Senior Resource Guide (Spring 2022) by Senior Resource Guide for the Modern Caregiver

SENIOR

RESOURCE guide CAREGIVING ENDURANCE

your

Handling difficult behaviors

ULTIMATE GUIDE TO

aging care

NEW LOOK!

SAME TRUSTED RESOURCE.

SENIOR LIVING

Local communities to consider

APPETITE BOOSTERS

Ideas to increase nutrition

SENIOR LIVING

with Style

Call today to schedule a free lunch and a tour of our beautiful community! Franklin Park® Sonterra 18323 Sonterra Place San Antonio, TX 78258 (210) 404-1441

Franklin Park® Alamo Heights 230 W. Sunset Road San Antonio, TX 78209 (210) 829-5955

Lic.# 147405

Lic.# 148688

Independent Living Assisted Living

Independent Living Assisted Living - Memory Care

Franklin Park® TPC Parkway 21802 Encino Commons San Antonio, TX 78259 (210) 462-1004

Franklin Park® Boerne 18 Old San Antonio Road Boerne, TX 78006 (830) 816-5150

Independent Living Assisted Living - Memory Care

Assisted Living - Memory Care Lic.# 147707

Lic.# 146061

Franklin Park® Round Rock 4155 Teravista Club Drive Round Rock, TX 78665 (512) 388-6076 Assisted Living - Memory Care Lic.# 147329

Learn more about us at... franklinpark.org

ACT YOUR AGE ever you want how

We are redefining what it means to “act your age” by offering the opportunity to indulge in your interests and passions in every aspect of community life.

Three communities in Texas | See our ad on the back cover

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

When his wife suffered a stroke, Joe had a choice. Where would she have the greatest chance at recovery? He did the research and chose Encompass Health. Find out why rehabilitation works best when you choose the right partner at encompasshealth.com.

Encompass Health Rehabilitation Hospital of Austin 330 West Ben White Boulevard • Austin, TX 78704 • 512.580.9405 Encompass Health Rehabilitation Hospital of Round Rock 1400 Hester’s Crossing • Round Rock, TX 78681 • 512.270.2989 ©2021:Encompass Health Corporation:1724601_1B

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. 64)

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

• Understanding Hospice (see pg. 114)

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.”

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

• Questions to Ask During Hospital Discharge (see pg. 94)

• Home Care versus Home Health Care (see pg. 60)

IDENTIFYING YOUR ROLE “I’m needed to help out.”

• How to Handle Anger + Difficult Behavior (see pg. 14)

MID PHASE

PLANNING AND PREPARING

• Signs Not to Ignore: Dementia versus Normal Aging (see pg. 88)

EARLY PHASE

• Getting Connected with Help (see pg. 24) • 5 Must-Have Legal Documents (see pg. 46)

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DETECTING CHANGES “Is this part of normal aging?”

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

CONTENTS \\

GENERAL INFO \\ 4

The Caregiving Journey

Our Legacy

The Senior Resource Guide Team

EARLY PHASE \\

THE PLAN

What Level of Care is Right

5 Steps to Take When Your Parents Require Different Levels of Care

What’s an Adult Day Center?

Warning Signs of Unsafe Driving in Seniors

Ombudsmen are Here to Help

THE ROLE

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How to Handle Anger + Difficult Behavior?

20 Navigating Family Conflicts 22

What to Do When You Need a Break

Get Connected

Five Must-Have Legal Documents

Paying for Long-Term Care

CONVERSATIONS Having the Conversation: When Dad Disagrees on Mom’s Care

40 How to Talk with Your Parents About Their End-of-Life Wishes 42

How to Talk with Your Siblings About Caregiver Responsibilities

LEGAL + FINANCIAL

INITIAL MEDICAL CARE

50 Understanding Medicare: Parts, Plans and Meeting Your Needs 54

A Guide to Medication Obstacles

Mobile Care

MID PHASE \\

Meaningful Minutes for Caregivers

Five Vital Tips to Help Deal with Caregiver Stress

Anxiety Reducing Drink Recipe

When Do You Need to Consider In-Home Care?

SELF CARE

Home Care versus Home Health Care

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DAILY CARE

CONTENTS \\

MID PHASE \\

Care Transitions

Questions to Ask During Hospital Discharge

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

Encompass Health Rehabilitation Hospitals (see also pg. 3)

DIET + WELLNESS

72 75

How Can You Stimulate a Senior’s Appetite? Relaxing Refresher Recipe Why are Seniors More at Risk of Dehydration?

MEMORY + DEMENTIA

Steps to Take After a Memory Issue is Recognized

80 Reminiscence Therapy

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NEW STEPS

Tips for Effective Alzheimer’s Communication

Signs Not to Ignore: Dementia versus Normal Aging

101 Selling Your Home to Pay for Care

104

104 Types of Residential Care for Seniors

107 Senior Living Communities

SENIOR LIVING Spectrum Retirement Communities (see also back cover)

109 Franklin Park Senior Living (see also pg. 1) 110 Questions to Ask When Looking for an Assisted Living Facility 112 Questions to Ask When Considering Skilled Care

LATE PHASE \\ 114 Understanding Hospice

122 Steps to Take After the Passing of a Loved One

119 OpusCare of Texas (see also inside front cover)

124 Preparing & Presenting a Eulogy 126 7 Items to Consider When Planning a Celebration of Life

See you online srgtexas.com

Visit srgtexas.com to enhance your caregiving journey even further. Access this edition’s extended content + additional helpful articles, local caregiver events, support groups, and our online directory of senior care services in your area.

