Month: November 2017

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Taking Over Your Aging Parents’ Finances

When to step in — and how to guide their financial future

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[I]n the year 2011, the Baby Boomer generation started turning 65. Over the next 13 years, 10,000 Boomers will reach retirement age every day.

For the adult children of the Baby Boomers, these are not abstract statistics but real-life turning points that can provoke uncertainty and anxiety. But consider the advice of certified financial planner and author Lise Andreana:

“There is no time like the present to begin preparing for your aging parents’ financial future. Being proactive can help minimize a great deal of stress and uncertainty down the road — for your parents, yourself, and your entire family.”

The Simple Dollar is here to help you begin the journey of guiding your parents through this stage of their lives. We’ll cover how to approach the conversation, documents you’ll need, costs to consider, and more. Let’s get started.

Table of contents

Broaching the subject
Power of attorney
Document checklist
Long-term care costs
The sibling situation
Glossary
Additional resources

The Talk: How to handle a sensitive subject

Every family is different, and yours may have its own quirks or hangups about money. Although no size fits all, here are some suggestions on having The Talk with your parents:

When is the right time?

Many senior care experts recommend following the 40/70 Rule. As you approach 40 and your parents approach 70, it can be the most opportune time to discuss financial issues, as well as long-term care, estate planning and other relevant topics.

It’s better to address the situation proactively than to wait for a crisis to unfold, which could force your family into making decisions on the fly.

Are my parents already having trouble?

Be on the lookout for warning signs that your parent may be struggling to manage his or her finances, which can include:

  • Unpaid bills
  • Bounced checks
  • Calls from creditors
  • Unusual or frivolous purchases

What’s the right approach?

To help prevent conflict with your parents when you talk about finances, consider the following.

  • Keep the circle small.
    Discussions involving a few key people can be less intimidating than a full-blown family meeting that could leave your parents feeling like you’re ganging up on them.
  • Focus on positives, not negatives.
    Don’t frame your concerns in terms of physical or mental decline. Keep the focus on a bright future for the entire family.
  • Treat them as peers and equals.
    Help your parents understand that you’re trying to look out for them, not look after them. Invite them to join an ongoing conversation.
  • Find an ally.
    Your parents might be more receptive if your family attorney or financial planner joins the discussion in the role of an objective third party.
  • Make a show of solidarity.
    This subject presents an opportunity to do a thorough check of your own finances to see that everything’s in order. This way, your parents might not feel that you’re singling them out or passing judgment.
  • Avoid fighting words.
    Certain words and phrases — including always, never and nothing — have a tendency to put people on the defensive and shut down communication. It can happen in any kind of personal relationship, including parent-child.

When in doubt, preserve your parents’ dignity. Be aware of the potential for wounded pride — speak respectfully and tread lightly.

Expert opinion

“Start the conversation early. Put in place a plan your family can follow when your parents can no longer make decisions on their own. … It’s important to ask questions and help your parent come to a decision on his or her own terms.”

Terri Rasp
Director of Sales, Analytics, and Training
StoneGate Senior Living, LLC

Power of attorney

A power of attorney, also called a POA, is a legal document that grants a person or organization (known as the agent or attorney-in-fact) the authority to act on behalf of someone (the principal) in specific financial, legal and health-related matters.

A POA with you as the agent and your parent or parents as principal could play an integral role in helping you protect their financial well-being. With a power of attorney in place, you will be able to act quickly if a parent suffers a medical emergency, for example, or experiences a steep decline in mental competence.

Should I use a lawyer for a POA?

The answer is, most likely, yes. You don’t necessarily have to go through an attorney, but it’s probably the wisest course of action. The power of attorney process can vary from state to state, and trying to go it on your own could result in a costly oversight.

Unless you’re an attorney or a financial adviser, you may not have the expertise to navigate these waters. Also important is the fact that a professional often brings some much-needed objectivity to a situation where emotions can cloud the issues.

Can I get a POA on my own?

Some legal advice websites let you download a printable version of your state’s POA form. However, bear in mind that you’re dealing with the complexities of legal documents and contracts. There’s no shame in seeking the advice of your family attorney, your financial adviser, or both to help you craft a POA that addresses your family’s specific needs.

What’s the best time to get a POA?

The key factor in a child-parent power of attorney is obtaining it proactively, before the parent loses the ability to manage their own affairs.

What kind of POA should I get?

A lot depends on the current status of the parents and when the family wants the POA to take effect. An attorney may recommend a durable power of attorney, which contains a durability provision to ensure it remains in effect if the principal’s condition changes. The change in status could be a sudden medical issue that leaves the parent debilitated or a deterioration in mental capacity.

A power of attorney covering financial affairs differs from a health care POA, which means you’ll need to address those issues separately.

What if my parent has dementia or Alzheimer’s?

Depending on the laws of your state, getting a POA for a parent who has dementia or Alzheimer’s disease may require a letter from a physician affirming that your parent understands what the POA means and can legally consent. If a parent is deemed unable to meet that standard, another option may be for the child to become an adult guardian or conservator instead — a process that would require a judge’s approval.

