Posted by Sheri Samotin on Tue, Apr 13, 2010
A just published book for adult children and their aging parents is "The Daughter Trap: Taking Care of Mom and Dad ... and You" by Laurel Kennedy. This is a valuable resource for all adult children, daughters and sons alike. Ms. Kennedy bases her work on hundreds of interviews with baby boomers in the thick of caring for their parents and the anecdotes help to illustrate her key points and make the work come alive.
The first half or so of the book frames the problem. While this section doesn't introduce much in the way of new insights, it does effectively capture the issues faced by so many who care for aging parents and summarizes many of the important studies and resources that have been published on this important topic over the past few years. At the end of each chapter, Kennedy has a section of "what we've learned" where she tries to guide the reader on actions they might take or things to think about. Some of this tidbits are more helpful than others. For example, at the end of Chapter 4, Kennedy writes, "When you need outside help -- ask for it." This sort of feels like motherhood and apple pie. On the other hand, in the wrap up of Chapter 6, Kennedy wisely opines, "Acknowledge your limitations and those of your family. Develop a plan B if caregiving becomes overwhelming to the detriment of your life..."
The second portion of The Daughter Trap focuses on solutions and here is where Kennedy forges new ground. For example, in Chapter 9 entitled "It Takes A Village", Kennedy does an excellent job of bringing her readers up to date on the various initiatives underway to explore alternatvie senior living models and later chapters focus on ways that corporate America can make a difference and technology solutions that are needed.
Kudos to Kennedy for this well researched work. For those who are well versed in the issues of baby boomers and their aging parents the second half of the book provides some "aha" moments. For those who are just getting involved with this critical demographic reality the first half provides a thoughtful overview.
Posted by Sheri Samotin on Tue, Jan 19, 2010
John and Jane Smith (names and some of the personal details changed to preserve the privacy of those involved) are a lovely couple in their mid-seventies who became southwest Florida snowbirds in 1996 and permanent residents in 2002. When I met them, the Smiths were both healthy and engaged in an active lifestyle. Their two adult daughters live in Connecticut and Ohio and lead busy lives with careers and families of their own. The elder Smiths have always been highly independent and determined never to become a burden on their children. They've consulted with an estate planning attorney and have a financial advisor they trust. Mr. Smith has always handled the bulk of the family finances and it was the Smith's financial advisor who first suggested that they consult with me regarding putting all of their day-to-day affairs in order so that if something happened to John, Jane would be able to take over. As it turns out, that advice was incredibly important.
When I first met with the Smiths, they weren't sure exactly why their financial advisor had suggested the meeting since John was confident that all of their financial details were under control. During that first meeting, we discovered that while John knew all of those details, that Jane had only a vague idea of what investments they had and had no idea what the password was for their online banking service which John used to pay most of their bills. She also didn't know where the insurance policy papers were kept or much about what they covered. Finally, we discovered that Jane did not have a credit card in her own name. During that first meeting, we discussed the various things that need to be done so that Jane could take care of the family finances in the event of John's incapacity. By the end of that first meeting, the Smiths agreed that their financial advisor was right and they needed some help getting their affairs organized.
I use a very detailed approach to helping clients to organize their affairs, the goal of which is to assemble all of their critical information in one place for easy access when it's needed. As we worked through the various topics, we made a list of all of the things that had to be done, the documents that had to be found, the bills that had to be paid, and the decisions that had to be made. Over the next several weeks, I worked with John and Jane to make sure that everyone stayed on track. The end product was a computer flash drive that contains all of the critical information, including scanned copies of important documents. I also prepared one hard copy version of the information in a binder since Jane is more comfortable with holding things in her hands than with accessing them on the computer. In addition to the things you'd expect to find, like account numbers, passwords and copies of military records, this repository also lists important vendors like the air conditioning company with which the Smiths have a service contract and the name and phone number of the dog walker for their beloved schnauzer Sam. The idea is that if something happens, the Smith's daughters (or another trusted person) can quickly take over.
In the Smith's case, we needed for Jane to apply for a credit card in her own name, so that she would have access to credit if something happens to John. We also discussed the Smith's end-of-life wishes and they decided to meet with a funeral director to make pre-need arrangements so that no one had to guess what they would have wanted. Finally, we prepared documents that permitted the Smith's daughters to have access to information about their various accounts in the event that was necessary.
