Strategies to Reduce Caregiver Stress Part III

Understanding Caregiver Stress

A 2003 study of caregivers by a research team at Ohio State University has proven the off-repeated adage “stress can kill you” is true. The focus of the investigation was the effect the stress of caregiving had on caregivers. The team, led by Dr. Janice Kiecolt-Glaser, reports on a 6-year study of elderly people caring for spouses with Alzheimer’s Disease. The study not only found a significant deterioration in the health of caregivers when compared to a similar group of non-caregivers but also found the caregivers had a 63% higher death rate than the control group.

Reduce Stress Through Proper Nutrition

Avoid Over Eating

Many people react to stress by eating. Eating too much for a long period causes obesity. This causes your heart and lungs to work harder, overloads your organs and reduces stamina. Studies show that fat cells excrete IL-6 and that overweight people have high levels of IL-6 in their blood. This in turn leads to the IL-6-associated illnesses such as heart disease, immune disorders and diabetes.

Good Eating Habits

Some people react to stress and stress-induced depression by not eating or eating poorly. If you eat a good, well-balanced diet, your body will be receiving all the nutrients it requires to function properly. On the other hand, if you are eating an unbalanced diet or not eating enough you may be stressing your body and contributing to stress-related complications by depriving yourself of essential nutrients.

Coffee, Tea, Caffeine Soft-Drinks & Chocolate

Caffeine is a stimulant. One of the reasons you probably use it is to raise your level of activity. This chemical actually enhances the stress response and thus increases your existing stress. Small quantities probably do little harm but large quantities over a long period produce excessive stress and lead to many of the physical ailments attributed to chronic stress. Too much caffeine can be dangerous. If you are drinking many cups of caffeine products a day, then you may find you can reduce a lot of stress and save your health by switching to caffeine-free products for a portion of your daily intake.

Alcohol

Some people react to stress by imbibing in alcohol. In small amounts, spirits may help you relax. In larger amounts alcohol may increase stress as it disrupts sleep. Over the long-term, alcohol will damage your body. Alcohol is also a depressant. If you’re prone to depression, alcohol will only make it worse. Studies show that depressed people have eight times the level of IL-6 as compared to the general population. As we have seen, high, prolonged levels of IL-6 are a marker for debilitating illness and early death.

Tobacco

In the short-term tobacco use seems to relax people but the toxic effects of nicotine raise the heart rate and enhance the stress response. If you smoke, try taking your pulse before and after a cigarette, and notice the difference. After the initial period of giving up smoking, most ex-smokers report feeling much more calm.

Sugar and Refined Flour

Sugar can be a stimulant for people experiencing stress and stress-induced depression. Sugar-rich foods (the starch in refined flour is also a form of sugar) can raise your energy level in the short-term. The problem is your body copes with high levels of sugar by secreting large amounts of insulin, which in turn, quickly reduces the excess amount of sugar in your blood stream often causing blood sugar levels to swing too low.

These up and down spikes in blood sugar can cause agitation, mood swings, irritability and fatigue, which in turn can contribute to the creation of additional stress. The ups and downs of sugar spikes also contribute to depression. And of course, excess sugar is readily converted to body fat thus causing obesity. Consuming sugar in the form of complex carbohydrates–whole grains, fruits, vegetables and tubers–forces the digestive tract to release blood sugar more slowly and keeps insulin and blood sugar levels more normal. Avoid fruit drinks, sugar drinks, candy, pastas, white bread and pastries.

Prepare Now to Reduce Stress Later

Idaho Estate Planning is part of the Treasure Valley Care Planning Council, a non-profit network of elder care professionals available to provide information beyond the items discussed above. Let us know your concerns and we will help you find the resources you need.

In addition to caring for your parents or other family members, it is also important to consider your own concerns for the future. How will you maintain your independence as you grow older? What effect would a costly health issue have on your quality of life? The more planning you do now the less difficulty there will be later. Better planning now will reduce the stress placed on you and your future caregivers. Good planning is no accident.

