Senior Resource Guide Austin + San Antonio (Fall/Winter 2021)

SENIOR

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AUSTIN/SAN ANTONIO EDITION FALL/WINTER 2021

RESOURCE guide

MEMORY MATTERS

Steps to take after a dementia diagnosis

WHEN IT’S TIME

to address driving, housing, finances

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the

CAREGIVING journey Rosalynn Carter says there are only four kinds of people in the world: •

Those who have been caregivers Those who are currently caregivers • Those who will be caregivers • Those who will need caregivers •

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aregiving has a way of creeping up on us. As family, friends and neighbors, we all want to be there for our loved ones when they need us. Very few of us see ourselves as a “caregiver,” and most of the time we haven’t had any training on how to be a caregiver, or an understanding of the depth the role requires.

For the majority, it takes a “trigger event” such as a fall, hospital admittance or diagnosis of a health condition before there’s full realization of the situation and what plans/actions need to take place.

The Senior Resource Guide is designed and geared towards the unique needs of the modern caregiver. We’re here to help take the guesswork out of this challenging role by providing support and knowledge-based information at your fingertips when you need it—both in print and online.

As you journey through different stages in your caregiving quest, our hope is that you’ll be able to use the Guide to help create space for flexibility and make well-informed decisions.

At the end of the day, feeling good about your care and efforts, as well as seeing your caregiving experience as a positive expansion and transformation, will help you and your loved one live more fully.

In the words of our Founder, here’s to your quest!

TRANSITION AND REFLECTION “What do I do now that they’re no longer here? How can I honor my journey? How have I grown?”

LATE PHASE FINDING BALANCE “I’m needing to recharge but there’s not enough time.”

• 5 Vital Tips to Help Deal with Caregiver Stress (see pg. 60)

FINAL PLANNING “How do I make sure they’re taken care of and their wishes are met?”

• Understanding Hospice (see pg. 112)

SHIFTING PRIORITIES “I know this is what’s going on and need to give it attention.”

INCREASING DEMANDS “This is getting bigger and needs more of my attention.”

IDENTIFYING YOUR ROLE “I can help out.”

PLANNING AND PREPARING DETECTING CHANGES “Is this part of normal aging?”

• Signs Not to Ignore: Dementia versus Normal Aging (see pg. 80)

EARLY PHASE

“This is not normal aging, what is it and what can I do?”

• Getting Connected with Help (see pg. 24) • 5 Must-Have Legal Documents (see pg. 44)

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MID PHASE

AUSTIN & SAN ANTONIO EDITION

• Setting Expectations for Your Role as a Caregiver (see pg. 14)

SENIOR RESOURCE GUIDE

• Questions to Ask During Hospital Discharge (see pg. 88)

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“What are our next steps now that this event has happened?”

• Home Care versus Home Health Care (see pg. 56)

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MAJOR TRIGGER EVENTS

CONTENTS AUSTIN & SAN ANTONIO EDITION

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GENERAL INFO 4

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The Caregiving Journey

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The Senior Resource Guide Team

10 Our Legacy

EARLY PHASE

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THE ROLE

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Setting Expectations for Your Role as a Caregiver

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20 Navigating Family Conflicts 21

Franklin Park Senior Living (see also pg. 32A + 32B)

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What to Do When You Need a Break

24 Get Connected

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THE PLAN

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Creating a Care Plan

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Paying for Long-Term Care

30 What Level of Care is Right 32 What’s an Adult Day Center?

34 Warning Signs of Unsafe Driving in Seniors 36

Ombudsmen are Here to Help

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CONVERSATIONS

38 How to Talk with Your Parents About Their End-of-Life Wishes 40 How to Talk with Your Siblings About Caregiver Responsibilities

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INITIAL MEDICAL CARE

46 Understanding Medicare: Parts, Plans and Meeting Your Needs 50 Make the Most of Your Doctor’s Visits

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52

Mobile Care

LEGAL + FINANCIAL

54 When Do You Need to Consider In-Home Care?

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DAILY CARE

56

Home Care versus Home Health Care

SELF CARE How to Manage Caregiving Fatigue

60 Five Vital Tips to Help Deal with Caregiver Stress

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MID PHASE

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44 Five Must-Have Legal Documents

CONTENTS AUSTIN & SAN ANTONIO EDITION

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How to Address Appetite Changes in the Elderly

88 Questions to Ask During Hospital Discharge

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Why are Seniors More at Risk of Dehydration?

90 Encompass Health Rehabilitation Hospitals (see also pg. 1)

DIET + WELLNESS

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MEMORY + DEMENTIA

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Steps to Take After a Memory Issue is Recognized Tips for Effective Alzheimer’s Communication

What Type of Mental Health Professional is the Right Fit?

91 Making the Right Choice for Your Loved One’s Rehabilitation Services 95

Selling Your Home to Pay for Care

97 Spectrum Retirement (see also back cover)

80 Signs Not to Ignore: Dementia Versus Normal Aging

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84

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84 Care Transitions

100 Arbor Terrace Lakeway (see also inside back cover)

NEW STEPS

SENIOR LIVING Types of Residential Care for Seniors

101 How do I Pay for Assisted Living or Memory Care?

104 Texas Senior Living Locators (see also pg. 3) 105 S enior Living Communities 108 Questions to Ask When Looking for an Assisted Living Facility 110 Questions to Ask When Considering Skilled Care

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112 Understanding Hospice

122 Steps to Take After the Passing of a Loved One

116 Hospice Options

124 Preparing & Presenting a Eulogy

117 OpusCare of Texas (see also inside front cover)

68 Homemade Turmeric Almond Dressing Recipe

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64 Anxiety Reducing Drink Recipe

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OTHER INFO

SENIOR RESOURCE GUIDE

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119 Questions to Ask When Choosing a Hospice Program

126 7 Items to Consider When Planning a Celebration of Life

AUSTIN & SAN ANTONIO EDITION

LATE PHASE

Cora Hobbs 1915-2006

Our

Karyn Dean 1957-2020

LEGACY

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hat began as a simple collection of local resources has blossomed into what we now know as the ultimate guide to aging care.

As a caregiver for her grandmother and an eldercare advocate for over 25 years, our Founder Karyn Dean realized she was not alone in the quest for information and resources.

It was her dream to create a reliable resource that caregivers, seniors and eldercare professionals could turn to when navigating the many challenges associated with aging—thus was born the Senior Resource Guide.

Although Karyn is no longer with us, her dedicated mission of educating family caregivers and senior care professionals as well as her memory lives on. Her beautiful spirit guides every thought and decision throughout our transition into the modern caregiver’s resource.

What started out as a passion project with her husband quickly grew into something more when their children united behind the mission and joined SRG. Today, a team of compassionate individuals are part of the SRG family and bring an enthusiastic energy to helping caregivers through their journey.

AUSTIN & SAN ANTONIO EDITION Fall/Winter 2021

PUB L I S H ER The Dean Family

CO N T R I B U TO RS Arbor Terrace Lakeway, Encompass Health Rehabilitation Hospitals, Franklin Park, John B. Earthman, Mayo Clinic, Sharon Wagner, Texas Health and Human Services, Texas Realty Buyers, The American Elder Care Research Organization

A RT D I R ECT I O N /G RA P H I C P RO D U CT I O N Erin Suwwan, Jaclyn Threadgill – LuckyYou! Creative

SA L E S Alex Dean – Director of Business Development RJ Gibbs – Senior Account Manager Tiffanie Gupton – Account Manager

MARKETING

©2021. Senior Resource Guide is published semi-annually for the Greater Houston, Austin & San Antonio markets by: SRG Services, Inc., 77 Sugar Creek Center Boulevard, Suite 600, Sugar Land, Texas 77478 \\ 281–277–2333 \\ SRGTEXAS.com Disclaimer of Endorsement: Reference herein to any specific products, process, or service by trade name, trademark, manufacturer, or otherwise, does not necessarily constitute or imply its endorsement, recommendation, or favoring by the Senior Resource Guide.® The views and opinions of authors herein do not necessarily state or reflect those of Senior Resource Guide® and shall not be used for advertising or product endorsement purposes.

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Karyn Dean

SENIOR RESOURCE GUIDE

FO U N D E R & C H I E F V I S I O N A RY A M O N G T H E A N G E LS

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C H I E F EX EC U T I V E O F F I C E R Terry Dean

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D I ST R I BU T I O N Brian Stavert – Manager Myles Moore – Senior Distribution Executive

AUSTIN & SAN ANTONIO EDITION

Jennifer Dean Stavert – Director of Marketing Winona Vo – Senior Marketing Executive

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RESOURguCidE e

MEMORY MATTERS Steps to take after a dementia diagnosis

WHEN IT’S TIME to address driving, housing, finances

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EARLY PHASE

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SETTING EXPECTATIONS FOR YOUR ROLE AS A CAREGIVER

Getting Prepared for the Position

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t’s not always easy watching a loved one age. This can become especially hard when they reach the point of no longer being able to take care of themselves. And, if you didn’t already find yourself providing some level of assistance before a major life event occurs, you may now find yourself in the role of being the caregiver.

You may have intentionally elected to become a professional caregiver or a caregiving volunteer to help those in need.

In any case, if you’re new to this journey, here are some helpful tips to keep you prepared as you embark on this path.

THE ROLE OF CAREGIVER This is a role you can find yourself in rather quickly without knowing it happened.

A serious health event is typically the catalyst for this type of situation. However, this change can also happen gradually, and the role of caregiver might be taken on without even realizing it until you're deep into the process.

For instance, you may initially stop by just to check on your loved one. Gradually the number of visits increase, and

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progressively those visits turn into helping prepare meals, assisting with lawn maintenance, light housekeeping, and managing medical appointments.

Before you know it, they’re heavily relying on you and unable to do many of these things themselves.

Whether you had a conversation about it or not, at a certain point you realize you’ve accepted and taken on the role of caregiver.

Although you're now taking on the responsibility to care for someone else, you may already have quite a lot of responsibilities of your own (perhaps children or a full-time job). It’s important to know and understand the responsibilities that come with your new caregiver role. This way you're better able to care for them with confidence, empathy, preparedness and love throughout this journey.

AUSTIN & SAN ANTONIO EDITION

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THE ROLE

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Your caregiver quest doesn't come with a manual, so here are some examples of tasks you can anticipate in your new role: •

Help with finances such as paying bills, credit cards, managing rent and utilities or care home fees • Buy groceries, clothes and toiletries • Arrange medical appointments and provide transportation to and from • Be a companion or arrange for companion care • Help cook and clean • Assist with pet care • Ensure legal documents such as wills, trusts, guardianships, power of attorney are addressed • Keep other family members apprised • Make hard medical decisions

PREPARING FOR THE ROLE It can be easy to become overwhelmed and stressed when taking on this role for the first time. Here are some tips that can help you and the person you’re caring for feel more at ease.

BE SURE to have all physicians’ information on hand and establish yourself as the primary caregiver for the person. You may need to have them sign paperwork allowing you to see their health information under HIPAA or have a medical power of attorney document

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HAVE A CONVERSATION about you becoming their official caregiver and establish responsibilities and boundaries

MAKE A LIST of all medications they’re taking as well as allergies and hospitalizations in the last 10 years

CREATE A LASTING LEGACY WITH US

United Way of San Antonio and Bexar County

700 S. Alamo St. | San Antonio, Texas 78205 | 210.352.7000 www.unitedwaysatx.org

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SENIOR RESOURCE GUIDE

The enduring nature of your vision and generosity will continue to serve San Antonio and Bexar County for many years to come.

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By making a gift to United Way’s Endowment and Legacy Fund, you can honor a loved one, perpetuate your family name long beyond your lifetime, and ensure the programs and services to children, individuals and families continue into the future.

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EVERY MAN, WOMAN, AND CHILD DESERVES AN OPPORTUNITY FOR A GOOD LIFE.

AUSTIN & SAN ANTONIO EDITION

“What you leave behind is not what is engraved in stone monuments, but what is woven into the lives of others.” Pericles

EARLY PHASE

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SPEAK to them about how their financial obligations will be resolved TALK about where they want to live out their remaining years ASK if possible to be added to their bank account which will allow you to easily pay bills BE SURE to determine whether they have a power of attorney or other legalities in place FIND SUPPORT for both yourself and your loved one as neither of you are alone in this process CREATE a catalog of experts that you’ve interacted with. You never know whose expertise you might rely on in the future

Ways to Cope

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• Taking care of yourself

• Seeking mental health assistance when needed • Getting enough sleep • Building a strong support system • Drinking plenty of water • Exercising • Eating clean

SETTING EXPECTATIONS It’s important to take care of yourself.

Being a caregiver can easily take over your life if you’re not mindful. While you want to be there for your senior loved one, you also need to be there for yourself.