As the final step in our process, I facilitated a conference call between the Smiths and their daughters. The stated objective of the conference call was to bring the girls up to speed in the event that both of their parents became incapacitated at the same time. While John and Jane did not want to turn the flash drive containing all of the information over to their daughters immediately, they did want them to know that this resource existed and where to find it.
As luck would have it, within several months of completing this effort, John suffered a stroke. While he is recovering well, Jane was able to easily step in and take care of the day-to-day matters that had previously been John's domain. The fact that the Smiths had prepared for this in advance meant that both were less stressed than they would have been during an otherwise difficult period.
©2010 LifeBridge Solutions, LLC. All rights reserved.
Posted by Sheri Samotin on Fri, Dec 18, 2009
Visiting your aging parents over this holiday season provides a wonderful opportunity to create memories and to take a good look at how they are doing. Make sure you take advantage of this time to do both, especially if you live at a distance and don't get to see them often.
Perhaps the most important objective for your visit is to create memories. After all, who knows what next year will bring? One way to do this is to resurrect old traditions. Maybe your mom always baked Christmas cookies when you were young, but she hasn't done so in years. That's something you can do together, all the while chatting about the holiday in years past. Another approach is to establish new traditions together. Not only will these new traditions become part of your family lore, but they allow you to engage your parent in a new way. One way to make sure your visit is full of energy is to involve the younger generations in this memory creation marathon.
Of course, if you're like most of us, you have a list of tasks you hope to accomplish for mom or dad while you're visiting. Perhaps Dad needs help cleaning out the garage, or Mom can use some new clothes. Maybe it would be helpful for you to accompany your parent to a doctor's appointment or to take care of some banking. Whatever the task, taking care of some ordinary activities with your parent will give you a good idea of how he or she functions on a daily basis when you're not around.
During your visit, it is critical that you are a careful observer of both your parent and his or her surroundings. Observe both what Mom is doing and what she's not doing. Sometimes your best clue as to your parent's status is noticing the things they used to do with ease that they're not doing at all. For example, if Dad used to love to garden and the yard is a mess, that's worthy of your attention. Look for signs of deteriorating health, such as weight loss, recent ER visits, failing vision or hearing, or an empty refrigerator. Signs of safety or mobility concerns include recent falls, unexplained bruises, medication mishaps, or leaving the tea kettle on all night. Is Dad having trouble climbing the stairs to his bedroom? Does Mom wear her cane like a bracelet? Financial issues might be evidenced by piles of unopened mail, past due notices, or medical paperwork unopened or in piles. Perhaps the home looks different than it has in the past, with lots of clutter or maintenance and repairs ignored.
A holiday visit can be a wonderful time to engage in dialogue about these matters with your parents, siblings, or other family members if you choose the right time and approach. The right time is NOT at the dinner table on Christmas Eve or in the middle of the latke party on Hanukah! Rather, look for less formal and quieter times or even go so far as to create opportunities. A car ride or long walk can be a great time to talk, as can be a mother-daughter visit to the nail salon or spa. And remember, a dialogue means that everyone gets a chance to speak and that you're having a conversation, and that it isn't necessary or even desirable to reach any conclusions. There's time enough after your visit to work through details or logistics by telephone or email.
Finally, remember to use some of your visit to help you plan for the future. Take home a copy of the latest yellow pages. This can be very helpful if you need to marshal resources for your parent from a distance. Get to know a few of your parent's neighbors if you don't already know them and make sure to take their phone numbers home with you. Make a list of important phone numbers, such as your parent's doctors or providers of household repair services. Anything you can do to be prepared for the day to day "crises" will help keep your stress down later on.
Above all, remember to enjoy the time with your family.
©2009 LifeBridge Solutions, LLC. All rights reserved.
Posted by Sheri Samotin on Thu, Dec 17, 2009
Dear Sheri:
My husband recently passed away and he always handled our household bills and budget. I don't even know where to begin to get everything in order. Is there someone who can help me with this?