Is a power of attorney the same as a living will?

No, there’s a difference. A living will expresses the signer’s wishes regarding medical treatment in the event he or she loses the capacity to make decisions (for example, whether extraordinary measures should be taken to preserve their life or resuscitate them). This kind of document is sometimes called an advance health care directive.

As with a power of attorney, state-specific versions of living wills are available online. Still, it’s wise to consult an attorney about the specifics of your situation.

Obtaining power of attorney: 3 key steps

Expert opinion

“Prior to cognitive decline, I advise my clients to help their parents establish the proper paperwork. This includes the creation of a will, durable power of attorney, health care power of attorney, and advanced directives. The power of attorney forms are very powerful documents that should only be in the hands of somebody your parents trust. Whether that is a family member or a professional, it is up to them.”

Nate Byers
CPA/PFS, MBA
JBC Wealth Advisors, LLC

Financial document checklist

Here’s a list of important documents for reviewing a parent’s finances. These records will help you get a better idea of income and financial obligations. Double-check this list with your financial adviser to see if anything needs to be added.

_ Bank accounts
_ Credit card statements
_ Monthly bills (utilities, rent/mortgage, subscriptions, etc.)
_ List of loans and other debts
_ Social Security statements
_ Social Security benefit verification letter
_ Pension, 401k and annuity documents
_ Tax returns (for three to seven years)
_ Investment documents (savings bonds, stock certificates, brokerage accounts, etc.)
_ Insurance policies — life, health, and property
_ Vehicle titles
_ Property deeds
_ Dues-paying memberships (HOA, AARP, clubs, etc.)
_ Birth certificates and marriage licenses

Don’t forget …
_ List of their usernames and passwords for online customer portals
_ Combination/keys to their safety deposit boxes

Expert opinion

“The first thing that children should do is to start aggregating information on the parents’ financial information. Help your parents consolidate their holdings. Fewer bank accounts can save you tons of time.”

Scott W. Johnson
Owner, WholeVsTermLifeInsurance.com

Long-term care costs

When looking at long-term care solutions, be aware that private insurance and Medicare have some limitations. While Medicare and insurance do provide coverage for medical treatment and prescription drugs, custodial care such as long-term care facilities and home health care may be a different story. As a 2013 study points out, Medicare:

  • Pays only for “medically necessary care in a skilled nursing facility” — which is not the same as an assisted living center.
  • Pays for home health care “under very limited circumstances and for brief stretches of time.”

In some unfortunate cases, coverage gaps in Medicare and private insurance can lead to families exhausting financial resources (known as “spending down”) until their parents qualify for Medicaid. To help prevent this worst-case scenario, you may want to consult a financial planner about some proactive options such as:

Long-term care insurance (LTCI)

Expenses covered by long-term care insurance generally include assisted living, nursing home, adult day care, Alzheimer’s care facilities and hospice. The key is encouraging parents to buy coverage early, before they develop health problems.

Pros and cons include: LTCI can be pricey, although it could cover some expenses that Medicare or private insurance do not.

Long-term care benefit plan

This option involves converting a life insurance policy into funding specifically for long-term care. These insurance conversions are also called life care assurance, Medicaid life settlement, or life care funding. It’s commonly used as part of a spend-down strategy to receive Medicaid eligibility.

Pros and cons include: This strategy can provide an immediate source of funding. However, the family will lose the death benefit that an unconverted insurance policy would have provided.

Reverse mortgage

Some aging homeowners turn to reverse mortgages (also called home equity conversion mortgages) to turn their equity into cash while still retaining ownership.

Pros and cons include: Although it can provide a cash infusion, using a reverse mortgage to pay for senior care is a potentially risky, “last resort” type of move. Not everyone will qualify, and defaulting could lead to loss of ownership.

Medicaid

Unlike Medicare, Medicaid is jointly administered by the federal government and individual state governments. As a result, eligibility requirements and other rules vary from state to state.

In general, though, Medicaid recipients must have low incomes and assets with very low value. The program is intended to benefit the poorest Americans, so many middle-class families likely don’t qualify.

To get more information, check with the agency that manages Medicaid in your state. You can also contact an elder law attorney in your state or visit these websites:

Claiming your parents on your tax return

To claim a parent as a dependent, your financial support for them must be substantial — at least 50% of the total cost for housing, food, medical care and other items. Also, the parent can’t earn more than the personal exemption for that tax year (which was $4,050 in 2016).

So, unless your parent has a very low income and you pay more than half the cost of keeping them cared for, they probably wouldn’t qualify as a dependent. If the parent does qualify, you could receive tax benefits such as the Dependent Care Tax Credit and reduced taxable income.

To get definitive answers, ask your tax preparer. You can also call the IRS or make an appointment at a local Taxpayer Assistance Center.

