We all have heard the comments for many years and toward a variety of matters….’Bigger is better’; ‘Think big’; ‘Go big or go home.’ There is no question that big can be best – depending on the situation being addressed – but an equally compelling argument can be made for something less than the biggest. Take for example the matter of senior living. In Atlanta, many seniors find advantages in large, complex residential communities. Those Assisted Living communities certainly offer many attractive benefits for those wishing to reside in a larger community. On the other hand, there are great advantages in living in smaller home environments with personal touches.
The question these seniors and their families must ask is whether or not these smaller residences can meet their needs and offer amenities scaled to their requirements. Can big things be found in small packages?
For many Atlanta area residents, the answer is a resounding yes, as more and more seek the benefits of a move into a Residential Personal Care Home.
In Georgia, a Residential Personal Care Home is an adult residence that provides protective care and watchful oversight of seniors who desire to maintain an active lifestyle but need some degree of supervision and assistance with daily personal needs. Residential Personal Care Homes provide housing, meals and assistance with daily living activities for one or more non-related seniors. The homes typically house between 2 and 10 residents who rent private or shared bedrooms but have access to the entire house.
So who would likely benefit by such a residence?
Residential Personal Care Homes work well for those who can no longer maintain independent living, who need some level of supervision, require some assistance with personal care, are in need of assistance with medication management or have physical or cognitive impairments. The last is of particular importance as many Residential Personal Care Homes provide a program of dementia care as the need arises.
For many, Residential Personal Care Homes offer advantages that the larger communities may not be able to match. Since the homes are smaller with fewer residents per building, the resident receives more hands-on care and personal attention since the caregiver to resident ratio is higher. These homes are often converted family homes found in residential neighborhoods that offer a more ‘homelike’ atmosphere that include a living room, dining room,a patio as well as more opportunities for social interaction with the owner, staff, other residents and their families, pets, and the neighborhood at large.
Residential Personal Care Homes are generally less expensive than other types of senior housing. The cost per month in a Residential Personal Care Home depends on the location of the home and the services required by the senior and can range from approximately $1500 a month for a shared bedroom to more than $3500 a month. Many Atlanta area seniors with a limited amount of financial resources find these homes and their costs in line with what they are seeking.
For those with anticipated memory care needs, many Residential Personal Care Homes specialize in memory care through the design and layout of the home, the education and training requirements for their staff, and the special programs and activities afforded their residents.
With smaller residences, seniors often express a higher degree of satisfaction with their sense of control, privacy, and independence in making choices and decisions.
One key question seniors and their families need to ask prior to any move to a senior living option is what happens when the senior is no longer able to care for themselves? Residential Personal Care Homes offer the opportunity to ‘age in place’ with continuity of staff and residence; this helps avoid multiple relocations and reduces stress.
Before any move to a senior living residence, the senior and his or her family should contact Atlanta Senior Advocates. Advocates have the most up to date information on residential personal care homes and the levels of care they can provide.
Big can be good, but for many seniors, small can be better. A move to a large or small senior residential setting is a decision that must take into consideration a number of factors such as cost, location, needs, amenities and the overall feel of what would work best for the senior.
“Life is a highway.” To most drivers, there is more to this Tom Cochrane tune than meets the ear; being behind the wheel is essential to living an independent, self-sufficient and adventurous lifestyle. However, as we age and especially as we move into our ‘elder’ years, safe driving begins to take on new challenges.
Accidents on the road happen at any age. However, according to the Insurance Institute for Highway Safety, elderly drivers experience higher rates of fatal accidents based on miles driven, more than any other group with the exception for of young drivers. In large measure, the result for this high fatality rate is that elderly drivers tend to be more frail and generally do not survive severe auto accidents. Coupled with diminishing eyesight, reflexes, hearing and judgment, many elderly drivers are primed for a major incident on the roadways if they do not modify their driving habits. Some do. But what about the others who refuse to make a change? How do families approach this delicate subject with an elderly driver…is it time to ask for the keys?
Elderly driving statistics.