Intimidated Irene
Dear Irene:
First off, please accept my condolences to you on your loss. It may help to know that your situation is not at all unusual. Often, one spouse handles the family finances. This works out well from the standpoint of division of labor, but leaves the other spouse at a real disadvantage when the situation changes, especially if it is a sudden and unexpected change. As a new widow, I'm sure you have a lot on your mind, not to mention the piles of paperwork you're probably handling to settle your late husband's estate.
Fortunately, there are professionals who specialize in helping people in your situation. They are called Daily Monday Managers, or DMMs. DMMs offer a range of services, including helping you to manage your mail and set up a system for paying your bills, assisting with check writing and maintaining bank accounts, helping you create a realistic budget and stick to it, and developing a tax planning and organization system. In addition, many DMMs have expertise in medical billing advocacy and can make sure you are paying only those medical bills that have been correctly billed and processed. A DMM can also help you with the many tasks that are necessary to settle an estate, including obtaining various records, closing accounts, and gathering items needed by attorneys and accountants.
Be sure to choose a daily money manager who is bonded and insured. Also, be sure the person you choose specializes in working with older adults and their families and is not simply a bookkeeper for businesses. Many DMMs are members of a national organization called the American Association of Daily Money Managers. You can learn more about this profession, as well as search for a DMM to help you, by visiting their website at http://www.aadmm.com.
Posted by Sheri Samotin on Wed, Nov 04, 2009
Have you ever walked into your aging parent's home and seen a stack of Medicare papers on the kitchen table? Has the thought crossed your mind that maybe you should have these papers come directly to you since they seem so confusing to your Mom? Is your Dad asking you which Part D drug plan he should select, or whether he should consider a Medicare Advantage program? Have claims been denied that your parents thought were for covered services? If so, you're not alone. Many seniors find dealing with their medical paperwork to be overwhelming.
Dealing with the sheer volume of medical paperwork can be intimidating for many beneficiaries. It is important that the explanations of benefits that are received from both Medicare and any supplemental insurance policy be reviewed promptly and if errors are detected, those should be reported immediately. Similarly, if claims are denied, they must be reviewed and possibly resubmitted if you believe they were denied in error. Time is of the essence for these matters, since there is a time limit for appealing the carrier's decision. If you decide that handling these tasks are too much for your parent, you might consider handling it for them or enlisting the help of a medical billing advocate who will review all of the paperwork on a monthly basis, ensuring that your parent is getting the benefits for which she has paid. In either case, you should be aware that Medicare will only send the paperwork to the beneficiary's address on file with the Social Security Administration or to a properly documented Representative Payee. (Further information is available at http://www.ssa.gov/.)
What about if your parent simply needs help selecting the right plans? Each year, Medicare-eligible people are allowed to switch their plan during "open enrollment". This process begins on November 15th and ends on December 31st. The best place to start is the Medicare website at http://www.medicare.gov/. There you can learn about "original Medicare", as well as about "Medicare health plans", "Medigap policies", and "Medicare prescription drug plans." Which offering is right for your parent will be determined based on a number of factors, including their overall health, finances, and the degree of choice they desire. You may find that while one approach works well for Mom, Dad is better off on a different plan due to the maintenance medications he takes. It is perfectly fine for your parents to each select the coverage that works best for him or her as an individual. Again, if you find that this selection process is overwhelming, a medical billing advocate may be a helpful resource.
Posted by Sheri Samotin on Tue, Oct 20, 2009
I am often asked to describe the benefits derived by adult children of aging parents when they elect to work with a family transition coach. Perhaps the best way to answer this question is through an example. I've changed some of the personal details to preserve the privacy of those involved, but the situation itself is based on a real situation from my practice.
Jennifer found me by reading an article I had written and published about family transition coaching in a local senior resource publication. I was in a meeting when she initially called, so she left a voice mail message that began, "I really need help, and I need it fast!" When I called Jennifer back, she told me that she is one of four siblings and the long distance caregiver for her mother Nancy. Nancy lives in southwest Florida and Jennifer lives in Michigan. Jennifer's siblings are scattered across several states, but none live near their mother.
Nancy is 84 and suffers from memory loss and some confusion. She is otherwise in good health and remains fairly active. Ever since Dad died six years ago, Nancy has been managing herself. She continues to live in the condo that she and Dad moved to in 1995 when they first relocated to Florida and until recently has maintained an active social life with her friends from church. Jennifer usually visits Nancy a few times each year; her siblings visit less frequently. Several months ago, when Jennifer came to visit, she noticed that Nancy seemed confused and somewhat withdrawn. Jennifer accompanied Nancy to her doctor's appointment and learned that Nancy's condition is considered to be "age related memory impairment." It was explained that this is a "normal part of aging" and that "there is nothing to worry about." Nancy assured Jennifer that she was fine and still able to manage on her own.
Several weeks after returning home from that visit, Jennifer called Nancy for her regular check-in and found her agitated and confused. She became extremely concerned, and called Nancy's neighbor and asked her to check on Nancy. When the neighbor called back, she told Jennifer that Nancy seemed okay. The next morning, Nancy didn't answer the phone when Jennifer called, and didn't respond to a knock on the door by the same neighbor whom Jennifer had called again. Fearing the worst, Jennifer called 911 who responded and took Nancy to the hospital. It turns out that Nancy suffered a stroke. Jennifer jumped on a plane to come to be with Nancy. She has taken on the role of primary long distance caregiver by default. The family has never discussed Nancy's situation as a group.
That's when Jennifer called me. She knew that she had to return home to her job and her family within a few days and was in a panic about what would happen to Nancy. At the same time, she was getting frustrated trying to convey information to her siblings, each of whom offered lots of input but none of whom offered to come and take over so that she could get home. Jennifer was under extreme stress.
The first thing I helped Jennifer to do was to get organized and get her siblings involved. We started by making a list of all of the things that had to be done, the documents that had to be found, the bills that had to be paid, and the decisions that had to be made. We then scheduled a conference call among the siblings which I facilitated. The stated objective of the conference call was to identify Nancy's needs and the resources that could be provided by the family working as a team. These resources included knowledge, time, and money. Once we had an exhaustive list of what needed to be accomplished, we matched the available resources. By the end of that first call, each of the siblings had their assignments and was committed to working as a team. Within a few hours of Jennifer's initial call to me, she was feeling as though she was back in control of the situation and didn't need to carry the burden on her own shoulders.
Over the next several days, I worked with each of the siblings on their piece of the puzzle, making sure that everyone stayed on track. The family had one very important decision to make, and that was where Nancy was going to go upon her discharge from the hospital. We worked with a geriatric care manager to identify the options and concluded that she could return to her condo safely as long as she had appropriate in-home care. Nancy's family now needs to address whether this is a sustainable solution given the financial realities, and the siblings have arranged to all come to visit Nancy at the same time within the next month. During that visit, they plan to go and look at several assisted living facilities and determine if that might be a better solution for Nancy. In preparation for their visit, Jennifer has asked me to help her identify several alternative facilities and to gather all of the necessary information so that she can share that with her siblings in advance of their visit so that they can make the most of their time together.
Family transition coaching can be helpful during a crisis, as in the case study presented above. While it is always better to plan ahead, the reality is that most people avoid thinking about the inevitable issues that will arise as their parents age. If you find yourself in the midst of a caregiving crisis, don't hesitate to reach out to a family transition coach.
Posted by Sheri Samotin on Mon, Oct 19, 2009
One of the most difficult aspects of parenting your parents is the very delicate balance between preserving their independence and taking charge. While most of us will perceive it as "easier" to take on an activity ourselves, it is usually better to find a way to get the job done in a manner that allows our aging parents to remain in control.
For example, if your Mom is having difficulty managing her mail and her bills and keeping her checkbook balanced, you might decide to have her mail come directly to you and to set up automatic payments for most of her bills. However, by doing so, you rip control from your Mom, likely making her feel angry toward you. An alternative might be to ask your Mom to put all of the mail in a special place each day, and then for you to come once a week and sit with her while she sorts through the mail and prepares her checks. Sure, this will take you more time, but you will allow Mom to feel as though she is still responsible for herself.
Sometimes, we will have no choice and we will have to take charge in order to keep our parent safe. If Dad has cracked up the car and you've determined that it is no longer safe for him to drive, you must make sure that he no longer is behind the wheel. How can you preserve Dad's independence in this situation? One idea might be to arrange for transportation services that he can access when he needs them that don't require him to ask you for a ride. In some areas, local taxi companies will allow you to set up an account. This way, if Dad wants to meet a friend to play cards, he can do so without the extra stress of arranging to get there and back.