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Strategies to Reduce Caregiver Stress Part II

Understanding Caregiver Stress

A 2003 study of caregivers by a research team at Ohio State University has proven the off-repeated adage “stress can kill you” is true. The focus of the investigation was the effect the stress of caregiving had on caregivers. The team, led by Dr. Janice Kiecolt-Glaser, reports on a 6-year study of elderly people caring for spouses with Alzheimer’s Disease. The study not only found a significant deterioration in the health of caregivers when compared to a similar group of non-caregivers but also found the caregivers had a 63% higher death rate than the control group.

Lifestyle Changes to Reduce Stress

Exercise

Exercise is a powerful and effective way to fight stress. It is recommended you do about 30 minutes of moderate exercise at least 3 days a week. Here are a few reasons why exercise works.

• Distraction–Exercise provides time away from the stresses of the day.
• Endorphins–Endorphins are opiate-like chemicals that the body produces naturally during periods of stress or physical exertion to relieve pain.
• Neurotransmitters–During exercise, the body releases higher levels of dopamine. These hormones improve the thought process by facilitating transfer of information between neurons.
• Self-esteem–Exercise can be a gratifying and fulfilling activity for people. The act of doing something good for self can promote self-esteem.

Support Groups

Participating in a support group can help manage stress. Sharing coping strategies in a group setting lets you help others while helping yourself. It may also help you to realize that some problems have no solutions and that accepting the situation is reality. Social support has a huge impact on reducing stress. Those who suffer alone, suffer a lot.

Get Adequate Sleep

The catch-22 with sleep is that if you are over-stressed, you are likely to experience a disturbed sleeping pattern, and if you are experiencing a disturbed sleeping pattern, you are likely to become over-stressed!

Sleep isn’t a luxury; it’s a necessity. Sleep restores the body and mind and helps us maintain our mental and physical health. Studies have shown that people who get seven to eight hours of sleep each night enjoy better health and live longer than people who get less sleep.

To ensure that you get enough sleep, try some of the following suggestions:

• Develop a sleep schedule and stick to it.
• Get 30 or more minutes of physical activity each day. Avoid working out during the three hours before bedtime.
• Avoid caffeine, nicotine, and alcohol. Quit smoking. An alcoholic beverage (a “night cap”) before bed may make you drowsy but it actually deprives you of deep, restorative sleep.
• Engage in relaxing activities before bed.
• Leave your troubles outside the bedroom door. Make your bedroom a worry-free zone.
• Create a cozy sleep environment free of distractions.

Pursue Diversions, Hobbies and Relaxing Activities

Another simple way to reduce stress is to distract yourself — go to a movie, play a sport, immerse yourself in a hobby, listen to some favorite music or take a walk. It cannot be emphasized enough how important it is as a caregiver you spend some quality time alone every week, doing exactly what it is you like to do.

Prepare Now to Reduce Stress Later

Idaho Estate Planning is part of the Treasure Valley Care Planning Council, a non-profit network of elder care professionals available to provide information beyond the items discussed above. Let us know your concerns and we will help you find the resources you need.

In addition to caring for your parents or other family members, it is also important to consider your own concerns for the future. How will you maintain your independence as you grow older? What effect would a costly health issue have on your quality of life? The more planning you do now the less difficulty there will be later. Better planning now will reduce the stress placed on you and your future caregivers. Good planning is no accident.

Idaho Estate Planning

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Strategies to Reduce Caregiver Stress Part I

Understanding Caregiver Stress

A 2003 study of caregivers by a research team at Ohio State University has proven the off-repeated adage “stress can kill you” is true. The focus of the investigation was the effect the stress of caregiving had on caregivers. The team, led by Dr. Janice Kiecolt-Glaser, reports on a 6-year study of elderly people caring for spouses with Alzheimer’s Disease. The study not only found a significant deterioration in the health of caregivers when compared to a similar group of non-caregivers but also found the caregivers had a 63% higher death rate than the control group.

Ask for Help

Most caregivers are reluctantly thrust into their role without preparation because the need for care usually comes with little warning. Caregivers end up operating in a “crisis” mode–arranging medical care and living arrangements, scheduling care time, providing meals and household chores and so forth. Because they are so stressed and burdened, they rarely take time to find out what resources are available to help them. Ironically, caregivers often sever ties with family, friends and support groups about this time just when help from these people is most needed.

