, he played golf three times a week, playing at a 14 handicap and striving to regain his 4. When he wasn’t on the fairway, he spent a lot of time volunteering.


 


Then one morning, he had a hemorrhagic stroke, and everything changed.


 



 


His wife, Sue, found him in the garage, alarmingly disoriented, called 911 and prayed.


 


Bob was rushed to the hospital, where he spent three weeks in intensive care, clinging to life.


 


The doctors warned Sue that Bob wasn’t expected to make it. But one day he opened his eyes and awareness began, slowly, to return.


 


Coming Back to a New Life


 


Then came 5 1/2 grueling weeks in a rehab facility.


 



 


Then came reality. Bob recovered from the acute phase of the brain trauma, but he may never get back to normal.


 


He doesn’t have some of the cognitive capabilities he used to have. He can’t, for example, immediately recall numbers, such as age or quantity. Ask him his own age, and he can’t answer until he first counts 40, 50, 60, 70, 71, 72, 73.


 


His short-term memory is poor. He might forget where the TV remote is, whether he turned off the stove or where the newspaper he’s reading is. (He can’t manage reading a book yet.) He still has trouble to recalling specific words or places, such as the cities where his children and grandchildren live.


 


“I’ve had to recraft myself,” he said. “And that means learning how to do basic things again — and accepting that I’ll never be able to do some things I used to do ever again.”


 


Keeping Active And Keeping Perspective


 


What Bob does do is stay active. He’s taking golf lessons to regain some of his former prowess. He plays about once a week now, and sticks to 9-hole courses, since he tires easily and finds it impossible to make par on par-5 holes. He’s taken up rowing and hopes to further challenge himself by switching from doubles to singles.


 


While his brain recovers and he works on his physical fitness, he’s also keenly aware of two other areas that need healing: his emotional and social life.


 


Sue and Bob both want to share what they’ve learned from this experience.


 


First, Bob’s list of five realities he wants other stroke victims and their loved ones, friends and colleagues to understand:


 


Expect your life as you knew it to end. You must begin a new life post-stroke without trying to go back totally to your old one. You won’t be able to simply pick up where you were before the stroke. “You and your family and friends will have to work together to make this happen,” he says.


 


Expect to lose your full independence. This means no driving, even with someone else in the car. You may have to give up being alone for extended periods of time. You’ll also have to have someone accompany you for walks and activities. If you’re used to solitude, this may be jarring, but it’s a necessary safety precaution.


 


Expect to lose some friends and gain some others. While people will be kind overall, others, even close friends, may be uncomfortable with someone who’s in some way disabled. Be patient. For some people, the awkwardness creates a rift; they may not know what to say or how to behave around you, and/or they may have trouble managing their shock or sadness at your new limitations. If these people come around, great; if they don’t, that’s the way it goes. Accept it, don’t dwell on it and focus on finding new friends.


 


Keep focusing on improvement. Even after a catastrophic brain injury, the body still can recover. Can you recover everything? No, but it’s up to you to do the best you can, to be the best person you can be and keep pushing to improve. “I don’t know how much better I can get, but I’m cool with that,” Bob said.


 


Think of your caregiver. It’s natural for anyone recovering from a serious medical emergency to be self-absorbed. But it’s especially important to be considerate of the loved ones who are also deeply affected by your situation. Bob puts it this way: “I’m not in this by myself. I’m in this with a partner who’s incredibly caring, and I don’t want to compromise her position in this life. I want to be a contributor, and in order to do that I have to respect her wishes. I must be gentle with myself and with her, and that means fighting the frustration (and often anger) when I can’t remember how to do common things, like take my pills. I have to make up for the fact that I’m hard to live with when I’m acting or reacting badly.”


 



 


Now, Sue’s four tips for partners and caregivers of people who’ve suffered a stroke:


 


Don’t delay calling 911 if you even suspect someone is having a stroke. Know the symptoms (see below) and be vigilant.


 


Expect your life to dramatically change. You will have new responsibilities, such as scheduling care (if there’s a paid companion or home care worker) and managing transportation. You’ll have to take over some of the responsibilities your partner used to shoulder — from handling family finances to managing home maintenance. “You’ll need to be really organized, especially if you’re still working,” she said.


