Caregiving 101: A First Glance at Aging in America

Caregiving 101: A First Glance at Aging in America
It's old news that we are growing older as a nation, but only four in ten Americans, aged 40 to 70, know that 60 to 70 percent of 65-year-olds today will require long-term care services at some point in their lives.
There are more than 45 million caregivers for older adults. These are people who need information and support to make their lives easier.
Who Needs Our Care?
We need to be aware of our changing demographics.  Statistics today will quickly become personal realities -- affecting our families, friends and neighbors.

• The number of people aged 85 or older—those most likely to need long-term care services is expected to increase by 74 percent between 2007 and 2030. (AARP Public Policy Institute. Across the States 2009. Profiles of Long Term Care and Independent Living.)
• In the next 20 years, one in five people will be 65 or older and this population is projected to grow by more than four times as fast as the population as a whole. (U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2008).  And older adults are living longer, too.

The growing number of older adults will be trying to manage conditions like dementia, falls, diabetes, stroke and sensory losses. Thirteen percent of persons over the age of 65 have Alzheimer's disease. (2009 Alzheimer's Disease Facts and Figures, Washington, DC.  Alzheimer's Association.)
Older adults face an increasing need for transportation services. The average number of years a person continued to drive -- the driving expectancy -- was significantly less than overall life expectancy.

• Men and women who were still driving at ages 70 to 74 were expected to drive, on average, another 11 years. But these men were expected to live about 17 more years, and the women nearly 21 more years.

This gap between driving expectancy and overall life expectancy means men in this age group who stopped driving were dependent on alternative transportation for an average of six years. For women, the gap translated into about 10 years dependence on other transportation modes. (Foley, DJ, Heimovitz HK, Guralnik JM, Brock DB, "Driving Life Expectancy of Persons Aged 70 Years and Older in the United States," 'American Journal of Public Health,' vol. 92, no. 8 pp. 1284-1289.)
Who are Our Caregivers?

Caregivers are not just professionals. You are a caregiver if you provide social or physical support to an aging relative or friend or to a person with a disability.

• Family caregivers provide the overwhelming majority of long-term services in the U.S.,approximately 80 percent. (Thompson, L., Long-term care: Support for family caregivers [Issue Brief]. Washington, DC: Georgetown University, 2004 and Long-Term Care Financing Project, Long-term Care Users Range in Age and Most Do Not Live in Nursing Homes. U.S. Agency for Healthcare Research and Quality, November 8, 2000.)

The most common type of informal caregiving relationship is an adult child caring for an older parent.

• 1.4 million children ages eight to 18 provide care for an adult relative; 72 percent are caring for a parent or grandparent. (National Alliance for Caregiving and the United Hospital Fund, Young Caregivers in the U.S., 2005.)

The increasing number of older adults will put even more caregiving pressure on fewer middle generation adults.

• As the baby boomers turn age 85 between 2030 and 2050, the age 85+ population will skyrocket by another 118 percent. (U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2008)

The current nursing home facilities are ill-equipped to handle the growing number of older adults and this population will be more dependent on family for care.

• Current nursing home facilities are operating at an 88 percent capacity. (American Health Care Association, 2009).

We would rather ignore the statistics if we are not personally affected by them. But the truth is, it's happening sooner than we think,

• First baby-boomers will turn 65 in 2011. (Administration on Aging).

It's more common than we think,

• In the past 12 months, an estimated 65.7 million people in the U.S. have served as unpaid family caregivers to an adult or a child.

We don't have the information we need to provide the best care for our loved ones;

• 78% of caregivers feel they need more help or information about at least one of 14 specific topics related to caregiving.

And caregiving duties will most likely fall on you or someone close to you.

• Family caregivers provide about 80 percent of all long-term care services in the U.S. (Metlife Mature Market Institute, 2001).

Without the right supports and information, the current situation will affect:
Our Health

• Family caregivers experiencing extreme stress have been shown to age prematurely. This level of stress can take as much as 10 years off of a family caregiver's life. (Elissa S. Epel, et al. From the Proceedings of the National Academy of Sciences, Dec 7, 2004, Vol 101, No. 49).

Our Jobs
Most caregivers work either full or part time while providing care (59 percent). (National Alliance for Caregiving with AARP and MetLife, 2004 in addition to their caregiving responsibilities).

