“What’s for dinner?” Mom asks for the third time and you think, “Same thing I said five minutes ago.” Dealing with a parent in the early stages of memory loss is trying. But try to remember your parent’s forgetfulness and confusion are symptoms of dementia or Alzheimer’s Disease—he or she can’t help it and would prefer not to be confused. But beyond feeling frustrated, is there anything you can do?

Consider the following four tips for improving communication with someone in the early stages of memory loss:

Improve focus—theirs and yours.

The days of days of casually throwing out a rapid-fire stream of questions and comments to your parent may be over. Instead, try this:

• Use your eyes to make contact, touch your parent’s arm, or address your parent (e.g. “Mom, are you thirsty?”) to get his or her attention.
• Face your parent when you speak and speak slowly, so he or she can focus on your words.
• Limit distractions. Turn the TV and/or radio off and move into a quiet area.
• Wait for your parent’s answer. If necessary, repeat the question using the same exact words. If you change the words, Dad will need to reprocess the thought, which may add to his confusion and anxiety.

Consider your tone – what non-verbal messages are you sending?

• Your tone of voice and facial expressions may express more than your actual words, especially with someone with memory loss. If you are smiling and supportive, your parent will feel comforted and reassured. However, if your eyebrows are raised and your tone is irritable, you’ll convey your frustration.
• Focus on what Mom can do, not what she cannot do.
• Don’t get into pointless discussions or arguments. If your parent says something incorrect or something you don’t agree with–try to let it go. Instead, restate, clarify, or change the subject.

Take your parent’s feelings into account.

• Try to identify the feelings Dad is expressing instead just listening to the actual words (or lack of words). See if you can figure out what might have caused them—worry? Frustration? Happiness?
• Avoid quizzing Mom or Dad needlessly. If you don’t get an answer, it may be because he or she doesn’t know it, and persisting will only embarrass or frustrate your parent.
• Avoid saying “Don’t you remember?” or “I just told you.” It will just make your parent feel bad.

Always treat your parent with dignity and respect.

• At times, Alzheimer’s Disease or dementia can cause childish behavior, but the person is still an adult. It may help to keep an image in mind of a moment when your parent was competent and at his or her best.
• Avoid talking about your parent as if he or she isn’t there—you know how you’d feel if someone did that to you.

Never give up on trying to communicate. Even if your parent doesn’t say much, he or she will still benefit from your conversation and loving touch.

Accepting the new reality of your parent’s memory loss is hard, at and at times, heartbreaking. But adapting your communication style will keep you connected and help reduce frustration. Check out these articles and websites for additional information about communicating with a person with memory loss: Alzheimer’s Association, Colorado Coalition for Elder Rights and Adult Protection, and Suite101.com.

Picture this: your elderly parent is taken by ambulance to the emergency room for stroke symptoms. Or perhaps you’re simply accompanying him or her on a doctor visit to a new specialist. Whether an ordinary doctor visit or an emergency, you may be called on to provide health care information.

Knowing the answers to these ten questions can help your parent receive better care. You can also reduce the hassle associated with making a health insurance or Medicare claim. Here’s what you’ll need to know:

1. Date of birth – Hospitals and clinics usually ask this when your parent is checked in, since it helps the doctor evaluate your parent. Knowing the date of birth also helps the clinic be sure they have the correct medical record, which can reduce medical mistakes. Note: Try not to get frustrated when you or your parent is repeatedly asked to give date of birth or ID number. It’s not that the nurse or clerk is too lazy to look it up. In order to prevent medical mistakes, hospitals and clinics ask this often as a way of verifying your parent’s identity before doing tests or giving medications.
2. Social Security number – You will need this information to access many services.
3. Doctors’ names, phone numbers, and addresses – Make a list of your parents’ internist/family practice physician, eye doctor, dentist and other specialists such as cardiologist, so that their physician can be alerted if your parent is hospitalized. Also, your parent’s primary care doctor will want to receive reports of any care given by specialists. Don’t expect the clinic to think of this—it’s best to be proactive.
4. Allergies to medicine or latex – Penicillin, iodine, codeine are common allergies. Be sure to let the doctors know about any allergies, so they don’t order a medication that will cause a reaction.
5. Copies of the front and back of all insurance cards - Health care providers routinely ask about insurance information when you parent is checked in. If your parent is 65 or older, you will need also a copy of his or her Medicare card. For a summary Medicare’s benefits and answers to the most frequently asked questions, click on Medicare & You. It’s also wise to know where your parents keep health insurance policies in case you need to look up something about their coverage.
6. Advance directives –The National Institutes of Health, describes an advance directive as a legal document that allow a person to convey decisions about end-of-life care ahead of time (the use of dialysis and breathing machines, whether to be resuscitated if breathing or heartbeat stops, tube feeding, organ or tissue donation). Encourage your parents to prepare one, and if they have one, all close family members should have a copy.
7. List of all medications – Include prescription drugs, over-the-counter drugs such as aspirin, antacids, herbal remedies, nutritional supplements – even daily multi-vitamins. If possible, include the dosage amounts and instructions for taking them (time of day, with food or between meals, etc.). Take this list with you to ALL of your parent’s medical appointments to help avoid dangerous prescription drugs interactions.
8. Date and results of recent medical tests – Include lab tests, x-rays, CT scans and MRIs, any surgeries or outpatient procedures.
9. Complete health history – What medical conditions run in your family? Were any of your grandparents diabetic? Did any close relatives have heart disease (heart attacks, high blood pressure, stroke, etc.)? Cancer? If possible, be able to list major illnesses and medical conditions for your loved one’s parents, brothers and sisters.
10. Pharmacy - Keep the address and phone number of the local and mail order pharmacy your parent usually uses. Be sure to make a note about any discounts your parent has available.

Having this information on hand can relieve stress (yours and you parents’) and enhance their care.

How would you feel if someone you’ve barely met follows you into the bathroom to help? How well would you rest if a strange woman is sitting in your kitchen drinking coffee while you nap? And what if that person is constantly reminding you to take your pills, use less salt, and throw out leftovers?

You can see your parents’ point. Having in-home help invades their privacy and threatens their independence. You wouldn’t welcome those changes either. But sometimes hiring in-home help is the only way your parents can safely continue to live in their home. Here are three tips for smoothing the transition:

1. If your parents are both living together in their own home, suggest that the less needy parent would benefit from outside help, even though they both need it. For example, tell Dad, whose health is worse, “Keeping up with everything is tiring Mom out. Maybe we should get someone in to clean and shop for groceries.” Because he cares about her, Dad is more likely to agree to get her outside help (Obviously, get Mom onboard with the plan first). Once a caregiver is in the door, hopefully your parents will see the value of the service and come to trust the caregiver. Then your parents will be more open to accepting additional assistance as the need arises.

2. If your parent lives alone or with you, your focus can be that the assistance will benefit you. For example, explain to Mom that having an aide assist her in the bathroom will relieve you of worry while you are at work. You won’t have to be concerned that she will fall and lie there for hours. Often a parent will place the child’s welfare ahead of his or her own.

3. If your parent is really resistant to the idea of a caregiver even though it is clearly needed, enlist the help of a trusted professional such as a physician, pastor, or family friend in the medical profession. Emotions can run high in families, and sometimes an objective outsider can break the impasse.

These discussions can be frustrating. Try not to take your parent’s resistance personally. Remember that he or she feels vulnerable and a bit powerless, and may also be mourning the loss of his or her independence. More than likely you would feel exactly the same.  Be patient, persistent and stress that you want your parent to remain at home as long as possible, but accepting help is the key. For additional suggestions about making this transition, visit www.agingcare.com/Caregiver-Support/ or www.mnaging.org/advisor/caregiver.htm.

How can you be sure the people you hire to help Dad or Mom are caring, well-trained, and professional? Whether the home healthcare agency is a local franchise of a large national corporation, a small privately owned local firm, or a local nonprofit organization, here are 7 important questions to ask:

1. Is the agency is accredited by a national organizations such as the Joint Commission on Accreditation of Health Care Organizations (JCAHO) or Commission on Accreditation of Rehabilitation Facilities (CARF)? These certifications tell you that the agency conforms to national industry standards. There is always comfort in dealing with an organization that has proven its worth to its peers.

2. Is the agency Medicare-certified? As the name implies, if you want Medicare to pay for the services, the agency must be Medicare-certified. However, be aware there are some complications associated with Medicare’s coverage of home health services (see “Surprise! Medicare Doesn’t Pay for Most Home Healthcare”). Many high-quality home healthcare agencies are not Medicare-certified. Instead, their clientele pays for the services directly or their private insurance covers it.