 



 


Develop a new long-term strategy to take care of yourself. Don’t get lost in the caregiving, which can easily get overwhelming. It’s too easy to realize weeks later that you have had no time to yourself. See your friends. Take regular breaks. Take care of your health. You’ll need energy and stamina to take care of a loved one (and yourself) in newly difficult circumstances.


 


Let your family and friends help. Be honest with them about how they can help. There is nothing to be embarrassed about. They will be happy to step in periodically in small and large ways. The Seiters are progressing, inventing solutions and tackling limitations one day at a time. They’ve just gotten a puppy named Oliver who will, with training, become a service dog for Bob. Oliver will even be able to find the TV remote.


 


Stroke Symptoms


 


Likely symptoms of stroke, according to the American Stroke Association:


  • Sudden face drooping

  • Sudden numbness or weakness of the leg, arm or face

  • Sudden confusion or trouble understanding

  • Sudden trouble seeing in one or both eyes

  • Sudden trouble walking, dizziness, loss of balance or coordination

  • Sudden severe headache with no known cause


If someone you know shows any of these symptoms, immediately call 911 or emergency medical services.


For more information, visit the American Stroke Association.

 


© Twin Cities Public Television – 2015. All rights reserved.


 

Best Steps to Plan for Health Costs in Retirement

This expert says pre-retirees need to rethink the way they save and invest


By Peter Stahl for Next Avenue


 


Prescription pills on money


Credit: Thinkstock


 


There is great concern among pre-retirees regarding the scope and cost of their health care during their retirement years. Anxiety leads to action, so as we consider the convergence of health care and financial planning, let’s take a look at the most important steps to take.


 


Estimate Your Retirement Health Costs


 


It is critical to estimate the overall cost of health care during your retirement years. This involves starting with an accurate number and using an accurate inflation rate; too many articles on this topic provide an annual cost figure without explaining that the estimate is only for a portion of your overall cost.


 


To approach the estimate comprehensively, think of your costs in two categories: routine medical costs and custodial care costs.


 


Routine out-of-pocket costs will include Medicare premiums (Medicare benefits begin at age 65), Medigap premiums and uncovered expenses. Leaving out any of these areas from your financial plan will lead to underestimating your overall cost. Most financial advisors have tools to calculate these costs. For example, Jester Financial Technologies estimates that a 65-year-old will spend approximately $6,000 to $9,000 for them in 2015; most Americans are closer to the $6,000 side. Keep in mind that the higher your taxable income, the higher your Medicare premiums.


 


Also, remember that health care inflation is historically well above the overall inflation rate. A 6 percent annual inflation rate is realistic for routine medical costs, based on historic rates.


 


Planning for custodial care is beyond the scope of this article, but a few thoughts are warranted. The national average for nursing home care is approximately $90,000 per year and in-home care is close to $70,000. Since paying for those costs out of savings is not possible for most Americans, funding a long-term care insurance policy or hybrid policy is the ideal solution.


 


Change Your Saving and Investing Approach


 


The next step is to plan for health costs in retirement is to change your traditional approach to saving and investing during your pre-retirement years.


 


Since the amount of your annual Medicare premiums is determined by your taxable income, it is important to accumulate assets in accounts that will provide a tax-free cash flow.


 


A new law will trigger higher Medicare Part B &D premiums for individuals with incomes between $133,500 and $214,000 starting in 2018. As Mark Miller wrote on Next Avenue, those with incomes of $133,000 to $160,000 would pay 65 percent of total premium costs, rather than 50 percent today and people with incomes between $160,000 and $214,000 would pay 80 percent, rather than today’s 65 percent.


 


Consequently, it’s now even more important to create sources of tax-free income in order to prevent an increase in your Medicare premiums.


Two good ways to do this: Roth 401(k) and Roth IRA accounts. Income from either type during retirement is free from taxation.


 


If your employer offers a Roth 401(k) option, use it instead of the traditional 401(k), even though you won’t be able to deduct your contributions. (Over 50 percent of employers offer Roth 401(k)s but fewer than 10 percent of employees use them.) Since the income from a Roth 401(k) during retirement won’t be taxable, that money won’t push you into owing higher Medicare premiums.


 


And if you qualify for a Roth IRA (income below $193,000 if you’re married and filing jointly; below $131,000 if you’re single), contribute to one and use your catch-up provisions as you approach retirement. The catch-up rules let people 50 and older contribute up to $6,500 to a Roth IRA in 2015, compared with the $5,500 limit for those who are younger.