• Family caregivers comprise 13 percent of the workforce. In one study, 37% of human resource directors did not feel that their organizations made a real and ongoing effort to inform employees of available assistance for managing work and family responsibilities. (Wagner, D. and Neal, M. (2002). Working Caregivers: Issues, Challenges and Opportunities for the Aging Network. National Family Caregivers Support Program, Program Development Issues Briefs, Administration on Aging, DHHS. Galinsky, E. and J.T. Bond. (1998). The 1998 Business Work-Life Study. New York: Families and Work Institute).
• More than half of working caregivers (57 percent) say they have to go into work late, leave early or take time off during the day to provide care. (National Alliance for Caregiving with AARP and MetLife, 2004).

For some adults with heavy caregiving responsibilities, the impact on their ability to work is significant. Some working caregivers reported having to (17 percent), shift from full-time to part-time work (10 percent), quit work entirely (6 percent), lose job benefits (5 percent), turn down a promotion (4 percent), or choose early retirement (3 percent). (National Alliance for Caregiving with AARP and MetLife, 2004).
Our Finances
Over the course of a caregiving "career," family caregivers who provide intense personal care can lose as much as $659,000 in wages, pensions, and Social Security. (Dimensions of Family Caregiving: A Look Into the Future; Metlife Mature Market Institute, 2000).
And Our Economy.

• American businesses lose between $11 billion and $29 billion a year in reduced productivity costs related to caregiving responsibilities. This includes workplace disruptions, scheduled and unscheduled absences, leaves of absence, reduction from full- to part-time work, early retirements, and leaving work entirely to care for a loved one. (Metropolitan Life Insurance Company, 1997).

Next Steps

• Assess your loved one's medical, financial and transportation needs.
• Explore and discuss preferences in terms of care and living arrangements with the person you care for.
• Know there are resources, services and people to help. Visit www.easterseals.com/seniors to learn more.

http://www.easterseals.com/site/PageServer?pagename=ntl_adult_and_senior_services_caregivers_america

Providing Home Care for an Older Adult: A Good Fit?

By Kate Rauch, Caring.com senior editor

What to consider when an older adult needs daily care at home

When someone you're caring for begins to need daily care, one option is to set up systems to provide care in her own home. Whether this will work depends on many factors, including her health and your ability to give or hire care. The first step is to realistically review what's involved.

Will it work on a practical level for her to live at home?

• Start with a medical consultation. When an older adult needs daily assistance, start by consulting with her doctor about housing options. Be sure to ask how her needs could change over time, which may influence your decision.
• Home safety and accessibility. Her house may need adaptations, such as grab bars in the bathroom, handrails, and wheelchair ramps. Are these changes doable? Will stairs, stoops, and narrow hallways make getting around difficult or impossible if she uses a wheelchair or walker?
• Room for overnight caregivers. If she needs 24-hour in-home care, is there sleeping space for an overnight caregiver or room for another bed or large couch?
• Space for equipment or supplies. Does she have enough room for a hospital bed (bulkier than a regular bed), commode, oxygen tank, or other portable medical equipment if needed?
• Bathing. Because they're weak or have trouble balancing, some older adults can only bathe in a bathtub. Others need a freestanding shower stall with handholds. Can these adaptations be made?
• Proximity to you. Does she live close enough so you can assist with her care without long commutes? If she lives far away, can you manage -- and afford -- the traveling back and forth, or can you afford to hire a caregiver and possibly even a care manager?

Can you or she afford it?

• Will you need to cut back on your work hours? In some cases, managing home care in someone else's house is only possible if you, your spouse, or another caregiver leaves a job or works reduced hours. Can you afford this?
• Paid caregivers. Providing daily care often requires the help of paid caregivers, including overnight coverage. Factor this into your budget.
• Home upgrades or accommodations. Consider the costs of any needed remodels, safety-proofing, or accessibility accommodations such as wheelchair ramps.
• Distance. If the older adult lives far from you, take into account the costs of commuting and long-distance calls -- it might be worth buying an unlimited calling plan.

Do you have enough caregiving and emotional support to provide daily care to an older adult?

There's rarely one perfect solution for providing daily care. It boils down to weighing and balancing many factors to settle on the best option. Home care is challenging, but it can also be deeply rewarding. Caring for an older adult in her home is a great choice for some and simply not workable for others. Other options to consider include moving her into your home or into an assisted-living community.
Support considerations

• Caregiving support. Daily care requires hours of labor. Many people use a combination of family members, friends, and paid caregivers. Are you comfortable building and managing a network of caregivers? Do you have family members or friends who can pitch in and help on a regular or occasional basis, especially if you can't afford hired help?
• Outside caregivers in her home. Is she comfortable having paid "stranger" caregivers in her home?
• Overnight care. Will she need 24-hour care? If so, how do you feel about organizing this level of care? It can be especially tricky if you live far away, but possible if you have enough family friends or relatives and can hire some help.
• Breaks. All caregivers need time off, and sick days are inevitable. Any care plan should include backup for caregivers, including you.
• Emergencies or unexpected events. Obviously, an emergency is more challenging if you're not on the scene. If a caregiver suddenly quits or the person in your care has a medical emergency in the middle of the night, you'll need to have a plan in place. Apersonal emergency response system is also a good idea.
• Your daily routine. Can you adjust your routines to make enough time for daily care management if you don't have hired help? Do you have scheduling wiggle room; or are you OK with cutting back on your activities if necessary, including what you do for fun?
• Getting her out and about. Will she need to be driven everywhere, by you or someone else, or can she use public transportation or paratransit? Are there reliable senior transportation or paratransit services in her area?

Emotional considerations

• Your feelings. Being responsible for a frail older adult can be draining, especially if she's very sick or experiencing dementia. Do you think you can handle all of this emotionally, and do you have the support you need?
• The older adult's feelings. Most older adults prefer staying in their homes, or "aging in place," for as long as they're able, and it's beneficial for their health and well-being. But some are more relaxed in a situation where they feel more supported, like an assisted-living community or your home. Pay close attention to her opinions and ideas, and give her as much control as possible.
• Family dynamics. Spouses, kids, and grandkids can all be affected by home care, even when it's done in the older adult's home rather than your own. What will change for your family? How do you think it will affect your marriage? Consider holding a family meeting or two to discuss changes, fears, and expectations. Remember that caring for someone usually has rewards, too.
• The reality of intimate care. Daily care can include personal tasks such as bathing, dressing, toileting, and feeding. Some people are more comfortable with this than others. If you can't afford a paid caregiver, can you handle these tasks?
• Your instincts. Does your gut tell you it's a workable situation?

http://www.caring.com/articles/daily-home-care

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10 Things You Should Know About Writing a Will

Who inherits the good silver is just the beginning.