3. Can the agency provide references from former clients? By talking to former clients, you can get a good sense for whether or not the staff is caring and respectful. Family members can tell you all the reassuring (or alarming) details.

4. What experience and training do Home Health Aides (HHAs) have? How about Homemakers? All Home Health Aides need to be trained, competency-tested and supervised by an R.N. However, the level of training required may vary depending on what type of license the agency has. For example, agencies with a Minnesota Class C license require their HHAs to be Certified Nursing Assistants (also called Certified Nursing Aides, Nursing Assistant –Certified, or Nursing Assistant-Registered).

But Minnesota agencies with a Class A license don’t require their HHAs to be Certified Nurse Assistants. Instead, they provide some training for their HHAs. Whether or not the agency employs Certified Nursing Assistants, their training should include home safety practices as well as training in caring for and communicating with elderly people.

Homemakers and Companions should have driving safety training as well as first aid, home safety training, and experience working with elderly people. Answering these questions will help you establish the agency’s professionalism.

5. Does the agency do criminal background check on ALL of the employees? In addition, the in-home staff should be bonded and the agency should have malpractice insurance.

If you have any concerns about an agency’s practices, contact the Minnesota Office of Ombudsman for Long-term Care. They can answer questions and investigate if necessary. The Minnesota Board on Aging can also provide information.

6. Is there a care plan? Is it updated regularly for the HHA? Before a HHA starts helping your parent, an R.N. should assess Dad or Mom. Then the family and the R.N. will discuss what care is needed, and the nurse will write a care plan for the HHA to follow. If your parent’s needs change, the care plan will be updated.

7. How closely are the HHAs and Homemakers supervised? HHAs can only be supervised and directed by an R.N. Homemakers are usually supervised by the agency’s program manager. However, any time you have questions or concerns, you should contact the agency, and the appropriate person should call you within 24 hours.

By law, you and your parent should also be given a copy and explanation of the Minnesota Home Care Bill of Rights, so you know what to expect. In addition, the R.N. supervising your HHA will visit in 14 days to check on progress and then every 14 to 60 days after that, depending on what tasks the HHA performs. The nurse can also change the care plan by phone if need be.

Knowing how to evaluate home health care agencies will help you find the best services for your loved one.

If you’re like most people, you probably think Medicare covers most home healthcare. After all, most people think taking care of our elders is important.

But at best, Medicare Part A helps pay for some home healthcare.

For a limited time.

IFFF your parent’s physician orders skilled home care services.

IFFF your parent is sick enough to need skilled nursing or occupational/physical/speech therapy.

And IFFF Mom or Dad is homebound, which means going somewhere is a major effort for your parent and requires someone to help.

And IFF the home healthcare service is certified by Medicare.

And then Medicare only covers home healthcare provided on a part-time or intermittent basis.

Historically, Medicare’s focus was on providing care for elderly people who are sick enough to need inpatient hospital care or care at skilled nursing facilities (rehab centers, nursing homes). The purpose is to help a person recover at home or in a skilled nursing facility. The expectation is that the patient will improve and discontinue services in a fairly short time. More recently, Medicare began to cover limited home healthcare and long-term hospice care.

Examples of home healthcare Medicare usually covers:

If your Mom has a stroke or your Dad has open-heart surgery, the doctor may order skilled nursing services to help your parent recover at home.

Skilled nursing care

Mom or Dad’s care would be supervised by an R.N., who would assess your parent’s condition and coordinate with a Home Health Aide (HHA) and the Occupational, Physical or Speech Therapists, if they are needed. The R.N. can do things like set up and teach Mom or Dad the proper way to follow a new medication regimen, give medications, change surgical dressings, assess Mom or Dad’s progress and alert the doctor about any problems, and so forth.

Personal care services supervised by an R.N.

The R.N. will also supervise the Home Health Aide, who will help your parent with bathing, toileting, eating, and dressing –whatever non-medical personal care is needed. However, once your parent is improved enough that he or she no longer needs the R.N.’s services, Medicare will stop paying for the Home Health Aide, even though Mom or Dad may not be able to do his or her own personal care. From the Medicare perspective, that is long-term custodial care, and Medicare doesn’t cover it.

