-Kay Paggi, LPC, NCGC, CMC

“My mother doesn’t even like me, she never has.”

This statement is not uncommon at a support group for the adult children of elderly. It seems out of place, coming from someone who cares enough about the parent to be attending a caregiver group. Yet it is repeated, over and over again, at different meetings and in many different ways.

“My father moved to another city after my parents divorced. I did not see him from the time I was nine until he got off the airplane to come live with me.”

“My mother was sightseeing in Europe when I graduated from high school; she didn’t care enough about me to even attend my graduation ceremony.”

Why are these people spending their precious time and resources caring for their aging parents when they were not nurtured by these parents?

Partly it has to do with hope. People universally seek parental approval and acceptance. A hallmark of entry into adulthood is the parent’s recognition of their child as an adult and acceptance of the child as a peer. Children who have not had parental approval often will continue to seek it, even after they have children themselves. The sad reality is that, if the parent has not loved and approved this adult child during the past years, he or she is unlikely to have a change of heart now, no matter how much caregiving is provided.

Partly it has to do with love. Just because the parent was indifferent to the child does not mean that the child does not love the parent. Most children do love their parents, even when that love is not returned or demonstrated. When the parents age and become frail, the unloved child often shows his love by providing assistance for the parent, because the child loves the parent.

Partly it has to do with self-respect. Most people believe they have the responsibility to provide care for their parents as they age. If they fail to fulfill this, they lose respect for themselves.

Responsibility

Where does this belief, that adult children have the responsibility to provide assistance for frail parents, come from?

Some find it mandated in the Bible, as one of the Ten Commandments. “Honor your father and your mother, that your days may be prolonged in the land which the Lord your God gives you.”  ‘Honor’ is defined as ‘to treat with respect’. Besides being the foundation for Jewish law, these commandments provide excellent common sense guidelines for living a satisfying life. The commandments were given at a time when people continued working until they died. Retirement was unknown. When the father of the family grew too frail to work, he still retained ownership and control of the family wealth and property until his death, including the right to cede it to whomever he pleased. It absolutely makes sense to treat the person who controls your future with respect!

There is no mention made of any responsibility to provide support or financial assistance for frail adults who have ended their working lives. Such a concept was unthinkable.

In 1900 the average lifespan was 49 years in America. In Biblical times, it was much shorter. Certainly there were those individuals who lived to a very advanced age but they were the exceptions, not the average. During most of the history of the world, death has not been associated with age. Childbirth, famine, disease, and war caused death. Most people were not fortunate enough to survive to become old enough to die of old age.

In more recent times, people who had the misfortune to live long enough to be unable to work went to the poor house if their children were unable to provide food and shelter for them. Conditions in these establishments were so deplorable that families made as many sacrifices as necessary to keep their parents from the necessity of going to one. There is an excellent discussion of the history of long term care in America at http://www.elderweb.com/history by Karen Brown. There was no law requiring adult children to provide care for their frail parents.

There is no such law today. Parents are required by law to provide for their offspring. Children are not required to provide care for their parents. No one will take adults who refuse to support their parents to court.

The decision to provide care for frail parents is a choice; care for offspring is not.

The Power of Choice

There have been several studies done on improving the quality of life in long term care facilities. Once such study gave residents on the first floor eggs, pancakes bacon and fruit for breakfast every morning. They had movies every Tuesday and Thursday. During the study the residents on the second floor could choose whether to have eggs or pancakes, and they could choose whether to go to the movies on either Tuesday or Thursday. At the end of the study it was found that the residents on the second floor had less depressed mood and were generally in better health than the participants on the first floor. Why? The second floor residents exercised the power of choice; the residents on the first floor had no choice.

If adult children believe that they must provide care for their parents or else, the care they provide is far more likely to be perfunctory than if they make a conscious choice to provide care. Gifts that are freely given are more generous than mandatory ones. Angry, exhausted caregivers often say that, given a choice, they would never see their mother again. Yet, when asked to visit only when they want to visit and not at any other time, these same caregivers actually visited more often than previously.

Given a choice, most parents would rather have a cheerful adult child drop by for an unexpected visit than a scheduled visit from a harried adult child. Coerced caregiving is impossible to hide. Even dementia patients can be aware of the impatience of their children, or their reluctance to visit.

Choice impacts the quality of care. Adults who choose to visit a frail parent instead of attending their child’s school function will be much less resentful than those caregivers that believe they must visit. These caregivers feel forced by their aging parent to miss their child’s school function; they are angry and the quality of the care they provide suffers.

Authority

Parenting children is an awesome responsibility. Requirements for not only food and shelter, but also medical care, religious training, and education begin at birth. Parents of teenagers are increasingly held accountable for the behavior of their offspring.  Parents are responsible for providing an ethical foundation, culturally appropriate behaviors, manners, and driver training. It is considered an act of responsible parenting to take away driving privileges or the keys to a car as consequences for reckless driving.