As a caregiver you must ask for help. The stress of going it alone is dangerous to your health. If it’s difficult to ask for yourself, use an advocate–a sibling, friend or professional care manager –to arrange a meeting and get formal, written commitments from those people who are willing to help you. The extra help will give you breathing room to find all those resources that are there to help you.

Assistive Technology

There are a number of technologies to make sure your loved-ones are safe while you’re away. Such things as emergency alert bracelets and pendants, GPS tracking for wandering, remote video surveillance, telehomecare, sensory augmentation and all sorts of assistive devices to help disabled people cope on their own.

Take Time Off

Taking a break from caregiving is just as important as taking a break at work or taking that long-awaited vacation. A care manager may be of help in selecting the best temporary help to give you a break. Or you may make arrangements with family or friends to give you a break from caregiving.

Seek Care Management Advice

A number of organizations and private companies will give you advice and guidance — many for free. If your care recipient has a very low income, you might get free help from your local Area Agency on Aging. A lot depends on available funds.

Idaho Estate Planning is part of the Treasure Valley Care Planning Council, a non-profit network of elder care professionals available to provide information beyond the items discussed above. Let us know your concerns and we will help you find the resources you need.

In addition to caring for your parents or other family members, it is also important to consider your own concerns for the future. How will you maintain your independence as you grow older? What effect would a costly health issue have on your quality of life? The more planning you do now the less difficulty there will be later. Better planning now will reduce the stress placed on you and your future caregivers. Good planning is no accident.

Idaho Estate Planning

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Caregiving Stress – Hazardous to Your Health

Understanding Caregiver Stress

A 2003 study of caregivers by a research team at Ohio State University has proven the off-repeated adage “stress can kill you” is true. The focus of the investigation was the effect the stress of caregiving had on caregivers. The team, led by Dr. Janice Kiecolt-Glaser, reports on a 6-year study of elderly people caring for spouses with Alzheimer’s Disease. The study not only found a significant deterioration in the health of caregivers when compared to a similar group of non-caregivers but also found the caregivers had a 63% higher death rate than the control group.

Stress produces real physical changes. In some unknown way the fears in our mind, both conscious and unconscious, cause the hypothalamus and pituitary glands, deep in our brain, to initiate a cascade of hormones and immune system proteins that temporarily alter our physical body. This is a normal human physiological response inherent to the human body when a threat is perceived–real or not. It is often called the “fight-or-flight response” or the “stress response”. The purpose is to give us clearer thought and increased strength as well as to activate the immune system to deal with potential injury and to repair potential wounds. When the perceived threat is removed, assuming no damage is done, the body returns to normal.

In the aforementioned study the Ohio State University team found a chemical marker in the blood that shows a significant increase under chronic stress and is linked to an impaired immune system response in aging adults. With the caregivers, the team found a four-fold increase in an immune system protein — interleukin 6 (IL-6) — as compared to an identically matched control group of non-caregivers. Only the stress of caregiving correlated to the marked increase of IL-6 in the caregiver group. All other factors, including age, were not significant to the outcome. Even the younger caregivers saw an increase in IL-6. Another surprising result was that high levels of IL-6 continued even three years after the caregiving stopped. Dr. Glaser proposes the prolonged stress may have triggered a permanent abnormality of the immune system.

IL-6 is released when the brain signals a person is threatened with harm, injury, undue mental or physical stress or death. The hormones prepare the body to react quickly by increasing heart rate, making muscles more reactive, stimulating thought, altering sugar metabolism and producing many more changes that result in the “rush” people experience when they think they may be harmed.

This response to harm — either real or perceived — is an important and beneficial life-saving activity of a normally functioning body. The problem is if this response is initiated over and over again, frequently, and over a long period; it can have a dangerous effect on the body. This constant initiation of the stress response is common among caregivers — especially those caring for loved ones with dementia. Providing supervision or physical assistance many hours a week and over a period of years turns out to be extremely stressful. This type of stress is often unrelenting, occurring day after day and week after week. And the long-term effects of this stress are more pronounced in middle-aged and older people who are precisely the group most likely offering long term care to loved ones.