That means if your parent still needs the services of a Home Health Aide, the family pays for it or your parent’s private insurance may pay for it (check your policy). Otherwise, you and your parent will need to explore other options including Medicaid, Veterans Benefits, or possibly community services. To learn more about what to expect from Medicare, visit these websites:  www.mnaging.org, www.medicare.gov, and www.agingcare.com.

One hundred years ago, women held quilting parties. Of course, Great Grandma was too ladylike to call it “Stitch N’ Bitch” (that came in the latter part of the 20^th century).

For G.G. and her neighbors, piecing a bed quilt was a big tedious job. Sharing the work made it go faster. Plus it was a lot more fun. Often women were isolated on their farms, and G.G. could discuss her joys and worries with other women at the quilting bee. So the visits were as important as the quilting. The same is true today. Companionship matters.

Loneliness can lead to depression, poor nutrition, and more.

When Mom or Dad spends a lot of time alone, she or he can get depressed. Then it becomes too much trouble to fix a proper meal and eating it alone is, well, lonely. Snacking and not-so-nutritious frozen dinners are easier. So Dad’s diet may not be good for his heart disease. Or Mom may not be controlling her diabetes as well as she should.

Similarly, Mom might think, “Why bother to get dressed, comb my hair and put on makeup, when no one’s going to see me?” So she may be more lax about hygiene. Dad may say, “Going to Rotary/golf/church just isn’t worth it.”

If one of your parents is housebound most days because he or she no longer drives, isolation can set in, and with it, depression and poor nutrition.

Sometimes all it takes is company.

Maybe a neighbor or someone from Mom’s church can drive her to her favorite activities. Or if that’s not practical, you can take advantage of companion services. Several times a week (more or less—it’s up to your parent), a companion can play a game of cards with Dad or drive Mom to her quilting group or keep her company while she pots a few begonias.

Companions can also assist Mom with planning her meals, preparing a grocery list, and clipping coupons. Dad can get help with organizing mail or a woodworking project. Companions can share whatever activities your parent wants to do—from addressing holiday cards or baking—to going for a walk or watching a movie. Having company makes these activities more fun. Conversation and companionship are the point, not the activity.

To learn more about companionship services, check out these resources: ElderCare Link, My Senior Care and Pinnacle Services.

And who knows? Maybe Dad will build you a bird feeder. Or Mom will make a baby quilt for your niece.

You can see Mom and Dad are slipping—maybe their home isn’t very clean or they aren’t eating properly. Perhaps they’ve had a few falls. But what’s the best way to help?

Used to be, there were only two options for taking care of aging parents: the family did it or your parent went to a nursing home. Neither you nor your parent(s) want to consider a nursing home—especially if your parent is still fairly healthy but occasionally forgets things or has trouble keeping up with household chores.

That leaves you.

Of course you want to take care of your parents.

If you’re like most people, you probably assumed you and your family would handle it somehow. But you might not have thought about how that would work exactly.

Mom and Dad may need help periodically throughout the day while you’re at work. Or you may find that if you’re cleaning their house and running their errands after work, you aren’t home to supervise your daughter’s science project or available to watch your son’s basketball game. And because you’re stretched so thin, your family is eating a lot of frozen pizza.

If you no longer live in the same town as your parent(s) or your job requires frequent travel, the arrangements are even more complex.

Sometimes you just can’t do it all.

Years ago, your mother wouldn’t have had any help taking care of your grandparents. Now fortunately, there are many flexible options for giving your parents the help they need:

• In-home care, either short-term (i.e. after surgery) or ongoing
o Companion
o Homemaker
o Personal care (Home Health Aide)
o Nursing
• Housing with services
• Residential care homes
• Assisted living

So quit feeling guilty because you can’t do it all (no one can). For more ideas about flexible care options, visit www.mnaging.org/.

When you see your parents often, you may not notice a gradual decline. But your parent(s) may be getting to the point where they need more help.

Next time you visit, look for these 7 signs your parents need help:

• Does their home still meet Mom’s housekeeping standards? Or are there fingerprints on the doors, sticky spots and crumbs on the counter, floor, and kitchen table?
• Are a few of yesterday’s pills still sitting in the pill sorter?
• Are Dad’s clothes spotted and in need of washing? Are the kitchen and bathroom
towels dirty?
• Does the smell from the cat litter box or garbage hit you when you walk in the door?
• Does Mom frequently fix cereal or a can of soup for dinner, because, “It’s just too much trouble to cook?” Are the leftovers in the fridge going bad?
• Does Mom still get together with friends or neighbors? Does Dad still plan outings and enjoy some of his favorite pastimes?
• Is the mail stacking up? Are bills past due, even though your parents have the money?