When you’re struggling, seek help. When you’re unable to do something, it’s okay to say no.

When you take care of your mental and physical self, you’re better able to care for your loved one.

We are here with additional resources as needed. Remember, you are not alone as it takes a great deal of strength to be a caregiver.

EARLY PHASE

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THE ROLE This content is proudly provided by

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2019-FranklinPark-SeniorResourceGuide-4.625x7.625-Ad.indd 1

While Caring for Aging Parents

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roviding care for aging parents can be an emotional and challenging experience. When siblings, spouses or other family members get involved, it can become even more complicated. As conversations escalate over how to best care for your parents, it’s essential to remind yourself, no matter what, each of you has their best interests at heart.

CALL A FAMILY MEETING A family meeting is one of the most effective ways for multiple family members to communicate. Proactive discussion can be beneficial as the family has ample time to research and come to a decision everyone is comfortable with. The point of the gathering is to outline various care options and define each family member’s specific role and responsibility.

BRING IN A THIRD PARTY When an agreement as a family seems difficult, consider hiring a professional counselor or family therapist who specializes in these situations. It can also mitigate strain or tension among siblings.

8/7/19 3:12 PM

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REEXAMINE FAMILY ROLES Labels placed on you when you were children, such as “troublemaker, bossy or caring,” can last through to adulthood and can become especially problematic when discussing care for your aging parents.

Adult children need to set aside any childhood roles and labels they may have been given and come together to help the family unit.

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PUT YOUR PARENTS’ NEEDS BEFORE YOUR OWN When navigating care options for your parents, it’s essential to separate your parents’ needs from your own. Set aside sibling differences and come together as a cohesive family unit to do what’s best for your parents. Ultimately, by ensuring your parents are safe, happy and properly taken care of, this can ease tension among family members.

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WHAT TO DO WHEN YOU NEED A BREAK Reviewing Your Respite Options

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here are several different types of respite care you can look into, each serving various purposes depending on the needs of your aging, disabled or sick loved one. But, in choosing your respite plan, it’s essential to think of your own requirements along with the needs of the person in your care.

Respite care also makes sure you are properly taken care of so that you can continue with the great work you’re doing for your loved one.

IN-HOME RESPITE CARE In-home respite care is when you enlist someone to replace you as the provider of your aging loved one in the home. If the person in your care is especially fragile and traveling would be both unhealthy for them and additional stress for you, in-home care is going to be the best option. In-home respite care can come from several sources, including: Trusted volunteers, like family members, friends, coworkers or members of your local church or nonprofit.

• Professional care providers from a company that specializes in traveling or short-term care.

• Trained staff that are available for short-term visits from one of your local care homes.

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Skilled health care services from a medical facility that enables highly trained staff to provide short-term care.

• Homemaker services from a company specializing in preparing meals, cleaning and running errands.

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Discover why respite care is especially important for caregivers of a loved one with memory issues as well as typical costs in the full article, visit srgtexas.com/getcaregivertoolkit

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Dive Deeper

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Specialized residential centers like group care homes, hospitals and skilled nursing facilities.

• Adult day cares, which are developed specifically for adult seniors who need care.

• Respite retreats and camps, which are fun getaways for you and your aging loved one that promotes healing and revitalization.

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OUT-OF-HOME RESPITE CARE Out-of-home respite care is when you take your aging loved one out of the home and into a different space for care. Out-of-home care may be overwhelming for some people, but for others, it’s a way to add excitement, new experiences and the chance to meet others. Out-of-home care can be:

AUSTIN & SAN ANTONIO EDITION

The great thing about in-home respite care is that it’s quite flexible. You could use these services for a weeklong vacation or just for some needed help for a few hours or throughout one day. Respite care doesn’t always mean you have to do a 180° and book a flight to Bora Bora. Sometimes, you just need some help in the home while you take the time to catch up on your to-do list, spend time in the garden, or kick your heels up in the comfort of your living room.

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GET CONNECTED Familiarizing Yourself with Local Resources That Can Help

TEXAS HEALTH AND HUMAN SERVICES The agency offers a wealth of information to connect you to resources, health care providers and services that can help you and your aging loved one live healthier. In the menu bar on their website is a dropdown for “Services,” which provides a wide range of helpful resources for people with medical, physical, intellectual or developmental disabilities; older adults; and caregivers who need a break from their duties. If you’re unsure how they can help, or even if you may not qualify for a program or service, Texas Health and Human Services’ trained professionals can help steer you in the right direction.

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Call 1-855-937-2372 or visit hhs.texas.gov

2-1-1 TEXAS As a trusted state resource available for free 24/7, 211 Texas is a connector for all Texans to critical, community-based services.

Whether it’s a sudden medical bill, a natural disaster, a veteran trying to return to civilian life, or a concern about an aging parent—people from all walks of life can find themselves in need of assistance and confronted with a maze of agencies and programs that are challenging to navigate. Their trained helpline specialists are good listeners, blending understanding and expertise to provide information and referrals drawn from a comprehensive database of social services.

Call 2-1-1 or visit 211texas.org

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An Overlooked Resource

Area Agency on Aging of the Capital Area Call 512-916-6062 or visit aaacap.org Alamo Area Agency on Aging Call 210-362-5212 or visit aacog.com/65/Alamo-Area-Agency-on-Aging Bexar Area Agency on Aging Call 210-477-3275 or visit aacog.com/108/Bexar-Area-Agency-on-Aging

AUSTIN & SAN ANTONIO EDITION

Area Agency on Aging of Central Texas Call 254-770-2344 or visit aaact.org

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AREA AGENCY ON AGING Serving over 250,000 people annually, Texas’ 28 area agencies on aging offer help to Texans age 60 and older, their family members and caregivers to locate and access local services, including benefits counseling, legal assistance, care coordination, caregiver support services, in-home support and the ombudsman program.

SENIOR RESOURCE GUIDE

UNITED WAY OF SAN ANTONIO AND BEXAR COUNTY Call 210-352-7000 or visit uwsatx.org

Support groups are an excellent resource and there are many specifically for caregivers.

See srgtexas.com to find support groups in your area.

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Visit unitedwayaustin.org/connectatx for a searchable directory that offers information on several community programs covering an array of categories including transportation, housing options, benefits screenings, meal options and elder abuse.

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UNITED WAY FOR GREATER AUSTIN United Way seeks to ensure that all older adults can live vibrant lives.

They offer resources to a number of programs that focus on older adults’ health, financial security and engagement.

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THE PLAN

CREATING A CARE PLAN

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ith more Americans living well beyond their 70s, more adult children are now left in a position where they find themselves caring for aging parents. For many, providing help for aging parents can be financially, logistically and emotionally challenging. This is why addressing long-term care needs before a major life event occurs can help alleviate some of the stress. Here are four steps to creating a cohesive care plan:

1. CONDUCT A NEEDS ASSESSMENT Put together a list of topics and questions to discuss with your parents. Consider the following:

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Family Support – who is available to provide support/care as needed?

• Home Safety – are there safety concerns to be addressed?

• Medical/Cognitive – are medical and cognitive health needs being considered?

• Mobility – what assistance with transportation is needed?

• Legal Documents & Finances – are there plans in place for paying for long-term care? Have necessary legal documents been addressed?

• Housing – is their preference to age at home or move to a senior community?

• Socialization – are they getting adequate opportunity to socialize?

THE PLAN

Remember

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• Support comes in many shapes • Open the lines of communication before a crisis happens • Understand their financial situation without judgment • It’s not all about you

Communicate your concerns and include your parents in the dialogue on their future needs. If they’re unwilling to discuss something you feel is important, agree to a time in the future when they would be willing to readdress.

To see a Care Plan example and access a free template for you to work from, visit srgtexas.com/getcaregivertoolkit

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4. EXECUTE A CARE PLAN Now that you’ve outlined any needs, steps and goals, along with roles and responsibilities, it’s time to put the plan into action.

Over time, you’ll need to look for signs and know when to reassess the situation to put updated roles and responsibilities in place.

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3. CREATE A CARE PLAN Put a plan together that everyone agrees will meet both immediate and long-term needs. See an example of a Care Plan in our Caregiver Toolkit.

AUSTIN & SAN ANTONIO EDITION

2. RESEARCH ELDERCARE PROVIDERS AND RESOURCES The current and future needs of your loved one will dictate the types of services and resources you need to look for. Explore available aging options on srgtexas.com.

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THE PLAN

PAYING FOR LONG-TERM CARE

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ong-term care is a type of personal care service older adults may need if they become unable to care for themselves because of a prolonged physical illness, a disability or a cognitive impairment, such as Alzheimer’s disease. Long-term care can be expensive.

Long-term care insurance is designed to cover medical and personal services in a number of settings such as your home, adult day care, skilled nursing facility or assisted living community. Most long-term care insurance policies are individual policies and can differ from one company to the next.

According to medicare.org, long-term care may be divided into three levels: Skilled care is continuous “around-the-clock” care designed to treat a medical condition and performed by skilled medical personnel, such as registered nurses or professional therapists.

Intermediate care is intermittent nursing and rehabilitative care provided by registered nurses, licensed practical nurses, and nurse’s aides under the • Medicaid supervision of a physician.

• Medicare Custodial care is designed to assist with one’s activities of daily living (such • Long-term care insurance as bathing, eating and dressing). It can be • Long-term care provided by someone without professional riders attached medical skills but is supervised by a to a life insurance physician. policy or annuity Texas created the Long-Term Care • Accelerated death Partnership Program, which is a joint effort benefits from life insurance between private insurers and the state.

For a list of companies participating in the • Personal cash or savings program visit: tdi.texas.gov/consumer

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Ways to Pay

EXPERIENCE THE NOT-FOR-PROFIT DIFFERENCE EXPERIENCE THE of NOT-FOR-PROFIT DIFFERENCE Not-for-profit providers aging services offer a commitment to quality EXPERIENCE THE of NOT-FOR-PROFIT DIFFERENCE Not-for-profit providers aging services offer a commitment to quality

that stems from a mission of service and a history of compassion Not-for-profit of aging servicesand offer a commitment to quality that stems providers from a mission of service a history of compassion that stems from a mission of service and a history of compassion LOCATE PROVI DERS I N YOUR AREA

www.leadingagetexas.org/directory www.leadingagetexas.org/directory www.leadingagetexas.org/directory

LOCATE PROVI DERS I N YOUR AREA LOCATE PROVI DERS I N YOUR AREA

LeadingAge Texas is a trade association representing the full continuum of LeadingAge Texas is a tradeaging association the full continuum of mission-driven, not-for-profit servicesrepresenting providers. Providers can learn more LeadingAge Texas is a tradeaging association the full continuum of mission-driven, not-for-profit servicesrepresenting providers. Providers can learn more & apply for membership at www.leadingagetexas.org/memberships mission-driven, services providers. Providers can learn more & apply fornot-for-profit membershipaging at www.leadingagetexas.org/memberships & apply for membership at www.leadingagetexas.org/memberships

info@leadingagetexas.org info@leadingagetexas.org info@leadingagetexas.org

www.leadingagetexas.org www.leadingagetexas.org www.leadingagetexas.org

(512) 467-2242 (512) 467-2242 (512) 467-2242

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THE PLAN

WHAT LEVEL OF CARE IS RIGHT

Understanding the Care Continuum ADULT DAY CARE An ideal option for older adults who wish to age at home but need daytime supervision. Adult day care centers provide services which typically include meals and activities that provide social interaction. Some centers specialize in services for individuals with Alzheimer’s and dementia.

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HOME CARE/HOME HEALTH For seniors living independently but require assistance. Nonmedical care (home care) or skilled medical care (home health) aim to allow an individual to remain at home by filling any gaps in care. These care services can range from specialized such as wound care to generalized like companionship and housekeeping.

CONTINUING CARE RETIREMENT COMMUNITY A housing option whereby a spectrum of aging care can all be met within one community. Beginning with independent living, moving to assisted living and finally skilled nursing as needed. All are typically located together on one campus.

INDEPENDENT LIVING A housing option for individuals who require little or no assistance with activities of daily living but enjoy access to dining, medical, hospitality and entertainment services. Also known as 55+ apartments or independent/retirement communities.

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Medicare

These types of care typically accept Medicare: • Skilled Nursing Continuing Care • Skilled Nursing Rehab • Home Health Care • Hospice Care

ASSISTED LIVING A housing option similar to independent living but for those who require more assistance and have difficulty with daily living activities.

SKILLED NURSING/ REHABILITATION FACILITY Ideal for those individuals who require constant nursing care.

These facilities are licensed and equipped to provide residents with health care that meets the needs of more involved medical conditions.

For a more detailed look at each of these levels of care, visit srgtexas.com.