Expert opinion

“When budgeting for an aging parent, Medicare costs need to be factored in. They pay a monthly premium for Medicare Parts B and D for life and then also a Medigap or Medicare Advantage plan to pay for the things like deductibles and coinsurances that Medicare doesn’t cover.”

Danielle Kunkle
Co-founder, Boomer Benefits

The sibling situation

Among adult siblings, the care of aging parents has the potential to spark conflict like few other subjects. Handling parents’ finances is no exception.

It’s not uncommon for someone who takes the lead as caregiver to feel overburdened and resentful toward a sibling taking a less active role. Fortunately, a personal care contract or caregiver agreement can help ensure that the sibling who makes the most sacrifices is at least financially compensated.

Under this type of agreement, parents or other family members agree to reimburse the family member acting as caregiver. Compensation options include:

  • Direct payments (the income will be taxable)
  • An estate plan, or additional consideration in the parent’s will
  • Transferring homeownership to the caregiver
  • A life insurance policy with the caregiver as beneficiary

An elder law attorney can help you draw up a caregiver agreement. As for the form that compensation takes, families should think carefully about options that could lead to future conflicts between siblings (specifically, an estate plan or home transfer).

About those conflicts…

Even if you have a financial arrangement in place, don’t forget that sibling caregivers often have emotional needs in addition to financial ones. Expert tips on how to defuse conflict and increase support include:

  • Stay in communication, even if it’s just a weekly call
  • Arrange for someone else to step in every now and then so the caregiver can have time off
  • Ask for outside help (family counselors, social workers, clergy, etc.) when conflict becomes unmanageable

Expert opinion

“Personal care agreements are valuable for two very different reasons. One is emotional, for the family caregiver to feel as though they have a ‘real’ job and have at least a written record of what they need to do. Many have to cut back on work or stop working during a period of caregiving. The agreements can also serve as a record of the work done for siblings.”

Michael Guerrero
Senior Benefits Adviser
Elder Care Resource Planning

Complete Article ↪HERE↩!

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Ashes to Ashes, Stardust to Stardust

Delivering cremated remains to the stratosphere joins a growing list of new ways to memorialize the dead.

By Marina Koren

[M]ark Harris says funeral directors talk about it all the time. More and more people are growing tired of traditional funeral services and opting for something a little more creative. “It’s getting more difficult to offer the cookie-cutter send-off,” explains Harris, the author of Grave Matters, which examines how people have started to think, er, outside the box about death.

And so, Harris wasn’t surprised to hear that a new British company is offering to send cremated remains to the stratosphere. High-altitude latex balloons will float to 100,000 feet above the surface of the Earth, where the curvature of the planet appears against the darkness of space, and then release the ashes into the cold, creating a glittering display. “Scatter your loved one’s ashes in space,” Ascension Flights says on its website. “We are all made of stardust.” The stratosphere is not technically space, but for their purposes, it’s close enough.

Ascension Flights, run by funeral directors and a near-space launch firm, will soon offer its high-altitude funerals, with the cheapest package starting at £795, or about $1,040. For more money, customers can choose the launch site and have the scattering photographed and filmed

The near-space funeral is, at first glance, a contrast to “green” burials, which return remains to the soil in biodegradable coffins or urns. In this way, the deceased can meet “the green reaper,” as a Guardian article in 2014 colorfully put it, and contribute to the physical processes of the Earth. Blasting ashes into the stratosphere sure sounds like the opposite of that, but Ascension Flights promises some kind of return to the planet. “As the particles eventually return to Earth, precipitation will form around them, creating raindrops and snowflakes,” its website explains. “Small amounts of nutritious chemicals will stimulate plant growth wherever it lands.”

Harris, who favors going the natural route, said this promise seems considerably less certain than that of green burials, where at least “I wouldn’t have to worry about having my loved one’s ashes raining down from space on some random location like a landfill or a Superfund site or a nuclear power plant,” he said.

Both kinds of memorials are part of the same growing trend in end-of-life affairs, Harris said. People are becoming increasingly interested in how their physical remains, and the remains of their loved ones, will be handled. They want something more personal and more personalized.

These days, people can forgo metal caskets and be buried in bamboo or recycled cardboard instead, or have their remains wrapped in banana leaf, cotton, or wool. A company called Eternal Reefs will fashion an environmentally friendly artificial reef out of cremains—cremated remains—and drop it into the ocean for nearby marine life to populate. Cremains can be pressed into diamonds, incorporated into paint, and ejected as fireworks. The variety of options for the dead reflects the consumer culture of the living, says Phil Olson, a Virginia Tech professor who studies funeral practices, like the home-burial movement. “There are at least seven kinds of Coke, 500 kinds of cigarettes—options, options, options,” Olson said. Consumers want just as many choices in death as in life.

The option to send a loved one’s ashes to actual space has existed for several years already, for a steeper price than Ascension Flights charges. Since 1997, the company Celestis has flown missions into space delivering the cremains of dozens of people, including Star Trek creator Gene Roddenberry. The payload is launched inside a capsule to more than 300,000 feet, beyond the boundary of space, and eventually falls back to Earth.

While the concept of commemorating life’s final frontier in the final frontier may seem incredibly high-tech, the emotion behind it is no different than run-of-the-mill funerals on Earth. Funeral services can be, in the end, more for the benefit of those who are left behind than those who’ve passed away. They are about processing grief, and grief is personal. For some, the thought of sending their loved one’s ashes into the stratosphere is, simply, very fitting, and it’s difficult to pin down the exact reasons why.

Olson points to alkaline hydrolysis as an example of the funeral industry misunderstanding its customers. Providers of alkaline hydrolysis, which reduces bodies to skeletons in a liquid solution, believed the appeal of the process came from its eco-friendliness. They later found that the primary reason people gave for choosing hydrolysis was that they perceived it to be gentler than cremation. “For some reason, people see being dissolved in caustic alkaline as being gentler than being incinerated,” Olson said.

Perhaps having more options to memorialize the dead may ease the grieving process in some way, he said, even if it’s not clear exactly how.

“We can speculate all we want for people’s motivations for doing this, but we could be dead wrong,” Olson said of the high-altitude memorial and, when I laughed in response, quickly realized his choice of words. “Sorry, pardon the pun. I didn’t even notice that.”

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What Vets Want at the End of Life Is Very Different From What Civilians Want

Ron Fleming

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[A] lot of Ron Fleming’s fellow soldiers spent the last five decades trying to forget what they saw and did in Vietnam. Now 74, Fleming has spent most of that time trying to hold on to it. He has never been as proud as he was when he was 21.

“I take issue with those who say we lost. We didn’t lose that war,” he said, sitting on the edge of his hospital bed at the San Francisco VA medical center. “Everywhere I went, we literally kicked the crap out of them.”

Fleming was a door gunner in the war, hanging out of a helicopter on a strap with a machine gun in his hands. He fought in the Tet Offensive, sometimes 40 hours straight, firing 6,000 rounds a minute. But he never gave much thought to catching one himself.

“You see, at 21, you’re bulletproof,” he said. “Dying wasn’t on the agenda.”

But now, it is. Fleming has congestive heart failure, arthritis and breathing problems. He often lands in the VA hospital with asthma attacks, and the palliative care team visits him regularly. He thinks about death.

“I wish it’d get off its ass and come on me. I’m sick of this crap,” he said, as his heart rate monitor ticked up. “You see, dying’s the easy part. Living is what’s hard.”

Fleming has had trouble holding down a job since he got back from the war. He had a girl he lived with for 10 years, but they never married, never had kids. He lives alone in Oakland now. He says he angers easily and is always hypervigilant. About 10 years ago, he was diagnosed with PTSD. More than anything, he says, he suffers from a “rotten outlook” on life.

“Sometimes I think that now I’m being paid back for all the men I killed,” he said. “I killed a lot of them. More than I can count.”

Unlike Fleming, some Vietnam vets don’t find out they have PTSD until they have just months or weeks left to live. Symptoms of terminal illnesses, like pain or breathlessness, can trigger flashbacks, making vets feel as threatened as they did on the battlefield.

“The war memories start coming back, they start having nightmares,” said VJ Periyakoil, a palliative care physician at the VA in Palo Alto. She says opioid medications, like morphine and oxycodone, that are often used for treating pain and breathlessness can make PTSD symptoms worse.

“The side effect of those medications, they make you fuzzyheaded,” she said. “Your defenses that you use to cope with the PTSD, which might help repress a lot of the difficult memories, that coping strategy starts to come apart.”

She has had patients tell her: “I would much rather tolerate the physical pain, the cancer pain, than take opioids and my defenses crumble.”

Some vets see their pain or PTSD as retribution for their work in the line of duty.

“Sometimes I’ve had patients refuse medications that might ease their experiences because they feel that they deserve to suffer,” Periyakoil said. “This is redemptive.”

The best thing to do in these situations can be to stand down, she said. With weeks left to live, there isn’t enough time to resolve the mental anguish, and staff have to let patients set the pace and tone for their care.

But doctors and nurses, just like soldiers, hate doing nothing.

“We talk about the moral distress that we have sometimes about really knowing that we’re doing the right thing for this individual, so that we can be present for their suffering, the way they need to do it,” said Patrice Villars, a hospice nurse at the San Francisco VA.

For Ron Fleming, death is still likely a couple of years out. His doctors have been begging him, gently, to consider mental health counseling or antidepressants. But he has refused.

“I don’t want to take psychiatric drugs. The vets call them the happy pills,” he said. “I don’t want any of those, because they change you. I don’t want to change.”

He’s not sure if he deserves to be happy.

“That I don’t know,” he said.

His pain is what connects him to the past. Fleming was awarded 18 air medals for acts of meritorious achievement and heroism. The loss and grief he experienced in Vietnam are woven into the same memories of victory and glory. He doesn’t want treatment that might make that go away.