That same action is illegal if the keys taken belong to frail parents. According to the law of the land, even if a minor child pays for their own car and owns it outright, their parent has the right to suspend access to it. To take the keys to a car owned by a parent is considered an act of theft, punishable by law. To take the car or hide the car is illegal; to damage the car so that it cannot be driven is illegal, if it is legally owned by another adult, even if that adult is driving recklessly.

The difference is authority. You have not only the responsibility to parent children but also the legal authority to do so. No one has the legal authority to set limits on the behavior of parents, except the state. If an adult has been tried and found incompetent to limit his or her own behaviors, then the state is empowered to name a guardian for that person. The guardian is then responsible for limiting their ward’s actions, and has the legal authority.

This is very different from a Power of Attorney (POA). A POA names an agent to perform certain tasks. These tasks can still be done by the granting party, and the grantor retains the right to remove the POA at any time. A POA does not grant authority to manage money, allow medical care, or limit behavior unless it is specifically mentioned in the document.

A POA for grounding misbehaving teenagers is not necessary, nor is it necessary to have a POA for medical care to take children to physicians or authorize medical treatments.

There is a world of difference between assuming responsibility for care and having the authority to provide care.

As long as an aging, frail adult has not been found incompetent to manage their own affairs by a court, they retain the authority to make their own decisions about whether or not they will drive, how they will spend their money, and what medical treatments they will receive.

This is the appropriate place for recalling the Commandment: treat your parents with respect. To respect means to honor the wishes. There are times when as a concerned and living caregiver, it is necessary to honor your parent’s decisions, even when they seem to you to be wrong.

Limits of Responsibility

So, does this mean that at some point in life, an older adult gets carte blanche? Can an older person demand and expect to receive any attention or financial support from an adult child? Or are there limits?

At some point in life, children become adults. The authority for providing support, money, and guidance passes from the parents to the child, as well as the responsibility. The new adult becomes responsible for acting like an adult and gains the right to be treated as an adult and a contributing member of society.

When parents make a decision that is unwise or even harmful, the respect owed by the children does not require them to support it. Loving adult children can respectfully decline by stating their continuing love and respect for the parent while refusing to assist with implementing an unwise decision. A guideline is to treat parents in the same manner that good friends are treated.

For example, a good friend decides to quit working and move to a commune. You, as his friend, may advise him on the inadvisability of this decision. If he persists, then the bonds of friendship do not require you to assist him in making the move. You can remain his friend but still refuse to help him do something that, in your opinion, is harmful. This leaves the door open. Later, when your friend decides that the decision to quit work and move was a poor one, you are still his friend. He will remember that you supported him but not the decision, and will know that you are available for help with implementing a better choice.

A common problem that parents and their adult children experience is the difficulty remembering that the children have changed from dependent children into independent adults. This transition affects the nature of the parent-child relationship. Adult children who are having difficulty with their aging parents often find that they are relating to their parents in the same ways they did when they were children, and then they wonder why they feel resentful. It is the young adults’ job to remind the parents that they are now dealing with a peer. They must remind themselves that it is permissible to say “no” to mama, and to set limits on parental demands. It can be difficult to act like an adult around parents. It is very difficult to make your own independent decisions when you are still need parental approval.

This dilemma causes much grief for adult caregivers because they cannot have it both ways. Honoring parents is an adult to adult process. Adult to child (of whatever age) puts the balance out of kilter.

Summary

You cannot parent your parents. Caregiving adult children cannot take the keys  when their frail parents do not drive responsibly. Caregivers must use tact, diplomacy, deception, peer pressure and other tactics to achieve their goals. At the same time, they must treat their parents with the respect due them, even when their behavior is childish or unreasonable.

Treat aging and frail parents with respect. Is it respectful to help frail elders move into a new house that they cannot possibly manage the upkeep on? Is it respectful to drive them on numerous errands during work hours, or it is more respectful to ask that they use the van available at their facility? Is it respectful to do for them what they are capable of doing for themselves?  Do you honor your mother when you allow her to refuse care from anyone by you? Is your mother honored when you are too tired from caregiving to nourish your own children?

Long lives bring bonus time. They also bring new questions and the need for new moral and ethical guidelines. That’s your job. Your parents’ generation is the first in history to live into late life. Your generation is the first generation to provide care for parents, on average the same number of years that you provide care for your children: 18 years. The precedence you set now, as you provide care for your parents, will establish the guidelines for future generations. Be careful what you establish.

Kay Paggi is a Licensed Professional Counselor in TX who specializes in aging and caregiving. She is a National Certified Gerontological Counselor, and a Care Manager, Certified. She works as a professional geriatric care manager.

Two days later I wrote, “This is horrible. B really wants to leave Lourdes’s house and go home, and I have no business taking her. How am I going to get through this? I can see how hard it is for Lourdes to care for her, and she’s only into her third week. It’s been six years for me. I have to rise above these thoughts. Otherwise, I will either be dead or take on the traits of the disease. Neither is acceptable.”

My emotions were all over the place.  My mother had just been diagnosed with Alzheimer’s, and I was still reeling from the shock and the clarity that diagnosis brought. I loved my mother and I wanted to help her.

My journal was a lifesaver before and after the diagnosis. It let me vent, analyze, and find hope. It never argued or interrupted. It listened unconditionally, which gave me the space to process events and my reactions to them.

Why should caregivers journal? Writing gives perspective and restores sanity. Writing is a lifeline as well as a record. Writing saves lives. Do not underestimate its power.

What do you do if you have nothing to say?

Look around the room for an image or a sensory detail—the way the sun makes a path on the carpet, the way steam rises off a cup of coffee, carrying the aroma of morning with it. Listen to the high pitched whirring of an omnipresent machine, the tick of the kitchen’s black-and-white, kitty-cat clock—any image at all.

What do you do if you can’t get started? Sentence starts like those listed here can help.

Today I feel…

No one knows I worry about…

I don’t like to brag but…

I lust after…

Next time…

What if…

Pick a sentence start and finish it. Write another sentence. Voila! You are journaling.

Where can you find sentence starts?

There are over 200 in You Want Me to Do What? Journaling for Caregivers. I wrote the book once I realized how lucky I was to have a journal that helped me process my “stuff.”

You might be thinking that only writers can journal. Wrong! A writer is someone who writes. That can be you.

After she got her copy, Joanne Padley, writer and staff member at the State University of NY at Buffalo said, “What a good idea the book is.  I’m sure it will help me sort things out as well as serving as a good reference book and one day, a good remembrance.”

She’s right. According to Marilyn, who wrote in one of my workshops, “Writing from the heart seems to be all that is needed.”

Want to start right now? Finish the sentence, “Today I feel…” and keep going. Go wherever the writing takes you. Get your story, your nuances, your frustrations, your hopes, and your love on the page. Your story is buried treasure.

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B. Lynn Goodwin is the owner of Writer Advice, www.writeradvice.com and the author of You Want Me to Do What? Journaling for Caregivers. Order it from Amazon or at http://www.writeradvice.com/ywmtdw.html. You’ll also find more information about journaling, workshops, and the author there.

Elderly people often suffer from what is often termed as “pre-existing medical conditions”. The one I encounter most frequently is arthritis. The cases I see involve significant worsening of an arthritic condition resulting in disability, reduced quality of life and the need for surgery. Are you entitled to recover for damages in a personal injury accident when a pre-existing medical condition is exacerbated or worsened?  Absolutely!

The Egg Shell Theory

Under Massachusetts law, if the conduct of a negligent party contributes to cause an ultimate outcome, then that party is responsible for the aggravation of that injury.  Some Massachusetts lawyers refer to this concept as the “one percent rule of causation”.  In other words, if the negligent act of a party plays some role in an injury, even if that role is slight (1%), that party is legally responsible for all damages which flow from the aggravation of the injury.  This standard would clearly be important to persons who live with a pre-existing medical condition, which is worsened as the result of the negligent conduct of another person.

This is also known as the Egg Shell Theory. This theory says that a negligent person takes his victim as he finds him, egg shell and all. The Massachusetts law of personal injury requires persons who are negligent to be liable for reasonably foreseeable injuries they cause. Court decisions have concluded causing an injury to a person with a pre-existing medical condition is reasonably foreseeable. Put another way, a negligent person, must take the injured person as he finds him. The egg shell theory holds a negligent person liable for all consequences resulting from his or her conduct resulting in an injury to another person, even if the victim suffers an unusually high level of damage. Let’s say someone is caused to fall his knees by the negligence of another person. Let’s also say that such a fall usually does not result in significant injury. However in this case the person who falls to his knees suffers from a pre-existing arthritic condition of his right knee. As a result of the trauma to his knees he can no longer use the right knee as he had previously and now needs knee replacement surgery to regain pain free use of his knee. This person is considered and “egg shell.”

Various Kinds of Pre-Existing Conditions

I handle many personal injury cases where a person suffers an injury due to the negligence of another. The diagnosed injury is to a body part that was already injured prior to the accident. Where the prior injury was exacerbated or developed pain symptoms after the accident, the injury can be compensated.

Many people who have pre-existing conditions learn to live with the discomfort associated with their conditions.  Others are pain or symptom free (this is especially true of backs) Others may live with a significant pain accompanied by loss of mobility or function. However, if a trauma worsens this condition to the point where, for example, a knee or hip replacement surgery is now necessary, then the injury is compensable. Although the law states that a negligent person is responsible for the cost of the surgery, rehabilitation, physical therapy, occupational therapy and continued medical care as well as  “pain and suffering damages” insurance companies are often reluctant to settle these cases. In fact insurance companies will try to avoid or minimize  responsibility to pay compensation for pre-existing conditions. They will claim that the injured person did not sustain injury in the accident, at all.

Therefore, ligation is often the only method by which to obtain reasonable compensation.

The bottom line is that any person who is injured due to the negligence of another, and who has a worsening of pre-existing medical condition, is entitled to recover compensatory damages directly related to the accident.

The legal treatment of preexisting conditions may differ depending on the State where you live.  Accordingly I have developed relationships with personal injury lawyers in other states to assist me with claims  that require the application of another State’s law.

It takes a good, aggressive personal injury lawyer, armed with knowledge and experience to get you what you deserve.

My experience in senior care has started as the personal one. That is not an atypical situation.  I can’t say that my mother’s Alzheimer changed the field of my occupation. Yet my personal story certainly affects my professional life. The approach to senior care care was quite different in those days. There were fewer options.  Geriatric care managers didn’t appear quiet yet. There was no wide range of home care agencies. Essentially, there was virtually no one you could turn to for advice.  Alzheimer disease itself wasn’t as well known as it is today. Consequently, when I realized that  my mom could no longer live alone , a  nursing home  began to sound  as a suitable outcome. I’ll never forget my desperate search for a decent one I could afford.  Did  I have  doubts regarding the move ? Certainly. That’s  precisely what I had referred to at the beginning of this article . The judgment was poor, the courage was lacking. “It would be so good to have nice person in the house with Mom…”  That thought kept reappearing in my mind. But  there was no support and I backed off.

Don’ get me wrong, I’m not trying to say that the care was poor . What I wanted, was for it to be personal. In fact what had become clear was that the the only crucial things that nursing   homes didn’t seem to provide were: A personal touch and continuity. It wasn’t deliberate. It  just wasn’t in “their love map”.  Nursing home  were clearly geared as homes for the masses.What I wanted  was a true  home for an individual. “There is no place like home”., concept firmly planted its roots in my head. The concept seemed to be especially true when any part of the body or mind declines.

Ladies and gentlemen, fellow caregivers, presence of spirit and patience might come in handy. Finding the right  caregiver   is no easy job.  Yet,  to me  this was the  only path to take. Succeeding in  home care, making it personal  led to amazing rewards : Optimal care for your parent and,  and crucial  peace of mind for yourself.

It’s no secret  that I’m passionate supporter of home care. At times the passion carries me away. Consequently, I  have neglected to mention the difference in cost. That difference is tremendous. However, even if you are so well off that you can spread money like confetti, choose the home care road.  The care of your loved ones are  will be hand crafted to satisfy their needs as well as your wishes.  In return, you will receive the reward of satisfaction and true  joy.

Good luck!

Consequently, here’s the question: Have you had The Big Talk, the one about “getting old,” or “future plans?” Probably not: A recent study by the American Association of Retired Persons (AARP) found that two-thirds of us Boomers haven’t. The AARP claims that it’s because we don’t know what information our parents need or where to go to find it. Just as likely, though, we’ve put off having The Big Talk because it’s too uncomfortable.
Getting started. Many of our parents have recent and unpleasant memories of the difficulties that friends or relatives have had in this situation. Maybe it was the elderly cousin whose health precipitously deteriorated and required the nieces and nephews to scramble to get him into eldercare. Perhaps it was the neighbor who broke her hip and her son in Australia had to take a month away from work to solve the problem without any guidance.
Considering the situation as a necessary conversation for your own piece of mind is essential. The family—not just the parent, but also you, your spouse, your siblings and the extended family—shares this challenge. This approach broadens the focus of the discussion and preserves Mom’s or Dad’s dignity.
Newspaper or magazine articles can be used to start the conversation. We are usually able to find a related letter in a “Dear Abby” or other advice column in our local paper. You might begin like this: “Gee, Dad, I don’t know anything about what you’d want me to do if you’re unable to live at home. I’d feel a lot better if you would tell me, so I won’t have to guess.”

Now that you’ve got the conversation underway, what are the questions you’ll want to ask to prepare for the housing transition? Let’s start by examining the elder’s current living situation.

• “Mom, do you want to live here as long as you can? Are there some improvements to your house we should make so this will be possible?”
• “I’ve noticed that you are a little tired lately, Dad. Would you like to have someone help you with some things around the house?”
• “Is senior living of something you might consider in the future? What arrangements would you like us to make?”
• “I know you love your home, but even with the kids mowing the lawn and taking you shopping, are the other chores more work than you want to tackle these days? What would you think about moving into a more manageable place—a condo or a smaller apartment–at some point?”
• “When you feel living at home is no longer a good option for you, would you want to live with me, or someone else in the family? Would some form of senior housing be an acceptable option for you? What do you know about senior housing–say, assisted living–and those kinds of options? Maybe we could make a list of the things that are most important to you and see if we could find a good match. Does that sound like a good idea?”
• “Could somebody in the family begin to find out about senior housing facilities that might be a possibility for you in the future? How would you like to go about it? Have any of your friends moved into senior housing that they really liked?” Or, “When you have visited friends in their senior communities, have any of those facilities appealed to you?”

Turning to questions about health:

• “Dad, do you find you still have the energy to do the shopping, prepare meals, do laundry and personal care, and still continue to keep up the house and yard?”
• “Do you feel comfortable driving or taking public transportation to do the things you need to do?”
• “Are you finding it difficult to get up and down the stairs, get to the bathroom, and pick up the mail and your newspaper?”
• “Are you having any trouble doing the exercises your doctor has recommended? Are you remembering to take your medications?”
• “Would you be willing to let us talk with your doctors about your health? Could we go with you to your next doctor’s appointment to find out more about your medications and any problems you’re having?”
• “Have you made any decisions about the kind of medical care you may want in the future? Would you want someone else to make these decisions for you if you are unable to do so for yourself?
• “What are your thoughts about assistive devices—ventilators, feeding tubes, for example—to keep you alive?
• “Do you have records of the decisions you’ve made? Where do you keep them?”

Next Steps.

Hopefully, The Big Talk has gone reasonably well. Mom and/or Dad has been willing to talk, perhaps hesitantly, and you’ve made some progress in finding out about their current and long-term housing needs and preferences, as well as some health and related issues that will factor into these decisions.

Families Urged to Keep Alert for Signs Seniors Need Help

Watching your once active parents or other relative decline into someone who needs constant care is heartbreaking and overwhelming. But with 36 million seniors living in the U.S. and the elderly population projected to double, caring for a senior loved one is a reality most people will face.  That’s why Senior Helpers, a leading provider of in home senior care, advises family members to learn the signs your senior relative needs assistance.

It’s much better to arrange for help for an elderly family member while they can still be part of the process rather than during a crisis because it gives everyone time to make thoughtful decisions,” says Peter Ross, CEO and founder of Senior Helpers.  “Seniors often believe getting help means being moved out of their house and that’s where the resistance to any kind of help comes in.  But many times in home care is a better option.”

Senior Helpers’ elderly care experts remind people to respect a senior family member’s pride and dignity when discussing the need for assistance.  Approach the topic with respect and understanding and express concern for the family member’s safety.  The warning signs could be an indication of many issues so if there is a concern it is important to contact a doctor.

10 Warning Signs a Senior Relative Need Assistance

• The house is cold, the telephone is cut off.
• Losing track in a conversation, forgetting the names of children, grandchildren, the day of the week, etc.
• The death of a spouse.
• The refrigerator and cupboards are half empty even though you know the relative can still get out.
• Personal hygiene is poor.
• Constantly making excuses when asked to go somewhere or do something, or wanting to be alone.
• Sudden weight loss.
• Never cleaning or delaying home repairs.
• Failure to take prescribed medications.
• Behavior changes.

“The best way to keep track of a senior family members situation is to keep in touch with them and this is one time where being nosy is justified,” says Ross. “Visit or call often and use one of the warning signs as a way to approach the topic if needed.”

One way to pay for your care is a long-term care (LTC) insurance policy, which only pays for long-term care.  While the need for this type of care may be a long way off, you are usually encouraged to buy LTC insurance well before you’ll need to use it, because by doing so, premiums are generally less expensive and you are less likely to be turned down due to health conditions that may develop as you age.

Types of Policies

Several types of policies are available. The most common are “indemnity” or “expense incurred” policies. An indemnity or “per diem” policy pays up to a fixed benefit amount regardless of what you spend.  Under an expense-incurred policy, you select your benefit amount when you purchase the policy and are reimbursed for actual expenses for services received up to a fixed dollar amount per day, week, or month.

Some companies also offer “integrated” or “pooled benefits” policies.  This type of policy provides a total dollar amount that may be used for different types of long-term care services such as home health care or nursing home care. There is usually a daily, weekly, or monthly dollar limit for your covered long-term care expenses.

How Premiums are Determined

Your age at the time you purchase is a major factor in determining premiums—the younger you are when you first buy a policy, the lower your premium will be.  Before you can even purchase a policy, however, insurers will perform a health screening or “medical underwriting.”  People who already need long-term care are not insurable.  You will be required to sign a medical records release, and answer health questions on the policy application.  It is very important to disclose your information completely and accurately.  If you don’t, the insurance company may have a right to deny coverage when you file a claim.

Other factors that can determine the amount of your initial premium:

1. The type of policy you select.
2. The dollar amount of the daily benefit to be paid.  You may save money by selecting a lower daily benefit amount and paying the difference yourself.
3. Your benefit period.  Policies usually have a maximum number of years or maximum dollar amount they will pay.  The longer the benefit period, the more expensive your policy will be.
4. The number of days you wait before the insurer begins paying benefits after you qualify for them.  Known as the “elimination” or deductible period, you select the number of days you will pay for your own care before your policy begins paying benefits.  Common choices are 0, 30, 60 or 90-day elimination periods.  Keep in mind that care costs rise each year with inflation.  Be sure you can afford care for the duration of your deductible period now and in the future.
5. Inflation protection.  Inflation protection will either automatically increase the amount of your daily benefit, or allow you to periodically increase your benefit levels (for a higher premium) without providing evidence of insurability.
6. Nonforfeiture benefits.  This option allows you to retain some benefits if you decide to drop the policy at some point in the future.  The most common types of nonforfeiture benefits are either a “return of premium” benefit, which provides a cash benefit that is usually a percentage of premiums paid, or a “shortened benefit period” in which case coverage continues but the benefit period or amount is reduced.  These types of benefits can add anywhere from 20 to 100 percent to the premium cost.

Other Considerations

In addition to cost and benefit considerations, you should also carefully evaluate the company providing the policy.  Financial solvency ratings are available from several sources.  Try to choose a company that is likely to be around 15 or 20 years from now, when you’re likely to need your benefits.  Consider what your own financial situation may be that many years from now.  Although insurers must get permission from the state insurance commissioner to raise premiums for entire classes of policyholders, rates can and do increase, sometimes sharply.  Ask the insurance agent to provide you with the company’s rate increase history.

Above all, don’t be afraid to ask your insurance agent to thoroughly explain anything that isn’t clear.  You should also plan to review at least two or more policies to make a side-by-side comparison of your costs and options.  Lastly, be aware that even after you have purchased a policy, you generally have 30 days to return it and get a full refund of any premiums paid if you find it doesn’t meet your needs.

H1N1 Influenza Virus

H1N1 influenza A virus, H1N1 Novel Virus, New H1N1 or Swine Flu is in every publication from newspapers, to magazines, to tiny 3-page newsletters. The theme is always the same; panic, but don’t really panic, count the number of fatalities and anticipate the worst. The media’s reactive headlines and body of words are the same, fear, fear, fear, a followed by a couple of suggestions as to what to do, then more fear, wear masks and hoard prescriptions of certain drugs just in case.

In France, the government is suggesting the long tradition of “la bise” (greetings of a kiss) may no longer be acceptable if we are to curb the potential increase of the H1N1 Virus. I’m getting the feeling of an International reactive state to something that we have the ability to control and manage.

There is a different approach to the issue and everything else that becomes pandemically oozing as headline news. Become a proactive warrior to all that ails.

What does it mean to be proactive? Taking preventative steps to your health, such as protecting yourself from H1N1 and other illness, before a pandemic.

H1N1  is not that much different than any other flu. Some people die from the flu. According to wrongdiagnosis.com:

“Deaths from Flu: An estimated 100,000 hospitalizations and about 20,000 deaths occur each year from the flu or its complications. (Source: excerpt from Focus On  The Flu: NIAID) … average of 20,000 to 40,000 deaths per year. (Source: excerpt from Microbes in Sickness and in Health – Publications, National Institute of Allergy and Infectious Diseases: NIAID) … in the United States more than 100,000 people are hospitalized and more than 20,000 people die from the flu and its complications every year. (Source: excerpt from The Flu, NIAID Fact Sheet: NIAID).  In an average year, flu leads to about 20,000 deaths nationwide and many more hospitalizations. (Source: excerpt from What to Do About the Flu – Age Page – Health Information: NIA)”

According to The Center For Disease Control, U.S. Human Cases of H1N1 Flu Infection (As of May 10, 2009, 11:00 AM ET) States* Laboratory confirmed cases Deaths TOTAL 44, 2532 cases 3 deaths including the District of Columbia. International Human Cases of Swine Flu Infection,(see World Health Organization). During the week of August 30-September 5, 2009, a review of the key indicators found that influenza activity increased in the United States compared to prior weeks. This is expected as children return to school and naturally with the stress of a new regime and inadequate nutritious meals to boost the immune system, there will be a tendency for illness.

I recently conducted a webinar lecture on preventive measures to H1N1 by boosting the immune system. I had a few interested, which was great, but was surprised by the number of people who were not interested. It further engaged my thoughts and hypothesis of reactive as opposed to proactive. Most would rather sit around in actual hysteria, wear masks, bathe in Purell and live in fear waiting for the first symptom to strike us down rather than take a proactive approach of prevention. The actual proactive approach would be cost effective and would actually put you in a preventive state so that you would not have to buy into the mass hysteria of spending hundreds of dollars on just-in-case medications and over the counter relief aids.

How do we become proactive? Don’t live in fear waiting for the first symptom to appear. You have the cost effective tools to take a proactive approach. Sleep, good nutrition, stress management, avoiding excesses, hand washing and looking for natural alternatives to boost your immune system to provide extra support during the naturally occurring flu and cold season,

Not convinced? Getting 6-8 hours of sleep each night helps to assimilate nutrients that boosts your immune system. It is during our deepest sleep that immune cells are regenerated and natural killer cells are activated. Natural Killer cells are specialized to kill target cells that are infected with viruses, such as the H1N1.

The average American processed and refined diet is high in fats, refined sugars and sodium and devoid of immune system building nutrients. These foods produce free radicals that create toxicity and weaken the immune system. Choosing whole fruits and vegetables, grains and quality protein provide us with antioxidants and phytonutrients that destroy free radicals which foster a weakened immune system increasing susceptibility to illness. If there is vomiting, diarrhea and fever, dehydration will set in quickly, Water helps to transport nutrients to the cells and transports wastes out of cells and out of the body.

Omit alcohol caffeine and tobacco. Alcohol and caffeine rob your body of key nutrients needed for repair growth and a healthy immune system. If your immunity has been compromised it makes it tougher to combat viruses and other illness. Cigarette smoke damages the lining of the respiratory tract. There are minute hair-like organelles called cilia that beat in rhythmic waves that constantly sweep out germs inhaled. Any damage to these delicate hair-like substances results in the inability to combat viruses, germs and bacteria at the point of entry.

Did you know that many illnesses and diseases could be nonexistent from

simple hand washing?

The Center for Disease Control prescribes to wash your hands with soap and water for a minimum of 20 seconds. More effective; wet your hands, lather

Wash hands with soap

your hands with soap for 20 seconds, scrub your wrists, fingers, front and back of your hands and wash your rings (rings can contain bacteria in the settings and design). Under warm to hot water, wash your hands again for another 20 seconds; dry your hands with paper towel. If you are in a public restroom, take two pieces of paper towel; use one to turn on the tap, and the other to dry your hands, turn off the tap and to open the door.

Some Physicians (not all) are of the opinion that nutracueticals, natural herbs or, homeopathic have no effect on illness. As a Nutritional Functional Medicine Consultant I beg to differ and here is why; most medical physicians have no education in nutrition and supplements. However, I commend Dr. Mehmet Oz for his enlightened views of the importance of alternative and natural therapies and the integration into mainstream medicine. With that said, here are some over the counter natural remedies that may provide extra support and have been extensively studied. Vitamin D, is naturally made with 15 minutes of sun exposure and important for immune function. Studies suggest that the sunshine vitamin may significantly lower respiratory infections, colds and flus.

Vitamin C, offers cellular protection by stabilizing cell membranes. It acts as an immunostimulant in that it boosts immunity by actually activating neutrophils that are responsible for cleaning up viruses, bacteria and anything else that is not supposed to be in our blood. During illness, neutrophils are rapidly transported to sites of infection releasing interferon which combat viruses.  Numerous studies have shown people taking vitamin C can actually lessen the transmission of viruses.

Zinc supports mucosal integrity and boosts immune function by supporting white blood cells and natural killer cell protection. Zinc in lozenge form can actually battle viruses in the mouth, throat, palate and nasopharyngeal.

Important friendly intestinal bacteria Lactobaccillus acidophilus, Bifidobacterium bifidum and Streptococcus faecieum are the facets of a healthy immune system. Your immune system is your gut health. Acidophilis acts as a natural antibiotic and has antibacterial activity. With regular use it may replace harmful bacteria in the colon and improve immunity. Bifidobacterium bifidim inhibits the growth of coliform bacteria and possibly pathogenic bacteria. If you are thinking about yogurt-forget it, there is not enough in yogurt to re-inoculate your bowel health and it is high in sugar, which suppresses the immune system.

Garlic’s active ingredient allicin is responsible for its name, the Stinking Rose. Allicin is the essential oil released that studies have shown to protect against flu viruses and enhance antibody production.

Oscillococcinum is a homeopathic remedy that, when taken with the first onset of symptoms, may reduce the severity and length of flu.  Homeopathy works on principles of dilution of similar; taking minute doses of the actual substance causing illness stimulates the body’s ability to heal itself.

Reactivity is to do nothing and to live in fear of contraction. Be proactive; educate yourself for the prevention of flu and illness. There are many options out there to protect you from this year’s pandemic and many years after.  The choice is yours. Which do you prefer? A reactive approach or a proactive approach to your health?

Karen Langston is a Chief Body Reorganizer

Many different floor plans or homes are called “accessible”, when indeed they may not be.  An “accessible” home which has steps to a raised front porch, or which has a kitchen too small and enclosed for a chair or scooter to turn, will not provide the ease of living which is necessary.

If you or a family member has special needs, or you’re thinking ahead to a time when it might not be quite as easy to get around your home, consider each of these features before making a decision on what to include in your home.

Accessible Home Features

Bathrooms

• Roll In Showers
• Built In Shower Benches
• Grab Bars
• Room for Maneuvering (5 Foot Minimum Diameter)
• Knee Space Under Countertops/Reduced Height Countertops

Kitchen

• Room for Maneuvering
• Reduced Height Countertops
• Built-in Range Countertops with Front Controls and Knee Space Below
• Pull-Out Shelving (Slide Out Shelves)
• Accessible Electric Outlets and Switches
• Roll-Under Kitchen Sinks

Accessible Homes

• Ramps and Walkways
• Enlarged Garage
• Egress (exit) Door From Bedroom
• Enlarged Hallways and Doorways
• Non-Slip Flooring
• Low Pile Carpet
• Turning Radius in Laundry Room

No matter which features you’re looking for, a good remodeler or home builder can incorporate just what you need in your plan.  Look for remodelers or home builders who are known for creating appealing, affordable, and accessible spaces, and check references.   A reputable builder or remodeler will also be happy to suggest cost effective methods and floor plans, and provide you with different options to consider.

Life with a parent before the diagnosis will never be the same as after, but may be even better.  As you work through finding ways to spend enjoyable time together, you will learn more and more about that parent, discovering aspects of his or her personality that were previously buried in the parent/child relationship.

Because dementia is a progressive condition and the senior’s abilities will change, it is important to enjoy this time of friendship building and discovery with the senior.

Crossword Puzzles or Word Searches with assistance/cueing- Word finding, word recognition and similar functions may be areas of difficulty in persons with early dementia, so activities that involve words are not just helpful but offer the senior a sense of pride and accomplishment.  An example might be asking the person a 4 letter word for paid employment, then cueing by saying “When you left the house in the morning to go the store, you were going to ______” .  Provide similar clues till the individual “gets” the answer.

Exercise – depending upon the physical limitations and abilities of the senior, exercise can be a brisk walk, a seated exercise sequence such as those seen on television, or even some form of housework, with assistance or guidance.  Exercise will help elevate mood, as sadness often accompanies the diagnosis of dementia.  Walk and talk is one of my favorites, offering an opportunity to tune in to the surroundings, such as noticing the colours of the trees and bushes, the birds, while engaging in exercise.

Music- listening to appropriate music is important, as it helps with long term memory, word recognition and elicits emotional responses.  Music can elevate mood, and can also help with the grieving process (many seniors go through a kind of grieving at some point during early dementia, as this diagnosis most assuredly signifies a loss for the senior that he or she fully recognises).  Helping the senior reminisce about earlier times, feelings, and life experiences can be a wonderful shared experience.

Easy Card Games & Board Games- even seniors who were not game players in earlier years will often agree to engage in games such as Tile Rummy ( great for sequencing, number recognition and eye/hand coordination) Scrabble ( simplified and with verbal/ physical cueing) Whist, Uno, Sorry, Yahtzee, Dominoes, and similar activities.   Any of these games can still be played, with adaptations (remember the crossword puzzle clues?) to provide success and enjoyment for the senior.

Kitchen Activities- if the senior is no longer able to safely bake, the helper can bake a cake or cookies, and make an activity out of decorating.  An assessment by occupational therapist will determine which kitchen tasks the senior can safely engage in and which must be supervised.

The activities mentioned are just a minute sampling of activities suitable for those with early dementia and ways to adapt the activity to the senior.

Individuals with early dementia retain many of their previous abilities and interests and are able to enjoy success with some helpful cueing, direction and guidance.   Some people will respond better to demonstration, as opposed to verbal instruction.  Some will respond better to pictures than words.

The idea is to experiment with the activities the senior already knows and loves and find the best way for that activity to be enjoyed with success.  It is better to make it too simple at first and modify upwards than to make it too difficult.  Those with early dementia should be given failure proof activities. We, the caregivers, just need to help them find the way to success.