Of course, you don’t want to go overboard—at the end of long week, your kitchen and bathroom probably need cleaning, too. And certainly, no one lapse is a reason to call out the cavalry. But if you regularly see a number of the scenarios described above, it may be a sign that your parent(s) are having trouble keeping up.

How to help—from family involvement to in-home care

The solution may be as simple as asking family members to get more involved—make a double batch of stew and bring half to Mom and Dad. Throw in a load of wash when you visit every week. Give Mom a gift certificate for a cleaning service, and then encourage her to have someone clean weekly or twice a month. That may be all the help they need right now.

But what if your aging parents’ needs are more extensive? Do you see signs of forgetfulness (skipped medications and unpaid bills) or poor grooming (greasy hair, clothes that need washing)? You and the other family members will try your best, but it’s very hard to provide daily care, when you’re also taking care of your children and working. You may need help bridging the gaps.

Perhaps you and your parents want to consider a home health aide, who can remind Mom or Dad about medications and help with bathing and grooming. Similarly, if your parent(s) are apathetic about eating and getting more isolated socially, they may benefit from companion or homemaker services—someone who can cook, clean, do laundry and keep your parent(s) company when you can’t. If someone else does laundry and cleaning, you’ll have more time to simply visit or have fun—maybe putting up seasonal decorations or shopping.

Each family’s needs are unique, and you’ll want to determine the right combination of support services to help your aging parents live in their home happily, comfortably and safely as long as possible.

For more insights into dealing with aging parents, visit http://www.agingcare.com/Housing/1159/Home-Care/. To learn more about what community resources and service options are available to you, visit http://www.mnaging.org/ in Minnesota or http://www.usa.gov/Topics/Seniors.shtml for national resources for seniors.

Pinnacle Services and Summit Fiscal Agency attended the 117th Annual Minnesota Social Service Association’s (MSSA) conference and expo at the Minneapolis Hilton.  This was the first year the conference was held at the Minneapolis Hilton, which provided spacious layout for vendors, ample seating for session attendees and the many amenities of downtown Minneapolis.

New venue, new attractions.  This year Pinnacle Services began what it hopes to be a tradition; The Pinnacle Pub Crawl.  Approximately 150 participants gathered Wednesday evening to receive pub crawl T-shirts and patronize some of the area establishments surrounding the Hilton.  Pre-registration was required and managed by the MSSA conference committee.  Pinnacle Services employees served as guides visiting Hell’s Kitchen, 8^th Street Grill, Brit’s Pub and Eating Establishment, The Local and Zelo.  Feedback from attendees of the event was overwhelmingly positive.  Pinnacle Services also participated in the Booth Bash conference event Thursday evening.  While the organization did not sponsor a booth, attendees were invited to try the 14 foot Velcro Wall the agency provided.

The widely attended annual conference and expo provides opportunity for those in the field to attend educational sessions, network and gather information.  Pinnacle Services provided information to attendees regarding the services the agency provides including In Home Family Support, Housing with Services, Case Management/Service Coordination, Employment Services, Independent Living Skills, Semi-Independent Living Services, Support Planning, Corporate Foster Care and Supported Living Services, Home Care Services and 24 hour Customized Living Services.

For more information regarding any of these services please contact Sara Yee, Program Director at sara.yee@pinnacleservices.org.

Pinnacle Services and Summit Fiscal Agency will be exhibiting at the Minnesota Social Service Association’s (MSSA) 117th Annual Training Conference and Expo. The conference takes place at the Minneapolis Hilton and runs from Tuesday, March 23, 2010 to Friday, March 26, 2010. Exhibits will be open during the conference on Wednesday and Thursday. Pinnacle and Summit invite everyone to stop by our booth in the exhibit hall. Stop by early to make sure you get some of the great promotional items we have. They won’t last long! In addition to exhibiting, Pinnacle is sponsoring the first annual “Pinnacle Pub Crawl” which will take place Wednesday night. It is sure to be a fun time! More information about the conference and expo can be found at: