Month: October 2018

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Spotting Elder Abuse: Tips for Long-Distance Caregivers

From a distance, it can be hard to assess the quality of your family member’s caregivers. Ideally, if there is a primary caregiver on the scene, he or she can keep tabs on how things are going.

Perhaps you have already identified friends or neighbors who can stop in unannounced to be your eyes and ears. Sometimes, a geriatric care manager can help.

You can stay in touch with your family member by phone and take note of any comments or mood changes that might indicate neglect or mistreatment. These can happen in any setting, at any socioeconomic level. Abuse can take many forms, including domestic violence, emotional abuse, financial abuse, theft, and neglect.

Sometimes the abuser is a hired caregiver, but he or she can also be someone familiar. Stress can take a toll when adult children are caring for aging parents, or when an older person is caring for an aging spouse or sibling. In some families, abuse continues a long-standing family pattern. In others, the older adult’s need for constant care can cause a caregiver to lash out verbally or physically. In some cases, especially in the middle to late stages of Alzheimer’s disease, the older adult may become difficult to manage and physically aggressive, causing harm to the caregiver. This might cause a caregiver to respond angrily.

But no matter who is the abuser or what is the cause, abuse and neglect are never acceptable responses. If you feel that your family member is in physical danger, contact the authorities right away. If you suspect abuse, but do not feel there is an immediate risk, talk to someone who can act on your behalf: your parent’s doctor, for instance, or your contact at a home health agency. Suspected abuse must be reported to adult protective services.

Learn more about the signs of elder abuse and how to get help.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Elder Abuse

Eldercare Locator
1-800-677-1116 (toll-free)
https://eldercare.acl.gov

National Committee for the Prevention of Elder Abuse
info@preventelderabuse.org
www.preventelderabuse.org

National Center on Elder Abuse
1-855-500-3537 (toll-free)
ncea-info@aoa.hhs.gov
https://ncea.acl.gov

Complete Article ↪HERE↩!

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How to ask your parents about their estate plan

Asking your parents about their estate plan isn’t always easy, but in the end, it’s about making their wishes come to reality.

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Making plans for the end of life is important, but it’s a topic a lot of people tend to avoid. In fact, surveys show that some 60 percent of Americans lack a will or estate plan.

Yet, if you were to ask, most of them would assure you they want to care for their family after they die. They want to safeguard the assets they’ve carefully built over the years, keep them in the family, and make sure Uncle Sam doesn’t take the lion’s share.

How do you find out if your own parents have taken care of their plans? Adult children find it challenging to talk with their parents about such things. The subject can be sensitive and emotional. You may worry about appearing self-serving. Yet, it’s important for you to have such details so that you can be better prepared.

Here are some ways to make the topic easier to broach.

1. Watch for off-handed cues, such as your father mentioning his mortality or the reference to having attended a friend’s funeral. This is an opportunity to mention that as much as you don’t want to think about it, you want to respect their wishes, should a critical health situation come into play. Do they have an advance directive and power of attorney? Tell them you need to know in order to help carry out their wishes.

2. Ask your parents for advice on your own estate plan. Inquire as to how they have handled their own will or trust, and open with such questions as, “Who is on your team of professionals for your estate?” Refer to having reviewed your life insurance policy to make sure your beneficiaries are current and ask if they have checked theirs lately to make sure their beneficiaries are up to date.

3. Set an appointment to talk with your parents. If an opening does not come up to talk about this casually, set a time with them to discuss it. Let them know this meeting is about making sure their wishes for the future are respected. When you meet, assure them that you don’t want to guess about their desires and have some questions that address some delicate but important areas.

Once the door opens for you to talk with them about this, be sure you don’t shut it quickly. Assure them you have asked for this conversation in order to make sure they are well taken care of.

Once you begin exploring the details, don’t put your parents on the defensive. Asking why your parents have decided certain things the way they have can cause sensitivity. Instead, as they share information, mirror this back to them so that they feel heard.

An example would be, “What I hear you saying, Mom, is that you prefer to be cremated rather than buried, is that right?” Take it slow, allow them to express feelings about the choices they have made for their future. If they are reticent to talk about money, tell them numbers are not important – you just want to make sure they have planned well for what lies ahead.

If you can set the stage for an honest and candid discussion, be sure you include addressing the following four things: (1) A will or trust with a coordinated estate plan; (2) an advance health care directive; (3) a durable power of attorney; and (4) a list of assets and where they store important documents you might need when the time comes.

Complete Article ↪HERE↩!

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The cost of not talking about death to dying patients

By Colleen Chierici

Will you know when it is your time to die? It is a question that has permeated my mind since July 14, 2017. This was the day my mother died. It was a sad day, but it pales in comparison to the months preceding it. A breast cancer that had returned aggressively, a hasty port placement to receive chemotherapy that was too late  and an ICU admission that began many futile interventions that never saved her life, but prolonged my mother’s suffering.

As a registered nurse, I watched a scene unfold that I swore to myself I would never let happen to anyone I loved. Yet, there I was listening to an oncologist discuss a 30 percent chance she would respond to chemo (which did not mean she would be cured) and choosing this inappropriate treatment for my critically-ill mother. I was party to these decisions when my mother couldn’t make them and when she made some recovery in her mental status, she also chose to continue treatments.

Were these decisions well founded? They were missing a key piece of information, that even with my training, I failed to see. My mother was dying. She was dying and none of my mother’s care providers were able to say those words.

Would my family have chosen a different path for my mother, if there had been a more explicit conversation? Resoundingly, yes. If my mother’s health-care providers would have had a deliberate discussion about her impending death my family would never have chosen chemotherapy and instead chose to initiate hospice care.

As a nurse, I have a duty to advocate for patients. Advocating can take many forms, but most often, it is helping patients navigate the complexities of the health-care system as well as explaining the meaning of test results, procedures, and diagnoses. Often, answering the question “What does this mean for me?” In my own practice, I have helped many patients understand the life changes needed to manage, diabetes, heart failure, and coronary artery disease.

But, like the nurses who provided care for my mother, I struggle having explicit conversations about dying with my patients. This does not appear to be an isolated phenomenon. In a 2018 study, researchers in Australia surveyed acute care and critical care nurses to assess their understanding and utilization of end-of-life discussions and care planning. They found that nurses’ own knowledge and rates of participation are low when it comes to end-of-life care.

On the other side of this, is a patient who may not be making a well-informed decision, because they don’t understand their disease is life-limiting or that they are dying. When the focus is shifted from “fighting to live” to “death is imminent,” other care decisions can be made by these patients. They can choose hospice care. Patients who have a prognosis of 6 months or less are eligible.

In hospice, care is shifted from procedures, tests and medications that can cause discomfort or pain for the patient, to comfort measures that improve the quality of one’s last days. Medicare, who pays for this benefit, found that only 12-25 percent of beneficiaries’ days during the last year of life are being spent in hospice. Are we having these conversations with our patients too late? I have coordinated and provided care for patients who only hours before their death have been enrolled in hospice, even though their diagnosis had been terminal and had been known by the patient’s providers for months.

To be sure, there are nurses who are adept at having these difficult discussions about death with patients and their families. But it is not a skill that comes easy to the majority of the profession. Fortunately, there are resources available to help nurses facilitate these conversations in an effective way.

The End-of-Life Nursing Education Consortium (ELNEC) project, for example, is a national education initiative that seeks to educate nurses on better end-of-life care. Their curriculum includes coursework on how to lead effective communication during end-of-life care.  

Perhaps, we need to re-evaluate how we train our nurses to have conversations about death and dying. Have those who are experts at these discussions share their wisdom and teach nurses how to have these conversations in an empathetic and impactful way so that patients can receive the comfort and dignity of hospice care in a timely manner. If we can make these changes in our communication with patients and their families, perhaps, one day we will all know when it is our time to die.

Complete Article ↪HERE↩!