 


Work with your financial adviser and tax professional to convert appropriate levels of existing IRA assets into Roth IRAs. This involves paying current taxes on the amount converted in order to enjoy tax-free income during retirement; that tax-free income won’t push you into paying higher Medicare premiums. The income limits that prevent some individuals from making a contribution to a Roth IRA do not exist for Roth conversions.


 


You might also consider using a Health Savings Account (HSA) if you have a high-deductible/HSA eligible health insurance plan. HSA contributions are tax-deductible, earnings are tax-free and distributions for qualified health care expenditures are tax-free. Use the HSA as a long-term investment account you can tap in retirement to help cover health expenses.


 


Based on 2015 HSA contribution limits, a 50-year-old couple who makes puts in the max of $6,650 and earns 8 percent on the money would accumulate approximately $200,000 by age 65. When you reach retirement, why not pay your Medicare premiums with tax-free cash flow from your HSA account?


 


Lastly, consider funding an annuity from money that’s not in your IRA or employer-sponsored retirement plans. Many retirees go through periods where their income exceeds their expenses and an annuity lets you reduce taxable income during those periods by deferring taxes on its investment earnings.


 


In addition to the enormity of its cost, health care will be one of the only mandatory expenses you have in retirement. Traditional approaches to financial planning should be modified to best prepare for them.


 


© Twin Cities Public Television – 2015. All rights reserved.


 

Making Sense of Person-Directed Care

Roberto MuñizWritten by Roberto Muñiz

President and CEO

Francis E. Parker Home



With so many of us looking at options for senior care and services, whether for ourselves or a loved one, you may have heard the terms “person-directed care” or “person-directed living.” While it sounds pretty straight forward, what does it really mean?

 

Person-directed care encourages and empowers care partners to help elders and others needing support make decisions about how they want to live, wherever they call home. Whether Assisted Living, Skilled Nursing, or in the community – it is about having personal wishes expressed and heard – and every effort being made to incorporate those desires into one’s daily life.

 

At its foundation, person-directed care means providing care and services that support the individualized needs and preferences of those we serve. This model is based on core values including:

  • Choice

  • Dignity and respect

  • Privacy

  • Self-determination and control

  • Purposeful living


It can be as simple as asking someone if they need assistance before offering it; providing an option for a favorite food in place of a traditional dinner; or ensuring the television is tuned to a particular program. A good care partner learns about someone’s preferences first and then acts on that information.

 

For most of us, we practice our own “person-directed living” by choosing our own pleasures and preferences of daily life, from eating our favorite breakfast cereal whenever we want to choosing our preferred radio station. But for those in need of assistance, their pleasures and preferences may be overlooked in the many demands of providing care.  

 

While the options and opportunities for senior care and services continue to expand rapidly, we must always be mindful of who we are serving and how we affect their quality of life. Person-directed care can help us do just that by supporting elders in expressing choice and making decisions that are meaningful in their daily life. And isn’t that what we all want?

How to Create Meaning in Dementia Care

Everyone deserves to feel needed and have a sense of purpose

By Mike Good for Next Avenue



The hands of an older and a younger woman

Photo Credit: iStock


 


One of the most important things to a caregiver of someone with Alzheimer’s is to know their loved one is happy. However, they are often so overwhelmed by the responsibility of caregiving, that the fun of being together is lost.


 


All engagement tends to be for survival and not for enrichment. This often results in a negative atmosphere affecting the mood of everyone, including the person with Alzheimer’s. Left unchecked, the resulting tensions will often lead to behavioral issues from both individuals.


 


Slipping Away


 


Unsure how to even act around each other, the care partners (the person with Alzheimer’s and his or her caregiver) may fall into a world of isolation. They may worry about what others think or feel their situation is unlike others’. They can become so uncomfortable that they may withdraw from family, friends and society.


 


Changing these tendencies is important to the health and well-being of both individuals because meaningful human interaction, whether in a one-on-one situation or in a group setting, is important to everyone’s happiness.


 


Finding Happiness


 


With Alzheimer’s disease, it’s important that engagement is adapted to meet the changing needs of the individual while focusing on the things that enrich the person’s life and bring happiness. For this to work, the caregiver must accept how things are now and discover ways to incorporate meaningful activities on daily basis.


 


While a caregiver will routinely look back at how things were, it’s vital to appreciate that the person with Alzheimer’s is the same person as in the past. It’s the disease that’s making the individual act different, and typically, the same things will still bring happiness to his or her heart.