Recent studies have challenged the notion that elderly drivers are more likely to be involved in auto accidents. In 2014, the Insurance Institute for Highway Safety’s Highway Loss Data Institute issued a report showing that between 1995 and 2012, older drivers were less likely to be involved in a fatal crash. Safer vehicles and improved senior health were cited as key factors in the decline. While the trend is significant, the sobering fact remains that older drivers continue to have higher rates of fatal crashes than any other age group.
When viewed by miles traveled, the risk of fatality caused by an auto accident increases at 70 to 74 years of age according to the IIHS. The statistics also show that elderly drivers are more likely to be involved in certain types of accidents and less likely in others. For example, elderly drivers are less prone to be involved in drunk driving or bad weather accidents but more likely in situations involving left-hand turns while crossing oncoming traffic. This may be attributed to weakened eyesight, slower reaction time and reflexes needed to gauge the timing of oncoming vehicles.
The statistics and research are of little consolation to families who are worried that their elderly loved one may cause or be involved in an auto accident due to diminishing abilities. The concern grows exponentially; the U.S. Census Bureau estimates that the population 65 years of age and older is expected to exceed 82 million by 2050, nearly twice that of the 2012 level. Thus, more families will be faced with similar dilemmas.
It is important to note that driving requires a set of skills, clarity of mind and judgment in order to safely get from point A to point B. As we grow older, the physical and mental changes that often accompany aging can impact these capabilities. Such changes include:
- Diminished vision and hearing
- Reduction in response time
- Loss of muscle strength and dexterity
- Loss of capacity to concentrate
- Reduced alertness due to medications
Taken individually, none of these equates to removing the keys but each capability needs to be carefully monitored as it pertains to the elderly driver’s ability to remain safely behind the wheel.
How do we stop elderly driving accidents?
So what practical steps can families take now and into the future to reduce the risk of their elderly loved ones causing or experiencing an auto accident?
Many experts believe one of the best things families can do when they suspect diminishing driving abilities is to take short periodic drives trips with the elderly driver to gain a first-hand experience with their driving habits and/or abilities. Some of the tell-tale clues to reduced capacity in driving include:
- Difficulty with traffic signs or signals; difficulty reading them
- Driving at inappropriate speeds
- Difficulty in using brake or gas pedals or confusing the two
- Close calls with other traffic; near misses
- Frequently getting lost or confused on roads
- Slow responses to traffic situations, pedestrians or cyclists
- Drifting across lanes
- Difficulty concentrating or becoming easily distracted
- Scratches, dents noticed on the vehicle or garage
- Difficulty using rearview or side mirrors or simply not using them
- Multiple traffic citations
Suppose you observe one or more of these cautionary signs with an elderly driver.What do you do?
Your checklist should start with these questions:
- When was their last physical examination by their physician? Were their reflexes tested and were conditions discussed that might impede driving?
- Were there any falls in recent months? Any difficulty walking or climbing stairs?
- Is the elderly driver on any medication or set of medications that might cause drowsiness or fatigue?
- When was the last time their vision and hearing were tested?
Answers to the questions above may point to issues that if resolved medically, might contribute to stabilizing driving habits and capacity. Once these are addressed, return to your observations during the ride-along trip and address them promptly, do not procrastinate. Given the consequences, it is worth your time and the safety of your elderly driver as well as others to sit down and gently begin reviewing what you observed.
How to talk with elderly drivers.
It is important to plan how you will discuss your observations or issues involving the elderly driver. A word of caution, it will take several discussions, not one, as this issue is an emotionally-charged matter and one the elderly driver may not immediately grasp or agree with. David Solie, a recognized thought leader on the psychology of aging, author of “How To Say It To Seniors: Closing The Communication Gap With Our Elders” notes that elders will fight for control since at this stage of their lives they are losing control over many other facets of life. Depression, isolation, and loneliness are likely to be brought up. To them, giving up driving means changing where and when they go, who they see, and possibly where they live in addition to other significant lifestyle changes.