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‘Vampire’ discovered buried in Cemetery of Children in Italy

‘I’ve never seen anything like it. It’s extremely eerie and weird,’ says archaeologist

The 10-year-old’s skeleton is the oldest body to have been uncovered at the fifth-century Italian cemetery

By Josh Gabbatiss

A “vampire burial” unearthed at a Roman site in Italy is evidence of ancient funeral practices to stop corpses rising from the dead, according to archaeologists.

The body of a 10-year-old child was buried ritualistically with a stone in its mouth, possibly out of fear it would return to spread disease to its community.

Known locally as the “Vampire of Lugnano”, evidence collected from the bones suggest the child was infected with malaria at the time it died.

“I’ve never seen anything like it. It’s extremely eerie and weird,” said Professor David Soren, an archaeologist at the University of Arizona who has run excavations in the region for over three decades.

The remains are the latest unusual discovery to emerge from the Cemetery of Children, a site containing dozens of children’s bodies and evidence of witchcraft including toad bones, raven talons and bronze cauldrons. 

Dated to a time in the fifth century when a deadly malaria outbreak swept across central Italy, archaeologists thought the cemetery had been set aside specifically for the babies and young children who would have been most vulnerable to the disease.

The “vampire” skeleton, which is of unknown sex, is the oldest child to be identified so far at the site.

It was one of five new burials discovered there over the summer, and was found placed underneath a makeshift tomb constructed from roof tiles.

“Knowing that two large roof tiles were used for this burial, I was expecting something unique to be found inside, perhaps a ‘double-inhumation’ – not uncommon for this cemetery – where a single burial contains two individuals,” said David Pickel, a PhD student a Stanford who directed the excavation.

“After removing the roof tiles, however, it became immediately clear to us that we were dealing with an older individual.”

The child’s open jaws and tooth marks on the surface of the stone were evidence that it had been placed in the mouth intentionally.

Similar burials have been documented from Venice to Northamptonshire, and along with dismembering bodies and forcing stakes through the heart are thought to be methods of preventing these “vampires” from returning to haunt the living.

“This is a very unusual mortuary treatment that you see in various forms in different cultures, especially in the Roman world, that could indicate there was a fear that this person might come back from the dead and try to spread disease to the living,” explained bioarchaeologist Jordan Wilson, another PhD student who examined the body.

Professoer Soren added: “We know that the Romans were very much concerned with this and would even go to the extent of employing witchcraft to keep the evil – whatever is contaminating the body – from coming out.”

An abscessed tooth, which can be a side effect of malaria, provided evidence that the child had been killed in the epidemic that struck so many of the cemetery’s inhabitants.

Elsewhere at the site, a three-year-old girl had been buried with stones weighing down her arms and feet – a practice also thought to prevent corpses from returning to life.

The researchers said these practices provide a fascinating insight into the thought processes of ancient Romans and their fears about life after death.

“It’s a very human thing to have complicated feelings about the dead and wonder if that’s really the end,” said Ms Wilson.

“Anytime you can look at burials, they’re significant because they provide a window into ancient minds.”

With much of the cemetery still unexplored, the archaeologists intend to return to the site next summer to complete their excavations.

Complete Article ↪HERE↩!

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When Is the Right Time for Hospice Care?

Caregivers should know what hospice involves and how to navigate the decision

By John F. Wasik

When my 91-year-old father returned from the hospital after a bout of pneumonia and was readmitted scarcely a week later, his doctor suggested that hospice care was probably a good idea. He was extremely frail and barely able to walk. His overall health wasn’t improving.

Like most people eyeing hospice care as the end stage of medical intervention, I was reluctant to make that decision. What if he could get better? Wasn’t hospice only for people with a few weeks — or days — to live? Was I being unrealistic about his condition?

Such questions often torment families. It’s one of the most difficult health care decisions you’ll make because of hospice’s astounding recognition of mortality. According to the Centers for Disease Control and Prevention (CDC), hospice care involves more than 1.3 million patients and 4,000 agencies — most of them private — but it’s still not well-understood and often offered much too late.

How Hospice Works

Medicare pays for hospice care for people who are terminally ill, “with a life expectancy of six months or less, if the illness has run its normal course,” according to Medicare.gov. While that definition sounds muddled — many could live for only a few days or several years — it’s a different philosophy of care. It’s rare that hospice patients survive for half a year. The average hospice from 2011 through 2016 was 71 days or about 2 1/2 months, according for the Center for Medicare and Medicare Services.

Medicare defines hospice care as a “specially trained team of professionals and caregivers providing care for the ‘whole person,’ including physical, emotional, social and spiritual needs.”

At the core of hospice is palliative care — making the patient feel as comfortable as possible and not directly treating an illness. Medicare offers hospice through its Part A, but a patient must be certified by both a regular and hospice doctor that he or she has only six or fewer months to live. You still pay your regular Medicare Part A and B premiums, plus $5 co-payments for prescription drugs. (Note: Medicare supplemental policies can cover co-payments, depending upon the plan).

A Misunderstood Option

The major difference between hospice care and conventional treatment is no longer isolating and treating specific causes of health issues. “The biggest myth of hospice care is that you have to relinquish all treatments,” says Ruth Finkelstein, executive director of the Brookdale Center for Healthy Aging at Hunter College and the City University of New York (CUNY). “You’re only relinquishing ‘further extreme measures’ such as another course of chemotherapy.”

While hospice care can be offered in facilities, it’s generally given in the home and includes counseling, drugs and equipment like hospital beds. There’s also support and counseling for the family.

But the biggest barrier with hospice isn’t its end-of-life focus, it’s the fact that most patients and families choose it too late, says Finkelstein. Relieving pain — the centerpiece of palliative care — should be considered earlier rather than later in the process. And you don’t have to be terminally ill to receive it.

“The time for palliative care is anytime,” says Finkelstein. “Look at the situation from the patient’s and family’s point of view. Anytime something serious is happening [with pain management]: How do you want to handle it? You can employ a ‘pain team.’”

Making the Decision

After weighing what hospice care entailed, I enrolled my father with a local hospice care provider. The paperwork was simple: three Medicare authorization forms. While it hardly put my mind at ease over his state, I knew he would receive care that focused on day-to-day comfort instead of endless treatments and tests.

I sat down with the hospice provider and the care manager of his senior living center to discuss what hospice meant in practical terms. When would narcotics be administered? What happened beyond the six-month Medicare limit for coverage? Would I have some control over the kind of care offered?

Since I had health care power of attorney and my dad had dementia, I would be consulted on his care. He could qualify for more benefits if his conditions improved, which happens in a handful of cases. That was somewhat reassuring. Focusing on his comfort, the hospice company ordered a hospital bed to reduce the incidence of bed sores. They also increased his nurse visits and monitored his painkillers.

No heroic medical measures would be offered, though, which is hard for most families to accept. The hospice providers were trying to make my father feel as comfortable as possible and add a measure of peace to his life, which had been marked by a series of diagnostics for maladies that couldn’t be cured under ordinary means. He’d still be given antibiotics for frequent urinary tract infections, which are common in older people, but he wouldn’t be shipped off to the hospital at the first sign of trouble.

It’s Never Easy

The decision to enter into hospice care is painful. How can a family best approach it?

Try to get everyone on the same page. Evaluate the prospects of a loved one getting better with conventional treatments compared to the suffering that extensive medical care will entail. Does the person have multiple chronic conditions? Is the person gravely ill?

Sit down with a hospice provider, who can be recommended by a doctor, hospital or long-term care facility, and ask how the provider would respond to specific situations. If you’re searching for a hospice provider on your own, you can obtain a referral from Medicare (800-633-4227) or at Medicare.gov/hospicecompare. You’ll want to make your selection carefully; a new Government Accounting Office study of the Medicare hospice program found that “hospices do not always provide needed services to beneficiaries and sometimes provide poor quality care. In some cases, hospices were not able to effectively manage symptoms or medications, leaving beneficiaries in unnecessary pain for many days.”

Ask the provider staffers under what conditions they take a person to the hospital. What drugs will they use to relieve pain and how often? How do they handle overall management of care?

Hospice is less about what we think modern medicine should do and more about finding a small sense of serenity in one’s final moments. It may be little consolation to most families, but it’s a more compassionate approach that can strive to ease suffering.

Complete Article ↪HERE↩!

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5 Reasons to Plan Your Funeral Now

No one likes to think about death, but planning ahead for your funeral is smart

By Candy Arrington

Although I didn’t know it at the time, a week after my father received a terminal cancer diagnosis, he asked my cousin to take him to a local mortuary where he made decisions about his burial and paid for his funeral. Following his death five months later, as a grieving only child, I was thankful my father had the foresight to plan ahead, as he had always done for other life events. His choice to preplan was a gift that prevented me from making emotional and costly decisions based in grief.

Death is a subject none of us want to confront. Talking about death causes us to face mortality and run head-on into the fact that we will not always be here. Yet death is inevitable and planning your funeral is a lot like planning for retirement. It requires honest evaluation and sometimes hard decisions, but it’s something that needs to be done.

Here are five reasons to overcome hesitancy and consider planning your funeral now:

1. Rising Costs

Each year, funeral costs continue to rise. Planning and paying for your funeral now is a way to avoid those increasing costs. According to the National Funeral Directors Association (NFDA), the median cost for an adult funeral with viewing and burial, including vault, was $8,755 in 2017. For a funeral with viewing and cremation, the median cost was $6,260. These amounts do not include cemetery costs, monument or marker, pall flowers, obituary or other related expenses, which could raise the cost to between $10,000 and $12,000. However, consumers have options.

“Charges at all mortuaries are based on operating costs and overhead and are higher in larger metropolitan areas,” said Glenn Miller, manager at J.F. Floyd Mortuary in Spartanburg, S.C. “With a full-service mortuary, there are many options. All of our services are itemized, and families can choose what to include. Our fees are the same for a funeral at a church or at our chapel as long as it involves our standard five staff members.”

2. The Ability to Make Your Own Decisions

Most people like to feel in control over decisions that affect their lives, and often that extends to end-of-life decisions. While no one can predict the time and circumstances of death, many take comfort in knowing they’ve selected the type of burial, location and funeral they want. While many plan to make these decisions eventually, most never actually follow through.

“Emotions are the greatest deterrent to preplanning,” said Miller. “People often have the attitude that if they don’t talk about death, it won’t happen.”

If you approach funeral planning as you would a financial or business decision, you may be able to get beyond those difficult emotions. Many mortuary websites provide preplanning information. Other websites, such as Funeralwise, help calculate costs. Move beyond any superstitious notions that funeral planning hastens death, and take time to investigate.

Be aware that preplanning does not require prepayment. The NFDA provides a Bill of Rights for Funeral Preplanning. Knowing your rights helps you plan wisely and avoid being overcharged.

3. To Lessen Future Family Conflict

If you’ve ever tried to plan a family reunion or holiday get-together, you know suggestions and opinions abound and conflict. When planning a funeral — factoring in intense emotions, personality conflicts and multiplying by the number of siblings — you potentially have a recipe for a family squabble.

“Many people are still traditional in their faith and type of funeral they want, while their children may not be,” said Miller. “Children think differently than their parents and often have a more contemporary approach to burial, funeral location, music and minister. Planning ahead documents your wishes.”

While you can’t guarantee family members will abide by your choices, preplanning documents your wishes and provides a benchmark.

4. To Reduce the Financial Burden

We all hope to leave assets for our children, yet a prolonged stay in a care facility can deplete savings. Remaining assets are often non-liquid, which doesn’t help with the immediate need to pay mortuary or crematorium costs. Prepaying for your funeral and associated costs eliminates or reduces the financial burden on those left behind. Most mortuaries provide incremental prepayment options over months or years.

5. Preplanning is a Gift to Loved Ones

Planning a funeral is a huge hurdle for grieving family members who may be physically and emotionally exhausted. If even some planning has been done ahead, the burden of making rapid, costly decisions is eased.

Sometimes planning occurs near the end of life, but any information given or selections made are gifts to those who will execute the funeral.

Sherry Cochran’s father made decisions about his funeral while in hospice care, with his wife and six children present.

“My father was a minister, and he openly discussed his funeral,” said Cochran, a retired attorney in Raleigh, N.C. “He chose the hymns, minister, mortuary, cemetery and told us any casket we chose was fine as long as it was plain and didn’t cost much. When your parent is willing to talk about end-of-life issues and make decisions, it teaches you how to approach death and provides closure.”

Complete Article ↪HERE↩!

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The Raw Feeling of Losing a Fiftysomething Friend

The death of a friend provokes difficult reflections for this writer

By Judy M. Walters

My husband’s friend died last week. He was 57. That’s how old my husband is.

His friend was a great guy, married, a father of three, always kind and generous, thoughtful and considerate. We both liked him a lot. He developed a chronic form of cancer about 10 years ago, and for a long time he just lived with it. Every so often, he’d have to go off for chemo or tests or surgery, and then he would come back like before, still the great guy he had always been.

Until a few weeks ago, when suddenly the cancer was everywhere and no one could do anything except watch him die.

So it wasn’t like we were surprised.

It was more like shock. How could a 57-year-old man with children barely into their 20s die, even if he’d had cancer for 10 years? Even if that was what the doctors had told him would happen? Even if he had grown weaker over the last few years, and no treatment seemed to be working after a while?

It’s hard for us to wrap our brains around it.

Considering Our End-of-Life Wishes

My husband and I have talked about death a lot. I don’t consider us weirdly obsessed with the subject, but we have definitely talked about it. We talk about what we will want when we are dying — not to be kept alive by artificial means or if in pain that will result in death anyway. My husband has a living will (an advance directive laying out wishes regarding medical treatment when you’re not able to convey them); I do not, but I will get on that soon.

We’ve discussed, at length, what I will do if my husband dies — he is especially prepared for that one. “Go right to the special green folder,” he’s told me more than once. The green folder is filled with codes for me to get to our money and his life insurance.

We talk about what we might do if the other dies. How long is it okay to wait to look for a future spouse? My husband says, “At the funeral,” but I’m pretty sure he’s joking. I say: Not for at least a year. In fact, I’ve told my husband, friends and family, I can never imagine being married to anyone else. Which is why when someone my husband’s age dies, I think: Would I be happy being single the rest of my life? I am 50. Would I really want to start all over, to date?

What I Imagine Would Happen

I know some things I would do. I would sell the house. It’s too big and unwieldy for me to manage myself, and it will be too expensive — mortgage, maintenance — to deal with. But then where would I go? I don’t know. All my friends would still be married. I would be alone.

Of course people wouldn’t tell me I was alone. They’d tell me they were right there with me. But they would still be couples, doing couple things together. They would invite me for dinner now and then but not when they were having date nights, or on vacations because who wants your single friend to come on vacation with you and your spouse?

Fifty-seven is too young to die. You miss out on all of the good stuff. Retirement. Vacations. You don’t get to go to the movies during the day just because you feel like it. You don’t get to have lunch at the diner with all your friends because no one is working anymore and there’s nothing else to do.

You don’t get to ever hug your spouse or kids again. You don’t get to watch your grandchildren grow into awkward teenagers who you think are the cat’s pajamas, even though you know they are actually royal pains in the neck to their parents and you sort of enjoy it after what you went through with your own kids. At 57, you feel like you still have another whole life to live.

But then it’s all gone. All of it. And you made the most of it while you were living it, but you are still missing so much. While you might not know anymore, your family will know. They’ll name kids after you and talk about you at all the family functions. Your kids will desperately try to keep you alive, even though you will never be old enough to need to be kept alive.

Fifty-seven is too young to die. My husband is 57. But our friend was 57. So it happens, and more than we would like to think. When it happens like this, you can’t help but wonder, will it happen to you, too?

Complete Article ↪HERE↩!