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120 Questions to Ask When Choosing a Hospice Program

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.

P U B L I S H ER The Dean Family

CO N T R I BU TO RS 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 Morgan Keefe – Campaign Success Manager Caroline Davis – Account Executive

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

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

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

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 ©2022. 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

EARLY PHASE \\ THE ROLE

HOW TO HANDLE ANGER + DIFFICULT BEHAVIOR And Not Take It Personally

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ave you noticed that as your loved one has aged, you’re seeing things in them you’ve never seen before? Memory loss? Difficulty managing emotions? Do they make decisions that compromise the safety of themselves or others? Do these troubling behaviors sometimes have a clear trigger and at other times no discernible reason? Difficult aging behavior can take a huge emotional and physical toll on the family member who is providing care. Learning to navigate these changes is critical to developing caregiving endurance. Let’s walk through a few common scenarios that frequently pop up for family caregivers. It’s important to keep in mind the symptoms will vary from one person to the next, and for any given individual, what works one day may not work the next. So, keep these tools in your back pocket.

FRUSTRATION AFTER FORGETTING Beginning early in the onset of dementia, a person may become angry or frustrated when they forget something. They may realize this on their own or when it’s brought to their attention. The key is to try to take the focus off these moments of confusion.

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ADJUSTING TO RESIDENTIAL CARE Struggles can also arise with change, such as the transition to a senior living residence. Your loved one may not remember where they are or why they are there. In this situation, your goal should be to validate their concerns while also giving a simple explanation. Try framing it as a temporary situation or agreeing with them and telling them you’ll work on bringing them home soon. This idea, known as a “therapeutic fiblet,” is used frequently in caring for people with memory issues.

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In most cases, not correcting your loved one is vital to avoiding frustration. Some people living with dementia experience anosognosia (pronounced ANN-uh-sog-KNOW-zha). This means that they have limited or no insight into their deficits. A person living with dementia may acknowledge their disability on some level but perhaps not the full extent of it. When their forgetfulness is brought to their attention, they may become defensive, angry or even frightened. Taking the emphasis off their forgetfulness minimizes the chance of a negative reaction.

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It may feel counterintuitive not to tell the complete truth, but you’re meeting your loved one in their reality. Trying to argue and rationalize will likely cause frustration for both parties. Even if you persuade them, they may subsequently forget, and then you’ll have to relive this difficult conversation. It’s important to keep in mind that you’re not trying to get your loved one to permanently remember something. You’re simply offering comfort and reassurance in the moment.

PREVENTING TRIGGERS The family member in your care may exhibit outbursts even without any triggers. When they experience anger, agitation, and other challenging symptoms, keep track of them in a journal. Journaling their symptoms can help identify any consistent triggers. Write down what happened leading up to the outburst, and record what strategy was successful in de-escalating the symptoms. While the strategies to deal with the situation can help your senior get through a difficult moment, avoiding the trigger in the first place can keep the situation from developing or escalating. However, avoidance may not always be possible, so keep this formula in mind: validate their feelings; provide a simple (even temporary) solution; and redirect to a more pleasant activity.

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aid Easier S Than Done

“DON’T TAKE IT PERSONALLY” Aging can cause personality changes or behaviors that can be upsetting and emotional to deal with as the caregiver. It’s not easy to provide such a high level of care for someone who may not notice or appreciate the care, or who may be resentful and angry. At times, it may be necessary to walk away after doing a quick assessment of your loved one’s safety. Whether it’s to recharge emotionally, or for your safety, having a separate space to walk into is important. If you’re providing care and meeting resistance, it’s okay to consider whether that particular task really needs to

CREATE A LASTING LEGACY WITH US “What you leave behind is not what is engraved in stone monuments, but what is woven into the lives of others.” Pericles

EVERY MAN, WOMAN, AND CHILD DESERVES AN OPPORTUNITY FOR A GOOD LIFE. 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. The enduring nature of your vision and generosity will continue to serve San Antonio and Bexar County for many years to come.

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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EARLY PHASE \\ THE ROLE

This

be accomplished at that particular moment. Reapproaching at a later time may be advisable. It’s not uncommon that your loved It’s important to one may at times respond better to keep in mind that someone other than you. Are there your loved one friends, family members or professional doesn’t have care providers to whom your loved control over their one may be more receptive? Is there symptoms, and someone who can physically step in with a different approach or provide a what they say in a distraction over the phone? painful moment is The most challenging behaviors are not personal, nor is often directed at the primary caregiver it a reflection on the simply because you’re the one who has care you provide. the most trusting relationship with the aging family member. It’s important to keep in mind that your loved one doesn’t have control over their symptoms, and what they say in a painful moment is not personal, nor is it a reflection on the care you provide. It’s still valid for you to feel upset. Allow yourself to feel the emotions caused by their behavior. Journal them as you would journal your loved one’s symptoms and triggers. Connect with someone you trust to help you deal with these moments. Most importantly, have patience with yourself. If you respond in the wrong way, chances are you will remember that longer than your loved one will. Giving them some space will help them reset, and you should take that as an opportunity to reset yourself. Difficult aging behaviors aren’t easy to navigate. They can take a lasting toll on the caregiver and the whole family, and positive moments can be hard to find. But take every opportunity to remind yourself of all the things you loved—and still love—about this person you’re caring for. Those thoughts can help carry you through the most challenging times.

