There is a very interesting commercial produced by Liberty Mutual as part of their www.responsibilityproject.com. It shows a man and a woman driving through empty city streets in the pouring rain. They stop in front of a diner and see an elderly man dancing in the rain---no umbrella. The woman, obviously distressed, comments that Dad can’t live on his own anymore. The man turns to her and says, “What are you going to do.” She responds with some asperity that this is his Dad too. “You’re part of this family.”
What struck me right off? The woman is driving and looks very worried. The man is sitting on the passenger side---kind of slumped down---almost sullen. Right away you get that the woman has two problems: the parent who has dementia and a sibling who is signaling in multiple ways that this is no concern of his.
The day I saw this commercial, I had done a consult with a family whose mother has Alzheimer’s disease. Now in her early eighties, she is in an assisted living facility. She has enough money to cover the costs for the next 2+ years. Her children blithely assured me that once she had spent down her assets, government aid would pay for her nursing home care (Medicare and Medicaid).
My questions to them were: How can you be so sure? What’s plan B?
If they’re reading the same newspapers I am, it is conceivable that the increasing needs of the aging population and the economic recession are producing a perfect storm. Will federal and state budget deficits allow government to continue to be in the nursing home business? If not, what happens to people like my client’s mother?
If there is a chance that this family will have to share the cost of private pay for their mother’s care in a couple of years, it might be a good idea to confront that possibility now.
Wednesday, May 27, 2009
Saturday, May 23, 2009
Caregiving Decisions: What is the right thing to do?
Right for whom? Right for now? What about later?
Caregiving often requires hard choices about priorities---how to allocate scarce resources like time and money. How do we make these decisions in a way that works for us as individuals? How do we make these decisions in tandem with others who are also part of the equation?
Suzy Welch, in her book 10-10-10, 10 Minutes, 10 Months, 10 Years, A Life-Transforming Idea, offers a deceptively simple technique for evaluating priorities and making choices. Basically one asks oneself what will be the consequences of a particular choice in 10 minutes, in the next 10 months, and in the next 10 years. Of course no one has a crystal ball with which to accurately predict the future, but we can use our intellects to gather facts and our imaginations to describe probable outcomes.
Then comes the real challenge: making a choice. Even if the decision is not to make a choice at this time---one has examined the probable consequences of not making a choice.
Sound too existential? Think about this. The commitment to care for a parent or spouse or whomever is a commitment to dedicate resources. This often means transferring resources from one use or one person to another. Paying for nursing home care for a parent might mean less college tuition for a grandchild. Staying home to take care of someone might mean one less paycheck.
Thousands of families are already facing these hard choices; making these decisions. Many wonder if they are doing the right thing. Many feel torn between responsibilities to their parents and to their children. Using techniques like 10-10-10 can help us articulate the decision-making process and identify the values that underpin our choices. This can provide a place of peace when worry and doubt threaten to overwhelm us.
Caregiving often requires hard choices about priorities---how to allocate scarce resources like time and money. How do we make these decisions in a way that works for us as individuals? How do we make these decisions in tandem with others who are also part of the equation?
Suzy Welch, in her book 10-10-10, 10 Minutes, 10 Months, 10 Years, A Life-Transforming Idea, offers a deceptively simple technique for evaluating priorities and making choices. Basically one asks oneself what will be the consequences of a particular choice in 10 minutes, in the next 10 months, and in the next 10 years. Of course no one has a crystal ball with which to accurately predict the future, but we can use our intellects to gather facts and our imaginations to describe probable outcomes.
Then comes the real challenge: making a choice. Even if the decision is not to make a choice at this time---one has examined the probable consequences of not making a choice.
Sound too existential? Think about this. The commitment to care for a parent or spouse or whomever is a commitment to dedicate resources. This often means transferring resources from one use or one person to another. Paying for nursing home care for a parent might mean less college tuition for a grandchild. Staying home to take care of someone might mean one less paycheck.
Thousands of families are already facing these hard choices; making these decisions. Many wonder if they are doing the right thing. Many feel torn between responsibilities to their parents and to their children. Using techniques like 10-10-10 can help us articulate the decision-making process and identify the values that underpin our choices. This can provide a place of peace when worry and doubt threaten to overwhelm us.
Wednesday, May 20, 2009
Mini Nursing Homes
Another set of statistics in Maria Shriver’s e-mail to The Huffington Post (www.huffpost.com) provided backup to one of my major themes---more and more homes are becoming mini-nursing homes. She tells us:
“Seventy percent of people with Alzheimer's live at home, cared for by family and friends. There are nearly 10 million Americans providing 8.4 billion hours of unpaid care to people with Alzheimer's disease or other dementias - valued at $89 billion. And believe it or not, there are getting to be almost as many kids actually "babysitting" a grandparent with Alzheimer's at home as kids babysitting children. That's where we are.”
Let’s see, that’s somewhere in the neighborhood of how many million mini-nursing homes? Maybe we could call these nursing homelets.
These nursing homelets are unsupervised, unregulated. Families and friends are often dealing with complex challenges. Completing simple activities of daily living (toileting, bathing, dressing, eating) can become ordeals. Behavior problems like uncontrolled anger and anxiety, rummaging, and wandering can be major challenges even to someone who is trained in this work.
What about the person who isn’t trained? Who might not be there by choice? Is it any wonder that tempers flare? That it becomes easier to forgo the bath or the meal or the medication?
What can we do? One idea is that health care organizations providing medical care to someone with a neuro-degenerative disease also provide oversight of these mini-nursing homes and ongoing training and support for those caregivers. There could be an initial home visit at the time of diagnosis with additional elective visits either at the request of the caregiver and/or the client or mandatory visits if medical professionals perceive problems with care, i.e. weight loss, poor hygiene, bruising, etc.
Another is to set up an on-demand cable channel showing programs that deal with just these issues. Programs already exist at many health care institutions: how to lift a person; strategies for bathing a resisting adult; short courses on specific diseases and treatments---but you have to go there for access. Caregivers often have little free time. I can tell you from experience that when I get time away from a client I am not going to a library to read up on their situation. I want to get as far away from the reality as possible. But at 9 in the morning, faced with a dementia sufferer who doesn’t want to eat or take a bath---it would be so helpful to be able to see a program that shows strategies for accomplishing these activities.
“Seventy percent of people with Alzheimer's live at home, cared for by family and friends. There are nearly 10 million Americans providing 8.4 billion hours of unpaid care to people with Alzheimer's disease or other dementias - valued at $89 billion. And believe it or not, there are getting to be almost as many kids actually "babysitting" a grandparent with Alzheimer's at home as kids babysitting children. That's where we are.”
Let’s see, that’s somewhere in the neighborhood of how many million mini-nursing homes? Maybe we could call these nursing homelets.
These nursing homelets are unsupervised, unregulated. Families and friends are often dealing with complex challenges. Completing simple activities of daily living (toileting, bathing, dressing, eating) can become ordeals. Behavior problems like uncontrolled anger and anxiety, rummaging, and wandering can be major challenges even to someone who is trained in this work.
What about the person who isn’t trained? Who might not be there by choice? Is it any wonder that tempers flare? That it becomes easier to forgo the bath or the meal or the medication?
What can we do? One idea is that health care organizations providing medical care to someone with a neuro-degenerative disease also provide oversight of these mini-nursing homes and ongoing training and support for those caregivers. There could be an initial home visit at the time of diagnosis with additional elective visits either at the request of the caregiver and/or the client or mandatory visits if medical professionals perceive problems with care, i.e. weight loss, poor hygiene, bruising, etc.
Another is to set up an on-demand cable channel showing programs that deal with just these issues. Programs already exist at many health care institutions: how to lift a person; strategies for bathing a resisting adult; short courses on specific diseases and treatments---but you have to go there for access. Caregivers often have little free time. I can tell you from experience that when I get time away from a client I am not going to a library to read up on their situation. I want to get as far away from the reality as possible. But at 9 in the morning, faced with a dementia sufferer who doesn’t want to eat or take a bath---it would be so helpful to be able to see a program that shows strategies for accomplishing these activities.
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