by: Brett Widness | from: AARP | September 30, 2010
Writing a will isn't the most pleasant of tasks. After all, by doing so you're not only acknowledging your own inevitable demise but actively planning for it. That might explain why so many adults avoid this cornerstone of estate planning. According to an AARP survey, 2 out of 5 Americans over the age of 45 don't have a will.
But creating a will is one of the most critical things you can do for your loved ones. Putting your wishes on paper helps your heirs avoid unnecessary hassles, and you gain the peace of mind knowing that a life's worth of possessions will end up in the right hands.
"A will is an important way you can stay in control over who gets what of your property," says Sally Hurme, an attorney with AARP, "and by planning in advance you can also save your family time and money."
The laws governing wills vary from state to state. If you aren't familiar with them, consider consulting a knowledgeable lawyer or estate planner in your area. Before you do, brush up on these 10 things you should know about writing a will.
What is a will?
A will is simply a legal document in which you, the testator, declare who will manage your estate after you die. Your estate can consist of big, expensive things such as a vacation home but also small items that might hold sentimental value such as photographs. The person named in the will to manage your estate is called the executor because he or she executes your stated wishes.
A will can also serve to declare who you wish to become the guardian for any minor children or dependents, and who you want to receive specific items that you own — Aunt Sally gets the silver, Cousin Billy the bone china, and so on. Someone designated to receive any of your property is called a "beneficiary."
Some types of property, including certain insurance policies and retirement accounts, generally aren't covered by wills. You should've listed beneficiaries when you took out the policies or opened the accounts. Check if you can't remember, and make sure you keep beneficiaries up to date, since what you have on file when you die should dictate who receives those assets.
What happens if I die without a will?
If you die without a valid will, you'll become what's called intestate. That usually means your estate will be settled based on the laws of your state that outline who inherits what. Probate is the legal process of transferring the property of a deceased person to the rightful heirs.
Since no executor was named, a judge appoints an administrator to serve in that capacity. An administrator also will be named if a will is deemed to be invalid. All wills must meet certain standards such as being witnessed to be legally valid. Again, requirements vary from state to state.
An administrator will most likely be a stranger to you and your family, and he or she will be bound by the letter of the probate laws of your state. As such, an administrator may make decisions that wouldn't necessarily agree with your wishes or those of your heirs.
Do I need an attorney to prepare my will?
No, you aren't required to hire a lawyer to prepare your will, though an experienced lawyer can provide useful advice on estate-planning strategies such as living trusts. But as long as your will meets the legal requirements of your state, it's valid whether a lawyer drafted it or you wrote it yourself on the back of a napkin.
Do-it-yourself will kits are widely available. Conduct an Internet search for "online wills" or "estate planning software" to find options, or check bookstores and libraries for will-writing guides. Your state's departments of aging also might be able to direct you to free or low-cost resources for estate planning.
And while you're working on your will, you should think about preparing other essential estate-planning documents. "When you create or update your will, that's also a good time to think about other advance-planning tools like financial and health care powers of attorney to ensure that your wishes are carried out while you're still alive," says Naomi Karp of AARP's Public Policy Institute.
Should my spouse and I have a joint will or separate wills?
Estate planners almost universally advise against joint wills, and some states don't even recognize them. Odds are you and your spouse won't die at the same time, and there's probably property that's not jointly held. That's why separate wills make better sense, even though your will and your spouse's will might end up looking remarkably similar.
In particular, separate wills allow for each spouse to address issues such as ex-spouses and children from previous relationships. Ditto for property that was obtained during a previous marriage. Be very clear about who gets what. Probate laws generally favor the current spouse.
Who should act as a witness to a will?
Any person can act as a witness to your will, but you should select someone who isn't a beneficiary. Otherwise there's the potential for a conflict of interest. The technical term is adisinterested witness. Some states require two or more witnesses. If a lawyer drafts your will, he or she shouldn't serve as a witness.
Not all states require a will to be notarized, but some do. Check. You may also want to have your witnesses sign what's called a self-proving affidavit in the presence of a notary. This affidavit can speed up the probate process because your witnesses likely won't be called into court by a judge to validate their signatures and the authenticity of the will.
Who should I name as my executor?
You can name your spouse, an adult child, or another trusted friend or relative as your executor. If your affairs are complicated, it might make more sense to name an attorney or someone with legal and financial expertise. You can also name joint executors, such as your spouse or partner and your attorney.
One of the most important things your will can do is empower your executor to pay your bills and deal with debt collectors. Make sure the wording of your will allows for this, and also gives your executor leeway to take care of any related issues that aren't specifically outlined in your will.
How do I leave specific items to specific heirs?
If you wish to leave certain personal property to certain heirs, indicate as much in your will. In addition, you can create a separate document called a letter of instruction that you should keep with your will.
A letter of instruction, which isn't legally binding in some states, can be written more informally than a will and can go into detail about which items go to whom. You can also include specifics about any number of things that will help your executor settle your estate including account numbers, passwords and even burial instructions.
Another option is to leave everything to one trusted person who knows your wishes for distributing your personal items. This, of course, is risky because you're relying on this person to honor your intentions without fail. Consider carefully.
Where should I keep my will?
A probate court usually requires your original will before it can process your estate, so it's important to keep the document safe yet accessible. If you put the will in a bank safe deposit box that only you can get into, your family might need to seek a court order to gain access. A waterproof and fireproof safe in your house is a good alternative.
Your attorney or someone you trust should keep signed copies in case the original is destroyed. Signed copies can be used to establish your intentions. However, the absence of an original will can complicate matters, and without it there's no guarantee that your estate will be settled as you'd hoped.
How often does a will need to be updated?
It's possible that your will may never need to be updated — or you may choose to update it regularly. The decision is yours. Remember, the only version of your will that matters is the most current valid one in existence at the time of your death.
With that in mind, you may want to revisit your will at times of major life changes. Think of pivotal moments such as marriage, divorce, the birth of a child, the death of a beneficiary or executor, a significant purchase or inheritance, and so on. Your kids probably won't need guardians named in a will after they're adults, for example, but you might still need to name guardians for disabled dependents. A rule of thumb: Review your will every two or three years to be safe.
Who has the right to contest my will?
Contesting a will refers to challenging the legal validity of all or part of the document. A beneficiary who feels slighted by the terms of a will might choose to contest it. Depending on which state you live in, so too might a spouse, ex-spouse or child who believes your stated wishes go against local probate laws.
A will can be contested for any number of other reasons: it wasn't properly witnessed; you weren't competent when you signed it; or it's the result of coercion or fraud. It's usually up to a probate judge to settle the dispute. The key to successfully contesting a will is finding legitimate legal fault with it. A clearly drafted and validly executed will is the best defense.
http://www.aarp.org/money/estate-planning/info-09-2010/ten_things_you_should_know_about_writing_a_will.2.html

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Elderly at greater risk for fire related deaths

• October 14th, 2010 3:03 pm ET

Americans over the age of 65 are one of the groups at greatest risk of dying in a fire. People over the age of 80 die in fires at a rate three times higher than the rest of the population. Many steps can be implemented to reduce becoming a fire casualty.
Older Americans are at risk for fire death and injuries for a number of reasons:
· They may be less able to take the quick action necessary in a fire emergency.
· They may be on medication that affects their ability to make quick decisions.
· Many older people live alone and when accidents happen others may not be around to help.
Fire Hazards that affect older people:
· Cooking accidents are the leading cause of fire related injuries for older Americans. The kitchen is one of the most active and potentially dangerous rooms in the home.
· The unsafe use of smoking materials is the leading cause of fire deaths among older Americans.
· Heating equipment is responsible for a big share of fires in seniors' homes. Extra caution should be used with alternate heaters such as wood stoves or electric space heaters.
· Faulty wiring is another major cause of fires affecting the elderly. Older homes can have serious wiring problems, ranging from old appliances with bad wiring to overloaded sockets.
Safety Tips for Older Americans
· Kitchen Fires - most kitchen fires occur because food is left unattended on the stove or in the oven. If you must leave the kitchen while cooking, take a spoon or potholder with you to remind you to return to the kitchen. Never cook with loose, dangling sleeves that can ignite easily. Heat cooking oils gradually and use extra caution when deep-frying. If a fire breaks out in a pan, put a lid on the pan. Never throw water on a grease fire. Never use a range or stove to heat your home.
· Space Heaters - buy only Underwriter's Laboratory (UL) approved heaters. Use only the manufacturer's recommended fuel for each heater. Do not use electric space heaters in the bathroom or around other wet areas. Do not dry or store objects on top of your heater. Keep combustibles away from heat sources.
· Smoking - do not leave smoking materials unattended. Use "safety ashtrays" with wide lips. Empty all ashtrays into the toilet or a metal container every night before going to bed. Never smoke in bed.
· Smoke alarms -dramatically increases your chances of surviving a fire. Practice a home escape plan at least every 6 months with your family or neighbors.

http://www.examiner.com/senior-care-in-national/elderly-at-greater-risk-for-fire-related-deaths

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When Your Elderly Parents Move in with You

Here's a tough one . . . Your Mom and/or Dad has moved in with you. At some point s/he told you s/he wants to pay you something to help defray the cost and you said no. Or maybe when the subject came up and you were uncomfortable and said "let's discuss it later".

I mean. . . what do you say? Your aging loved one is now living with you so s/he is not a guest. In fact, it's even worse than that . . . they're your parents!! After all they've done for you, can you seriously ask them to pay rent? So now s/he has moved in with you and the issue of money has never been resolved.

First of all, repeat after me: "Yes, s/he is my parent but we're not living together as parent and child - we're living together as adults and this is an adult/adult relationship." Please keep this mantra in mind. You might even want to print it out and tape it onto your mirror.

And second, no, I'm not saying they should pay rent or any expenses. Nor am I saying they shouldn't. You may have plenty of money and you don't want them to pay for anything. Or you many need them to chip in and help defray some of the costs. And frankly, your aging loved one probably wants to contribute something. The point is that money is one of the most sensitive issues you'll have to address with your aging loved one so it shouldn't be ignored either.

The thing about expenses is that usually they are in such small, "insignificant" amounts that you don't realize how much money you're actually spending. Whether it's paying for things like medications or purchasing additional food or toilet paper or Depends, whether it's gas for visits or to take them to appointments, or whether it's installing safety bars in the bathroom, caregiving can have a significant economic impact on a family. In fact - a 1998 study found that 49% of Baby Boomer women caregivers suffered "financial hardship" as a result of their caregiving.

Unfortunately, most Baby Boomer women weren't raised to be comfortable establishing boundaries or asking for what they need - financially or otherwise. While you're not looking to make any money from your loved one living with you, it shouldn't cost you anything either. You may not want them to pay for anything but over time, you may end up suffering "financial hardship" as a result of caregiving and resent the cost or worse yet . . . resent your aging loved one.

So what do you do?

1.    The first step to determining how much your aging loved one might pay is looking at how much money they have. If they have very little (not enough even to cover basic costs) then you will have to pay some of the expenses yourself or ask your sibs to chip in. It's important to be prepared for that. You will also want to talk with your accountant to see if there is anything you can do on your taxes.

2.    Then guesstimate all the expenses and compare that number with how much they actually have to contribute. Bear in mind that initially you'll be guessing and you may need to revise the amount later on. If that happens tell them "We agreed to $XXXX . Unfortunately that amount turned out to be unrealistic. We need to take a look at the numbers again."

3.    Rather than getting reimbursed for expenses - and therefore having to keep track of every expense (eg: $5 deductible when you pick up their prescriptions, special foods) - have them give you a set amount - whether monthly or quarterly - that you'll work from. Whether or not you refund any leftover money is up to the two of you.

4.    Openly discuss with your aging loved one what the money is for. However, while they're entitled to know, it need not become a "nickel/dime" issue. In other words, rather than accounting for every roll of toilet paper for example, give them a general figure for sundries.

5.    Over and above expenses, you may want them to pay a set amount to help defray the cost of such expenses as the rent/mortgage, utilities, etc.

6.    However, while they may only be able to pay very little, they probably want to pay something. Be creative. Perhaps they'll pay for a meal once a month (either out or at home) and even that can be as much or as little as they can comfortably afford.

VERY IMPORTANT: Make sure they have "walking around" money - money that is theirs and for which they account to no one. Rather than having them give you all their money and then giving them an "allowance" (which is very demeaning), it's better to have them give you what was agreed to EXCEPT for their own spending money. Whether they save for the holidays or buy drinks or lunch for friends or wager on a friendly game of Bingo - it's theirs and how they spend it or when they spend it is their business. However, if they come back to you for more at the end of every month, then it becomes your business.

Some things to think about:

Consider the one-time expenses required to get your house ready (such as banisters, tub rails, etc) and get that reimbursed or have them pay for it directly. This would be separate from the monthly expenses.

Start by looking at and addressing the current situation with the understanding that needs will change over time. It's important to discuss this in the very beginning. For example, you may start by getting money for miscellaneous expenses but eventually have to be reimbursed for such things as:

- in-home aide while you're at work

- additional remodeling to accommodate their needs (eg changing the tub to a shower)

- a "fill-in caregiver when your work takes you away

If there are physical and/or cognitive issues, I strongly recommend that you get on their checking account NOW before there's a need so you can still pay for their care even if they can no longer write checks.

I can appreciate that this all may sound kind of mercenary but consider the following . . . part of an email that came to me from a client: "She (my mother) also told us that, since we were working so hard in an effort to sell our home and buy a new home to accommodate her more comfortably, she was going to buy all the groceries and cook all the meals so that I didn't have to food shop or cook. She gave me one $20 bill for one lunch and never mentioned it again! Now every time I make a meal I get angrier and angrier."

Don't let this happen to you - address the money issue openly right up front and it won't have to!!

Barbara Friesner

AgeWiseLiving LLC

Eldercare Issues Resolved By Choice, Not Crisis

http://www.evancarmichael.com/Work-Life/4336/When-Your-Parents-Move-in-with-You.html