Whenever you are concerned about your parent's ability to manage activities of daily living, you have an opportunity to help them preserve independence. There are always choices for how to solve the problems you will encounter. If you make a real effort to consider your parent's dignity, and balance that need with your need to get the task done efficiently, you are likely to enjoy a better relationship with your parents as they age.
Posted by Sheri Samotin on Thu, Sep 24, 2009
When it comes to our parents, it's only a matter of time before we adult children need to become more involved in their day-to-day lives. Unless we are incredibly lucky, our parents won't live to be 100 and die in their sleep with no deterioration in their physical or mental abilities. For the rest of us, we need to be prepared for the inevitable time when our help is needed. It makes sense to sit down with our parents and our siblings to think about how we'll handle things before the need to do so is a crisis. After all, these are not easy issues to think about, much less discuss, and being able to consider them over a period of time is preferable to making decisions during a time of extreme stress.
If you don't think this topic concerns you, consider that, according to the National Clearinghouse for Long Term Care Information:
- Long-term care is a variety of services and supports to meet health or personal care needs over an extended period of time. Most long-term care is non-skilled personal care assistance, such as help performing everyday "Activities of Daily Living" such as bathing, dressing, and eating
- At least 70 percent of people over age 65 will require some long-term care services at some point in their lives
- This year, about 9 million Americans over the age of 65 will need long-term care services; by 2020, that number will increase to 12 million
- On average, someone age 65 today will need some long-term care services for three years
- One year of care in a nursing home, based on the 2008 national average, costs over $68,000 for a semi-private room
- One year of care at home, assuming you need periodic personal care help from a home health aide (the average is about three times a week), would cost almost $18,000 a year
- A caregiver is a family member, partner, friend, or neighbor who helps care for an elderly individual or person with a disability who lives at home; in 2004, there were more than 44 million caregivers age 18 or older in the United States - about 21% of the adult population
- Approximately 60% of caregivers are women
- Thirteen percent of caregivers caring for older adults are themselves aged 65 or over
- The typical caregiver is a 46-year-old woman who is married and employed, and is caring for her widowed mother who does not live with her
- A 2006 study of caregivers found that on average caregivers spend 21 hours a week giving care
Taking the time to plan ahead will reduce the inevitable stress when the time comes. You will have an idea of the resources that are available to help you and your parent, and you will have prepared for how to pay for it. If you have siblings, it helps if you are all on the same page regarding how each of you will contribute to your parents' care, whether it is financially or by doing. If you're interested in learning more, check out the National Clearinghouse for Long Term Care Information at www.longtermcare.gov and download their very informative planning guide.
Posted by Sheri Samotin on Tue, Sep 15, 2009
If we're honest with ourselves, we can remember back to a time when we and our siblings were all living at home and we settled into certain patterns within our families. For example, in a family of three brothers, there was the elder who had his act together, the middle one who was the clown, and the youngest who was Mom's favorite. Does it surprise you when forty years later, these three brothers are dealing with their aging mother and the same patterns play out? The oldest brother, the "responsible" one, takes charge of the nuts and bolts, and at some point he probably feels put upon because his siblings aren't helping enough. The middle brother is always there for the fun and happy times, but he seems to disappear when the going gets tough. He might feel that he's not in the loop. And the baby, Mom's favorite, announces that he is coming to visit and Mom talks about nothing else for weeks before and after. It's likely that he's oblivious that both of his brothers are annoyed with him. This is an example of siblings who, despite the adults they have become, revert to their childhood roles when confronting the aging of their parent.
In addition to historical family patterns, gender roles often come to the forefront in family caregiving situations. Why is it that women so often take on the caregiver role? Is it because they expect it of themselves, or because their families expect it of them? Is there truth to the old saying that, "a daughter is a daughter for life, but a son's a son until he takes a wife?" Is it because caregiving is often still considered to be "women's work"? While there are certainly many families where men play leading and significant roles in the care of their parents, many surveys show that sons most often write checks while daughters (and daughters-in-law) provide more of the hands on caregiving. Whatever might be the situation in your family, it helps to be aware of gender roles, and think about whether you are falling into default positions or really are sharing the load.