Complete Article ↪HERE↩!

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For Patients With Heart Failure, Little Guidance as Death Nears

Americans are living longer with heart disease, managing it as a chronic condition. But there are few rules for these patients as they near the end of life.

Ricky Hurst, whose heart is failing, was told by doctors to get his affairs in order as his condition worsened. More patients like him are living longer with heart failure, but there are no widely accepted guidelines for care as they near death.

By GINA KOLATA

[R]icky Hurst’s doctors told him last year that there was nothing more they could do. His heart was failing and he should get his affairs in order. The end was coming.

His family gathered. He spoke to his pastor and resigned himself to death. “If it was meant to be, it was meant to be,” he said.

But. Mr. Hurst, 56, a former ranger and school football coach in Jackson, Mich., is still alive, although his heart continues to weaken. And patients like him are raising a new dilemma for doctors.

Heart disease once killed ruthlessly and quickly; patients like Mr. Hurst succumbed to heart attacks and sudden death from cardiac arrest. But with improved medical care and implanted devices that bolster the heart, a growing number of heart patients survive for years, even decades, coping with a chronic, progressive condition punctuated by crises and hospitalizations.

Their disease at that point is called heart failure — their weakened heart cannot pump enough blood to supply the body’s needs. The number of Americans with heart failure increased to 6.5 million in 2011-2014 from 5.7 million in 2009-2012, according to the American Heart Association.

More than 10 percent of those over age 80 have heart failure, and more patients are living longer with advanced disease. Even as the death rate from heart attacks is falling, the figure for heart failure is rising.

Yet there are no widely accepted guidelines for dealing with these patients as they near death. Cancer specialists regularly move their patients to hospice at the end of life, for instance, but few cardiologists even think of it. Heart patients account for just 15 percent of hospice deaths, while cancer patients make up half, according to a recent study.

Mr. Hurst carries a battery-powered and surgically implanted heart pump.

That paper, published in the Journal of the American College of Cardiology, reviewed a number of ways in which heart patients are let down at the end of life. Implanted defibrillators often remain activated until the very end, for example, even for those in hospice.

A fifth of heart patients with defibrillators get shocked by them in the last few weeks of life, and 8 percent get shocked minutes before dying. Most patients are never told that they can ask that the defibrillators be turned off.

“Getting shocks at the end of life is not really helping patients live longer or better,” said Dr. Larry Allen, a heart failure specialist at the University of Colorado and an author of the study.

“We shouldn’t have a single one of these cases happening,” said Dr. Haider Warraich, a cardiology fellow at Duke University and first author of the study.

Experts often focus on the strides made in preventing and treating heart disease. Its incidence has declined by 70 percent in the past 50 years. People have heart attacks later in life than they used to, are more likely to survive them, and often live for years afterward with few or no symptoms.

“We are very proud” of that progress, said Dr. Patrice Desvigne-Nickens, a medical officer at the National Heart, Lung and Blood Institute.

Still, she added, cardiologists and their patients should be discussing end-of-life options and palliative care earlier in the course of heart failure.

“Everyone is uncomfortable with end-of-life discussions,” she said. “The field of cancer may be ahead of us. We should learn from looking at their example.”

But cardiologists thrive on the dramatic saving of lives, said Dr. Michael Bristow, a cardiologist at the University of Colorado Denver. They devote their professional lives to rescuing patients having heart attacks and bringing them back from the brink.

End-of-life care is not typically their focus; neither do they spend much time pondering what some of their patients may experience in the future. “Those who go into cardiology are not necessarily ones who want to deal with death and dying,” Dr. Bristow said.

The very nature of end-stage heart failure makes it all the more difficult to prepare.

“Very few patients understand the trajectory of the disease,” said Dr. Lynne Warner Stevenson, a heart failure specialist at Vanderbilt University. The path has peaks and valleys, but as the patient declines, each peak is a little lower than the one before.

And often doctors do not tell patients what to expect.

“Unfortunately, when you have patients with a chronic illness like heart failure, everyone thinks someone else will talk about it,” Dr. Stevenson said. “Too often, no one takes ownership of the last stage of the journey with the patient.”

Dr. Ellen Hummel of the University of Michigan, one of a small number of doctors specializing in cardiology palliative care, said the typical patient with cancer will usually experience a “fairly predictable” decline.

“They will be less able to take care of themselves,” she said. “They will be more symptomatic and come back to the hospital more frequently. And once this starts, it will probably continue until they die. Most people can see the end coming.”

But patients with end-stage heart failure are more likely to have wild swings, Dr. Hummel said, veering from feeling better to being terribly ill.

“It is confusing to both the patient and provider. Are they actually dying, or can we rescue them from a particular episode of worsening?”

Dr. Harlan Krumholz, a cardiologist at Yale University, agreed: “The issue is knowing who is really at the end of life.” For patients with heart failure, seesawing between good periods and bad, it can be very difficult to make the call.