Broaching the matter requires tact, an appropriate space and time, and respect for the elder and their right to make decisions. Asking questions such as, ‘Are you experiencing any difficulties while driving?’ or ‘I noticed you are having some problem seeing well at night, how is your driving after dark?’ These will help open up the discussion without putting the elderly driver in an uncomfortable position or causing them to become defensive. As the discussion moves forward, your best approach is to help the elder express their concerns. Acknowledge that they are probably concerned about what giving up driving would mean but perhaps there are measures to be taken to reduce the current risk. Some families have suggested the following:
- Drive during day hours only and on familiar routes
- Don’t drive alone
- Don’t drive on freeways; take local streets
- Take a safe driving course; AARP, automobile clubs and commercial driving schools offer courses
- Set up a schedule for taking public transportation
- Arrange with family and friends to transport the elder on specific days
- Exchange old interests for new ones that do not require driving
- Show the positive financial results of not driving -no car insurance, maintenance costs, etc.
- Suggest relocation to an assisted living community where most needs including transportation are met; hire in-home care and access other resources to provide the services usually obtained out of the home.
For many families, a genuine, frank discussion with multiple alternatives to self-driving works very well. There are, of course, elderly drivers who will refuse any alternative and refuse to give up the keys. If the person is a danger to themselves and others on the road, the process will be more difficult. States allow for ways to report individuals to the Department of Motor Vehicles which may result in retesting or a formal communication with the elderly driver. Family physicians have been asked to talk with the elder about driving. Family interventions have been initiated that force the senior to drill into the denial. Taking the keys, disabling the vehicle, relocating the vehicle, and other measures have all been used as efforts to eliminate the risk on the road.
It can be a complicated and wrenching process, but one that must be taken to protect lives and the life of the elder. If done responsibly, the elder can adapt to changes with the support and firm resolve of the family.
We are taking a walk…2.4 miles to be exact…that’s about 4500 steps. It’s not a marathon or sprint race and there is no major prize money and no resort trips. We are not doing it because our physicians told us to get more exercise and not because we want to fit better in our fall and winter clothes. A little more than two miles may seem insignificant, but for many people concerned about Alzheimer’s disease, those two miles could be the path to a cure.
At 9:30am, September 26th, at 3100 20th Street in Atlanta (Atlantic Station, Pinnacle Lot) Atlanta Senior Advocates along with hundreds of other supporters will put one foot in front of the other and participate in the Alzheimer’s Association 2015 Walk to End Alzheimer’s.
This walk is the world’s largest event to raise awareness for the Alzheimer’s Association and funds for its education programs, counseling, support groups, 24 hour Helpline and research to find a cure. Atlanta is one of 600 communities across the country to tie up its laces and ease on down the road to underscore the need for resources to combat Alzheimer’s, the nation’s sixth-leading cause of death.
Some ask why we are involved in this endeavor.
Of the 5.3 million people in the U.S. with Alzheimer’s, 5.1 million are age 65 and older and of this number 3.2 million are women (that’s 2/3rds!) and 1.9 are men. The number of Americans with Alzheimer’s disease and other dementias will increase each year as the population 65 years of age and older grows. In ten years, the number of people age 65 and older with Alzheimer’s is projected to be 7.1 million. This year alone, nearly 700,000 people age 65 and older will die with Alzheimer’s; it is the only disease among the top ten causes of death in America that cannot be prevented, cured, or slowed.
The disease also takes a devastating emotional and physical toll on caregivers. According to the Alzheimer’s Association, nearly 60% of Alzheimer’s and dementia caregivers rate the emotional stress of care giving as high or very high and 40% suffer from depression.
Alzheimer’s is one the costliest chronic diseases in the country. Nearly 20% of Medicare dollars is spent on people with Alzheimer’s and other dementias.
Need we say more? The Walk to End Alzheimer’s is a national movement to reclaim the future for millions of people. The event offers a unique inspirational environment as friends and loved ones living with Alzheimer’s are recognized, honored and remembered. Donations may be made as a tribute or memorial donation, a general donation, a monthly donation, or you can donate to a walker; http://www.alz.org/join_the_
It may be one small step for us, but it can lead to a giant leap forward for millions.