EARLY PHASE \\ THE ROLE This content is proudly provided by

See their ad on page 1

Locally Owned. Locally Managed.

Independent Living • Assisted Living • Memory Care Franklin Park® Alamo Heights 230 W. Sunset Rd. San Antonio, TX 78209

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Lic.# 106581 Independent Living • Assisted Living Memory Care

Lic.# 104458 Independent Living • Assisted Living

Franklin Park® TPC Parkway

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(888) 697-5810

21802 Encino Commons San Antonio, TX 78259

19110 Huebner Rd San Antonio, TX 78258

NAVIGATING FAMILY CONFLICTS Lic.# 104834 Independent Living • Assisted Living Memory Care

Franklin Park® Boerne 18 Old San Antonio Rd. Boerne, TX 78006

(855) 502-2804

Lic.# 106798 Assisted Living • Memory Care

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Franklin Park® Round Rock 4155 Teravista Club Dr. Round Rock, TX 78665

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Lic.# 106733 Assisted Living • Memory Care

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

While Caring for Aging Parents

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.

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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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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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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.

EARLY PHASE \\ THE ROLE

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

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:

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• Trusted volunteers, like family members, friends, co-

workers 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 pre-

paring meals, cleaning and running errands. 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.

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: • Specialized residential centers, like group care homes,

hospitals and skilled nursing facilities. • Adult day cares, which are developed specifically for seniors

who need care. you and your aging loved one that promote healing and revitalization.

Dive Deeper

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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• Respite retreats and camps, which are fun getaways for

EARLY PHASE \\ THE ROLE

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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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. 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.

An Overlooked Resource

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.

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.

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

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

EARLY PHASE \\ 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. 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.

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

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

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

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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.

EXPERIENCE THE NOT-FOR-PROFIT DIFFERENCE Not-for-profit providers of aging services offer a commitment to quality that stems from a mission of service and a history of compassion

LOCATE PROVIDERS IN YOUR AREA

HIRING ALL OVER THE STATE

leadingagetexas.org/directory

careers.leadingagetexas.org/jobseekers

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

info@leadingagetexas.org

www.leadingagetexas.org

(512) 467-2242

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5 steps to take when

YOUR PARENTS REQUIRE DIFFERENT LEVELS OF CARE

ne parent requiring advanced care sooner than the other is a probable situation as women and men aren’t statistically equal health wise. When parents require different levels of care, it can be hard trying to balance these circumstances. For example, what if Mom has dementia and needs to move into a memory care community? What is Dad to do? This is similar in some ways to a divorce. However, in this instance, both parties typically want to be together, yet the Prioritize your separation is necessary to maintain health and welltheir health and safety. being too. Taking With the separation, feelings time to refuel of loneliness and social isolation will allow you to can arise. continue supporting The following are ways to help your parents support a healthy relationship through this new and quality of life for both turn in their journey. parents despite their change in environment.

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r e b m e m e R

EARLY PHASE \\ THE PLAN

Step

CREATE A SCHEDULE

A schedule offers routine and structure and will not only benefit your parents but also you. It can help ensure that each parent doesn’t go too long without a family member or friend visiting. Make time for Sunday brunch, biweekly game night or a monthly movie marathon. If a loved one doesn’t live nearby, then schedule virtual visits where the possibilities are endless.

Step

2 PLAN FOR TRANSPORTATION

Transportation may be required for various reasons such as taking one parent to visit the other, doctor’s appointments, shopping/ errands, etc. It’s often difficult to arrange for last-minute service, especially if both parents require transportation on the same day. Consider creating a schedule of availability with other loved ones willing to help drive each parent. You could also hire a private companion or care aid who can come spend some time with your parent(s) as well as drive to necessary appointments. For other options, see “Get Connected” in the Guide to discover local resources that can help.

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3 TAKE ADVANTAGE OF TECHNOLOGY

Smartphones, tablets, computers and more allow the opportunity to interact with people even when they’re not physically nearby. With apps such as Zoom and FaceTime, you can quickly connect with loved ones via video. If your parents aren’t tech-savvy, walk them through the process and show them how easy it is to reach their spouse and other loved ones whenever they desire.

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Step

4 ENCOURAGE A HEALTHY LIFESTYLE

A positive aspect of living apart is that each parent may have more time to focus on themselves. This offers a wonderful opportunity to build good habits that promote happiness. For example, Mom can enjoy Zumba and chair yoga at the community while Dad sharpens his golf or tennis skills at home. As a result of working on themselves independently, they can cultivate their own strengths and be a better team when they’re together.

Step

5 COMMUNICATE FREQUENTLY

Transitioning from levels of care can be physically and mentally draining for everyone involved, but with the tips we’ve outlined and a support system in place for both parents, it should make this phase easier.

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Check in often with each parent to see how they’re doing both emotionally and physically. Consider that your parents may not want to burden you and voluntarily come to you to voice their thoughts. Try asking yes or no questions like “Do you like how often you’re seeing Mom/Dad?” or “Are you happy with your current daily routine?” to help determine if things need to be adjusted. Creating a standard of open communication can increase the level of comfort and their willingness to share any concerns.

EARLY PHASE \\ THE PLAN

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

dult day centers provide care and companionship to seniors in a structured setting, which allow primary caregivers an opportunity to work, catch up on personal items or simply relax. Are adult day centers the same as your 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 $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

EARLY PHASE \\ THE PLAN

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

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 or 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

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: • 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

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.