Dr. Allen recently discussed all this with a patient, Ed Harvey.

Mr. Harvey, 75, has an implanted defibrillator, and his heart is weakening, pumping progressively less blood. Dr. Allen gave him medications that helped for a while, but, Dr. Allen said, “we have maxed out on what can be done.”

He can’t say with any certainty how long Mr. Harvey has. But now is the time, Dr. Allen told him, to talk about the end of life.

Mr. Harvey still feels pretty good, but “when you have congestive heart failure and it is not getting any better, you know that day is going to come,” he said.

He has been living with heart failure for more than a decade, and fears becoming a burden as his heart gets worse. It is now so weak that the only medical option left is an implantable pump. He knows that soon he will need full-time care.

“I have elected that if it got to that point,” he said, “put me in a hospice and let me go.”

Complete Article ↪HERE↩!

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What is Respite Care?

By SeniorAdvisor.com Staff

[T]he essential meaning of respite care is to support the caregivers via temporary institutional care for their loved ones. Respite care can be provided to a dependent, disabled, or elderly person. It is also known as short-term care and gives you (the caregiver) the opportunity to get a break from your caregiving role while ensuring your loved one stays on track with their normal routine.

Respite care may be provided in short hourly increments, days, or even longer periods of time and also depends on your loved one’s specific needs, your own needs, as well as on the available services in your area and their price points.

Benefits of Respite Care

Respite care enables the caregiver to continue with his or her caring role for a longer period of time and help prevent burnout. It is designed to help families, by giving the caregiver time to slow down and focus on one’s physical and mental health. It may also be given informally by family members, friends, neighbors, or by formal services.

Some studies have shown that respite care helps sustain caregivers’ health and well being, reduces the possibility of neglect and abuse, delays, and avoids out-of-home placements. An additional benefit of respite care is the fact that it helps sustain marriages by reducing the likelihood of divorce.
Types of Respite Care

In-home respite care provides caregiving to the individual at their home.

Attends to the senior’s fundamental self help needs, usually provided by family members.
Assists the family on enabling the senior with development activities to be at home.
Relieves family members from the constant and heavy responsibility of providing care.
Gives appropriate supervision and care to protect the senior’s safety if a family member is not present.

Adult day center respite care provides daily care via licensed facilities and is predominantly used by caregivers who work during the day and need a place for their loved ones to socialize and receive care.

Specialized facility respite care provides highly effective and specialized care (such as for dementia or Alzheimer’s) at a licensed facility.

Emergency respite care provides help and care on an emergency basis. Many home care agencies, help centers, adult day care centers and respite care facilities offer this service.

Therapeutic respite care provides services for seniors and adults, mostly during business hours, but sometimes 24 hours a day. Therapeutic respite care facilities usually care for designated clients only and are not related to the family support centers.

Informal respite care is care given by a family member, relative, friend, or volunteer. It serves to allow the caregiver a brief break to run errands or simply be removed from the current caregiving role. This form of care may also be used during special events.

If you are a primary caregiver, take time to ensure that you are also mentally, emotionally, and physically healthy. Although getting respite care may feel like a daunting task plagued with guilt, it can be a good option to temporarily remove yourself from the situation to regain a renewed sense of well-being for you and your loved one.

Complete Article ↪HERE↩!

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The fear that dare not speak its name:

How language plays a role in the assisted dying debate

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[A]rguments in the “euthanasia debate” (as it is colloquially referred to in Australia) hinge in part on the language used to describe “death”.

The inevitability and permanence of death make it a taboo fraught with fears (such as fear of losing loved ones, fear of the afterlife, fear of what happens to the body after death).

When it comes to fear, politicians are slick verbal smugglers, sneaking messages under our noses. Conservative pollsters found “global warming” was scary so they gave us “climate change”. Richard Nixon knew white voters afraid of minorities would respond well to “law and order”.

Those involved in the “euthanasia debate” draw on similar tactics. Are we talking about “assisted dying” – as the name of the bill suggests – or are we talking about “assisted suicide”? Does it even matter?

Debating a ‘good death’ in the Victorian parliament

Three terms loomed large a few weeks ago in the debate in parliament: “euthanasia”, “assisted dying” and “assisted suicide”.

Those who supported the Voluntary Assisted Dying (VAD) Bill tended to use the phrase “assisted dying” throughout the debate. A preliminary token count (factoring out references to the name of the bill) shows 678 references to “assisted dying” from October 17-19. The lion’s share of these were made by the bill’s proponents.

Conversely, those who opposed the bill favoured the terms “euthanasia” and “assisted suicide”. There were 264 references to “euthanasia” and 205 to “assisted suicide” across the three days. These terms were most often used by the bill’s opponents.

In fact, the bill’s opponents took issue with its euphemistic tone. Deputy Premier James Merlino argued in the debate that “language is important” and pointed out the reticence of the bill’s proponents to use “confronting words” like “euthanasia” or “suicide”.