In most younger people, when the threat lessens or disappears, the body reacts fairly quickly to shut down the stress response and return things to normal. But numerous studies have shown, as people age, the chemical cascade from stress lingers. Over a period of time, this constant chemical stimulus impairs the immune system and results in early aging, development of debilitating disease and early death. In this altered state, the body maintains high, potentially harmful levels of IL-6. The body does not return to normal without intervention.

Prolonged high levels of IL-6 and the accompanying hormones and cytokines have been linked to: cardiovascular disease, type II diabetes, frequent viral infections, intestinal, stomach and colon disorders, osteoporosis, periodontal disease, various cancers and auto immune disorders such as lupus, rheumatoid arthritis and multiple sclerosis. Alzheimer’s, dementia, nerve damage and mental problems are also linked to high IL-6. Wounds heal slower, vaccinations are less likely to take and recovery from infectious disease is impaired. People who have depression also have high levels of IL-6. Depression in caregivers is about 8 times higher than the non-cargiving population.

Those who find themselves in the role of caregiver are encouraged to find ways to reduce stress. Over the next few blogs we will discuss ways of reducing caregiver stress.

Idaho Estate Planning is part of the Treasure Valley Care Planning Council, a non-profit network of elder care professionals available to provide information beyond the items discussed above. Let us know your concerns and we will help you find the resources you need.

In addition to caring for your parents or other family members, it is also important to consider your own concerns for the future. How will you maintain your independence as you grow older? What effect would a costly health issue have on your quality of life? The more planning you do now the less difficulty there will be later. Good planning is no accident.

Idaho Estate Planning

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Helping Your Elderly Parent with COPD Related Depression

Experts say that over a million people in the United States have chronic obstructive pulmonary disease (COPD). It is a chronic lung condition that includes bronchitis, emphysema or both.

COPD affects the airways and air sacs within the lungs, which makes breathing difficult and can result in a person becoming less active over time. An elderly person who has COPD will easily become depressed, when dealing not only with breathing difficulties but other age related problems.

One example of COPD related depression is Martin, age 72. Martin had lived a busy lifestyle, playing golf, volunteering at the community center and working in his garden. Diagnosed with COPD six months previous, and uncertain how to manage his breathing difficulty and new medications, Martin stopped all his activities. Giving up the things he loved to do and sitting more at home along with improper diet, he became a victim to depression.

Martin’s son Anthony realized that his father could not handle his new situation and depression alone. A trip together to Martin’s physician began the steps to dissipating the depression and enabling Martin to return to his social life.

Anthony received instructions about his father’s medications from the doctor and how they were to be used and consequently could help his father with medication reminders.

The most common types of daily COPD medicines are:

• Inhaler for daily maintenance – Bronchodilators help relax the muscles around the lungs’ breathing tubes. This reduces shortness of breath and makes breathing easier.
• Steroids – Corticosteroids, taken in pill form or inhaler reduce swelling in breathing tubes to quickly make breathing easier. Not commonly for prolong use.
• Oxygen Treatment – Severe COPD will reduce your lungs’ ability to put oxygen into your blood to be carried throughout your body. Martin’s oxygen level was measured to determine if he would need prescribed oxygen therapy. Oxygen is usually prescribed if the oxygen in the blood is low during sleep, exercise, or while not active. A respiratory therapist from an oxygen supply company or home health service can help with learning how to use oxygen.

An important factor in Martin’s depression and COPD management was his diet.

“A healthy diet can play an important role in the management and treatment of COPD.
Finding the right diet can be tricky for people with chronic obstructive pulmonary disease (COPD), since they need to eat a healthy diet and maintain their optimal weight to keep COPD symptoms in check.”  (Krisha McCoy, MS, Lindsey Marcellin, MD, MPH)

Maintaining the right nutrition and taking vitamins not only keeps the body healthy but heals the mind, providing emotional well being. Fad diets or extreme dieting are not appropriate for COPD patients. Extreme weight loss can be as much a hazard as being overweight. A home care nutritionist can help establish a healthy menu and diet plan.

With medication and diet under control the final steps to overcoming Martin’s depression were to return to his daily activities. With COPD, an elderly person is more hesitant to leave home, especially if that person’s breathing capacity is not as it used to be. There is a lot of available mobility support for the elderly with small portable oxygen units, walkers, electric scooters and other supportive equipment to help these disabled people move about in the community.