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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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?

EARLY PHASE \\ 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.

THE PLAN \\ EARLY PHASE

Important Number

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: • 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

“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.”

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

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regulations and laws protect residents.

EARLY PHASE \\ CONVERSATIONS

having the conversation:

WHEN DAD DISAGREES ON MOM’S CARE

om and Dad have been together for decades, filled with the memories of good times and bad. Both are getting older, but they may not experience the same impacts of aging at the same rate. Dad, perhaps, is generally fit as a fiddle while Mom may be experiencing physical or cognitive challenges, or both. As dad or the adult children assume the role of the primary decision maker, how do you handle conflicts over care decisions?

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ASSESS THE SITUATION If Dad is providing care for Mom, or vice versa, it’s vital to assess his ability to meet her needs without neglecting his own. Is he missing doctor’s appointments because she can’t stay alone? Is he providing physical care that could cause a fall? If she were to fall, could he get her up on his own? Asking questions like these can help you determine the level of risk and help you decide whether to take the further steps in getting support for your parents. UNDERSTANDING YOUR LOVED ONE’S PERSPECTIVE Before stepping in or implementing formal care options, listen to your dad’s perspective. Consider why he feels the way he does. Older adults are frequently reluctant to accept help. Many emotions are involved. Dad may feel that it’s his job to care for your mom— on his own. He may feel that it’s weak to ask for or accept help, and he may be grieving the loss of his wife as he once knew her.

CONVERSATIONS \\ EARLY PHASE

Advance aging can bring the feeling of losing control, and while Mom may be the one in need of care, Dad may also feel this loss. He may struggle with releasing more of that control to his adult children. Here are a few suggestions for making hard conversations easier: • Start small. Change is hard for most of us! Rather than

making many changes all at once, think about where your loved ones are struggling the most and start there. • Pick your battles. Consider what behaviors really need to

be corrected. Prioritize safety issues such as medication mistakes, driving and lack of eating. It’s crucial to maintain trust between you and your parents. Don’t burn a bridge over a minor difference of opinion. • Spend quality time. In caregiving, it’s easy to get caught up

in day-to-day tasks and forget to spend quality time with your loved ones. You may even feel you don’t have time to enjoy your parents’ company. Think about the favorite activities you used to enjoy together and schedule them into your visits. Try not to bring up the need for help. Enjoying each other’s company breaks up the times when you need to have difficult conversations. It also eases the feeling that you’re interfering and shows them that you value them as individuals.

easier to mull over if they feel far off in the distance. Talk to Dad about what his emergency plan would look like if something were to happen to him and he couldn’t provide the great care he’s providing.

More to Say

For more suggestions and what to do if having a conversation isn’t working, visit srgtexas.com.

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• Call it an “emergency plan.” Sometimes, care options are

EARLY PHASE \\ 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

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in 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-of-life wishes, but it’s important to understand what those wishes are and what type of plan might be in place already.

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.

Important Documents

For a list of must-know important documents and to read the full article, visit srgtexas.com/getcaregivertoolkit

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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 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?

EARLY PHASE \\ 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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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: • Try to begin the

Remember the Why

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.

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.

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. • 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

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• Have the conversation in person if possible. These

EARLY PHASE \\ CONVERSATIONS

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

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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 can ultimately lead to resentment. No matter which role you are in, empathy and the courage to ask for and offer help will be vital. 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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EARLY PHASE \\ 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. 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

LEGAL + FINANCIAL \\ EARLY PHASE

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

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.

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.

EARLY PHASE \\ LEGAL + FINANCIAL

PAYING FOR LONG-TERM CARE

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

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EARLY PHASE \\ 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.

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.

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INITIAL MEDICAL CARE \\ EARLY PHASE

EARLY PHASE \\ INITIAL MEDICAL CARE

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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.

INITIAL MEDICAL CARE \\ EARLY PHASE

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.

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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.

EARLY PHASE \\ INITIAL MEDICAL CARE

A GUIDE TO MEDICATION OBSTACLES “I was discharged from the hospital with so many new medications and don’t even know what I’m taking them for.” As your senior’s health changes, medication requirements often change as well. Oftentimes, hospital stays result in several medication changes, including adjustments in dosages, removal of some, and the addition of new ones. This cumbersome process can leave room for errors. Fortunately, there are steps you can take that may help prevent errors when medication changes occur. Prior to being discharged, ask the nurse to review the updated list of medications with you. It’s important for you and your loved one to understand the reason they’re taking Repeat back what each medication. each medication is You’ll also be given a list with and what they treat. this information on the discharge This tactic will help paperwork. If any of this information in becoming familiar looks inaccurate or confusing, ask the with each. nurse to check with the doctor or other health care providers to confirm accuracy. If possible, have a family member or friend with you during this time. There’s typically a lot to take in at once and they can assist with asking any clarifying questions as well as taking notes. Follow up with their primary care provider after any hospitalization. The provider can review the discharge medications with you and update their medical records. This is

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Discharge Tip

INITIAL MEDICAL CARE \\ EARLY PHASE

“I’ve been out of my medication for three days. I’m not sure how to get more.”

Create a List Include each medication with an explanation of what it treats. Doing so may bring to light any medications that are duplicating efforts or no longer necessary. Keep the list—a printed and digital copy—easily accessible in case of emergency.