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HOSPICE CARE End-of-life care for the terminally ill, usually via visits in the home or facility of residence.

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ALZHEIMER’S/DEMENTIA CARE Provides special programs and assistance for those with memory loss. Some facilities may provide special security measures.

AUSTIN & SAN ANTONIO EDITION

PERSONAL CARE HOME Assisted living in a home-like setting and typically has fewer residents.

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WHAT’S AN ADULT DAY CENTER? How it Can Help Caregivers

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dult day care provides care and companionship to older adults in a structured setting allowing primary caregivers an opportunity to work, catch up on personal items or simply relax.

Are adult day centers the same as my community’s senior center? While senior centers are intended for healthy, independent and physically capable older adults, adult day services are for individuals with physical or cognitive limitations.

Adult day centers are an ideal option for older adults who wish to age at home but need some supervision.

Different programs and services can be found at each adult day center. For example, some centers may specialize in Alzheimer’s or dementia care while others may offer therapeutic exercise, mental interaction, social activities and assistance with personal care.

Some centers offer weekend or evening hours, but most operate weekdays during daytime hours. Many provide daily activities, nutritional meals and transportation to and from the center at no cost or on a per-ride basis.

Depending on the services offered, costs for adult day care can range from $25 to over a $100 a day, according Visit srgtexas.com to the U.S. Administration on Aging. to further your Texas has one of the lowest average understanding and learn: daily rates around $35.

• When exactly is the right To find adult day care programs time for adult day service in your area, type your zip code into • What questions to ask the National Adult Day Services when vetting centers Association’s searchable online directory • How to help your loved (found on their website) or contact your one adjust to the new care local Area Agency on Aging.

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More to Know

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THE PLAN

WARNING SIGNS OF UNSAFE DRIVING IN SENIORS and When it’s Time to Address

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hether warning signs surface gradually or because of a recent change in health, they shouldn't be brushed aside or overlooked. Even minor changes that manifest individually can quickly lead to a more substantial problem. For example:

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Neck pain or stiffness can make it tough to properly check mirrors and look out for other vehicles.

• Leg pain or stiffness can make it difficult to switch between the pedals.

• Diminished range of motion and arm strength can make it challenging to turn the steering wheel.

• Slowed reaction time can impact braking or honking if needed quickly.

• Reduced ability to multitask makes it tricky to effectively divide attention between multiple activities.

• Impaired vision or hearing can be troublesome to see traffic lights and street signs and hear emergency sirens or honking horns.

• Declining memory can be problematic for regularly driven trips and cause an individual to become lost or confused.

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Something to Ask

Do they remember/are able to fasten their seat belt?

• Do they sit comfortably at the wheel or lean forward?

• Do they appear tense or distracted easily?

• Is there any difficulty moving their feet between pedals? Do they often confuse the gas and brake?

• Are they able to properly observe traffic lights, road signs, pedestrians, and the reactions of other motorists?

• Do they drive too close to other vehicles or drift into other lanes often?

• How’s your loved one’s reaction time in general? Is there any confusion in unexpected scenarios?

• Are they consistently waiting too long to brake or accelerate at traffic lights?

• Has your loved one retained a good sense of direction? Do they complain that vehicles or people appear suddenly to them?

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If you notice any of these warning signs or others, it may be time to share your concerns, talk with their doctor, and/or have a driving assessment done.

Whether your loved one is still driving, driving with limitations, or having to give up driving altogether, being aware of the warning signs can help you to play a valuable role in their safety.

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Has your loved one’s car insurance rate gone up? This may be a sign that they’ve had recent driving infractions.

Consider giving their driving condition more attention.

AUSTIN & SAN ANTONIO EDITION

WHAT SHOULD YOU BE LOOKING FOR? When joining your loved one for an errand or an outing, encourage them to drive and observe the following:

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THE PLAN

OMBUDSMEN ARE HERE TO HELP Courtesy of Texas Health and Human Services

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long-term care ombudsman not only enforces, but also helps nursing home residents to understand their rights. Living in a nursing home doesn’t mean giving up your freedom.

If you feel someone is violating you or your loved one’s rights, the Texas Health and Human Services Commission’s long-term care ombudsman can help.

Nursing home residents have the same rights and protections of their health, safety and welfare that we all share.

For nursing home residents, these rights include the right to vote, voice complaints, exercise personal choice, the opportunity to make medical and social decisions, visit with anyone they wish, and to be lawfully discharged and leave the facility.

One of the most common issues one might face when being discharged is to potentially lose their spot in the nursing home they were initially admitted to. This practice, known as “patient dumping,” is among the top five frequent complaints Patty Ducayet, Texas long-term care ombudsman, sees.

The long-term care ombudsman will make sure the individual knows their rights, including the right to appeal and return to the nursing home after a hospital stay, and can represent them during that appeal.

Important Number

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Call 800-458-9858 to report suspected elder abuse or neglect that occurs in nursing homes, assisted living facilities, day activity and health services. You can also report care concerns about home health and hospice agencies.

Often the most direct and expedient way to ensure your issue is addressed is to inform the skilled nursing facility’s management team, but the Texas Health and Human Services Commission stands by ready to help if needed.

According to Texas Health and Human Services, some of the ways long-term care ombudsmen help nursing home and assisted living residents include:

For more information on the ombudsman in your area: 800-252-2412 hhs.texas.gov (search for ombudsman)

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“An ombudsman can help bring the resident’s concerns to management and offer ideas to address the concern,” Ducayet said. “An ombudsman can give everyone information about the nursing facility’s requirements about residents’ rights and will tell the resident about the option to report a complaint to HHSC LongTerm Care Regulatory Services.”

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Listening to residents and family members when they have concerns or issues.

• Telling residents about their rights.

• Protecting resident health, safety, welfare and rights.

• Helping families learn about nursing homes and how to pay for them.

• Working to solve problems and making sure state regulations and laws protect residents.

AUSTIN & SAN ANTONIO EDITION

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CONVERSATIONS

hat w w o n K nt they wa

how to talk with

YOUR PARENTS ABOUT THEIR ENDOF-LIFE WISHES

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he conversation involving your parent’s or loved one’s end-of-life wishes is a difficult one. Consider, though, that prolonging this discussion could lead to your mother or father’s inability to share their wishes should they become sick or injured.

Without some type of advanced planning, you may be left to make decisions for them and these decisions could lead to conflict, especially with siblings or other family members involved.

OVERCOMING THE HESITATION TO TALK The fear of saying the wrong thing, or even validating the tender realities of your loved one’s state of being, can lead to hesitation on your part when initiating this very important end-of-life conversation. One way to overcome this hesitation is to share with your parents your thoughts on why it might be important to address these issues sooner rather than later.

Perhaps you might share that you’re currently addressing your own future considerations and that it would be sensible to discuss theirs, stressing the idea that lacking a plan could result in

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Important Documents

More

There’s more of this article in our Caregiver Toolkit. To read the full article, visit srgtexas.com/getcaregivertoolkit

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There’s more of this article in our Caregiver Toolkit which offers tips on how you can open a dialogue, what questions to ask, and the important documents and resources to consider when it comes to end-of-life conversations.

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SOME QUESTIONS YOU SHOULD CONSIDER ASKING 1. Have you thought about who you want to make medical decisions for you if you’re not able to make them for yourself?

2. Do you know what kind of medical treatment you want if you were to become sick or injured?

3. If you need long-term care, do you want to be cared for at home or would you prefer to move?

4. Do you know who you want to handle your finances if you’re not able to?

5. Have you created a will, power of attorney or advanced health care directive?

AUSTIN & SAN ANTONIO EDITION

For a list of mustknow important documents visit srgtexas.com/ getcaregivertoolkit

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larger issues down the line. By opening up a dialogue about these issues in general, it’s easier to start talking about what your parents want.

Ideally your parents have already begun to consider their end-oflife wishes, but it’s important to understand what those wishes are and what type of plan might be in place already.

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CONVERSATIONS

how to talk with

YOUR SIBLINGS ABOUT CAREGIVER RESPONSIBILITIES Keeping the Conversation Positive and Productive

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ften there is more than one family member involved with taking care of a parent or aging loved one.

If you’re fortunate enough to have a sibling—or more—to rely on when you find yourself in a caregiving role, consider this as a blessing.

Unfortunately it’s not always the case that siblings are willing or even able to help. A family can become estranged over the years, a sibling may be physically or financially unable to provide assistance, or perhaps they simply live too far away.

Whatever your situation is, we’ve provided a few tips to begin the conversation with your siblings and to get the support needed for ensuring the best care for both the caregiver and the person they’re providing care for.

SIBLINGS AND ROLES Regardless of whether you are the primary caregiver or your sibling is, caregiving can come with feelings of guilt, frustration and many times helplessness. Personal emotions can sometimes get in the way of making decisions for what’s best for your parent or aging loved one.

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SENIOR RESOURCE GUIDE

Try to begin the conversation while your parent or aging loved one is still healthy and without cognitive challenges. Being proactive will help to ensure that everyone involved will enjoy less stress, and a plan can be put in place for when the time arises.

• Have the conversation in person if possible. These discussions can be sensitive by nature and are often hard to successfully carry out over the phone or by text. Schedule a time for you and your sibling to meet, and preface the meeting with the topic so everyone has some time to think about what they want to say prior to sitting down together.

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What’s most important is to try and keep in mind that it’s all about caring for your parent(s) or aging loved one and ensuring they have a great quality of life.

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HOW TO APPROACH SIBLINGS When we put our differences aside and come to the conversation prepared and without judgment, we place ourselves in a better position of getting the help we need for ourselves, our siblings, and the person for which we’re providing care.

Here are a few tips to keep the conversation with your sibling positive and productive:

Remember the Why

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CONVERSATIONS

If your sibling hasn’t seen your parent or aging loved one in a while, they may not be aware of the current situation. In this case, bring any helpful documentation such as medical visits, diagnosis paperwork, and medication prescriptions to show your sibling your loved one’s current condition.

• Discuss all upcoming needs. If it’s time for your parent or aging loved one to move out of their home, make sure to share this information with your sibling to avoid anyone feeling left out or blindsided. Discuss costs and location and determine whether you can agree on a place and be sure to share your parent or aging loved one’s wishes.

• If you find that the conversation begins to feel contentious, take a break to allow emotions to settle down. When resuming the conversation, remind everyone that this is an opportunity to make caregiving decisions cooperatively, and agree to move forward by focusing on the tasks at hand.

• Ensure that you remain emotionally available and supportive to one another. It’s often unrealistic to assume that the responsibility should lie with one sibling. If you are the primary caregiver, make it known that you will need help and how and when they can best assist you. If you are not the primary caregiver, offer your help when possible. It can be hard to ask for help in these situations, however failure to do so ultimately can lead to resentment. No matter which role you are in, empathy and the courage to ask for and offer help will be vital.

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Be sure that everyone involved is aware of present circumstances, who the primary caregiver is going to be, and where important documents can be found and accessed.

These can be challenging and emotional times, so if you find you’re unable to get everyone on the same page, it may be necessary to seek a professional mediator.

In the end, when tackling the caregiving process, remember that the whole is greater than the sum of its parts. Defined roles, communication, empathy and perseverance will see you through.

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LEGAL + FINANCIAL

FIVE MUSTHAVE LEGAL DOCUMENTS

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hether you’re a caregiver yourself, or perhaps interested in getting your own affairs in order, we’ve identified five recommended legal documents that every adult should have. There are many available online resources that explain each document in greater detail. Some will provide a free template for you to create your own documents for instance. If you have an attorney, be sure to ask them about these types of documents. Don’t wait until it’s too late—take a moment now to get organized.

1. ADVANCE DIRECTIVE Also known as a living will or health care declaration/directive, this document outlines your wishes for medical treatments and life-sustaining measures, in the case that you’re not able to communicate them verbally. Details might include a “do not resuscitate” order (DNR), the use of breathing machines, tube feeding or organ donation. Making these decisions in advance lets medical professionals know what measures to take and grants your loved ones peace of mind should they have to communicate these decisions for you.

2. DURABLE POWER OF ATTORNEY FOR HEALTH CARE While an advance directive is limited to end-of-life concerns, a durable power of attorney for health care accounts for all

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Online Resources

health care decisions in the case that you’re incapable of making decisions for yourself. In this document, you can outline how your designated power of attorney should act. Their authority to make these decisions ends when you’re once again capable of making your own decisions.

• eldercareteam.com • legalzoom.com

• nlm.nih.gov/medlineplus/ advancedirectives.html • texasnaela.com • texasprobate.com/ professional-forms

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5. FINANCIAL POWER OF ATTORNEY This document designates someone (principal) to do business on your behalf should you be unable to take care of necessary matters yourself. Tasks designated might include paying bills, selling property, managing assets or applying for medical benefits. Unlike a living trust, a financial power of attorney terminates upon the death of the grantor.