With the help of mobile services and his son at his side to start with, Martin returned to the golf course and community activities. His new diet and return to previous activity helped Martin overcome his symptoms of depression.

Studies show that the intervention of family and friends in helping and supporting elderly people with COPD results in a decrease of depression and a healthier outcome for the patient.

The Oxford Journals: Medicine, Age and Ageing states

“It is also worth exploring how family and friends may be involved in supporting the patient and to encourage social interaction. Educating the spouse, family members and friends about depression may help them to understand the consequences of the disease and to develop coping strategies and in turn may reduce the likelihood of isolation. A very recent study that investigated the benefits of emotional support by family and friends and of spiritual beliefs in patients with major depression showed that those with higher perceived emotional support had better outcomes.” (Oxford Journals Medicine Age and Ageing Volume 35, Number 5)

Idaho Estate Planning is part of the Treasure Valley Care Planning Council, a non-profit network of elder care professionals available to provide information on the information discussed above and much more. Let us know your concerns and we will help you find the resources you need.

In addition to caring for your parents or other family members, it is also important to consider your own concerns for the future. How will you maintain your independence as you grow older? What effect would a costly health issue have on your quality of life? The more planning you do now the less difficulty there will be later. Good planning is no accident.

Call us today and let us help.

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Medical Care at the End-of-Life

Medical Care Immediately Prior to Death

In the first half of the 20th century, most people who died had an accident or contracted a disease or they had physical disorders that inevitably lead to death. Life-saving medical interventions such as sophisticated resuscitation, complicated surgeries, life-saving treatments, ventilators, feeding tubes and other life-support were rarely used or even available. Nowadays there is great emphasis on curing medical problems sometimes to the exclusion of recognizing that death might be a more welcome outcome.

Surveys indicate that older people are often more afraid of death than younger people. But for all Americans — young and old — there is a great fear of death.  Oftentimes, the families of those near death will go to great lengths to try interventions that may be ineffective in prolonging life. Estimates are that about 30% of Medicare reimbursements are spent on people in the last year of their life. It is a fact that much of this medical care did little to prevent death and prolong life.

According to the Dartmouth Atlas study on death:

“The quality of medical intervention is often more a matter of the quality of caring than the quality of curing, and never more so than when life nears its end. Yet medicine’s focus is disproportionately on curing, or at least on the ability to keep patients alive with life-support systems and other medical interventions. This ability to intervene at the end of life has raised a host of medical and ethical issues for patients, physicians, and policy makers.”

The Dartmouth Atlas project uncovered some startling differences in what happens to Americans during their last six months of life. The level of hospitalization during those months varies greatly from one region to the next.

The Atlas researchers asked why this was so.  Why is someone living in Miami so much more likely to receive a great deal of high-tech, expensive medical services, while someone with the same condition who lives in Minneapolis receives so much less? The answer appears to have very little to do with religious or spiritual beliefs or personal preferences.  Rather, the answer appears to be that the capacity of the local health care system – the per-capita supply of hospital beds, doctors, and other forms of medical resources – is the dominating influence. Those who live in areas like Miami, where there are very high per capita supplies of hospital beds, specialists, and other resources, have one kind of end of life experience. Those who live in areas like Minneapolis or San Francisco, where acute care hospital resources are much scarcer, have very different kinds of deaths.

The question, then, is which is better? From the dying person’s perspective, more is not necessarily a good thing.  That is, more visits to doctors for someone who is very sick can be stressful and exhausting. For many people a hospitalized death is something to be avoided if at all possible. From the perspective of the health care system, much of the care being given is futile, and accomplishes little. People who live in areas with very high utilization of hospital resources do not live longer than people who die in areas where utilization is lower – and if extension of life is not the goal of intervention, what is?

Deciding How and When to Stop Curing and Start Caring

Some people are content to leave decisions regarding their death in the hands of others. By doing so, they may expose themselves to unnecessary and futile treatments as outlined above. They may experience numerous visits to the emergency room in the last stages of their life. And their dependency on others often results in great stress to family members when loved ones at the end-of-life lose their capacity and didn’t make their last wishes known. Families are often forced to make decisions about life-support and treatment without knowing whether their loved one would have wanted these interventions.