When decisions are required that affects a senior’s living circumstances, finances, safety, or long term care, it can be a difficult and confusing process for caregivers and families. Everyone involved has an opinion or suggestion that, while well-intentioned, only compounds the dilemma.
To assure a proper solution that addresses the need, protects the senior, and satiates decision-makers, professional legal help is often the best answer. With so many law firms in greater Atlanta, it is important to find the right type of attorney who understands issues impacting seniors. The area of legal practice which is specifically focused on senior matters is elder law.
What is Elder Law?
Many people are unaware of this relatively young law practice specialization. Its genesis has roots in the passage of the Older Americans Act in 1965. Funding from this Act lead to a range of legal programs and services designed to assist older people. In 1978, the American Bar Association formed what is now known as the Commission on Law and Aging whose mission is to “strengthen and secure the legal autonomy, quality of life, and quality care of elders.” The Commission studies a spectrum of issues that include legal challenges for older citizens, housing and benefits, guardianship, age discrimination in the workplace, elder abuse and more.
In the early 2000s, the baby boomers began announcing their retirements. As this segment of society exploded, so too their issues and concerns with such items as medical care, estate protection, wills, health insurance among others. From these early events, the practice of elder law has assumed a higher profile yet the law surrounding these types of cases remains largely unsettled. This may be due to the fact that this new, older, more diverse population is quite different from preceding generations – its issues numerous, its challenges unrelenting and its numbers increasing, and with it – viable political clout – to articulate its needs and demands.
What Issues do Elder Law Attorneys Handle?
Elder law has become an active division in many law practices in Atlanta and around the country, largely due to the expansive issues that seniors and their caregivers are taking to them. It is not uncommon for an elder law practice to help a 60 year old with an age discrimination issue at work, a 65 year old with a Medicare coverage problem, a 73 year old with estate planning, a 91 year old with a nursing home matter, and others. Among the many issues that elder law attorneys address for older people includes:
- Financial representation including income, taxes, estate, housing and financial planning
- Power of attorney, living wills, advanced care planning
- Rights of residents of long term care facilities
- Wills, trusts and probate
- Employment and retirement
- Asset protection, Medicare/Medicaid, Veteran’s Benefits
- Guardianship and Conservatorship
Elder law attorneys bring not only an expertise in the law, but perhaps just as important they bring an understanding of the aging process, sensitivity and an awareness of the senior population’s needs, limitations, and difficulties. Their broad knowledge often makes them more prepared to meet the specific needs of an older person. This includes a thorough knowledge of community resources and senior advocate networks who augment the work of the attorney so that a comprehensive solution is achieved that addresses all relevant concerns. For example, when an attorney is working with the family of a senior on estate planning, they may also bring in Atlanta Senior Advocates who will help the family plan for a move into an assisted living community for the senior or help identify a home care provider when the need arises.
What to Look for in an Elder Law Attorney?
Most any lawyer can call themselves an elder law attorney; there are more than 10,000 lawyers across the country using the term ‘elder law’ or ‘elder care law’ in their practices. Caregivers and families should exercise caution in selecting an attorney to help with legal matters involving older loved ones. Aside from asking questions like how many years have they practiced elder law, what results have they had in such cases, references from former clients etc., caregivers can ask about professional credentials and certifications. Some lawyers have earned the designation Certified Elder Law Attorney (CELA), having successfully completed additional competencies set forth by the National Elder Law Foundation. The criteria for certification include:
- The attorney must be licensed to practice in at least one state;
- The attorney must have practiced law for at least 5 years prior to application and currently practicing;
- The attorney must be in good standing with the applicable bars in their locale;
- The attorney must have practiced at least 16 hours of elder law –on average – each week during the 3 years prior to application and have handled 60 elder law matters with a specified distribution among subjects during those 3 years;
- The attorney must have participated in at least 45 hours of continuing legal education in elder law during the preceding 3 years prior to application;
- The attorney must submit 5 references from attorneys familiar with their competence and qualifications;
- The attorney must pass a full day of examination that tests the attorney’s knowledge and skill in elder law
There are more than 400 Certified Elder Law Attorneys practicing in most states and major cities across the country…and this number is growing. That’s a good sign for seniors and their caregivers, but in and of itself it is not a guarantee of the kind of representation one seeks for a senior’s needs. There are many attorneys in elder law practice that may not have the CELA designation but who are very effective in addressing legal issues of this demographic. Atlanta Senior Advocates can recommend an Elder Care Attorney in your area that is certified and has an excellent track record.
You are becoming concerned. You see your loved one struggling to remember everyday people or places. They are moody, withdrawn, confused and unable to find simple words or do simple tasks. The diagnosis you feared may be around the corner – Alzheimer’s and Dementia. What do you do? What if your concerns and fears are confirmed? What about you?
Locally, we receive inquiries every week from family members who are challenged by similar discoveries. They see the changes taking place with their loved one but often deny the seriousness of the early signs and symptoms on display, preferring to believe that the person is ‘getting old’ or ‘forgetful at times’. But as the signs become more prevalent and frequent, people generally seek advice from their family, friends, their physician, or community resources.
Once the behaviors and mood of the loved one intensify and cause more concern, they become the focus of discussion and from there all attention is centered on the loved one’s changes and needs. As weeks and months roll on, more is demanded of you to care for your loved one to the point where your life is completely enveloped by the care you must provide.
It’s a common story, and a sad one. It is very difficult to watch your loved one regress and lose their unique persona but it is also sad that caregivers do not seek the help and relief they need during the stages of early onset Dementia and Alzheimer’s. Emotions, rationalizations, and just plain overload of work frequently take over and result in ‘mental blinders’ where the caregiver only sees his or her responsibilities to provide care, often to the disregard and neglect of their personal needs.
They fail to see their own physician, eat poorly, interact less with the outside world, and lose sleep…all contributing to a toxic buildup of stress that compromises the health of the caregiver. A study conducted by Stanford University (2002) concluded that 40% of Alzheimer’s caregivers die from stress-related disorders before the person they are caring for. While statistics vary over years, it is vitally important to plan for your well-being in order to survive caregiving.
Families who call us express a range of questions and issues when they suspect early signs of dementia. Understanding what dementia is and having a clear picture of the early signs of dementia enables families to process, seek treatment for the loved one, come to terms with their own feelings, and make plans for the months ahead.
So what is dementia?
According to the Alzheimer’s Association, dementia is not a disease but a term used to describe a group of symptoms associated with a decline in thinking, memory and communicating severe enough to reduce the person’s ability to perform everyday activities. Alzheimer’s is the most common and prevalent type of dementia, accounting for more than 60% of all cases. The second most common type is vascular dementia which occurs after a stroke. There are many other conditions that can cause symptoms of dementia, several of which are reversible and include thyroid problems and vitamin deficiencies. In order for a true diagnosis of dementia to be present, no less than two of the following primary mental functions must be significantly impaired:
- Visual perception
- Attention and focus
Many seniors have memory loss but that does not automatically equate to having Alzheimer’s symptoms or dementia.
Alzheimer’s is a terminal, progressive brain disorder that causes a slow, insidious decline in memory, communication, and reasoning. It robs the individual of all ability to think and interact and leads to disorientation, personality changes, and confusion with dementia usually setting in during the mid and late stages of the disease. There is no known cause or cure however symptoms can be managed through medications and treatments if detected early.
What are some early signs of dementia and Alzheimer’s?
Many experts in the field including the Alzheimer’s Association post the following dementia checklist:
- Changes in short term memory – trouble with remembering what happened this morning but recalling events from years ago could be a sign. Memory loss includes asking for the same information over and over, forgetting where they left something, forgetting why they entered a particular room. This is different from forgetting names or things but recalling them later.
- Problems with words in speaking or writing – the person may not be able to explain things the way they want, can’t find the right words, use wrong words to describe something, or may stop in the middle of saying or writing something and unable to continue.
- Changes in following a plan or in working with numbers – this includes problems with balancing a checkbook or following a recipe, difficulty concentrating and taking much longer to do simple things than before.
- Mood and personality changes – the person may seem depressed, fearful or anxious, become easily upset with people at home or in social situations or become outgoing when normally shy.
- Become apathetic – the person may seem to lose interest in people or social activities, become listless and not want to go out.
- Poor judgment – this may include giving money to people for poor reasons or letting one’s personal appearance go or not keeping clean.
- Losing the ability to recall where things are – an early sign includes the inability to remember where things are kept, putting items in unusual places, accusing others of stealing money or personal items from them.
- Difficulty doing normal tasks –people with early signs of dementia find it difficult to complete daily routines, drive, find a familiar location, balance a checkbook or follow rules of a game.
- Confusion – this includes an inability to remember faces, dates, or interact normally with others.
- Trouble with visual images/spatial relationships – vision problems may include difficulty with reading, judging distances, not recognizing their own reflection in a mirror.
With a better understanding of the early signs and onset of dementia and Alzheimer’s symptoms, family members can take action sooner to get medical evaluation for their loved one. At this time of examination and testing, families need to consider a plan of care not only for the individual with dementia or Alzheimer’s but also for the primary caregiver. Too often, this just does not happen.
Resources like the Alzheimer’s Association, family physicians, social workers and other professional entities point to this as a crucial step in the long term plan that is missed or neglected – How to care for the primary caregiver.
What to do when faced with a diagnosis?
We suggest that building a support system and a care partner network become one of the first things families do when faced with a diagnosis of Alzheimer’s or dementia with a loved one. It’s the plan that keeps on giving.
Caring for someone with Alzheimer’s or dementia is not something that can be done alone for an extended period of time without consequences. The Family Caregiver Alliance notes that a person who provides care for someone with dementia is twice as likely to suffer from depression as a person who provides care for someone without dementia. Dealing with the dementia-related behaviors contributes to the development of depressive disorders in caregivers, with women experiencing symptoms of depression at twice the rate of male caregivers.
Just like the flight attendants say before takeoff “Reach up and pull down your oxygen mask, place it around your mouth and nose and breathe normally, then assist others around you.” Caregivers need to take care of themselves – and have a plan in place for the long haul – in order to take care of others. You must find ways to ‘inhale oxygen’ – get your needs met – or you will be out of breath and unable to provide the care needed by your loved one.
- Talk it out with family members – once the diagnosis is confirmed, convene a family meeting and decide the roles of each member and what each person will contribute to the situation – time, money, food, tasks, all the things that will be needed going forward. This will eliminate feelings of anger, resentment and jealousy among family members and help focus everyone’s attention to what must be done for the patient and for the primary caregiver.
- Be honest – caregiving is not easy no matter how much help is present. Acknowledge that this situation is terrible (for the patient and the caregivers) and avoid suppressing your emotions about it; this will, at the very least, be good for your own mental stability.
- Devise a respite schedule – caregivers need breaks, lots of them over the long course of care. If family members and friends are unable to spell you some relief, look into paid help through in-home care agencies or volunteer organizations. Atlanta Senior Advocates offers assistance in locating respite care in assisted living communities and can be a valuable resource to families and caregivers.
- Read, Listen, and Learn – you need to know what lies ahead. Read materials on Alzheimer’s and dementia to understand more about the conditions so you won’t be caught blindsided. Find resources online; the Alzheimer’s Association has a Caregiver Stress Checklist that will help pinpoint resources to assist you; join a support group to learn how others in similar situations handle the various duties and find balance.
- Stay connected to the outside world – continue with a hobby, exercise routinely, visit with friends, attend events, see a movie…the world does not stop and remain the same when you shut yourself off from it. No amount of guilt or moral imperative to provide care 24/7 should override your need (and dare we say right) to seek harmony in your life.
All these ideas do not make you self-centered or selfish, uncaring or unkind.
They will help you become a better you and a better caregiver.
After all, isn’t that what’s best for you and your loved one?