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4. LIVING TRUST A living trust designates someone (trustee) to help manage and distribute your assets rather than going through the court system, as in a last will. This often prevents your last wishes from becoming public record. This document also designates terms in which the trustee would set into action should you be unable to make decisions regarding your assets during and after your life.

AUSTIN & SAN ANTONIO EDITION

3. LAST WILL AND TESTAMENT Many people know this document simply as a “will.” It outlines how your property (including digital property such as email accounts and blogs) should be distributed and to whom. Different states have different requirements for one’s will. In Texas your will must be signed by two witnesses.

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INITIAL MEDICAL CARE

UNDERSTANDING MEDICARE:

Parts, Plans and Meeting Your Needs Courtesy of Sharon Wagner, seniorfriendly.info

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any Americans who enter into Medicare do so with a sketchy understanding of how the system works. That’s rather alarming considering how much older Americans rely on Medicare for their health care needs.

It’s essential that seniors and their caregivers understand how the program works to avoid missing out on important benefits and paying unnecessarily high costs. Sometimes, the best approach is to start from the beginning when unraveling a complex subject like Medicare.

PARTS OF MEDICARE When you sign up for Medicare at age 65 you’re automatically enrolled in Plan A, which is hospital coverage, and Plan B, which covers outpatient coverage. Part A covers room and board in a hospital or skilled nursing facility, while Part B covers things like doctor visits, surgeries, lab work, equipment and diagnostic tests.

Prescription drugs are covered under Part D, which provides a card that allows you to buy prescription medications at a significantly lower cost than retail. Part D insurance is voluntary coverage but it’s a key part of the system because paying out-ofpocket for medications can be extremely expensive.

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HOW THE PARTS WORK Your Medicare Part B coverage is based on income, with enrollees starting at a base rate of $135.50 while higher-income enrollees pay an “income adjustment” (meaning they pay more for Medicare). Part B is a necessity; you can’t purchase supplemental insurance unless you have both Part A and B. If you’re working for a large employer, your health insurance there continues as your primary with Medicare playing a secondary role, meaning you can delay enrolling in Part B if your group insurance already includes outpatient benefits.

Part B covers 80% of medical services, with your share being the remaining 20%. Certain treatments and procedures can be quite expensive, which means you could end up with a hefty co-pay. Part D has built-in co-pays for medications, so you won’t need supplemental insurance for the cost of needed medications.

AUSTIN & SAN ANTONIO EDITION

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MEDICARE ADVANTAGE Choosing the right supplemental coverage is one of the most important decisions you’ll make as a Medicare enrollee.

Fortunately, you can select plan options based on your budget.

Medicare Advantage, also known as Part C, offers plans that provide a low-cost alternative to Medicare. These plans have their own local network of providers and usually have lower premiums than Medigap, though there are co-pays for hospital stays, doctor visits and other approved services. Medicare Advantage also has a folded-in version of Part D, though it’s important to remember that it may not include the specific medications you need.

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DECIDING WHETHER MEDICARE ADVANTAGE COULD BENEFIT YOU Check to make sure your doctor is in-network and accepts Medicare Advantage (some accept original Medicare instead).

Keep in mind, most Advantage plans are good about pairing you with a specialist if your doctor is out of network. You’ll also want to make sure any medications you take are covered. If you take several prescriptions and have reached the “donut hole,” the annual limit on what Medicare Advantage will cover (between $3,820 and $5,100 on covered medications), bear in mind that Part D enrollees get a 75% donut hole discount on brand-name drugs starting at $3,800.

Consider also your out-of-pocket costs if you anticipate health care expenses. You can always choose a plan with lower out-of-pocket costs. Check out the plan finder at Medicare.gov to find Medicare Advantage plans in your area that meet your needs. Note that plans such as Humana Medicare Advantage have extensive benefits, including vision and dental coverage as well as an innovative fitness program called SilverSneakers, which provides access to over 13,000 fitness centers.

It’s important to understand the Medicare system so you can find the coverage you need. As you compare and contrast plans, carefully check network provider and covered prescription medication lists. And stay abreast of the changes which frequently occur with Medicare. It also helps to know that if your plan doesn’t work for you this year, you can change it next year.

AUSTIN & SAN ANTONIO EDITION

MEDIGAP As mentioned, Medicare pays 80%. A Medigap plan pays the other 20% of your Part B outpatient expenses. Some Medigap plans also cover Part A and B deductibles, though you purchase your own stand-alone Part D coverage since Medigap doesn’t cover prescription medications.

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INITIAL MEDICAL CARE

MAKE THE MOST OF YOUR DOCTOR’S VISITS A checklist of what to do before, during and after your loved one’s appointment.

BEFORE THE APPOINTMENT TAKE a photo(s) on your phone or write down all of your loved one’s current medications, supplements and vitamins. Bring the list with you to the appointment, or if you elect to bring all the medications in a bag, that works as well.

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WRITE down all the symptoms and problems your loved one is having, along with questions you have for the doctor. Prioritize the problems and questions in case you don’t get to address everything due to time constraints. A follow-up plan to address additional problems can be developed (consider making time for multiple appointments).

CALL to confirm the appointment. During this time, ask if your loved one needs to fast for blood work.

BRING their updated insurance cards and valid ID. Certain aspects of their insurance policy may have changed despite having the same insurance company for years.

ARRIVE early to fill out paperwork or complete the paperwork online (if available).

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KNOW which pharmacy you want prescriptions to be sent to and have their contact number on hand.

DURING THE APPOINTMENT SHARE with the doctor the symptoms (when they started, how long they last, how they feel, and where they are) your loved one is having, and ASK questions. Reference your prioritized list.

More

For the full checklist with more valuable tips to prepare you for before, during and after a doctor’s appointment, visit srgtexas.com/getcaregivertoolkit

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SCHEDULE another appointment before you leave (if possible), whether it’s a follow-up appointment or their next checkup.

As mentioned, if you were unable to get through all of your questions, this would be a good time to schedule another appointment as well.

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REPEAT back what you heard to ensure your understanding and to prevent any miscommunication if you must relay information to other family members.

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LISTEN and WRITE down what the doctor says. From important information to prescriptions, you want to remember everything they told you. You can either bring something to write on, or you can request a printed review of the doctor’s assessment and plan, which typically includes medication instructions, diet adjustments, plan of action, etc.

AUSTIN & SAN ANTONIO EDITION

BE HONEST. Don’t let your loved one leave out any details that appear to be “minor” or embarrassing. You want an accurate diagnosis and the only way to accomplish this is to be comprehensive with the physician.

EARLY PHASE

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INITIAL MEDICAL CARE

MOBILE CARE TELEMEDICINE PROVIDERS

The following offer a “digital visit” via an app, cell phone or computer.

Austin Geriatric Specialists 512-477-4088 agsaustin.com

Be Well MD 512-553-1921 stayhealthystayhome.com

CommuniCare 210-233-7000 telemedicinesanantonio.org

Docster Telemedicine 281-362-7837 docster.us

Doctor At Your Service

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210-570-9975 doctoratyourservice.com

Healing Hands House Calls PLLC

HOUSE CALL PHYSICIANS

There are times when getting to the doctor’s office is prohibitive or not practical.

For those times, consider a physician who makes old fashioned “house calls.”

Capitol House Calls 512-459-5204 (Austin area) capitolhousecalls.com

DispatchHealth 737-356-2604 (Austin area) 210-891-5236 (San Antonio area) dispatchhealth.com

Integrative Medical Home Care 512-906-0168 (Austin area) imedicalhomecare.com

The Medical Team 512-418-9555 (Austin area) 830-626-3525 (New Braunfels area) 210-227-9900 (San Antonio area) medicalteam.com

210-560-5841 healinghandshousecalls.com

Ministering Physicians 512-246-6170 ministeringphysicians.com

Visiting Physicians Association (VPA) 512-407-8880 (Austin area) 210-468-0800 (San Antonio area) visitingphysicians.com

Denotes Telemedicine Providers who also provide house call visits.

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WHEN DO YOU NEED TO CONSIDER IN-HOME CARE?

It May Be Time to Look for Assistance

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s we age, there are certain issues that we, or those we love, may eventually face when doing simple household chores, such as laundry, cleaning or grocery shopping.

These issues tend to arise from normal changes in our physiology including lack of mobility, vision changes, and physical dexterity to name a few.

With these changes, we often find that there's an increased need for help with necessities like bathing, dressing and meal preparation. When this happens, it may cause you to wonder if it’s time to hire in-home care or move to an assisted living.

Irrespective of your search for a caregiver for yourself or for a loved one, in-home care could be the ideal option.

Though research shows that most older adults prefer to age in place in their own home, there are many questions raised by older adults or their informal caregivers regarding home care. In this article we provide answers to a few questions you may have regarding in-home care.

It may be time to look for assistance when signs of decline begin to appear during various activities of daily living.

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Learn what aging signs you should be on the lookout for in the full article: srgtexas.com/getcaregivertoolkit

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From the Experts

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Many adult children who are caregiving may cohabitate with their parents. However, working adults may also have responsibilities that don’t allow them to provide care during the day. As time carries on, the dishes begin to stack up in the sink, the laundry piles up, and your parent is found in the same chair you left them in when you return home. Then the realization hits—your parent hasn’t had a shower in a long period of time.

Perhaps even more tricky is when your loved one lives alone, and you notice a similar situation as noted above with the dishes, laundry and hygiene. You might notice that the mail has piled up and bills aren’t being paid or medication refills go unfilled.

There’s also the scenario where your aging parents are living independently, however you begin to notice a decline in the health of the parent who typically provides care for their spouse.

The stress of providing care can take a physical and mental toll on even the most experienced caregivers. In-home care can provide respite for the caregiver, which can allow for some muchneeded rest and time for self-care. Give yourself permission to take a break!

These are just a few examples of when to consider exploring in-home care options. Moreover, receiving care assistance enables you to focus on spending quality time with your loved ones and less time worrying or stressing over daily care needs.

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DAILY CARE

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HOME CARE VERSUS HOME HEALTH CARE

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HOW CAN I DETERMINE IF HOME CARE IS NECESSARY? When self-care at home becomes difficult and/or family caregivers are not available to assist, home care may be the answer. Home care often relieves family members of basic caregiving functions and makes it possible to spend quality time, rather than the functional caregiving time. Home care is often easier and faster than moving to an institutional care setting and allows the senior to stay at home in familiar surroundings.

WHAT IS HOME HEALTH CARE? When the need exceeds what home and personal care can provide, a home health care agency may be required. Home health care provides skilled medical services (such as administration and adjustment of medication levels, monitoring and dressing of wounds, etc.) in the home by trained medical personnel. Home health care is always ordered and supervised by a physician.

WHAT IS HOME CARE? Simply put, home care is non-medical personal assistance provided in the home. Home care may include help with bathing, dressing and personal hygiene. It may include a wide range of services: taking and recording vital signs, assistance in the bathroom, light housekeeping, meal preparation,

DAILY CARE

MID PHASE

Meaningful Minutes \\

Taking time for yourself may seem impossible but try carving out 5 minutes in your day to press pause. It can make a world of difference.

• Get fresh-air • Make a gratitude list (write down 10 things you’re thankful for)

• Jot down your thoughts to clear your mind • Read a short article of interest • Stretch • Take a power nap • Chat with a friend or family member • Listen to a favorite song

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• Meditate (or just close your eyes and relax)

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• Five-minute breathing exercise

AUSTIN & SAN ANTONIO EDITION

• Make yourself a cup of tea or coffee

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WILL MY INSURANCE COVER THE COSTS? Medicare, Medicaid and private insurances are sources of payment for receiving home and home health care. Home health care services are typically medically necessary. They are paid for

by Medicare or other health insurance, and have been ordered by a physician. Private duty home care services are typically paid for privately, or using long-term care insurance, reverse mortgage proceeds, Veterans aid and attendance pension benefits, or some combination of any of these programs.

Consider turning your phone on silent mode and stepping away to:

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companionship, grocery shopping and pharmacy errands, home safety supervision, medication reminders, bill-paying, laundry and transportation.

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HOW TO MANAGE CAREGIVING FATIGUE

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ne in every three adults in the U.S. provides care for an adult as an informal caregiver. Be it out of love, obligation or a sense of care, caregivers form a significant part of any population due to a substantially ill and aging population.

Professional caregivers are already aware of the trials and tribulations of caregiving, and most have a support system in place to help with caregiving stress.

Conversely, the informal family caregiver who doesn’t recognize themselves as “caregivers” run the risk of constant burnout.