These men and women still want to be included in activities and to do things for themselves. To continually foster this throughout the disease progression, the caregiver needs to provide subtle assistance when appropriate and remain creative in identifying ways to help maintain the confidence and independence of the individual.


 


Purpose and Confidence


 


The Best Friends Dementia Bill of Rights states that every person diagnosed with Alzheimer’s has the right “to experience meaningful engagement throughout the day.” Whether this engagement is activity or socially based, it’s always important to empower the individual to be successful.


 


For instance, if the person is having a conversation with a friend but can’t remember a detail, subtly filling in the missing fact can help. Or if he or she is searching for the peanut butter to make a sandwich, placing it on the counter might reduce any agitation.


 


Enrichment


 


Keeping a loved one involved with meaningful activities rather than sitting him or her in front of a television for hours generally results in fewer behavioral complications. It also leads to more meaningful engagement and enriched lives for both individuals.


 


Whether it’s refolding the same basket of clothes several times or helping prepare dinner, the caregiver must remain creative in finding ways that create purpose and enrich a loved one’s day.


 


This responsibility creates a lot of pressure on the caregiver, so let’s not forget that every caregiver also deserves meaningful engagement on a regular basis. Helping the caregiver find time to step away and engage with other people will also help protect their well-being; meaningful engagement is important for all.


 


© Twin Cities Public Television – 2015. All rights reserved.


 

4 Things to Do When Your Parents Are Resisting Help

Taking these steps can reduce frustration and stress — for all of you


 


By Dr. Leslie Kernisan for Next Avenue



Older woman looking at hand mirror


 


“Doctor, my mom needs help, but she won’t accept it and she won’t listen.”


 


Sound familiar? It’s a complaint I hear all the time from families worried about older parents and aging relatives.


 


And it’s a very real issue that we must address. For better health and wellbeing in older adults, it’s not enough to identify the underlying health and life problems — although that is a key place to start.


 


Because even if you’ve correctly identified the problems and learned how the experts recommend managing them, older parents often seem, well, resistant. Understandably, this causes families a lot of frustration and stress.


 


Here are four actions I always recommend that families take when older parents are resisting help.


 


1. Consider the possibility of cognitive impairment


 


In other words, is a problem with brain function contributing to this resistance?


 


Now, let me emphasize that you should not assume that your parents are in their wrong mind just because they are making health or safety decisions that you don’t agree with.


 


That said, because it’s very common for the brain to become vulnerable or damaged as people age, decreased brain function is often a factor when an older person resists help. This can affect an older parent’s insight and judgment and can also affect how well they can process your logical arguments.


 


It’s important to spot such cognitive impairment. Some of the impairment is often reversible. For example, older adults frequently develop delirium when ill or hospitalized, and an older person may need weeks or even months to recover to their best thinking abilities. Cognition can also be dampened by certain conditions, like hypothyroidism, or by medication side effects.


 


In other cases, the problem is underlying dementia such as Alzheimer’s. Sometimes it hasn’t yet been properly recognized or diagnosed. Or it may be that a senior has been diagnosed with early dementia, and the challenge is figuring out whether it’s progressed to the point at which it’s a major factor in resisting help.


 


What to do: Get help spotting underlying cognitive problems. You can help a parent’s brain function at its best by avoiding brain dampening medications and encouraging a restorative low-stress environment. If your parent is cognitively impaired, you may need to get help assessing decision-making capacity. And avoid relying too heavily on logical arguments if signs of impairment are present.


 


2. Make sure you’ve heard and validated your parents’ emotions


 


Here’s something you may have noticed in your own life: Logical arguments often fail to convince the people we have emotional relationships with. This is true even when they are younger and presumably have good mental faculties.


 


That’s because people are not rational about many things, especially when it’s an issue that stirs up certain emotions in them. And issues that touch on aspects of our identity, self-worth and autonomy – all of which come up when we’re concerned about older parents — are especially prone to trigger emotional responses.


 


All people care about having their emotions validated. People also want to feel connection, love and self-worth.


 


Whether or not your parent might be cognitively impaired, it is crucial to remember this. In fact, if there is potential Alzheimer’s, it can be even more important to help a parent feel heard and validated because this will reduce stress and help the brain function better.