Advance Directives

These, are the minimum documents you need to make sure your wishes for health and medical care and end of life decisions are honored.

• Durable Power of Attorney for Health Care
• Living Will
• POST (Physician Orders for Scope of Treatment)
• HIPAA Release

A patient or his or her spouse or a family member will typically call 911 in the event of a life-threatening emergency. Very seldom will the advanced directives end up with anyone in the emergency room. Therefore, medical decisions are generally made by family members who show up at the hospital. The actual health treatment wishes of the patient may be at home in the desk drawer. It is therefore extremely important to remember to take these documents to the emergency room whenever a crisis arises. It is also critical that family members be made aware of your wishes and the existence of your advance medical directives as well as where they can be found.

When it comes to these very difficult questions timing is everything. In order to maintain control as long as possible and have an effect on your own end of life decisions you must choose to act now. Your decisions need to be made known and documented correctly. Good planning is no accident!

Call us today and let us help.

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Aging Parents: Warning Signs of Failing Health

Aging parents are becoming a concern for a growing number of Idahoans. In an article originally published on www.MayoClinic.com we find some useful tips on monitoring our parent’s well-being while allowing them the independence they desire. Below are 5 items to consider.

1: Are your parents losing weight?

Losing a significant amount of weight without trying can be a sign of trouble. Perhaps they are having difficulty cooking whether because of a lack of energy, difficulty using utensils and appliances, or maybe they’re having difficulty reading or understanding the instructions.

As we age it is normal for our sense of taste to diminish this can also lead to a loss of appetite when foods just don’t taste as good as they used to. Smell is very important to our appetite and a decline in our ability to smell can also lead to problems with proper nutrition.

Of course there is always the concern of deeper issues such as dementia, cancer or even depression.

2: Are your parents taking care of themselves?

A direct quote from the Mayo Clinic article explains this concern:

“Pay attention to your parents’ appearance. Are their clothes clean? Do they appear to be taking good care of themselves? Failure to keep up with daily routines — such as bathing, tooth brushing and other basic grooming — could indicate health problems such as dementia, depression or physical impairments.”

It is also important to monitor the living conditions in the home. Look for big changes from the past. Are lights burnt out? How about the bathrooms, are they kept as clean as they used to be? Scorched cookware may indicate forgetfulness when cooking. Depression or dementia can be a cause of chronic problems in this area as well.

3: Is their home as safe as possible?

Safety around the home is very important. Are hallways and stairs well lit? Are falls becoming a problem? Are they having trouble reading prescriptions or instructions? Is there a concern of falling or slipping when coming in and out of the house? A malfunctioning water heater or furnace can be deadly. Periodic maintenance is critical to keeping the home safe.

4: Are they in good spirits?

Again we want to see consistency in their behavior. Are they as active as they would like to be? Do they need help getting out and participating in activities? Are they still interested in life-long hobbies and activities? If they are religious are they attending worship services?

5: How are they getting around?

We all slow down as we get older. Watch your parents as they are walking. Make sure they can still get where they need to without too much discomfort or pain. Aching joints and lack of energy can lead to difficulties walking and that can lead to depression. Do they need a cane or a walker? Perhaps they would benefit from chairs that are easier to get out of or higher toilets that are easier to use?

What to do?

• First, take care of any safety issues. Replace light bulbs; add bars or grips where necessary. If canes or walkers are needed take care of the issue.
• Talk to your parents, share your concerns with them. Open communication can go a long way towards taking care of these issues. It isn’t always easy to admit you need help. Therefore, be patient and understanding. Remember how important your independence is to you, it is just as important to them. Sometimes just knowing that someone cares and is paying attention can make all the difference.
• Encourage regular visits with health care professionals.
• Consider Home Health services. There are a number of very good services in Idaho that have experience serving the elderly while helping them to maintain their independence.
• Network with local agencies and support groups.

It is important to make sure your parents know of your sincere concerns and that you truly care for them. Quality of life is an important variable and they need to know that you are concerned about the same things they are.

Idaho Estate Planning is part of the Treasure Valley Care Planning Council, a non-profit network of elder care professionals available to provide information on the information discussed above and much more. Let us know your concerns and we will help you find the resources you need.