Also during the debate, opponents made multiple references to comedian/actor Liz Carr and her show Assisted Suicide: The Musical.

Liberal MP Robert Clark highlighted one particular scene in Carr’s play in which societies engaging in euthanasia seek the most “palatable term” for what they do. These societies acknowledge, in Clark’s words, “to call it by its true name would be a big setback for their cause”.

Why do these words matter to politicians? Should they matter to us?

To name the tiger or to not name the tiger?

Cultures avoid naming the things they fear the most.

The Batek, a nomadic group inhabiting peninsular Malaysia’s tropical forests, fear and revere tigers. Consequently, hunters often use avoidance terms like “animal of the forest” or the mocking “smelly paws” to discuss them.

Modern English speakers linguistically dance around the concept of death with the same care and mocking humour as the Batek do the tiger. Among other things, we frame death in terms of “rest” (“rest in peace”), “loss” (for example, “my condolences on your loss”) and “a journey” for “the departed” (“pass away” originally referred to the soul’s “departure” from the body for the “journey” to heaven or hell).

We can also, with an irreverent nod to dark humour and idiomatic expression, “buy the farm”, “push up daisies” or “kick the bucket”. These seemingly frivolous statements can often have dark origins. For instance, “kick the bucket” is likely either a reference to suicide by hanging or an old way of killing of pigs (in both cases, the living thing is tied to a beam, and a bucket kicked from under them).

Such dark humour perhaps enables us to cope with death by downgrading its significance.

Returning to the current debate, opponents of Victoria’s VAD bill most commonly use the terms “euthanasia” and “assisted suicide”. They are sometimes used interchangeably, but also separately, as they have differing meanings (the former entails more direct involvement of a doctor or another person).

The Oxford English Dictionary (OED) traces the earliest uses of “euthanasia” to the mid-17th century, deriving from the Greek eu- “good or well” and thanatos “death”. It is worth noting in light of the current debate that this eu- also appears in “euphemism” – loosely, “good speaking”.

Euthanasia originally had this general sense of “good death” until the 18th and 19th centuries when it came to signify the “means” or “actions” to bring on a good death.

Words associated with taboo topics often taken on negative connotations, and euthanasia is no exception. We see similar processes at work with “coffin”, which once meant a “small basket” in French, and was originally a reference to the container in which we place our dead.

Opponents of the VAD bill also draw on the negative connotations of “assisted suicide”. Suicides are, of course, highly stigmatised. Moreover, the use of “suicide” conjures up a series of other negative words containing the element –cide (from the Latin “slayer of”), including “homicide” and “fratricide”.

Many of these –cide words are first noted in English in the 15th century but “suicide” (from the Latin suī “of oneself”) did not appear until the 18th century. Before this, the act was known, among other things, as “self-destruction”, “self-homicide”, “self-murder” and “self-slaughter”. The OED notes the first appearance of “assisted suicide” in 1976.

Proponents of the VAD bill favour “assisted dying”, which, of course, is in the name of the bill itself. The OED shows the first appearance of “assisted dying” in 1988 in the British magazine The Contemporary Review. It appears in an article referencing Sigmund Freud’s request that his life end early rather than suffer unduly from his inoperable cancer.

The term “dying” is arguably the more neutral of the two terms (though how accurately it represents the act will relate to one’s philosophical or religious viewpoint).

While we are squeamish about the concept of death, we may be coming to terms with the use of the word “death” itself. Linguists Keith Allan and Kate Burridge studied obituaries and “In Memoriam” notices in the early 2000s, and found only a single of these contained the verb “die” or the noun “death”.

However, last year PhD scholar Pawel Migut studied online obituaries and found “died” to be the most common reference to the process in 12 US states (“passed away” seemingly remains the most common euphemism across the US on the whole).

Naming the tiger or slick political strategy?

Politicians’ choices to use “euthanasia” and “assisted suicide” or “assisted dying” have demonstrable political impact, as evidenced by a 2013 Gallup poll.

This poll found that 70% of Americans supported ending “a patient’s life by some painless means” when they were suffering from an incurable disease. However, support dropped to 51% when Americans were asked whether they supported a request to “assist the patient to commit suicide.”

So then, it is worth noting that the selection of “assisted dying” or “assisted suicide” might reflect our pollies’ attitudes. But it just as equally may be an effective political act, playing to our fears of death, and those words we use to name, or either to not name, our cultural tiger.

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What It’s Like to Learn You’re Going to Die

Palliative-care doctors explain the “existential slap” that many people face at the end.

By Jennie Dear

[N]essa Coyle calls it “the existential slap”—that moment when a dying person first comprehends, on a gut level, that death is close. For many, the realization comes suddenly: “The usual habit of allowing thoughts of death to remain in the background is now impossible,” Coyle, a nurse and palliative-care pioneer, has written. “Death can no longer be denied.”