Another obstacle is running out of medication. Making a plan of how your loved one will access medications is essential and may help prevent missed doses. If transportation is an issue, look into mail delivery options, which can bring medications right to their doorstep or seek assistance from family members or friends. Home caregivers, aides or companions are also available to provide transportation to the pharmacy. Keeping a schedule with estimated refill timeframes for each medication will help keep them on track and prevent missed doses. Try to make it a habit of refilling medication a few days or a week before they’re out. Perhaps the medications are too expensive, and your senior loved one can’t afford them. If they are struggling to pay for medications, ask the primary care provider about alternate medication options or the pharmacy for recommended resources. The medication obstacles your loved one faces can be difficult but remember there’s a lot of help available. Your health care team, family and friends are all important resources who can work together with Your loved one may you to ensure your loved one takes have spilled some their medications as prescribed. With pills, misplaced the support of everyone involved, it’s the bottle, or possible to overcome any obstacle accidentally taken and maintain excellent medication an extra dose. compliance.

Make Checkpoints

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also a great opportunity to discuss any further questions you or your loved one may have after leaving the hospital.

EARLY PHASE \\ 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 210-570-9975 doctoratyourservice.com

Healing Hands House Calls PLLC

HOUSE CALL PHYSICIANS

When getting to the doctor’s office is prohibitive or not practical, consider a physician who makes oldfashioned “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

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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 offer house call visits.

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*$19.95 is the monthly price of subscription to a MobileHelp Classic at home only system. There is a one-time $49.95 processing fee and $15 shipping fee required to subscribe to this plan. Equipment may vary as shown. System featured in photo above is the MobileHelp DUO available at an additional monthly cost. Call or see terms and conditions for further details. 50% off Fall Detection Promotion valid when Fall Detection Service is added to your monitoring system and MobileHelp Connect Premium service is included with the order. Offer is valid for the first year of service only. This offer is for new customers only and cannot be combined with any other offers. Promotion available for select plans only and for a limited time. During the promotional term, you will receive $5 off the $10 full retail price of Fall Detection service. After first year, Fall Detect pricing reverts to discounted price of $7.50/ month when combined with MobileHelp Connect Premium. Fall Button does not detect 100% of falls. If able, users should always push their help button when they need assistance. Fall Button is not intended to replace a caregiver for users dealing with serious health issues. Service availability and access/coverage on the AT&T network is not available everywhere and at all times. Current GPS location may not always be available in every situation. MobileHelp is a registered trademark. Patented technology. MobileHelp is an FDA registered company. MHPN-00939 Rev. 1

MID PHASE \\ DAILY CARE

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 facility. 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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From the Experts

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

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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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HOME CARE VERSUS HOME HEALTH CARE 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.

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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

Ease into it

Based off advice from the Family Caregiver Alliance, here are tips for introducing a home care service into your loved one’s routine.

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.

• Listen and acknowledge your loved one’s feelings, and possibly fears, about hiring home care. • Involve your loved one in the hiring process as much as possible. • Consider alternative motivators. Using a doctor’s recommendation, the need for housekeeping or help with preparing meals might make your loved one more comfortable with the notion.

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

• Start slowly. Gradually add hours as needed and allow time for your loved one to get used to the idea.

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MEANINGFUL MINUTES FOR CAREGIVERS

Creating Space for Yourself to Recharge

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

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GET FRESH AIR. Open your windows or simply step outside to take in a new environment. A fresh atmosphere is excellent for resetting your mind and body, which can help you feel calmer. If you have the time, go for a walk or run to boost endorphins. MAKE A GRATITUDE LIST. Write down 10 things you’re thankful for. Shifting your mind to appreciation and finding the positive in your day cultivates a new perspective. The 10 items can be relatively small or large. Try to be as specific as possible and give thought to the reason you’re grateful for each of them. For example, you may be grateful you were able to pick up dinner for your mom because you received a huge smile from her. Or you could be thankful for your bed, pet, laughter, alarm clock, etc. In the words of Oprah Winfrey, “Be thankful for what you have; you’ll end up having more. If you concentrate on what you don’t have, you will never, ever have enough.”

SELF CARE \\ MID PHASE

JOT DOWN YOUR THOUGHTS TO CLEAR YOUR MIND. If you’re feeling overwhelmed or as if your tasks and demands are never ending, grab a piece of paper (or open a notetaking app on your phone) and unload your thoughts. Don’t attempt to organize them. Simply write them out as they pop up in your mind—things you’re worried or happy about, obligations, items on your to-do list or projects. Decluttering the mind and slowing down spiraling thoughts can help sort out a frazzled mind, but also may help clarify emotions. Additionally, the act of writing down any bright spots in your caregiving journey encourages calm and may help store it in your memory.

• lower our heart rate and

cortisol levels • release endorphins and improve

our sense of well-being • distract us, reducing physical and

emotional stress levels

More 5-minute ideas: • Make yourself a cup of tea or coffee • Five-minute breathing exercise

• Meditate (or just close your eyes and relax) • Read a short article of interest • Stretch • Take a power nap • Chat with a friend or family member

Music is a fantastic way to relieve stress. While some types of music, such as classical and ambient, have been studied for their calming effects, listening to your personal favorite song or genre also has its benefits. Whether it’s been a stressful day or you’re just looking for some good vibes, take a moment to turn on Spotify or queue Alexa to play “Dancing Queen” by ABBA. Listening to music that makes you feel good will help put a smile on your face. Additionally, research has shown that music can help reduce burnout and help you fall asleep. However you spend your five minutes, make the most of it. Fully dedicating time for yourself allows your mind and body the opportunity to recharge.

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LISTEN TO A FAVORITE SONG. According to Psych Central, a 2020 overview of research into music and stress suggests that listening to music can:

MeTime

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FIVE VITAL TIPS TO HELP DEAL WITH CAREGIVER STRESS

And Recognizing Unhealthy Stress Levels

ccording to the National Alliance for Caregiving and AARP, around 34.2 million Americans provided unpaid care to an adult age 50 or older in 2020. 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. • Feeling run-down or tired often • Difficulty sleeping

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• 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

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

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.

Tip

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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2 TAP INTO THE RESOURCES AROUND YOU.

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Tip

3 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.

Tip

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4 PERSONAL HEALTH ROUTINE. SET AND FOLLOW YOUR

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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Tip

5 TAKE CAREGIVING BREAKS REGULARLY.

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.

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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.

MID PHASE \\ SELF CARE

ANXIETY REDUCING DRINK Courtesy of mentalhealthfood.net

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!

Find more recipes on srgtexas.com

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MID PHASE \\ DIET + WELLNESS

HOW CAN YOU STIMULATE A SENIOR’S APPETITE?

roper nutrition is imperative as you age. It not only helps an aging individual stay strong and healthy, but also aids recovery from any ailments. But what do you do when your older loved one has lost their interest in eating and isn’t getting the nutrition they need? A senior with no desire to eat can prove to be a difficult challenge. We’ve rounded up some savvy ideas for you to try to help increase a waning appetite. • Create a routine: If your loved one doesn’t have a regular

eating schedule, encourage them to start eating at a specific time daily. This will help train their bodies and mind to look forward to a meal every day. Savvy suggestion: Identify the point in the day when their appetite is strongest and any factors that may have influence (i.e. sleep, mood, activities, etc.). • Get them to eat with others: Loneliness and depression are

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associated with an increased loss of appetite in older adults. Seniors may enjoy eating more if they view it as a social activity instead of a chore. Savvy suggestion: Plan dates with friends, family or neighbors. Also consider your local senior center or faith-based community for meal opportunities. • Include more finger foods: Seniors experience loss of

coordination and shaky hands, making it difficult to use utensils. This may lead to them rejecting their meals due to embarrassment or frustration. Consider items like fruit,

DIET + WELLNESS \\ MID PHASE

chicken nuggets and sandwiches as they can eat these with their hands. Savvy suggestion: Don’t shy away from variety. Changing up the menu not only prevents them from getting bored, but also allows you to analyze which foods they’re able to handle best. Also, be sure you’re incorporating vital minerals such as calcium and vitamin D for bone health. When providing protein, seniors require between 1 and 1.3 grams for each kilogram of their body weight. • Combat medication side effects: Medications can come

with nasty side effects such as dry mouth and metallic taste. Besides being uncomfortable, these can lead to loss of appetite. Encourage seniors to brush their teeth, use a mouth rinse or chew sugar-free gum before eating to treat dry mouth. Doing so gets saliva flowing, enhances their ability to taste, and reduces discomfort, which may help boost their appetites. Savvy suggestion: If their food tastes “off,” consider adding fruits or herbs to make a flavor more prominent. For example, try infusing water with lemon, mint or cucumber. • Let them choose: Help make your loved one feel more

empowered by including them in the decision-making. Let them get involved in what they will eat and how it will be prepared. Savvy suggestion: Start a meal off with a small portion of their favorite snack or appetizer. • Drink the food instead: Many seniors have difficulty

Savvy suggestion: Start with ingredients they already love. Mix in healthy flavor boosters such as cinnamon, turmeric, ginger, cocoa and unsweetened matcha powder.

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

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with chewing and/or swallowing. In such cases, go with smoothies, soups or bottled nutritional drinks.

MID PHASE \\ DIET + WELLNESS

RELAXING REFRESHER Recipe adapted from simplyrecipes.com

mong many other benefits, lavender is thought to calm nerves, lead to better sleep and improve skin health. Sip on this refreshing beverage and get ready to squeeze the day!

LAVENDER LEMONADE RECIPE

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Makes 6 servings

INGREDIENTS

DIRECTIONS

• 1 tablespoon dried lavender flowers, or 1 small handful of freshly picked and rinsed lavender flowers • 1 cup sugar • 2 cups boiling water • 1 1/2 cups freshly squeezed lemon juice • 2 cups cold water, plus more as needed • Ice • Thinly sliced lemons and a few lavender sprigs, for optional garnish

Pour 2 cups of boiling water over the flowers and sugar. Stir until the sugar has melted. Cover and let infuse for 30 minutes (or up to several hours).

e s o o h C to How Lavender

Strain the lavender-infused simple syrup into a serving carafe or pitcher. Stir in the lemon juice. Add 2 cups of cold water. Taste and adjust for tartness (add more lemon juice if too sweet or more sugar if too tart). Add ice and more water to your desired level of concentration.

Although all varieties of lavender are edible, some are not as good for cooking. Be sure to purchase culinary lavender and stick with English or French lavender varieties, which won’t be soapy or bitter. Where can you get it? Look in the spice aisle or get organic varieties online. Visit srgtexas.com for our recommended brands and a recipe for lemon lavender cookies.

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DIET + WELLNESS \\ MID PHASE

WHY ARE SENIORS MORE AT RISK OF DEHYDRATION?

eniors are not only at an increased risk of lacking proper hydration, but also the serious health complications 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

life-threatening • Heat exhaustion or heat stroke • Confusion, anxiety and disorientation

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

MID PHASE \\ DIET + WELLNESS

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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MID PHASE \\ MEMORY + DEMENTIA

steps to take after

A MEMORY ISSUE IS RECOGNIZED

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

MEMORY + DEMENTIA \\ MID PHASE

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? 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.

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.

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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STEP 3: TAKE CARE OF EMOTIONAL NEEDS.

MID PHASE \\ MEMORY + DEMENTIA

REMINISCENCE THERAPY:

How It Can Help with Memory Issues

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iving in the past is often viewed with negative connotations and discouragement. However, when it comes to patients with Alzheimer’s or dementia, reminiscing can be a healthy and beneficial way to feel connected, valued and heard. Reminiscence therapy or a “life review” was first proposed by Dr. Robert Butler, a psychiatrist specializing in geriatric medicine, in the 1960s as a new way to look at aging and the natural process of memory. This was counter to what the other leading psychologists and psychiatrists promoted, as they felt that one should focus on the present and the future rather than try to relive broken or disconnected memories. For caregivers working with patients who have cognitive difficulties, reminiscence therapy can be an effective tool for engaging in conversation, making the patient feel valued and heard, and dealing with difficult emotions. There are several easy and effective ways for even non-trained professionals to participate in this form of therapy.

WHAT IS REMINISCENCE THERAPY? The practice of reminiscence therapy involves exchanging memories from one’s past as a way to remember more things. Its main goal is to stimulate the brain and improve overall well-being. Professional clinicians and family members can use this approach in both a clinical setting as well as an informal setting.

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There are three main types of reminiscence therapy: • Simple: reflecting on the past in a natural and enjoyable way • Evaluative or Life Review: examining life and sometimes

addressing hard memories • Life Story: a narrative approach of past, present and future

REMINISCING VS REMEMBERING When asking patients to remember something on command, many can become frustrated or embarrassed as they may not be able to remember certain information right away. Patients may also try to read the expressions or tone of the caregiver to see which response is appropriate and may say that they do remember when in fact they don’t. There are a few key differences between simply remembering something instead of reminiscing. Remembering is the recall of specific things such as where you were born or where you parked your car. Reminiscing is walking through past events or memories but doesn’t always entail analyzing them. The goal of reminiscence therapy is not to get someone to remember something from the past, but instead to create an atmosphere that allows memories to arise organically. The difference between these two can be tricky to understand at first, but when done correctly, this approach can help foster a deeper understanding and emotional connection between caregiver and patient.

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The strategy one uses will depend on the patient and the intended result. It’s also important to note that one method may not work every time, and the caregiver may need to use one or more methods over time. Some methods may not work at all while others may work quickly. If one type doesn’t work, don’t simply give up. Consider trying another day or maybe at a different time of day.

MID PHASE \\ MEMORY + DEMENTIA

BENEFITS OF REMINISCENCE THERAPY Reminiscence therapy can be especially useful for patients who also deal with depression and anxiety. It helps to be reminded of past accomplishments, joys and struggles endured through the years, and how their past has defined who they are today. Studies have also suggested that it can help improve a patient and caregiver’s relationship. Many caregivers are often focused on a needs level instead of an interpersonal level and reminiscing on both positive and hard memories. REMINISCENCE THERAPY IDEAS FOR CAREGIVERS You don’t have to be a trained clinician or professional caregiver to participate in reminiscence therapy. Here are a few easy ways for caregivers and family members to begin: • Use a variety of mediums: Photographs, smells, music, food

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or objects can be a great first step to begin the conversation. • Ask open-ended questions: As with any conversation,

questions that result in a simple “yes” or “no” can be challenging to expand upon, so be sure to continue with follow-up questions if you ask a yes-or-no question.

MEMORY + DEMENTIA \\ MID PHASE

• Use your observational skills:

Are there objects or photographs they keep in a special place or tend to look at regularly? Look for conversation starters in the environment or home that can help trigger a conversation. • Be open to emotional

responses: Some memories can be hard or painful, but that doesn’t mean they’re bad. Encourage these emotions as it can provide a therapeutic response.

Important to Note Even though there is no research to show any negative effects of reminiscence therapy, recalling old memories can be difficult. Ensure you’re supporting them with an open and nonjudgmental mind.

• Begin early in the day: Many patients with Alzheimer’s

or dementia report the best time for recall is early in the morning. Working with them at a time that works best for them can lead to better results.

someone to an environment that is significant to them from their past can trigger these responses. Places like old homes, schools, religious places of worship, and workplaces are easy to visit if close by. Reminiscence therapy is just one approach to help patients who suffer from cognitive related diseases. One must consider the patient’s personal and medical history before starting this form of therapy, and it may not be suitable for all individuals.

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• Revisit special settings from one’s past: If possible, taking

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TIPS FOR EFFECTIVE ALZHEIMER’S COMMUNICATION

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:

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

AVOID DISTRACTIONS Communication may be difficult—if not impossible—against a background of competing sights and sounds. 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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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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DON’T INTERRUPT It may take longer than you expect for your loved one to process and respond. Avoid criticizing, hurrying and correcting. 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.

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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. 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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Map out a plan to approach Alzheimer’s alzheimersnavigator.org

Educational and dementia care resources alz.org/training

Online resources for caregivers alz.org/care

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SIGNS NOT TO IGNORE:

DEMENTIA VERSUS NORMAL AGING

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?

DEMENTIA OR AGING: THE SIGNS

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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

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.

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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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.

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WHEN IN DOUBT, TRUST THE PROFESSIONALS

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

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 into chest • Up into crown of the head • 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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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 become 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 between different care types. 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

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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questions to ask

h w w o n K to ask

DURING HOSPITAL DISCHARGE

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.

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4 5

What care or therapies are needed after discharge? i.e. home health, outpatient therapy, rehab/skilled nursing, etc. 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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9 10 11 12

What problems, symptoms and side effects should we watch for? 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? What are our options for when/where my loved one is being discharged?

My Questions

Jot down any questions or thoughts.

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FOR YOUR LOVED ONE’S REHABILITATION SERVICES

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:

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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.

MID PHASE \\ NEW STEPS

• 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.

Rehabilitation, like dancing, works best when you choose the right partner. After his wife suffered a stroke, Joe knew she needed the right rehabilitation to dance again. That’s why he did the research and chose Encompass Health, where an experienced team used personalized therapy and advanced technology to help Francine return to the life she loved. Find out more at encompasshealth.com/ choosesanantonio.

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

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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• Reverse mortgages

MID PHASE \\ NEW STEPS

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: • Is the sale before or after moving? • What is the impact on income tax or Medicaid eligibility?

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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

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MID PHASE \\ SENIOR LIVING

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

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

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

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 \\ MID PHASE

SKILLED NURSING (NURSING HOMES)

CONTINUING CARE RETIREMENT COMMUNITIES

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

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.

• 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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Information courtesy of The American Elder Care Research Organization

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SENIOR LIVING \\ MID PHASE

SENIOR LIVING COMMUNITIES

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AL Franklin Park Alamo Heights

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AL The Enclave at Cedar Park MC Senior Living

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questions to ask

h w w o n K to ask

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 \\ MID PHASE

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? Are there safety locks on the doors and windows? 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? Is rehab offered on campus? Can special dietary needs be accommodated? What is the meal program? Does the residence offer worship services?

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questions to ask

h w w o n K to ask

WHEN CONSIDERING SKILLED CARE

S 1

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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? 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 \\ MID PHASE

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 there a functioning security system? Are there pharmacy, lab, dental or x-ray services available on-site? Are they Medicare and/or Medicaid certified? 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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LATE PHASE

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. Whether paid for by Medicaid or private insurance, hospices will work with the person and their family to ensure needed services can be provided.

LATE PHASE

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. 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

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

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Hospice Resources

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

Hope Hospice

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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

h w w o n K to ask

WHEN CHOOSING A HOSPICE PROGRAM

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1 2

3 4 5 6 7

What services are provided? What kind of support is available to the family/ caregiver? What roles do the attending physician and hospice play? How does hospice work to keep the patient comfortable? 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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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?

My Questions

Jot down any questions or thoughts.

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8 9 10 11 12

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

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STEPS TO TAKE AFTER THE PASSING OF A LOVED ONE

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.

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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. • 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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• As part of the financial steps

Probate

after the death of a loved one, 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. • Take the will to probate so it can be executed appropriately. • 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. • Close out any remaining online accounts, such as social

Next Steps

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

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media pages (these can be memorialized if you’d like) and email inboxes.

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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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Remember

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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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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7 items to consider when

PLANNING A CELEBRATION OF LIFE

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!

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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. 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.

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. 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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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.

When it comes to home care, not all providers are created equal.

Use the Senior Resource Guide’s Home Care Comparison Chart and online Care Directory to find the provider that’s right for your loved one. SRGTEXAS.COM/HOME-CARE

Learning the ABCDs of Medicare can be confusing. We can help.

Questions about Medicare Insurance Plans? Get answers at a free Blue Cross and Blue Shield of Texas educational seminar. Virtual and in person sessions are available. Reserve a spot: By Phone: Call toll-free 1-866-427-7497, For accommodations of persons with special needs at meetings, call 1-866-427-7497 (TTY 711).

Online: bcbstx.com/medicare/seminars These events are only for educational purposes and no plan-specific benefits or details will be shared.

Blue Cross Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Y0096_TBSRGAD20_C

753378.0520

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Senior Resource Guide (Spring 2022)

Articles inside

Steps to Take After the Passing of a Loved One

Understanding Hospice

Signs Not to Ignore Dementia versus

Care Transitions

Tips for Effective Alzheimer’s

Reminiscence Therapy

Steps to Take After a Memory Issue is Recognized

Why are Seniors More at Risk of Dehydration?

How Can You

Five Vital Tips to Help Deal with Caregiver Stress

Anxiety Reducing Drink Recipe

Meaningful Minutes for Caregivers

Home Care versus

When Do You

A Guide to Medication

Having the Conversation:

Understanding Medicare: Parts, Plans and Meeting Your Needs

Paying for Long-Term Care

Five Must-Have Legal Documents

Ombudsmen are

Warning Signs of Unsafe Driving in Seniors

What Level of Care

5 Steps to Take When Your Parents Require Different Levels of Care

How to Handle Anger Difficult Behavior?

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