In addition to caring for your parents, it is also important to consider your own concerns for the future. How will you maintain your independence as you grow older? What effect would a costly health issue have on your quality of life? The more planning you do now the less difficulty there will be later. Good planning is no accident.

Call us today and let us help.

Idaho Estate Planning

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Hospice Care

Hospice Care

It is unfortunate that many people who died in a hospital emergency room or who received heroic treatments to prolong life in a hospital or nursing home may have had the alternative of dying at home in familiar surroundings, with family or other loved ones at their side.

Most often when it becomes apparent that there is really no hope for recovery, a family calls 911 and starts a process which can result in great stress and great emotional discomfort. The loved one who is dying ends up in a hospital or nursing home in a strange environment, frightened and confused and tied to tubes and monitoring devices. Given the option, this is not how most of us would choose to spend our last hours on earth.

Attending to a dying loved one in the peace and quiet of the home with caring family close at hand can be a comforting and even spiritual experience for all involved. Hospice can allow this to happen. Memories of a loved one passing in peace can provide great comfort for family members in years to come.

When there is no longer hope for prolonging life and especially when the decision is made months in advance, hospice is a viable alternative to other medical intervention.

Hospice care is a valuable service and is generally underused except for terminal cancer patients. Most families wait too long to have their doctor prescribe hospice from Medicare. Doctors or families don’t often consider this care alternative for Alzheimer’s, degenerative old age or other debilitating illnesses where a person is going downhill fast. They should.

Good Hospice Care:

• Manages the patient’s pain and symptoms
• Assists the patient with the emotional and psychosocial and spiritual aspects of dying
• Provides needed medications, medical supplies, and equipment
• Coaches the family on how to care for the patient
• Delivers special services like speech and physical therapy when needed
• Makes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time
• Provides bereavement care and counseling to surviving family and friends.

A person can receive hospice from Medicare if:

1. He or She is eligible for Medicare Part A (Hospital Insurance), and
2. The doctor and the hospice medical director certify that the person is terminally ill and probably has less than six months to live, and
3. The person or a family member signs a statement choosing hospice care instead of routine Medicare covered benefits for the terminal illness, and
4. Care is received from a Medicare-approved hospice program.

A person may continue to receive regular Medicare benefits from his or her customary doctors for conditions not related to the hospice condition.

Good planning is critical. Good planning leads to more options, more control and greater peace of mind. However, good planning is no accident. All of these decisions and options are best discussed well in advance. To secure your peace of mind as well as your family’s future, get started now.

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4 Steps of Long Term Care Planning Part II

Step 1-Knowledge & Preparation are the Keys to Success

This step requires an understanding of the variety living arrangements and different settings under which care is provided. In addition, understanding the provisions and limitations of government programs is essential because the public generally has a misconception that the government will step in and provide care when the time is needed.

Take time to investigate the options for short and long term care in your area. Knowledge of the choices available to you and the annual costs involved will make the steps that follow easier.

Government programs are limited and according to research by the National Care Planning Council, only 16% of all long term care services are provided by government programs. The other 84% is provided free of charge by family members, friends, charity, church groups or volunteers or paid for by private funds.

Step 2-Funding the Cost of Long Term Care

Much emphasis is being placed on purchasing long term care insurance or arranging for reverse mortgages in order to fund the cost of care. These can be useful tools for providing funding but in reality, this approach for planning is not working that well.

After 30 years of being touted as the ultimate solution, less than 2% of the American public and only 9% of seniors own long-term care insurance policies and using reverse mortgages may be a good strategy but in practice, few seniors are using them to pay for care.

Financial planning is an important part of being prepared for long term care if and when it becomes necessary. The scope of investment tools available to Americans has dramatically increased over the last few decades. Consult with an experienced professional to determine the best course of action.

Step 3-Using Long Term Care Professionals

Long term care services are complicated and provider contacts are fragmented throughout the community. For the majority of Americans, eldercare becomes a frustrating do-it-yourself process. This approach is unnecessary. Using care professionals is the most cost effective and efficient way to provide help for a loved one.

