• December 28, 2018
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Keeping Your New Year Resolutions With The "New Years Shuffle"

Every year I make New Years' Resolutions, and every year I come back to this 2010 article from The Wall Street Journal on how to keep resolutions.  It never gets old or out of date, so here you go: 

_________________

 

I take the process of making New Years' Resolutions very seriously. Every year I make the resolutions just before December 25--- and spend the final week of the year thinking about what I will do to make them a part of my routine seamlessly.  I like the idea of starting anew with a clean slate in areas that I have failed at during the year.

And then, beginning on January 1--- I'm off and running!

Last year was the first year that I did not fall "off the wagon" two weeks into the year. I attribute that to the New Year's Shuffle!

An article in the WSJ from a few years ago made me realize that perhaps my lack of resolve was not entirely my fault. I’d just been going about it all wrong. According to Sue Shellenbarger, it’s not so much about willpower and discipline as it is about retraining the brain to form new habits. In other words, saying that I’m going to change my behavior just wasn't enough.

New Years' Resolutions require a more detailed plan of action that looks something like the diagram of the New Year's Shuffle shown in the article (diagram on right). It's a process. So for each resolution I make I do the following:

  1. Decide on my goal and make a plan.
  2. Practice beforehand.
  3. Think about what I do that makes me slip up.
  4. Plan for rewards when I practice my resolution.
  5. Practice focusing on my improved behavior.
  6. Reduce other stresses that get in the way.
  7. Plan punishments that will help to get started.
  8. Have a plan to get myself back on track if I slip.

I think this makes good sense, and it worked for me last year so I am going start practicing my 2012 resolutions...tomorrow.

What about you? Have you ever been able to stick to a New Years resolution? If so, how?

  • January 29, 2019
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Simple Solutions for Diminishing Anxiety Levels in Dementia Patients

Nearly 90% of dementia cases exhibit behavioral changes such as apathy, agitation, anxiety, delusions, and to a lesser degree hallucinations. Managing these behaviors is difficult and stressful for family members to resolve and heartbreaking to witness.

There are many family caregivers in need of and searching for any solution, permanent or temporary, that will help family members with dementia.  Which brings me to the inspiration of writing this blogpost. For those of you who don't know, I like Twitter a lot. On it, I follow and engage with a world wide community of aging, caregiving and dementia experts. Some are physicians, healthcare journalists and bloggers, and others develop technology and, provide a variety of services for caregivers and older individuals. And many of them are just like you, caregivers. I learn from them all

The other day a British physician (@GrimmPhil) posted a photo of words of reassurance written on a white board that a daughter left for her mother, who has dementia and anxiety (see left).  I thought this was a great idea; the board was seen by over 1 million people around the world. Statements such as "Your meals are paid for," " You're ok, everyone's fine,"  "You don't owe anyone money," and "You haven't upset anyone" helped to reduce the number of anxious telephone calls made to the daughter. I was really taken by the many responses this post generated. Many shared their own "out of the box" remedies.

One response was from a caregiver of a hospitalized dementia patient who had been awake all night. He was looking for his bus stop, and afraid he would miss his bus. The caregiver made a bus stop sign, hung it on his IV stand and the patient fell asleep.  Another respondent said that he put notes into the pockets of his mother's clothing to let her know that everything was OK.

 

Another person introduced the Tweeters (and me) to Memo Clock, an app that allows you to make daily reminders. The app is downloaded on a tablet that can be placed in view of the person with dementia and also on the caregivers smart phone where they can change the message as many times as desired. Many were interested in learning more about this. I have no doubt that Memo Clock has had many new downloads over the past few days, including from me.

Others simply appreciated the {original} post and said they were going to try the white board for their loved ones. 

But what I also found so heartwarming and interesting was that for many, the caregiving experience and memories didn't end with the death of their loved one.  As proof, there were also responses from previous caregivers who wrote the messages they would have had they thought about this when caring for their loved one. Of particular note was this one:

"People have been visiting you constantly. Your family loves you."

 

  • February 05, 2019
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EmpathiCare Village: New Vision for Patients with Dementia and other Neurocognitive Disorders

You may have read about the recent groundbreaking of the new S. Donald Sussman EmpathiCare Village, a innovative Memory Care Facility on the campus of Miami Jewish Health. After attending a preview there last week, I hesitate to use the word facility because it will be a real home to 99 dementia patients and a community for them and their family members. It’s a very exciting concept that I hope will serve as a model for other areas that are seeking ways to offer high-touch, thoughtful care for dementia patients.  

Residents will live in one of nine “households,” each one complete with private rooms, a central living area, kitchen and dining room. Like any village, there will also be a large courtyard with greenery, walkways and fountains, indoor and outdoor cafes, a wellness center, stores, and quiet places where residents can socialize, and families can gather.

If you’re thinking that it sounds like a nice place to live, that’s exactly what its founder, Dr. Marc Agronin, envisioned.  Dr. Agronin is a Geriatric Psychiatrist and Senior VIce President for Behavioral Health and Chief of Clinical Research at Miami Jewish Health and author of several books on aging, caregiving and dementia.  He says the goal of EmpathiCare Village is to create a real community complete with daily routines and interactions - the same as anyone who has shopping to do or coffee dates with friends. The care model, based on empathy, will be delivered by trained caregivers who are knowledgeable about the needs and strengths of each resident. 

Doesn’t this sound like an environment that you would want for a loved one or yourself? I think it’s very exciting, and a relief to see something so promising being developed. It’s what we desperately need and it’s a wonderful option for dementia patients and their caregivers to consider.

Anyone who has had experience with a loved one with dementia knows that there are no easy solutions when it comes to creating a long-term sustainable care plan.  If you have a family member with dementia, even if it's at an early stage, I encourage you to learn more about Empathicare Village as you plan ahead and consider all options.     

 

Here are a few links to learn more about EmpathiCare Village and the vision behind it.

New Alzheimer's Health Village Coming Soon To Little Haiti

Donald Sussman's $15 million gift helps create the Miami Jewish Health EmpathiCare Village.

Miami Jewish Health Systems Pushes Vast Expansion

The Dementia Caregiver: A Guide to Caring for Someone with Dementia or other NeuroCognitive Disorders

 

  • February 07, 2019
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Introducing SoundPrint: An App That Tells You The Decibel Level of Restaurants

Just last week, my college pals and I reconnected for a reunion over dinner. We picked a restaurant whose menu we knew would please all of our finicky diets. What we didn’t check, however, was the rating of the noise level, which many reviewers now indicate with “noise bomb” icons. This one was off the charts, and even though we are still blessed with good hearing we (and the wait-staff) had to yell to be heard.

Needless to say, the decibel level will be a factor in how I select a restaurant in the future. It’s especially important to check if you or your dining companions wear a hearing aid, which amplifies all surrounding noises and can make ambient sound even louder. I remember taking my father out to dinner and he fiddled with his hearing aid before taking it off, because the noise was intolerably loud for him. 

I’ve recently discovered an APP, which will help me in my quest for a restaurant with a reasonable noise level. It’s called Soundprint. It’s easy to use and its built-in sound meter enables your smartphone to record and submit the restaurant’s decibel level, which helps build their database of locations, which in turn will help other noise-averse diners.

I checked the listings of restaurants near where I live in Miami and found several with decibel levels over 85, which OSHA (Occupational Safety & Health Administration) says is VERY loud.  Next time I want to have a relaxing evening out with friends, I may avoid those and look for a restaurant with a Quiet (less than 70) or Moderate (71-75) decibel rating.   I have a hunch that many of you have become as noise-averse as I am, so give it a try and let me know if you’ve discovered some good restaurant finds - those with good food and a reasonable noise level. 

 

  • February 11, 2019
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How to Start Helping Aging Parents: What You Must Know

How do you know if your parents need help?  Sometimes it's very obvious-- and can begin with a dire medical event such as stroke or fall.  For others it's a more lengthy but clear downward path that may be as a result of an early diagnosis of cognitive impairement. And for many it's not clear and we don't often recognize more subtle signs, and don't recognize that a few seemingly scattered minor events may be related and a sign that the need for assistance or at least recognition may be imminent.  Such "signs" may include: an empty refridgerator, or telling a joke in poor taste (assuming this didn't occur often before), making a wrong turn while driving on a route taken daily, not appearing as well put together, being late to appointments.

No matter how you arrive, when you cross the line from "not worrying" to "worrying and being concerned," it's time to get ready and be prepared.  Being able to help your parents effectively and with a  minimum of stress to them AND to you necessitates that you know the answers to the following questions.  So STEP 1 in this process is all about communications.... with your siblings (if available) and with your parent(s). It's time to learn what their long-term care wishes are and make a plan that best accomplishes them.

 

 

 

How many of the following questions can you answer YES to?

 

  • What your parents long-term care wishes are?
  • How caregiving responsibilities will be shared by family members?
  • The names of their physicians and if they have permission to speak with you?
  • Their medical history and current medical status?
  • What medications they’re on, who prescribed them and for what?
  • What medical insurance (supplement of Advantage plan) and Drug plan they have?
  • If they have completed appropriate HIPAA forms, POA, and Medical Directives, and if so do you know where they are and if they're up-to-date?
  • Where they have bank and other financial accounts?
  • Who their Accountant, Lawyer, and Financial advisors are?
  • If they have a long term care policy, or if there are any other benefits they may be entitled to?

 

Being prepared doesn't take away all the stresses of caring for aging parents, but it certainly makes it easier and allows you to focus on more important issues.  Being ready and prepared also helps you to manage the inevitable bumps better without jumping from crisis to crisis.

  • March 02, 2019
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Medication Management: Creating a Consistent Medication Process

Taking prescribed medicine seems like a no-brainer. The instructions are right on the packaging and you create a habit of taking it at the same time every day- perhaps with a meal. That certainly is manageable for someone who takes one pill daily and needs no reminders. But add multiple prescriptions medications, taken at different times of the day and add cognitive impairment to the mix, and you can understand how this can be a very complicated problem to resolve for older adults. 

In my current Ask Nancy column ,Laura S of Miami, FL expressed her frustration at trying to manage her mother’s multiple medicines saying it was turning into a full time job. My first piece of advice involved working with her mother’s physician to see if her long list of medications could be simplified. Dr. Marie Savard offered some wise guidance on how to do this and I encourage you to read what she has to say.  The second recommendation involves creating a sustainable daily routine and that’s what I want to delve into here.

Laura’s mother has 24/7 care, implying that her caregivers work in shifts. Whether it’s professional aids or family caregivers rotating shifts, do whatever you can to encourage consistent, quality communications. Maintaining a medication log can serve as a reminder to helpers so that medications are taken on schedule.

I'm also a fan of large white board, where notes can be kept for all to see.  They can be purchased at an office supply store, or on Amazon ( I've also seen special paint called Escreo White Whiteboard Paint that converts the wall into a space where you can easily write and erase right on the wall). Using simple descriptions on the board to positively portray what each medicine is for will often help the caregiver and your mother as well. For example, instead of saying “water pill” say “pill to prevent heart failure or hospitalizations.” Link the medications to what your mother or parent cares about and wants most.

Medications should be organized so that the caregivers can dispense them accurately. In Florida, and most states, paid caregivers from agencies are not permitted to physically give medications. They are licensed solely to provide reminders and place a prepackaged pill in front of the patient.

Thus, in order for the caregivers to dispense the medication they must be stored in a way that they can assist your mother in taking them without physically touching them. (Some agencies can send a nurse to complete this task as well as be responsible for refilling the prescriptions).

There’s always the multi-compartment pill storage box, which come in all sizes and can be filled weekly and placed in a protected area. It’s an inexpensive and simple solution. But there’s a downside if the patient is cognitively impaired. If the pill box is left on a table, patients often play with the medications and re-sort them based on color, size, or shape. Some patients will discard all of them fearing they are causing troubling side effects. 

What’s worth trying is a service such as Pill Pack, an online pharmacy that organizes and pre-packages medications by the time and day that they should be taken. Pill Pack accepts most insurances . Many independent local pharmacies and some CVS, Rite Aid, Target, and  Walgreens offer similar services for complicated drug schedules. Check your local pharmacy to see if they offer this type of service. 

Medication management Apps is another solution to research and there are many to choose from. Some such as Carezone, are better for patients who are cognitively impaired, and others such as Medisafe are better for independent people, who want to create their own medication reminders. They work well once you input all the appropriate information. I like this additional level of reminder because caregivers are busy all day long, and relying on their memory for this can result in an important medicine getting missed. To learn more about the pros and cons of each, I suggest you start with this review by Tech Enhanced Life

Finally, consider an in-home medication dispenser that works in conjunction with a phone APP. You enter the name of the medication and the schedule in an APP and the dispenser provides a cartridge for you to fill with pills, which are then inserted into the appliance.  Medications are dispensed into a cup for easy use for the caregivers. Most in-home dispensers can store up to 10 medications for one month and some companies can refill prescriptions as an additional service. Examples of these are Hero Health and Pillo Health .

Medicine dispensers can be pricey -- I’ve seen them cost as much as $500 in addition to monthly fees. But if you’re a family caregiver with a full-time job and a busy family life, they offer advantages that you may consider worth the expense.

For more information on medication management I encourage you to visit Dr. Marie Savard's website, Ask Dr Marie: Treat What Matters, where you can learn more about medication management, and follow her blog.

  • November 25, 2019
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Retirement Planning Should Include the Possibility of Diminished Capacity

Financial fraud among older individuals is responsible for nearly three billions dollars in personal loss each year.  A recent article in the New York Times  confirms that longer lives and increased years of retirements will result in even more financial fraud. 

Financial institutions seem to be stepping up to the plate and stressing the importance of having safety nets in place including obtaining a name of formal trusted contact (rule passed in 2018 that requires financial advisers and brokers to "attempt" to obtain a name of a trusted contact from their client), and providing information on critical tools such as Power of Attorney (POA). They are becoming more proactive and providing more written guidance and protections for their senior and perhaps more vulnerable clients.

This is a good article but really addresses only the tip of the iceberg. While it states the key point that we need to prepare for an decline in cognitive ability that naturally comes with age, it does not address the issue of financial fraud for the majority of individuals. Not only do many not have any trusted financial advisors, but the majority of people don't give finanical fraud much thought. They believe it just can't happen to them. 

Planning for retirement is a complex process that take time and many aspects must be considered.  Making sure you can outlive savings and make any necessary changes in spending and lifestyle habits are key considerations. Some even include long-term care needs. But most plans don't include "diminished capacity."  Diminished capacity or mild cognitve impairment is defined by cognitive changes that are serious enough to be noticed by the individuals experiencing them and sometimes by those who surround them but they're not severe enought to interfer with daily life or independent function.  Twenty percent of those 70+ fall into this category and are the prime targets for financial fraud. In other words, this effects nearly 9 million individuals. Not all seniors will develop cognitive impairment but research demonstrates that investment skills decline sharply after age 70, and that makes one a prime target for financial fraud. 

What can we do to prevent this from happening to our parents and to yourself down the road?  It starts with communications.  Ideally the conversations are initiated by parents, but most often this is not the case. Financial conversations are never easy. Often parents are reluctant to disclose such information to their children. In addition, family dynamics make it very different from family to family. However, I recommend parents initiate the conversation either at retirement time, or when retirement is imminent.  It's a good time disclose the key stakeholders with adult children, and to facilitate introductions.  These key stakeholder include not only financial professionals but legal, insurance, accounting and medical. The key is that it's done before any capability is lost. Having critical information about parents' finances will enable you to put personal safeguards in place if necessary and protect them from fraud.

Having the conversation with a parent who is mild cognitively impaired can be even more challenging. Tell them about your concerns. Don't tell them what you think they should do, but rather arm them with facts about fraud and the importance of keeping them safe. Suggest to them that they let a family member lend a hand and suggest that someone come with them to their next appointment with their accountant, attorney or financial advisor. If they are resistant provide them with a list of trusted resources, perhaps someone to help them with their bill paying, or tax preparation. Keeping parents in the drivers seat for as long as possible is crucial as long as they remain safe. We can protect our loved ones from financial fraud.

Here are some key Elder Fraud facts:

  • Women 2x more likely victims than men.
  • The most common ages: 80 - 89.
  • 38% of financial abuse is by strangers.
  • ~50% is by family, friends, neighbors & caregivers, though financial losses are greater from investment scams.
  • 12% is by bankers, attorneys, & nursing home administrators.
  • The vast majority of cases go unreported.

For more information on Elder financial exploitation and what is being done to prevent it, here's a link to a 2018 report from U.S. SECURITIES AND EXCHANGE COMMISSION, Office of the Investor Advocate.

 

  • December 16, 2019
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The Informed Patient: A Complete Guide to a Hospital Stay

I recently learned of a great book, one that could easily become a go- to reference for many patients and caregivers. Karen Friedman MD and Sara Merwin MPH have teamed up to write The Informed Patient: A Complete Guide to A Hospital Stay. Having been a caregiver myself I can tell you first hand that hospital stays can be emotionally and physically draining for the patient as well as family members. 

The book guides you through the inner workings of the hospital, explaining all the "routine" things that one experiences during a hospital stay - including the unexpected ER visit. The authors cover the admission process, testing, procedures and protocols, and discharge planning.  This knowledge will empower you to be a better health advocate for your loved one.  

Being informed and prepared for unexpected health events results in better decision-making and improved outcomes. So take the time now to gather the information you and your family members will need to make quick decisions should a hospitalization occur, whether planned or not. And don’t forget, information such as a detailed list of medications, recent test results, copies of insurance and legal documents should be readily available and brought to the hospital with the patient.

 

 

** For those of you who get information from Social Media, I recommend following @SaraMerwin1 on Twitter where she comments on issues related to Geriatric Care.

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Recent Posts

The Informed Patient: A Complete Guide to a Hospital Stay

I recently learned of a great book, one that could easily become a go- to reference for many patients and... Read more


Retirement Planning Should Include the Possibility of Diminished Capacity

Financial fraud among older individuals is responsible for nearly three billions dollars in personal loss... Read more