I don’t know exactly when my mother, who eventually died of metastatic breast cancer, encountered her existential crisis. But I have a guess: My parents waited a day after her initial diagnosis before calling my brother, my sister, and me. They reached me first. My father is not a terribly calm man, but he said, very calmly, something to this effect: “Your mother has been diagnosed with breast cancer.”

There was a pause, and then a noise I can best describe as not quite a sob or a yell, but feral. It was so uncharacteristic that I didn’t know then, and I still don’t know, whether the sound came from my father or my mother.

For many patients with terminal diseases, Coyle has observed, this awareness precipitates a personal crisis. Researchers have given it other names: the crisis of knowledge of death; an existential turning point, or existential plight; ego chill. It usually happens as it did with my mother, close to when doctors break the news. Doctors focus on events in the body: You have an incurable disease; your heart has weakened; your lungs are giving out. But the immediate effect is psychological. Gary Rodin, a palliative-care specialist who was trained in both internal medicine and psychiatry, calls this the “first trauma”: the emotional and social effects of the disease.

The roots of this trauma may be, in part, cultural. Most people recognize at an intellectual level that death is inevitable, says Virginia Lee, a nurse who works with cancer patients. But “at least in Western culture, we think we’re going to live forever.” Lee’s advanced-cancer patients often tell her they had thought of death as something that happened to other people—until they received their diagnosis. “I’ve heard from cancer patients that your life changes instantly, the moment the doctor or the oncologist says it’s confirmed that it is cancer,” she says.

The shock of confronting your own mortality need not happen at that instant, Coyle notes. Maybe you look at yourself in the mirror and suddenly realize how skinny you are, or notice your clothes no longer fit well. “It’s not necessarily verbal; it’s not necessarily what other people are telling you,” Coyle says. “Your soul may be telling you, or other people’s eyes may be telling you.”

E. Mansell Pattison, one of the early psychiatrists to write about the emotions and reactions of dying people, explains in The Experience of Dying why this realization marks a radical change in how people think about themselves: “All of us live with the potential for death at any moment. All of us project ahead a trajectory of our life. That is, we anticipate a certain life span within which we arrange our activities and plan our lives. And then abruptly we may be confronted with a crisis … Whether by illness or accident, our potential trajectory is suddenly changed.”

In this crisis, some people feel depression or despair or anger, or all three. They grieve. They grapple with a loss of meaning. A person’s whole belief system may be called into question because “virtually every aspect of their life will be threatened by changes imposed by the [disease] and its management,” Lee has written. In a small 2011 Danish study, patients with an incurable esophageal cancer reported that after their diagnosis, their lives seemed to spin out of control. Some wondered why they had received a fatal diagnosis, and fell into despair and hopelessness. “I didn’t care about anything,” one patient said. “I had just about given up.”

In the 1970s, two Harvard researchers, Avery Weisman and J. William Worden, did a foundational study on this existential plight. Newly diagnosed cancer patients who had a prognosis of at least three months were interviewed at several different points. At first, for almost all the patients in the study, existential concerns were more important than dealing with the physical impacts of disease. The researchers found that the reckoning was jarring, but still relatively brief and uncomplicated, lasting about two to three months. For a few patients, the crisis triggered or created lasting psychological problems. A few others seemed to face the crisis, then return to a state of denial, and then double back to the crisis—perhaps more than once. In the study, the researchers describe a patient who was told her diagnosis, only to report to interviewers that she didn’t know what it was—and then make it clear she wasn’t interested in receiving a diagnosis in the near future.

Palliative-care doctors used to think that a patient was either in a state of denial or a state of acceptance, period, Rodin says. But now he and his colleagues believe people are more likely to move back and forth. “You have to live with awareness of dying, and at the same time balance it against staying engaged in life,” he says. “It’s being able to hold that duality—which we call double awareness—that we think is a fundamental task.”

Whether or not people are able to find that balance, the existential crisis doesn’t last; patients can’t remain long in a state of acute anxiety. Coyle has found in her work that later peaks of distress are not usually as severe as that first wave. “Once you’ve faced [death] like that once, it’s not new knowledge in your consciousness anymore,” she says.

The existential slap doesn’t always entail mental suffering, and medical professionals who work with the dying say there are rare cases in which patients seem to skip this phase altogether, or at least experience it in a much less painful way. “People can gradually come to the realization,” Coyle says. “No one has to go through the sudden shock of awareness.”

But for most, figuring out how to adapt to living with a life-threatening disease is a difficult but necessary cognitive process, according to Lee. When patients do emerge on the other side of the existential crisis, she finds that many are better off because of it. These patients are more likely to have a deeper compassion for others and a greater appreciation for the life that remains.

To arrive there, they have to squarely face the fact that they’re going to die. “If you’re an avoidant person, and you don’t like to think about these things, that works better when life is going well,” Rodin says. “It just doesn’t work well in this situation because reality doesn’t allow it. It’s like trying to pretend you don’t need an umbrella or something, or it’s not raining, when it’s pouring. You can do that when it’s drizzling, but eventually, you have to live with the rain.”

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