If you notice any of these signs in yourself or a fellow caregiver, it’s time to take assessment of your situation and health as it’s better to get control of the situation before it becomes too serious. Incorporating stress-reducing activities (physical, mental and spiritual) will go a long way in helping ward off caregiver burnout.

HERE ARE SOME SUGGESTIONS FOR ACTIVITIES THAT HELP WITH STRESS MANAGEMENT: •

LAUGH out loud daily

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MEDITATE and/or practice yoga

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Take care of yourself

•

LOOK through happy photos or watch a happy or fun movie

•

GET plenty of rest and sleep

•

DO deep breathing exercises

•

TAKE daily walks

•

TAKE time away from being a caregiver even if it’s only a few hours per week—me time

•

LISTEN to relaxing music

•

TAKE a warm bath

•

PRAY

•

SPEND time with a pet

•

WRITE in a journal

•

TALK with someone about how you feel

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The first step is being aware that caregiver burnout is a possibility and knowing the warning signs. Then put a support system in place that will help you manage your stress and anxiety.

Now you’re well on your way to a happier, healthier caregiver experience.

AUSTIN & SAN ANTONIO EDITION

Caregiver burnout is a paralyzing psychological condition due to stress buildup.

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FIVE VITAL TIPS TO HELP DEAL WITH CAREGIVER STRESS

And Recognizing Unhealthy Stress Levels

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ccording to the National Alliance for Caregiving and AARP, around 34.2 million Americans have provided unpaid care to an adult age 50 or older in the last 12 months. Many of these caregivers also care for other family members, such as children, and work outside the home.

Without assistance from others and appropriate self-care, it’s a recipe for caregiver stress, fatigue and eventual burnout.

In this article, we’re going to talk about recognizing when your stress levels are getting too high and some tips for dealing with caregiver stress.

SIGNS THAT YOU MAY BE TOO STRESSED Everyone copes with stress differently, but if you find yourself experiencing any of the symptoms below then your stress might be progressing to unhealthy levels.

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Feeling run-down or tired often Difficulty sleeping • Trouble concentrating • Resenting obligations • Not taking care of your own health • Smoking, drinking or eating too much • Cutting back on activities that you usually enjoy •

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The good news is there are ways to deal with caregiver stress and keep it in check.

Tip

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DECIDE WHAT‘S IMPORTANT THEN SAY “NO” TO THE REST.

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Very few people can do everything alone. Tap into the network of friends, family and social services around you to lighten your own load. Even if they live far away or can’t help with hands-on care, you can delegate tasks that can be done online or over the phone.

Many state, local and religious organizations also have resources available to help senior adults and caregivers. Why not task a helpful friend or family member to look through what’s available and pick out the most promising services? They can also assist with applications and coordinating services.

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TAP INTO THE RESOURCES AROUND YOU.

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Tip

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No caregiver is perfect and it’s impossible to do everything all the time. Prioritize what you or your family member needs that is most critical and break that down into small, easier-tomanage steps.

It’s okay to say “no” or even just “not right now” to tasks that drain you. You don’t have to cook a homemade meal every single night, host holiday get-togethers or have the most well-kept yard in the neighborhood. Focus on what matters and cut the rest, especially in times of stress.

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Tip

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SIMPLIFYING COMMUNICATIONS.

If your loved one has experienced unstable health lately, you may find yourself on the phone giving multiple updates to friends and family. While they mean well, it can get exhausting for you to rehash the same information and answer the same questions repeatedly.

You can cut back on your update workload considerably by employing a phone tree (where you update one person and they pass the information to other designated people) or using private websites that allow you to post updates but still have privacy controls like CaringBridge or PostHope.

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SET AND FOLLOW YOUR PERSONAL HEALTH ROUTINE.

It’s easy to forget about your own health when you’re busy caring for someone else. Research has shown that caregivers, particularly female caregivers, have lower levels of self-care and higher rates of health problems than non-caregivers.

Developing your own simple routines to get enough sleep, water and exercise can help to improve your health and lower stress. Don’t put off recommended health screenings and checkups. You’ll be a more effective and less-stressed caregiver if you make taking care of your own health a priority as well.

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TAKE CAREGIVING BREAKS REGULARLY.

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FINAL THOUGHTS Taking care of a senior adult can be very rewarding, however there’s no doubt that at times it can also be stressful. Unrelieved stress can build up over time and damage your own health and your ability to care for your loved one.

By prioritizing activities, reaching out for assistance, simplifying communications with friends and family, taking regular breaks from caregiving, and sticking to your own personal health routines, you can reduce the amount of caregiver stress that you feel.

In the long run, this will help both you and your loved one to thrive during potentially difficult times.

AUSTIN & SAN ANTONIO EDITION

Schedule time for yourself and do not waver. These breaks can be small, like a walk around the block or coffee with a friend while your loved one sleeps. Consider asking a family member to visit for the weekend so you can take time away to recharge.

If you don’t have anyone in your personal circle who can take over caregiving duties on occasion, there are also networks of professionals available. Many communities have resources such as in-home respite care, adult day care centers or programs or senior living communities with short-term stays available.

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ANXIETY REDUCING DRINK Courtesy of mentalhealthfood.net

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any current studies are looking into turmeric to treat a whole host of health problems. Turmeric has antioxidant, anti-inflammatory, immunomodulatory, anticancer, antibacterial, antiviral, antifungal, antiparasitic and neuroprotective properties. Help reduce anxiety and cozy up with a delicious cup of Golden Milk.

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GOLDEN MILK RECIPE INGREDIENTS

DIRECTIONS

• 1 cup canned coconut milk • 2 cups almond milk • 1-2 teaspoons raw honey • 1 teaspoon turmeric • 1 teaspoon cinnamon • small piece of ginger root or 1/4 teaspoon ground ginger • small pinch of black pepper

Makes 2 servings.

Blend all ingredients in a blender on high speed for 20-30 seconds. Pour into a small saucepan and heat for 3-5 minutes over medium heat, stirring constantly, until hot, but not boiling. Enjoy!

More

Find more recipes on srgtexas.com

DELIVERING MORE THAN A MEAL MEALS ON WHEELS: Weekday home-delivered meals for seniors who have difficulty leaving their homes and preparing their own meals. Delivery is Monday – Friday around the noon hour.

AniMeAls: Monthly home-delivered pet food for the cats and

dogs who provide companionship for seniors receiving Meals on Wheels.

FRIENDLY VISITOR: Weekly visits from volunteers for a friendly chat and to provide minor assistance.

All services are provided at no cost to the recipient, donations are appreciated.

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GRACE PLACE ALZHEIMER’S ACTIVITY CENTERS

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Nacogdoches: 13420 Nacogdoches Rd. (at Higgins) Babcock: 4306 NW Loop 410 (at Babcock) For both locations, call 210-735-5115.

Nourishment + Independence + Caring

Learn more at graceplacesa.org

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DIET + WELLNESS

HOW TO ADDRESS APPETITE CHANGES IN THE ELDERLY

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lthough diet fluctuations are common among seniors, it can be worrying to observe these changes in a loved one. It’s important to be mindful of this and to promptly address and prevent issues before they become more serious.

Proper nutrition is imperative as you age as it not only helps an aging individual stay strong and healthy, but also in recovery from any ailments.

A senior with no appetite can prove to be a difficult challenge.

Let’s dive a bit deeper into some of the factors associated with your loved one’s low appetite, and perhaps most importantly, how to help.

UNDERSTANDING WHAT CAUSES THE LOSS OF APPETITE As people age, their metabolic rate slows, and their physical activity decreases too, which results in them needing fewer calories. While seniors need fewer calories, it’s essential that more nutrition is packed into each meal.

Although some change in a senior’s appetite is normal, there are several factors that can contribute to this issue, such as: •

A lack of energy to cook Changing taste buds, making eating less pleasurable • Loneliness and depression • Difficulty chewing or swallowing • Side effects of medication • Health conditions •

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Discover more powerful tips + tricks to handle diminishing appetites at srgtexas.com/getcaregivertoolkit

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ADDRESSING APPETITE CHANGES IN THE ELDERLY Loss of appetite in seniors could be a result of various factors, but you can help by monitoring any noticeable changes, trying out different methods to spark their appetite, and recognizing when it may need to be addressed by a doctor. You may also consider in-home care or a meal delivery service for your loved one. These ideas ensure your loved one has someone around to eat with or access to an easy and convenient meal. If circumstances seem beyond these measures, consider consulting a specialist.

AUSTIN & SAN ANTONIO EDITION

Tricks to Stimulate Appetite

In some cases, loss of appetite could be a sign of a more serious condition or illness. When seniors don’t show any desire to eat, express that they don’t feel hungry, or start experiencing unwanted weight loss, there could be an underlying medical condition.

• Offer smaller An underlying cause can certainly portions of be to blame if your loved one nutrient-packed consistently expresses they are fatigued food with very little appetite. Medical • Brush their teeth conditions that might contribute to before eating loss of appetite in seniors include: • Get them to eat kidney failure, thyroid disorders, with others hepatitis, chronic liver ailment, Alzheimer’s disease or dementia, chronic obstructive pulmonary disease (COPD), some cancers.

If you notice that a loved one is experiencing a decreased appetite that continues to worsen, or if they are losing weight without trying, consider contacting your health care provider soon.

MID PHASE

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HOMEMADE TURMERIC ALMOND DRESSING Courtesy of epicurious

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his creamy dressing is great drizzled over your favorite salad, grain bowl or cooked veggies. Bonus: Turmeric offers improved brain function and anti-depressant benefits.

TURMERIC ALMOND DRESSING RECIPE

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INGREDIENTS • 3 (2-inch) pieces fresh turmeric, peeled and roughly chopped, or 2 teaspoons ground dried turmeric • 1 (1-inch) piece fresh ginger, peeled and roughly chopped

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DIRECTIONS • 1 garlic clove, roughly chopped • 1/4 cup plus 2 tablespoons fresh lemon juice • 3 tablespoons natural almond butter • 1 tablespoon honey • 1/4 teaspoon kosher salt

Makes 3/4 cup.

Combine all ingredients with 3 tablespoons water in a blender and purée until smooth, about 3 minutes. Taste and adjust salt or lemon juice, if desired.

Find more recipes on srgtexas.com

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DIET + WELLNESS

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WHY ARE SENIORS MORE AT RISK OF DEHYDRATION?

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DECREASED THIRST RESPONSE The feeling of thirst decreases with age. Older adults’ bodies may not let them know when they need to drink more water.

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LESS TOTAL BODY FLUID The amount of fluid in your body decreases with age. Since you have fewer water reserves available for your body to use, any further decrease in water intake has a larger effect.

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There are a number of factors that make older adults more susceptible to suffer from dehydration.

AUSTIN & SAN ANTONIO EDITION

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eniors are not only at an increased risk of lacking proper hydration but the serious health complications that come from being dehydrated.

Severe or untreated chronic dehydration can lead to several conditions that caregivers should be aware of: • Urinary tract infections, kidney stones or kidney failure • Electrolyte problems that can lead to heart trouble or seizures • Low blood volume (hypovolemic shock) that can be lifethreatening • Heat exhaustion or heat stroke • Confusion, anxiety and disorientation

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DECREASED KIDNEY FUNCTION Some seniors can experience decreased kidney function with age. They may lose more water with urination than when they were younger.

MEDICATIONS AND UNDERLYING HEALTH CONDITIONS Senior adults are more likely to have underlying health conditions that require them to take medication.

Some medications can cause increased urination and water loss.

There’s no set formula to tell you how much a senior adult should drink in a day. This varies depending on their health status, activity level and the climate they live in.

Pro Tip for Hydration KEEP WATER HANDY.

This might sound basic but don’t underestimate how effective this simple measure could be. For seniors who experience mobility issues, it can be hard to get up, walk to the kitchen and refill a drink.

Keeping a water bottle convenient and nearby means water is always within reach. It also provides a visual cue to consume more water.

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HOW MUCH WATER SHOULD AN OLDER ADULT DRINK IN A DAY?

A study from the U.S. National Academies of Sciences, Engineering, and Medicine determined the following levels to represent adequate fluid intake, however, individual needs may vary.

MEN: About 15.5 cups (3.7 liters) of fluids a day WOMEN: About 11.5 cups (2.7 liters) of fluids a day These recommendations are for total daily fluid intake which covers water, food and any other drinks. They also estimated that about 20% of fluid intake comes from food each day.

Maintaining hydration is a serious concern for caregivers of older adults. The good news is it can be easily managed and worked into a daily care routine.

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Visit our website for program services or to volunteer: driveaseniorcentraltexas.org.