 


What to do: Try to understand the emotions your parent might be experiencing, and use active listening to help your parent feel heard. You may need to invite your parent to share his or her feelings by saying something like, “I really care about you, and I’d like to make sure I understand more about what you’ve been feeling about this situation.” If you can afford it, consider investing in a few sessions with a relationship therapist or another person trained to facilitate family conversations. It can be especially productive to work with someone experienced in helping families address aging issues, like a geriatric care manager.


 


3. Review your parents’ goals and what trade-offs they might be willing to make


 


As families and doctors, we often prioritize safety and longevity. In other words, we want to prevent falls, injuries, illnesses, new medical problems and catastrophes of any kind.


 


We also usually want our older parents to live as long as possible. Perhaps we can’t bear the thought of being without them. Or it might seem wrong to not want a person to live as long as long as they can. Furthermore, it often seems like our parents want to live as long as possible.


 


But here’s the thing. For most older adults, the goals of safety and longevity bump up at some point against the goals of autonomy and independence. Most conflicts that older adults have with their families end up revolving around this dilemma.


 


Unfortunately, there is usually no easy answer to this question. Once an older person becomes more vulnerable in body or mind, you cannot have perfect safety as well as perfect independence.


 


But when the trade-offs are identified and goals discussed, it’s usually possible to help everyone feel better.


 


Common goals that I hear from my older patients include:


  • Living in their own home for as long as possible

  • Dictating the terms of their daily life

  • Living their usual life for as long as possible

  • Minimizing pain, illness and suffering

  • Spending quality time with family and loved ones

  • A good quality of life, which generally means more enjoyable activities and fewer stressful or burdensome activities


Safety is important, but don’t fall into the trap of assuming it should always be your family’s No. 1 priority. Because when faced with a trade-off between safety and autonomy, most older adults choose autonomy.


 


This is especially true of people with dementia. And even though they may have lost the insight and judgment abilities needed to properly weigh the risks, their preference for independence is still very important for optimizing their quality of life. In fact, an approach called “positive risk-taking” is now being advocated as a way to make communities more dementia-friendly.


 


What to do: Ask your parents to discuss their goals regarding medical care and their living situation. You will want to have a frank talk with the doctors beforehand to ensure your parents understand their health problems and what declines or crises they should plan for. Be sure to talk about the pros and cons of the available options, and try to find out what kinds of trade-offs your parents might consider acceptable.


 


Remember, most families eventually face a trade-off between safety and independence. Being Mortal, by Dr. Atul Gawande, is a good book that explores how several families, including that of the author himself, navigated these dilemmas.


 


4. Distinguish what you need from what your parents need


 


When we get anxious about our parents’ safety, or their reluctance to accept help, what is it we really need and want? What fear or desire is driving us?


 


I try to explore this with families when there’s conflict or resistance because I find it helps untangle sticky situations. Some common underlying issues include:


  • A need to minimize guilt

  • A fear of conflict with other siblings

  • A fear that a parent is going to decline further and require more help

  • A desire to know that a parent is happy and comfortable

  • A desire for control and for knowing what will happen next

  • A fear that what is happening to our parents might eventually happen to us


People being people, we all have a tendency to try to address our needs by wanting other people to do something differently, or by trying to keep things from changing.


 


But as the relationship experts have been telling us for decades, the best approach is to accept that things change and to focus on what we can do differently. We shouldn’t try to meet our own needs by controlling what others do.


 


What to do: List your fears, frustrations, desires and goals regarding your parents’ well-being and health. Notice the ways in which they are distinct from what your parents’ own fears and desires might be for themselves. Look for ways to address your fears and desires while respecting your parents’ preferences. This often means giving up the idea that your parents have to do this or that. Relationship counseling can help.


 


There Are No Silver Bullets


 


Now, I won’t sugarcoat this. Even when you get informed, are thoughtful in your approach, and obtain the right kind of assistance, helping older parents through this stage of life will be a challenge. Of course you will worry about them. And they will probably never be entirely free of reluctance to make changes and accept help.


 


But over the years, I’ve seen that some families get stuck in a rut of conflict and frustration, whereas others find ways to move forward more constructively.


 


It might feel like an extra effort to do these things. But by investing in your ability to better navigate these difficult situations with your parents, your family will get closer to what we all want: less stress for ourselves and better quality of life for our parents.


 


Photo Credit: Thinkstock


 


Copyright© 2015 Next Avenue, a division of Twin Cities Public Television, Inc.

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