Those people who need help with long term care and use the services of professionals often find they save money over doing it themselves. They also reduce their stress and they free up a considerable amount of their personal time. Another benefit with using professional help, such as a care manager, elder law attorney or mediator, is to help you alleviate or avoid family conflicts that often arise as a result of caregiving.

Hiring professional advisers or providers to help with long term care is no different than using professionals to help with other complex issues such as investing, car repairs, dealing with taxes or legal problems. With their education and training, long term care professionals also bring experience that only comes from dealing with countless hands-on, caregiving challenges.

Step 4-A Written Plan that is Accepted by All Involved

The first three steps in the planning process are designed to give you a wealth of information about long term care. It is important for you to have an understanding of care systems and the resources you can turn to when the need arises. However, knowledge of long term care systems is not enough. You must take some tangible action now to prepare for the day when you will need to deal with eldercare for your loved ones or for yourself.

The final fourth step in the planning process is making a care plan. You need to prepare a written plan for you or a loved one. The challenge of dealing with long term care will unfold for you in a more manageable manner if you make a plan and put it in writing. You will experience less stress, have fewer costs, require less time committed and have fewer family conflicts.

At Idaho Estate Planning we have all the resources you need to put a plan together. We have the experience and expertise to help you maintain your options and protect yourself as well as your loved ones now and into the future. The best time to plan is always now!

Maintaining Control of Your Health Care Options

Being In Control
Perhaps the most important goal of any estate plan is to allow the client to maintain control. Most of our clients here at Idaho Estate Planning are very intent on “being in control” as long as possible. They want to make their own decisions about whether to go into a “facility” or stay in their house. (Usually the choice is to stay at home as long as possible.) However, the ability to be in control and stay at home is challenged constantly.

Some of the challenges to being in control consist of those disabilities we all fear:  Alzheimer’s disease, dementia, other mental challenges and numerous physical disabilities. The biggest question becomes, “How do I maintain control if I suffer one of these disabilities?” While these situations are varied (and extremely difficult), there are some basics that will allow you to exercise control, that is, allow you to voice your opinion is such a situation.

Durable Power of Attorney for Health Care
First and foremost, you need to execute a Durable Power of Attorney for Health Care. This is a legal document that allows you to personally choose who will make decisions or give instructions if you are not able to, whether from mental or physical disability. This is an extremely important document to have in your estate plan. It is, therefore, extremely important to carefully consider who you want giving instructions to health care providers on your behalf. Typically, this is a spouse.

But, if the spouse is unable to fulfill this responsibility, who will take over? This requires great thought and consideration. Who has the skill set to take on this responsibility? Who understands what you want to have happen? These are not easy decisions and should not be undertaken lightly.

Living Will
A Living Will is a form created by statute that allows you to express a preference if it is determined by two doctors that you are in a terminal state and being kept alive by artificial life support measures. The Living Will also applies if you are determined to be in a persistent vegetative state (some call this being “brain dead”). The Living Will allows you three basic choices: 1) to forego all life preserving efforts being applied whether artificial or natural; 2) to forego any life preserving efforts applied; or 3) only natural efforts applied including food or water or both. In reality, while these situations do occur, they are rare.

The POST
The Physician Orders for Scope of Treatment or “POST” is a more detailed legal document that allows you be very specific in how treatment, whether artificial or natural is applied to you. You can choose to forego intravenous feeding or the use of a feeding tube. You can choose to forego intubation to keep you breathing. You can choose to forego “aggressive methods” to preserve your life. Each of these is an option that you choose.

HIPAA
If your Living Will or POST is needed, it is your Health Care Agent as established in your Power of Attorney for Health Care who gives the instructions to the health care professionals. These documents, then, work together to help you maintain control of your own situation. One more document that makes all the others work better is the HIPAA release. This is an informational release in which you give the health care professionals permission to provide your health information to your Health Care Agent or other family members. In essence, the Power of Attorney allows your Health Care Agent to talk to the doctor. The HIPAA release allows your doctor to talk to your Health Care Agent.

These, then, are the minimum documents you need to make sure your wishes for health and medical care and end of life decisions are honored. Now is the time to address these concerns and plan for the most difficult of times. Once it starts raining (or hailing as it did yesterday), it’s a little late to start fixing the roof. Once you are incapacitated, it’s too late to do this planning.

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