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MID PHASE

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MEMORY + DEMENTIA

steps to take after

A MEMORY ISSUE IS RECOGNIZED

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he days following a loved one’s dementia or Alzheimer’s diagnosis can be difficult and filled with emotion. For many, the lack of knowledge is often scarier than the diagnosis itself as you have no idea what to do, what to expect or how you’re supposed to help.

We’ll examine this topic and discuss those critical first steps to take following this type of diagnosis, as well as how you can provide the best care possible.

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STEP 1: CONSULT A SPECIALIST.

Alzheimer’s and dementia diagnoses are often made at the hospital following a significant event or at a primary care physician’s office after the onset of some cognitive symptoms.

However, if you or your loved one haven’t spoken to a neurological specialist, it’s highly recommended.

This is because dementia isn’t always caused by unstoppable neurological degeneration. It can result from several medical conditions, such as heart disease, intracranial pressure, or a mass located at certain spots within the body. It can also be the result of certain medications, such as anticholinergic and bladder antimuscarinic (bladder suppressant) drugs. If this is the case, you’ll want to know so you can obtain the most effective treatment.

STEP 2: CONSIDER YOUR OPTIONS.

Alzheimer’s and dementia don’t currently have cures, but there are treatments and medications available to help improve

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symptoms. Make sure you talk this possibility over with your loved one’s doctor and keep up to date on new findings and treatment options.

Questions to ask your loved one’s doctor: What tools or tests were used to determine a diagnosis?

What were you measuring?

• What is causing the illness?

• What are the treatment options available?

• What symptoms are alleviated by each medication and are there any side effects?

• Are there any clinical trials available and where can I find additional information on those?

• How will the disease progress?

• What forms of care are available to help my loved one live with the disease?

Six More Steps

There’s more of this article in our free Caregiver Toolkit. To learn more critical first steps, visit srgtexas.com/getcaregivertoolkit

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Receiving a degenerative memory diagnosis is never easy, and it’s important to recognize and cope with any emotions you may have. Although your loved one is still around, feelings of loss, anger and fear are common. Coming to terms with the diagnosis will help you and your loved one move forward and discover new ways to live a positive and fulfilling life.

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STEP 3: TAKE CARE OF EMOTIONAL NEEDS.

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You should also be considering what long-term care may look like. For most adults with a memory-targeting illness, longterm care often involves professional at-home caregivers or a specialized 24-hour facility.

AUSTIN & SAN ANTONIO EDITION

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TIPS FOR EFFECTIVE ALZHEIMER’S COMMUNICATION

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lzheimer’s disease presents many challenges, and communication is a big one. Despite the challenges, you can communicate effectively with a loved one who has Alzheimer’s. Consider these tips provided by the Mayo Clinic staff:

KEEP IT SIMPLE Use short sentences and plain words. As the disease progresses, yes-no questions may work best, and only one question at a time is best. Break down requests into single steps.

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AVOID DISTRACTIONS Communication may be difficult—if not impossible—against a background of competing sights and sounds.

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STAY PRESENT Maintain eye contact, and stay near your loved one so that he or she will know that you’re listening and trying to understand.

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SHOW RESPECT Avoid secondary baby talk and diminutive phrases, such as “good girl.” Don’t assume that your loved one can’t understand you, and don’t talk about your loved one as if he or she weren’t there.

AUSTIN & SAN ANTONIO EDITION

SPEAK CLEARLY Introduce yourself. Speak in a clear, straightforward manner.

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USE VISUAL CUES Sometimes gestures or other visual cues promote better understanding than words alone. Rather than simply asking if your loved one needs to use the toilet, for example, take him or her to the toilet and point to it.

DON’T ARGUE Your loved one’s reasoning and judgment will decline over time.

To spare anger and agitation, don’t argue with your loved one.

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DON’T INTERRUPT It may take longer than you expect for your loved one to process and respond. Avoid criticizing, hurrying and correcting.

STAY CALM Even when you’re frustrated, keep your voice gentle. Your nonverbal cues, including the tone of your voice, can send a clearer message than what you actually say.

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SIGNS NOT TO IGNORE:

DEMENTIA VERSUS NORMAL AGING

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f you’ve found yourself worried about whether or not a loved one might be showing signs of dementia, you aren’t alone.

Distinguishing between dementia indicators and normal aging factors can be tricky, and it’s important to know the difference to avoid adding any unnecessary stress or worry to the situation.

Afterall, is rushing mom off to the doctor because she called you your sibling’s name—maybe even the family dog’s name once…or twice—the right next step or even a cause for alarm?

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DEMENTIA OR AGING: THE SIGNS

The Alzheimer’s Society notes six different abilities and how they may be impacted by normal aging compared to possible changes due to dementia. We’ll cover all six and highlight a few of the differences between the impact of dementia or aging on those abilities.

1. SHORT TERM MEMORY & LEARNING NEW INFORMATION Normal aging can impact short-term memory and the learning process by causing one to falter or struggle to remember

2. DECISION MAKING & PROBLEM SOLVING As we age, many people struggle to juggle multiple tasks at once, take a bit more time to process decisions or information, and occasionally make mistakes when completing everyday tasks.

People who are impacted by dementia, however, might make

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something commonplace. Forgetting about an appointment or misplacing the phone are all traditionally normal occurrences for many as they age. Dementia can impact short-term memory in a bit more comprehensive way. Forgetting the names of loved ones or close friends or being unable to recall who you had lunch with earlier that day can be cause for added concern. Similarly, misplacing the phone or keys in illogical places, like the bathroom cabinet or freezer, may be signs worthy of more attention.

AUSTIN & SAN ANTONIO EDITION

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frequent mistakes when completing tasks like cooking or cleaning, struggle to concentrate for very long, and get confused more often. If your loved one finds it difficult to comprehend finances or gauge the severity of everyday risk, these may be signs of a more serious issue.

3. LANGUAGE Struggling to remember the right word or keep up with a conversation where many people are talking at once is pretty normal for people of all ages, especially those who are older. Though if any of these things happen on a frequent basis, it could be a sign of dementia. Regularly referring to items using words like “that” or “this” may signal to you that something more serious is at play.

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4. ORIENTATION If your loved one occasionally needs to be reminded of the date or day of the week, this isn’t necessarily cause for worry. But if they struggle to recall what the season is or need daily reminders about the date, it may be time to address these issues. Another common characteristic of those impacted by dementia is feeling unsure of their surroundings when in an otherwise familiar place—like at home.

5. VISION & PERCEPTUAL SKILLS A common complaint among older adults is they have difficulty seeing as well as they used to, often impacted by cloudy vision or worsened eyesight. But struggling with depth perception when doing things like reaching for a door handle or climbing the stairs should be addressed by a doctor as these challenges go beyond the boundaries of worsened eyesight.

MEMORY + DEMENTIA

Feel less stressed in minutes. Set a timer for 5 minutes and close your eyes.

Take a few deep breaths releasing any tension in your body and imagining it melt away.

Focus on a fivecount breath: • Slowly inhale from the belly • Then into ribs

• Then gently hold the breath for the fifth count On the exhale, reverse for another count of five. This time start from the top of your head and move down to the chest, ribs, belly, pausing on that last bit of breath out of the body, and then repeat from the beginning.

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• Up into crown of the head

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• Then into chest

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As your loved ones age, it’s likely you’ll face challenges discerning whether or not their behavior is a symptom of something more drastic than old age, and that’s no easy task. While we often feel responsible for the well-being of those around us, remember it isn’t your job to diagnose them beyond your capabilities—unless, of course, you’re a neurologist. Not the case? Trust a professional to give your loved one the best care possible and address the needs that cause concern.

Take Five

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6. MOOD & BEHAVIOR Feeling stressed out or blue about life’s challenges or getting upset when plans don’t play out as expected is normal, especially as we age. If your loved one seems to be becoming withdrawn or uninterested in their hobbies and friends, this could be a signal for greater concern. Similarly, being extremely sad or scared for seemingly no reason, or as a result of relatively ordinary challenges, could be related to dementia.

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CARE TRANSITIONS

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hen it comes to long-term care, people often use more than one solution over time. As people switch from one type of care to another, there is a transition period.

A care transition may occur when someone leaves the hospital and needs support to heal at home after they’ve been discharged from the hospital, or it might happen when someone who is receiving in-home care decides to move into a supportive community, such as assisted living or senior housing. The goal is to avoid a gap in care for the individual as they pivot from care type.

When someone leaves the hospital or a rehab facility for home, their doctor or nurse can’t go with them and a family or professional caregiver might be needed as they continue to heal at home. For example, someone might need help with using the bathroom, taking new medications, or going back to see the doctor for follow-up appointments.

An even longer and different type of transition may occur when someone decides to move from their current residence to a

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new one—whether that’s from a stand-alone home into a senior housing apartment, assisted living facility or in with family across town or another state.

A caregiver—whether a family member or a professionallytrained one—can help to make these types of transitions smooth.

If they’re transitioning to an assisted living facility, a caregiver can inquire about opportunities to join in meals and activities prior to moving in. This type of engagement can help the individual feel more relaxed about their new surroundings and making a big change.

When making changes in long-term care options, aim for a continuity of care during the transition so risks for setbacks are minimized and chances for success are increased.

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WHAT TYPE OF MENTAL HEALTH PROFESSIONAL IS THE RIGHT FIT?

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hen exploring a potential therapist or psychiatrist, inquiring about their approach to treatment can be helpful in determining if they’re a good fit. For some, a medication-based treatment through a psychiatrist or other qualified medical professional might be best, whereas a combination of medication and therapy or just therapy on its own might be more appropriate for others.

If seeking traditional talk therapy, also known as psychotherapy or • Inquire counseling, there are a number of as to the experience possibilities, including clinical or level in counseling psychologists, social treating workers, counselors or family individuals therapists. The terms “therapist” with similar and “counselor” are often used problems interchangeably and sometimes highlight • Make sure the level of education or credentialing. they’re Psychotherapy might not work licensed to for everyone and alternative methods practice in your state including animal-assisted psychotherapy or somatic therapy might be healing

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Types of Counseling

Psychotherapy versus Psychological Counseling Counseling is often more short-term than therapy and focuses on specific issues—it’s designed to help a person address a particular problem, such as stress management.

The focus may be on problem solving or on learning specific techniques for coping.

Psychotherapy is more long-term and focuses on a broader range of issues.

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Jot down any reminders, questions or findings.

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options to consider. Another alternative is e-therapy via video conferencing or through services on an app, such as Talkspace which essentially puts a licensed therapist in your pocket.

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DURING HOSPITAL DISCHARGE

B

y asking the right questions and taking an active role in your loved one’s care, you can bridge the gap that patients typically experience when transferring from one care setting to another, which is one of the top causes for hospital readmission.

What care or therapies are needed after discharge? i.e. home health, outpatient therapy, rehab/skilled nursing, etc.

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Will my loved one be safe at home upon discharge or will someone need to be with them 24 hours a day?

Keep in mind dressing, bathing, cooking and housework.

Can you show me how to do tasks that require special skills? i.e. changing a bandage, giving a shot, wheelchair transfers, etc. If we need help with these tasks, who do we contact?

What is the average length of recovery time?

Which doctor appointments are needed after discharge and when should they be scheduled?

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May we have the latest list of prescribed medications?

What does each medicine do and why is it needed?

What are the medication dosages, conflicts and side effects? Who should we contact with questions about the medications?

What medical equipment is needed? i.e. walker, oxygen, etc. Who will arrange for this?

Are there any activity restrictions and for how long?

Are there any dietary restrictions?

Jot down any questions or thoughts.

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My Questions

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What are our options for when/where my loved one is being discharged?

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What problems, symptoms and side effects should we watch for?

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Because of Encompass Health, we’re here. Without them, I think we might have had a different outcome.

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This content is proudly provided by

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making the right choice

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REHABILITATION FACILITIES AND NURSING HOMES ARE DIFFERENT The amount of intensive therapy hours provided at each type of facility varies. Be sure to ask important questions before making your choice such as:

SENIOR RESOURCE GUIDE

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fter a loved one experiences a debilitating illness or injury such as a stroke, hip fracture or spinal cord injury, where you choose to do rehabilitation will make a difference in their independence and quality of life. However, most people don’t begin their research until they’re in the hospital and are faced with the life-changing decision.

With many types of health care facilities, the below tips can help you compare availability of services, personnel, approach to delivery of patient care and patient outcomes.

AUSTIN & SAN ANTONIO EDITION

FOR YOUR LOVED ONE’S REHABILITATION SERVICES

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•

How much therapy will the patient receive?

Are the programs customized to meet the specific needs of the patients?

• During the stay, how many visits will a physician make to assess the patient’s needs?

• Are members of the patient’s care team specialized in rehabilitation?

•

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TAKE A TOUR Before you make a decision, make an appointment to take a tour of the place. Look for cleanliness, smell for odors and ask to see therapy areas and equipment. Will they incorporate advanced technologies into the patient’s therapy? Also, talk with the providers and find out how familiar the team is with the patient’s condition being treated.

DO THE COMPARISON Make sure to compare the years of service, types of specialty programs offered, patient satisfaction, national clinical ratings and patient clinical outcomes among facilities. In addition, The Joint Commission awards many Disease-Specific Care (DSC) Certifications for rehabilitation programs that demonstrate compliance with national health care standards in quality and safety.

Ultimately, the provider chosen should strive to help your loved one achieve the highest level of independence possible.

Educate yourself as your choice can make a difference in the patient’s life post-illness or injury.

FREEDOM. TO BE YOU. If you think oxygen therapy means slowing down, it’s time for a welcome breath of fresh air.

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When we understand your circumstances, we can provide support and resources to inform your decisionmaking. We recognize that we’re not the best solution for every situation – often we advise that you don’t sell to us, or that you don’t sell at all.

We operate with complete transparency. From day one you’ll know exactly what to expect and when. Call today to learn more about what we can do for you.

Call us for a free consultation and we’ll discuss your options, enabling you to make the right choice for you and your loved ones.

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This content is proudly provided by

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Do you need to access the equity in yourSee home – simply and swiftly? their ad on page 94 You don’t need a real estate agent to sell your property.

Texas Realty Buyers can directly purchase your home in any condition, with no need for commissions, fees, investing money in repairs, listing, staging, showings or closing costs.

We can save you wasted time, stress and hassle. And we work on whatever timeline is best for you.

When we understand your circumstances, we can provide support and resources to inform your decisionmaking. We recognize that we’re not the best solution for every situation – often we advise that you don’t sell to us, or that you don’t sell at all.

We operate with complete transparency. From day one you’ll know exactly what to expect and when. Call today to learn more about what we can do for you.

SELLING YOUR HOME TO PAY FOR CARE Too many possessions?

We can help with downsizing, estate sales, and moving.

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Call us for a free consultation and we’ll discuss your options, enabling you to make the right choice for you and your loved ones.

For a free consultation call or text

512-436-3028

info@texasrealtybuyers.com

If a family member doesn’t wish or isn’t able to remain in their home, selling will probably be the best option. Once you’ve determined you’re going to sell the house, you’ll next need to identify which avenue for selling you’re going to take.

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Traditional (fixed-rate) home equity loans • Home equity lines of credit (HELOCs) • Reverse mortgages • Turning a home into a rental property

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CONSIDER YOUR OPTIONS Paying for elder care can be expensive. According to The American Elder Care Research Organization, approximate costs range from $700 to $12,000+ per month depending on the type of care needed.

Oftentimes, caregivers are left feeling stressed and wondering “How can I afford the care mom/dad needs?” A solution to this tricky question is within your reach.

There are several ways to utilize the equity in one’s home to pay for senior care. A homeowner can consider:

AUSTIN & SAN ANTONIO EDITION

Learn more at www.texasrealtybuyers.com

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WAYS TO SELL YOUR HOME There’s more than one direction for you to consider when selling a house.

•

Sell it to a professional homebuyer.

Sell the property yourself (known as For Sale By Owner or FSBO).

• Hire a real estate agent or broker to stage, photograph, list and show the property.

•

CONSIDERING THE IMPLICATIONS OF SELLING YOUR PROPERTY Your unique circumstances will determine your best option. You should also consider the financial and personal implications of each of the ways to sell the property: Financial implications based on timeline; these stem from questions including: •

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•

Is the sale before or after moving?

What is the impact on income tax or Medicaid eligibility?

Personal implications; on the emotional side, these are the issues of mitigating the stress of a sale and move, and what happens to all the contents of the home.

Selling one of your largest and most meaningful assets requires a great deal of thought and input. Make sure to seek counsel from legal and tax advisors as well as knowledgeable friends and family before embarking on the home-selling journey.

Pros d an Cons

It’s important to look at the advantages and disadvantages of each of these options. We dive into these further in the full article in our Caregiver Toolkit.

Visit srgtexas.com/getcaregivertoolkit

N A C E V I L U O Y E IVE R L E U O WH Y W O H E G CHAN We make life easier and more fulfilling by tending to all the necessities such as cooking, housekeeping, and maintenance while you sit back and relax.

3 COMMUNITIES IN TEXAS See our ad on the back cover for locations.

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SpectrumRetirement.com/Texas

©2021 All rights reserved. Spectrum Retirement Communities

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TYPES OF RESIDENTIAL CARE FOR SENIORS INDEPENDENT LIVING

ASSISTED LIVING COMMUNITIES

DESCRIPTION

Single family homes or townhomes for self-sufficient seniors that offer the security and social activities of a community living environment.

Communities, typically of 2-3 story apartments, that provide 24 hr assistance with activities of daily living such as eating, bathing, and using the bathroom, but not 24 hr medical services.

SERVICES

• Laundry/linen service • Meals • Transportation • Social activities

• Laundry/linen service • Meals • Transportation • Social activities • Bathing/Dressing • Toileting • Housekeeping • Medication assistance • Security and emergency calls

REGULATION

Not Regulated

State Regulations

ALSO KNOWN AS

Retirement Communities, Retirement Homes, Senior Apartments, Senior Housing, Senior Living Communities, Active Adult Communities

Assisted Living Facilities, Personal Care Homes, Eldercare Facilities, Domiciliary Care, Board and Care, Residential Care Facilities, Community-Based Retirement Facilities, Adult Living Facilities, Adult Foster Care, Sheltered Housing, Community Residences, Group Homes, Adult Family Homes

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NOTE – there are more luxury communities that have all the amenities of country clubs.

APPROXIMATE Market rate to rent or buy a COSTS home plus community fees from $700 – $6,000/month.

$2,844 – $9,266/month Avg cost in Texas is $3,795 – source Assisted Living Research Institute

SENIOR LIVING

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• Laundry/linen service • Meals • Transportation • Social activities • Bathing/Dressing • Toileting • Housekeeping • Medication assistance • Security and emergency calls • 24 hr nursing care • Condition specific care • Hospice/end of life services • Doctors on call

• Laundry/linen service • Meals • Transportation • Social activities • Bathing/Dressing • Toileting • Housekeeping • Medication assistance • Security and emergency calls • 24 hr nursing care • Condition specific care • Hospice/end of life services • Doctors on call

State & Federal Regulations

Some State Regulations

Skilled Nursing Facilities, SNF, Nursing Home CCRCS, Continuing Care, Retirement Facilities, Care and Rehabilitation, Convalescent Life Care Facilities, Life Care Communities, Life Hospital, Rest Home Plan Community

$4,639 – $12,623/month

Varies with breadth of services required.

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Campus-like communities that provide a continuum of care, from private residences to assisted living and skilled nursing care; designed for individuals with declining conditions and those that want to remain in a single location.

SENIOR RESOURCE GUIDE

Communities, typically private and shared rooms, which provide 24 hr assistance with activities of daily living and medical care by nurses and therapists.

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SKILLED NURSING (NURSING HOMES)

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Information courtesy of The American Elder Care Research Organization

ANYTHING BUT RETIRED

Designed to bring out the best in our residents, Arbor Terrace Lakeway makes everything possible. Incredible activities. Delicious food. Experienced, dedicated staff. And a sense of belonging that makes every day your best one yet.

CALL 512-271-9174 FOR MORE INFORMATION ArborTerraceLakeway.com/Seniors 300 Medical Parkway, Lakeway, TX 78738 INDEPENDENT LIVING | ASSISTED LIVING | MEMORY CARE

SENIOR LIVING

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This content is proudly provided by

See their ad on the Inside Back Cover

HOW DO I PAY FOR ASSISTED LIVING OR MEMORY CARE?

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hen I meet with families just beginning their search for assisted living or memory care, I find many are experiencing sticker shock. Unfortunately, the cost of high-quality senior care can be expensive.

However, remember that while these monthly costs aren’t inexpensive, they do allow many seniors to leave behind other expenses. If you’re living at home now, you may be paying rent or mortgage payments, property taxes, utilities, lawn care, groceries, property insurance, housekeeping, maintenance and repairs.

A move to a senior living community will mark the end of those bills. You’ll enjoy the freedom of a maintenance-free lifestyle and the many amenities the senior living community offers.

For some families, even with the expected savings, the cost of senior living remains out of reach. However, don’t give up too easily. I encourage families to look at other options such as longterm care insurance.

AUSTIN & SAN ANTONIO EDITION

Options to consider from a Senior Care Counselor

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Did You Know?

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LONG-TERM CARE INSURANCE Long-term care insurance can help make senior living The median cost affordable and gives you more of assisted living choices. Depending on the in the U.S. in 2020 policy, policyholders generally choose where they receive was $4,300 per care—a nursing home, assisted month according living or their own home—and to Genworth’s Cost the range of services they’re of Care Survey. eligible to receive is expanded.

However, not all policies are created equal.

For those who do have this type of coverage, I advise them to look carefully at their policies. Understand what is, and what is not, covered. Begin the claim process as early possible because it can take time and require a lot of paperwork.

Expert s Answer

There’s more of this article in our free Caregiver Toolkit. To discover three additional options available in Texas, visit srgtexas.com/getcaregivertoolkit

ASSISTED LIVING

MEMORY CARE

INDEPENDENT LIVING

HOME CARE

Alice Find the right senior living option for your mom or dad with our personalized process 1

Connect with a local advisor

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Review a tailored list of recommendations

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Evaluate, tour and decide with confidence

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Our service is free, as we’re paid by our participating communities and providers.

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SENIOR LIVING

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SENIOR LIVING COMMUNITIES

AL Franklin Park Boerne

IL

MC

18323 Sonterra Pl, San Antonio 210-404-1441

AL Franklin Park TPC Parkway

MC 21802 Encino Commons, San Antonio IL 210-462-1004

Key

AL Franklin Park Round Rock

MC

55+ Active 55+ Community SNF Skilled Nursing

18 Old San Antonio Rd, Boerne 830-816-5150

4155 Teravista Club Dr, Round Rock 512-388-6076

IL Independent Living

AL Assisted Living

MC Memory Care

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AL Franklin Park Sonterra

SENIOR RESOURCE GUIDE

MC 230 W Sunset Rd, San Antonio IL 210-829-5955

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AL Franklin Park Alamo Heights

MC 300 Medical Pkwy, Lakeway IL 512-271-9174

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AL Arbor Terrace Lakeway

AUSTIN & SAN ANTONIO EDITION

in the Austin & San Antonio Areas

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IL Lake Travis Independent Living

55+ Solea Cedar Park 1520 Juliette Way, Cedar Park 512-219-8800

302 Medical Pkwy, Lakeway 512-501-3488

AL The Enclave at Cedar Park MC Senior Living IL

55+ Solea Alamo Ranch 11133 Westwood Loop, San Antonio 210-981-5166

3405 El Salido Pkwy, Cedar Park 512-402-5040

AL The Enclave at Round Rock Senior Living IL

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2351 Oakmont Dr, Round Rock 512-693-2420

Key

55+ Active 55+ Community SNF Skilled Nursing

IL Independent Living

AL Assisted Living

MC Memory Care

230 W Sunset Road San Antonio, TX 78209

210-829-5955 Lic. #148688

BOERNE

18 Old San Antonio Rd. Boerne, TX 78006

830-816-5150

Our communities provides helpful services to support and enrich our seniors lives.

Call today to schedule a tour.

21802 Encino Commons San Antonio, TX 78259

210-483-9999 Lic. #146061

MEMORY CARE COMMUNITIES

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FRANKLIN PARK

TPC PARKWAY

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ALAMO HEIGHTS

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WHEN LOOKING FOR AN ASSISTED LIVING FACILITY

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2 3 4 5 6

tart with a visual assessment of both the inside and outside.

Also, note if the residents are engaged in activities or just sitting.

What is the staff-to-resident ratio during the day, at night and on weekends?

What kind of experience and training does the staff possess?

Is there an initial assessment prior to admission?

If there is a waiting list, how many are on it and what is the policy?

What are the billing and payment policies and procedures?

Is there a security deposit and is it refundable?

SENIOR LIVING

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What and how much are additional services not included in the monthly fee?

What additional services are available if resident’s needs change?

What is the discharge policy?

What off campus excursions are provided and how often?

Are happy hour activities provided?

Is Wi-Fi available and if so, where on the campus?

Is there an emergency generator or alternate power source?

Are transportation services provided or a parking lot for the resident’s vehicle?

What is the pet policy?

What is the meal program?

Does the residence offer worship services?

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Is rehab offered on campus?

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Are there safety locks on the doors and windows?

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WHEN CONSIDERING SKILLED CARE

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tart with a visual assessment of both the inside and outside.

Also, note if the residents are engaged in activities or just sitting.

What is the staff-to-resident ratio during the day, at night and on weekends?

Does the same team of nurses and certified nursing assistants (CNAs) work with the same resident all week?

What happens when the Medicare reimbursement runs out?

What amenities are private pay?

Is Wi-Fi available and if so, where on the property?

Are there safety locks on the doors and windows?

SENIOR LIVING

Is there an emergency generator or alternate power source?

What is the evacuation plan should it be necessary?

What is the pet policy?

Can special dietary needs be accommodated?

Do residents have a choice of food items at each meal?

Are the meals prepared on-site or off-site?

What is the policy for residents eating in their rooms?

Does the residence offer worship services?

Is abuse prevention training and background checks a requirement for all staff?

How often are residents bathed?

What special services can be provided if needed, such as on-site rehab, therapeutic whirlpool baths, ventilators, hospice, etc.?

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Are they Medicare and/or Medicaid certified?

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Are there pharmacy, lab, dental or x-ray services available on-site?

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Is there a functioning security system?

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UNDERSTANDING HOSPICE

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ospice care is a philosophy of care that accepts dying as a natural part of life. When death is inevitable, hospice seeks neither to hasten nor postpone it. Hospice provides care, comfort and support for persons with life-limiting conditions as well as their families.

HOW DOES HOSPICE WORK? Hospice care is for any person who has a life-threatening or terminal illness. All hospices consider the patient and family together as the unit of care. Most reimbursement sources require a prognosis of six months or less if the illness runs its normal course. Patients with both cancer and non-cancer illnesses are eligible to receive hospice care.

The majority of hospice patients are cared for in their own homes or the homes of a loved one. “Home” may also be broadly construed to include services provided in nursing homes or hospitals.

Typically, a family member serves as the primary caregiver and when appropriate, helps make decisions for the hospice patient. Members of the hospice staff make regular visits to assess the patient and provide additional care or other services. Hospice staff is on call 24 hours a day, seven days a week.

Medicaid or a private insurance company, hospices will work with the person and their family to ensure needed services can be provided.

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HOW IS HOSPICE PAID FOR? Hospice is paid for through the Medicare Hospice Benefit, Medicaid Hospice Benefit and private insurers. If a person doesn't have coverage through Medicare, Medicaid or a private insurance company, hospices will work with the person and their family to ensure needed services can be provided.

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WHO IS THE HOSPICE TEAM? Hospice care is a family-centered approach that includes, at a minimum, a team of doctors, nurses, social workers, counselors, and trained volunteers. They work together focusing on the patient’s needs; physical, psychological or spiritual. The goal is to help keep the patient as pain-free as possible until death.

The hospice team develops a care plan that meets each patient’s individual needs for pain management and symptom control.

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WHO IS ELIGIBLE FOR MEDICARE HOSPICE BENEFITS? Hospice care is covered under Medicare Part A (hospital Insurance). You are eligible for Medicare hospice benefits when you meet all of the following conditions: •

You are eligible for Medicare Part A (hospital insurance) Your doctor and the hospice medical director certify that you are terminally ill and probably have less than six months to live • You sign a statement choosing hospice care instead of routine Medicare covered benefits for your terminal illness • And you receive care from a Medicare-approved hospice program.

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Please note: Medicare will still pay for covered benefits for any health problems that aren’t related to your terminal illness.

WHAT DOES MEDICARE COVER? Medicare covers these hospice services and pays nearly all of their costs: •

Doctor services and nursing care Medical equipment (like wheelchairs or walkers) • Medical supplies (like bandages and catheters) • Drugs for symptom control and pain relief • Short-term hospital care, including respite and inpatient for pain/symptom management • Home health aide and homemaker services • Physical, occupational and speech therapy • Social work services and dietary counseling • Grief support to help you and your family

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Please note: You will only have to pay part of the cost for outpatient drugs and inpatient respite care.

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RESPITE CARE AND MEDICARE Respite care is care given to a hospice patient by another caregiver so that the usual caregiver can rest. As a hospice patient, you may have one person who takes care of you every day, like a family member. Sometimes your caregiver needs someone to take care of you for a short time while they do other things that need to be done. During a period of respite care, you might be cared for in a Medicare-approved facility, such as a hospice residential facility, hospital or nursing home.

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THE MEDICARE HOSPICE BENEFIT DOES NOT COVER THE FOLLOWING: • Caring Connections • Treatment intended to cure your caringinfo.org terminal illness. You should • Hospice Link talk with your doctor if you 1-800-331-1620 are thinking about potential • National Hospice and treatment to cure your illness.

Palliative Care Helpline • Medications not directly related 1-800-658-8898 to your hospice diagnosis.

• Texas and New Mexico Hospice Organization Hospice team members will 1-800-580-9270 consult with the hospice physician and will inform you and your family which drugs and/or medications are covered and which ones are not covered under the Medicare Hospice Benefit.

• Room and board aren’t covered by Medicare. You may receive hospice services wherever you live, even in a nursing home, however, the Medicare Hospice Benefit does not pay for nursing home room and board.

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HOW DO I BEGIN RECEIVING HOSPICE? Anyone can inquire about hospice services. You or your loved one may call a local hospice and request services. The hospice staff will then contact your physician to determine if a referral to hospice is appropriate. Another way to inquire about hospice is to talk with your physician, and he or she can make a referral to hospice. Hospice can begin as soon as a ‘referral’ is made by the person’s doctor.

As a hospice patient, you always have the right to stop getting hospice care and receive the “traditional” Medicare coverage you had before electing hospice. All care that you receive for your illness must be given by your hospice team.

HOSPICE OPTIONS OpusCare Texas Headquarters

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2943 Mossrock Dr San Antonio, TX 78230 210-988-1461

Hope Hospice 611 N Walnut Ave New Braunfels, TX 78130 1-800-499-7501

Hope Hospice of the Hill Country 29710 US Hwy 281, Ste 200 Bulverde, TX 78163 1-800-499-7501

Local options!

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questions to ask

hat w w o n K to ask

WHEN CHOOSING A HOSPICE PROGRAM

How are services provided after hours?

How and where does hospice provide short-term inpatient care?

Can hospice be brought into a nursing home or long-term care facility?

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How does hospice work to keep the patient comfortable?

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What roles do the attending physician and hospice play?

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What kind of support is available to the family/ caregiver?

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What services are provided?

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Are any of the staff members certified or credentialed in hospice?

Do physicians visit the patient in the home?

What is the staff-to-patient ratio?

Are any alternative therapies provided to manage symptoms?

What extras does the hospice provide?

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My Questions

Jot down any questions or thoughts.

Hope Redefined We offer a different kind of healing.

The kind that comes from Hope.

Because life is an unique, exceptional journey and should be treated as such.

www.hopehospice.net | 1-800-499-7501

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STEPS TO TAKE AFTER THE PASSING OF A LOVED ONE

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hen a loved one passes, it can often seem like the world has fallen off its axis. You no longer know which way is up or down, and while coping with grief, you’re forced to address pieces of their life that must be closed out.

The process of taking care of final affairs after the death of a parent, spouse, friend or other loved one who you provided care for can seem overwhelming.

We understand, which is why we’ve created a checklist outlining step by step what to do after someone passes, so you can spend more time focusing on healing.

In the weeks following the death, you’ll want to begin closing out accounts and buttoning up any unfinished affairs. Tackle the tasks that are most meaningful for you and be comfortable delegating the rest to others.

STEPS TO TAKE WITHIN A FEW WEEKS: • Procure certified copies of the death certificate when it becomes available. You’ll need at least 10-15 copies to provide to entities such as banks and government agencies.

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Find the will (if there is one) and figure out who the executor is. This will be the person in charge of settling the estate in the days going forward, and they’ll need to be involved in all estate decisions hereafter.

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Take the will to probate so it can be executed appropriately.

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Cancel any services that your loved one may have had, such as magazine subscriptions, regular house deliveries, Netflix, Hulu, etc. You’ll also need to close out any credit card accounts and cancel their driver’s license so it can no longer be used. Make sure to also cancel any insurance services, such as home or car insurance.

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Close out any remaining online accounts, such as social media pages (these can be memorialized if you’d like) and email inboxes.

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There’s more of this article in our free Caregiver Toolkit. To discover more critical steps, visit srgtexas.com/getcaregivertoolkit

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As part of the financial steps after the death of a parent, A court-supervised contact necessary agencies proceeding designed such as a CPA (certified to officially prove a public accountant) and will’s validity estates attorney. These aren’t necessarily required, but they do smooth the process and make the legal side of things more manageable.

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Probate

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PREPARING & PRESENTING A EULOGY

By John B. Earthman

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he purpose of a eulogy is to acknowledge and share information about a person’s life. It’s a great honor for someone to present and it’s an important part of the grieving process for the presenter, as well as the audience.

A good place to start is to make a list of thoughts and memories you’d like to share. While others might not be comfortable or able to give their own eulogy, they might find great comfort in sharing memories with you that you could incorporate into the eulogy. Things you might include are stories, quotes, expressions of love or prayers—all of which can be delivered in a serious or humorous manner depending on what you feel is appropriate.

In an effort to have the audience connected and involved in your tribute, the eulogy can be compiled from private memories that your audience might not be aware of as well as personal traits and details of the loved one that all will remember. You’ll want to include any accomplishments or honors no matter how big or small that were especially important to your loved one. Memories shared should always acknowledge the person in a positive manner and recognize them for who they were accurately.

Once you’re ready to write the eulogy, decide on how you’ll begin, then pick the main thoughts and memories that you wish to share and finally determine how you’ll close. You need to

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Thoughts

Is there a story about your loved one you’d like to tell? Jot down any ideas, reminders or notes.

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properly introduce yourself when you begin and have a summarizing statement to share when you close. You can read from your notes, but practice Nothing has to giving the eulogy and change make sense right any part that doesn’t feel like natural conversation in your now, you have time own words. to process what’s Presenting a eulogy can happening. cause great anxiety. Stopping at any time to collect your thoughts or emotions and then continuing when you’re ready is understandable and acceptable. If you decide that you can’t continue, simply skip to your final statement. It’s the message about the impact of your loved one that’s important, not the delivery, so just be yourself.

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7 items to consider when

PLANNING A CELEBRATION OF LIFE

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eing in charge of planning your loved one’s end-of-life tribute is an important undertaking.

How can you honor a person very dear to your heart— and the hearts of others—in a special way without it being a somber occasion? Hosting a celebration of life. This style of observance focuses on the joyous memories of how your beloved touched countless lives throughout their years.

If you’re planning this type of celebration for your loved one who has recently passed, or you simply want to plan ahead for the future, here’s a list to ensure you check off all the boxes!

1. CREATE AN INVITE LIST + DISTRIBUTE IT. Think of family, friends (new and old) and others in their life that they loved. Once the list is created, consider sending out the information via email, private Facebook event, printed invitation or phone call.

2. BOOK A VENUE. Choosing the right location can be challenging. Consider hosting the celebration at a park, faith-based community center or a place that held special meaning to your loved one. Then, decide if there’ll be a virtual aspect of the event to allow attendance from those who aren’t in close proximity to the location.

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3. SET A TIME. Will this take place during the week or on the weekend? Will it be in the evening after work or early in the afternoon? Pick a time that works best for you and your family and understand that it doesn’t have to take place right after the passing of your loved one.

If you’re wanting to wait a few days, weeks, or months, that’s okay.

4. INCORPORATE PERSONAL TOUCHES. Adding features that are unique to your loved one will make the celebration even more memorable. This could be having a special theme such as a luau because they loved Hawaii or wearing purple because it was their favorite color. The number of ideas is endless, and the sentimental factor will touch everyone in attendance.

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Remember, it’s a celebration for your loved one. Share wholesome experiences, laugh at funny stories and cry if you need to. Don’t hold back your emotions; be comforted knowing that your loved one is leaving this world with a beautiful commemoration.

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7. GATHER PHOTOS AND CREATE A SLIDESHOW. Sharing a slideshow of images and videos of your loved one can be impactful. Pull together the memories with family and friends and have your loved one’s favorite songs playing in the slideshow background.

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6. SERVE REFRESHMENTS. You don’t have to provide an entire meal; however, serving some appetizers and drinks is appreciated. Whether you choose to do this buffet or potluck style, create a spread that fits within your budget. Also consider offering alternative options for those with dietary restrictions.

AUSTIN & SAN ANTONIO EDITION

5. DESIGNATE SPEAKERS. Asking a few people to share stories about your loved one is the focal point of the celebration. After all, storytelling can be the best way to make everyone feel connected. Encourage opening the floor to others once the designated speakers are done.

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