Proximity and distance also become factors in the family caregiving dynamic. In many families, one sibling lives near their parents, while others don't. The one who is close by will tend to see the parents more often and may not notice subtle changes in a parent's ability or behavior. Then, one of the out-of-towners comes for a visit and begins pointing these things out. If not handled with care, the in-town sibling might take this personally, thinking that the sibling is saying that he or she isn't doing a good enough job of looking after Mom and Dad. At the same time, the distant siblings might take it for granted that their in-town brother or sister is both expecting and willing to take on the caregiver role, leaving that caregiver by default to feel taken advantage of.
Complicating the family dynamic, each of us has different needs. We all know someone who needs to be needed. This person will often have great difficulty when their caregiver role naturally comes to an end. What about the person who needs to fight fires, and who might even set a few in order to be able to save the day? Without even realizing it, this person might make the caregiving more complicated than it needs to be. Do you know someone who needs to be seen as the big spender? This person is likely to feel that money is the answer to every caregiving challenge, and will look for opportunities to show how generous she is. When that generosity isn't acknowledged, she's likely to get angry. Finally, do you know anyone who has a need to be the "good" son? This person will take actions based on how they appear to others, and will look down on his siblings who aren't as "good" as he is.
Money, competing responsibilities, and disparate skills rear their heads as well. It is all too easy for families to fall into roles when they don't take the time to discuss these things out loud. The best family caregiving situations arise when everyone is working together. There can be a role for everyone, even those who live far away. All it takes is some good ongoing communication and a plan. If you're not sure how to get started, you might consider hiring a family transition coach to help. As an objective third party, your coach can help provide focus and will have experience with others who have going through similar transitions so that you don't have to start from scratch. In addition, a family transition coach will be knowledgeable about the many resources that are available to you and can facilitate necessary but difficult conversations and decisions. If you can anticipate the challenges you may face with your siblings in these circumstances it is likely that you can avoid some of the pitfalls.
Posted by Sheri Samotin on Mon, Jul 27, 2009
Whether you are teaching your young daughter how to knit, or helping your aging mother balance her checkbook, how do you take charge without taking over? How many times have you found yourself "showing" someone how to do something by doing it for them? It's human nature. But while it might make sense to show by doing when you are "teaching" someone younger or less familiar with a particular topic than you are, it usually leads to anger when you do this when you are "assisting" someone with a task that he previously has been perfectly capable of handling himself.
It was probably hard enough for your mom to agree to let you help her pay her bills and balance her checkbook. And even once she agreed, it wouldn't be surprising if she told you that she didn't know why you were insisting on helping her since she is perfectly capable of doing it herself. The truth is that acknowledging that you need help with the business of life is really, really hard for most seniors. If they come to the point where they need your help, they are confronted with their own limitations. And those limitations won't "get better" in most cases. Deep down, your mom knows that this is the beginning of the end of her independence as she has come to know it.
So, how do you take charge without taking over?
1. If possible, do the tasks alongside your mom rather than doing it for her. While this approach might take longer than doing it yourself, you allow mom to retain some self esteem by letting her take the lead.
2. Let your dad tell you what aspects of a particular activity he needs your help with, and if possible, try to limit your assistance to just those things, at least for now. Of course, if your dad doesn't have a realistic picture of what he can do for himself, you will need to gently find a way to help him see your perspective.
3. Be respectful, and ask permission before you just jump in. For example, when you take your parents to a doctor's appointment, don't just assume that they want you to come into the examining room with them. Instead, ask them if they'd like you to be there the whole time, or if perhaps you can just be called in toward the end of the visit to make sure that YOUR questions are answered.
4. Set up invisible safety nets. For example, if you come every Sunday and set up your mom's medications in a weekly medication management system, you can have some expectation that she will take the correct medications at the right time. But it wouldn't hurt to also have a way of checking that once or twice during the week. This might take the form of a medication management visit by a home care company or trusted friend or relative or perhaps daily medication reminder phone calls from you.
5. Make a distinction between safety and everything else. When your dad's safety is on the line, you might just have to take charge by taking over. On the other hand, if you'd just prefer that something be done a certain way or at a certain time, there might be an opportunity to loosen the grip a bit.
Your job as your parent's caregiver is to keep them safe, comfortable, and happy. As long as you keep that in perspective you should have no trouble taking charge without taking over.