Are These Services for Older Adults Available in Your Community?

The following list was compiled by the Greater Detroit Area Health Council (GDAHC) for its policy paper entitled: "DESIRED CHARACTERISTICS OF A SYSTEM OF SERVICES FOR OLDER ADULTS."

These are services that a blue ribbon task force of experts on aging felt should be available in every community. Not every person will need every service, but every service will be needed by someone.

This blog post will list the Support Services that were identified.

SUPPORT SERVICES
housekeeping
laundry
food shopping
meal preparation and delivery
other chore services
home maintenance such as repairs, weatherization, painting, etc.
transportation
diversional and motivational activities
housing assistance
health screening, education, and health promotion services
information and referral
outreach
interpreter services
advocacy
security and crime prevention
companionship (visitation, attendant)
telephone reassurance
telephone technical assistance
emergencey response systems (e.g., Lifeline)
case management
preventive care (e.g., physical exams, immunizations, etc.)
adult education
employment
social work services
training in caregiving

A future post will present the GDAHC list of recommended Personal Care Services.

Bob Tell
Author, "Dementia-Diary, A Caregiver's Journal"
http://www.dementia-diary.com

WHAT SERVICES ARE ESSENTIAL FOR OLDER ADULTS

Believe it or not, it's been 24 years since the Greater Detroit Area Health Council (GDAHC) released its "DESIRED CHARACTERISTICS OF A SYSTEM OF SERVICES FOR OLDER ADULTS." GDAHC is a major coalition of consumers, purchasers, insurers, providers, and other stakeholders concerned with health care quality and cost.

24 years and the content is still relevant—in fact, with our ever increasing numbers of older adults, it may be even more relevant today than it was then. One wonders whether in the intervening years any community has actually succeeded (or has even tried) to put together a comprehensive palette of services such as were advocated in July, 1984. If you know of one, please let me know.

What are these services, you ask? I'll tell you in my next series of posts. Perhaps this can lead to a serious discussion of the content of this important (but neglected) position paper—and maybe even to some belated action by key decision makers. Stay tuned.

Bob Tell
Author, "Dementia-Diary, A Caregiver's Journal"
http://www.dementia-diary.com

What is a Health Maven?

To the right of this post you will see my Health Maven badge. Perhaps you are wondering what this means.

In these difficult economic times, it’s comforting to know there are medical and patient experts out there who care enough to answer health questions online for free. Dr. Geoff Rutledge, MD PhD, Wellsphere’s Chief Medical Information Officer, told reporters today about the new Health Maven Program, which connects volunteer doctors, psychologists, nurses, personal trainers, expert-patients and other experts with health seekers who are looking for answers. I am proud to be included in this special group. Anyone with access to the Internet can get their health questions and concerns answered quickly and at no cost at www.wellsphere.com/healthMaven.s.

Health mavens are carefully selected, knowledgeable, health experts who are committed to helping others live healthier, happier lives. Hundreds of Health Mavens have volunteered to join the program and answer questions, with new Mavens signing up every day. “We’re witnessing an incredible growth in the number of people using the Internet to find health information” said Wellsphere’s CEO Ron Gutman. According to an iCrossing research repot, for the first time in history people with health questions are more likely to turn to the Web for answers than to their doctor. “Recognizing this trend among our users, we assembled the world’s leading network of over 1,800 medical and patient experts to share their experiences and expertise with Wellsphere.com’s almost 3 million monthly visitors. We are humbled by the experience, expertise and genuine care these wonderful individuals share every day with people who come to Wellsphere looking for answers” said Gutman.

In addition to providing a wonderful service to people seeking answers to their health questions, the Health Maven program allows participating medical professionals and patient experts to broaden their impact by sharing their experiences and expertise with a much wider audience, and to get the recognition they deserve.

Bob Tell
Author, "Dementia-Diary, A Caregiver's Journal"
http://www.dementia-diary.com

HOW RISKY ARE PRE-NEED FUNERAL PLANS?

Not familiar with Pre-Need...or considering signing up for one? For a brief overview of Pre-Need, please read my archived post of July 18, 2008, with the title: IS “PRE-NEED” REALLY NEEDED?

As I point out in that article, there are times when such an arrangement can be useful. However, as I also point out, there are pitfalls to watch for. One of these pitfalls has to do with the financial strength of the funeral firm which is asking you for up front payment along with its contract.

Here's a pertinent quote from a Wall Street Journal article, "FBI INVESTIGATES FUNERAL CONTRACT COMPANY," published on November 12, 2008:

"The FBI is looking into alleged misconduct by a funeral contract company that guaranteed hundreds of millions of dollars of services to families before becoming insolvent…The FBI letter says the questionnaire is being mailed to funeral homes because it's impossible for agents to personally interview representatives from the "voluminous number of funeral homes" in the 19 states where the company had done business…In preneed funeral arrangements, customers pay for their funeral and burial services before their deaths. For example, a customer who bought a package of funeral services valued at $5,000 in 1995 would receive those same services upon his or her death in 2008, even if the value had risen to $8,500 with inflation. Under such arrangements, money for a prepaid funeral generally is placed in a trust account that bears interest."

Clearly, this will only work if the company remains in business. If it goes bankrupt before you or your family member needs the service, your money may be permanently lost. So the warning here is to make sure, to the best you are able, that the company wanting your business is likely to stay in business.

Admittedly, this is not always easy. But like all other transactions in the marketplace, the rule is Caveat Emptor: Let the buyer beware!

Bob Tell
Author, "Dementia-Diary, A Caregiver's Journal"
http://www.dementia-diary.com

Links of Love and Caring

First, I wish to thank my loyal readers for their comments and support. Sadly, the response has just been too few and far between to justify the time and effort involved in posting all the chapters from my book, Dementia Diary, here on this blog. For those wishing to read more, there is good news. There is a page on my website (http://www.dementia-diary.com) that provides a free download of additional chapters. And, of course, anyone may still buy a complete copy for themselves or as a gift for someone they love that might benefit from reading it.

It was an interesting experiment but, from now on, I am returning to posting more traditional articles.

For starters, here's a listing of helpful links from my website. All have been tested and are useful to dementia caregivers everywhere. If any of them don't work by clicking, copy and paste the URL into the address section of your browser. Give them a try:

1. Coping with Caregiving--Bob's Radio Interview:

http://www.wsradio.com/internet-talk-radio.cfm/shows/Coping-with-Caregiving/archives/date/selected/05-20-2006.html

2. Alzheimer's Association | Home:

http://www.alz.org/index.asp

3. MedlinePlus: Dementia:

http://www.nlm.nih.gov/medlineplus/dementia.html

4. Dementia Information Page: National Institute of Neurological Disorders and Stroke (NINDS)

http://www.ninds.nih.gov/disorders/dementias/dementia.htm

5. Minding Our Elders: Caregivers Share Their Personal Stories

http://www.mindingourelders.com/

6. Medicare Nursing Home Comparisons

http://www.medicare.gov/NHCompare/

7. ConsumerReports.org - Nursing home guide

http://www.consumerreports.org/cro/health-fitness/nursing-home-guide/0608_nursing-home-guide.htm

8. The American Geriatrics Society -Dementia

http://www.americangeriatrics.org/education/forum/dementia.shtml

9. Silver Planet

http://www.silverplanet.com/

10. Alzheimer's ideas

http://www.alzheimersideas.com/

If you know of other links that have helped you, please pass them along.

Bob Tell
Author, "Dementia-Diary, A Caregiver's Journal"
http://www.dementia-diary.com

Is This Important?

For the past month I've been posting copyrighted excerpts of my book, Dementia Diary, on this blog. As I said weeks ago, I hope that getting a taste of the book in this way will prompt more people to buy it (and many have)—but, more importantly, I want people to read it. I wrote it primarily to help caregivers cope with their own situations and I've been gratified by the hundreds of wonderful email comments I've received since my memoir was published. However, only two reader comments have been posted so far for the book excerpts on this blog, leading me to wonder whether anyone is reading these excerpts, and if this is something I should continue. So here's a test of whether this is important to you. If you are reading and enjoying these excerpts, please post a comment and let me know. If I don't receive substantial feedback during the coming week that these excerpts have a following, I will discontinue posting them. Of course, the entire book will continue to be available for purchase from on-line retailers. I hope to hear from you.

DYING TO SHOP

Here is the fourth excerpt from my memoir, "Dementia Diary, A Caregiver's Journal." Hope you enjoy it and return soon for future installments.

DYING TO SHOP

When Minnie and Sidney Sweet retired to Florida around 1970, he was in his mid 60’s and she in her late 50’s. They were young retirees. Sid sold his small manufacturing business, and the building housing it, for just enough money to promise a comfortable, if not opulent, lifestyle. So they took the plunge. They left their only son. They left their daughter-in-law, and their three grandchildren. They left siblings, cousins and lifelong friends, and they bought a condo in a Florida retirement village.

You know the kind. Two bedrooms. Two bathrooms. A living room leading to a Florida room (porch, to you) that looked out at the seventh hole. A small kitchen (who cooks? It’s cheaper to eat out with the Early Bird)—and insufficient closet space.

The community boasted a full time resort atmosphere complete with clubhouse, swimming pools, tennis courts, golf course, transit system, and security gate. And, of course, shuffleboard. The ubiquitous shuffleboard. The Sweets never looked back!

The stock market decline of the 1970’s took the glow off the carefree nature of their relocation. It was a disappointment for Sidney, and one that attacked his self-image as a provider and protector of his family. Even though he had no personal control over what was happening to the economy, nothing could convince him that their troubles weren’t his fault. For Minnie, it was a shock to her sense of security. Her verbal expressions of these feelings did little to help Sidney overcome his guilt feelings.

Still, the Sweets had enough money left, when combined with Social Security and Medicare, to maintain a modest but adequate existence. So they survived. Actually, they thrived. In spite of the economy, they soared. The years flew by. They joined every charitable organization they could find. So did all the other newcomers.

The Sweets were warm and affable people. They provided a happy home for me as a youngster and, after I married, a loving embrace for the new family that I was creating. It was not surprising that they made many new friends in Florida. People liked and respected them. Sidney’s sense of humor and his integrity were widely admired, and he was a role model that many aspired to imitate. This was especially true for his son. Minnie’s enthusiastic and outgoing nature attracted people to her like bears to honey. They played golf, went to meetings, played golf, enjoyed social events, played golf, had doctor appointments (of which there were many), played golf and, of course, they shopped.

Shopping, for most of us, is about meeting our basic needs and desires for food, clothing, gadgets and luxury items. For some people, however, it has other satisfactions and it fills other needs. It may be a social event with emotional overtones—or a way to fill time in an otherwise boring life—or even, for some, an addiction that brings cheer to an otherwise dreary disposition. This can be as true for snowbirds and retirees of the Sunbelt as it is for the rest of the population—maybe even truer.

Consider a typical day in the life of the Sweets. In the morning they’d shop for, say, a toaster oven. They’d buy one, take it home and plug it in. They’d then enjoy a nice lunch with slices of toast made in their new purchase. But there’d be a problem. The bread might be browning less evenly than expected. Maybe it would even be getting a little too dark and crisp along the edges. They wanted a perfect piece of toast, something that the new oven seemed incapable of producing. Too bad! They’d have to bring the toaster back. They’d return it to the store for a refund and then, of course, would proceed to buy something else that would probably have to be returned the next day. And so it went. Day after day after day. And the Sweets were joined in these daily shopping adventures by thousands of their contemporaries. One wonders how the retailers managed to stay in business.

If this description seems amusing, consider the other side of the story. Shopping can provide a brief escape from the preoccupation with death and disease that is the constant companion of the seniors that populate these retirement communities. Their adult children “up north” may still believe in the illusion of their own immortality, but our shoppers know better. And yet, these older Americans somehow manage to mix a laugh or two with the bad things that happen daily to their neighbors, friends, and to themselves. It’s how they cope with their reality.

A case in point: While there isn’t anything happy in the tragedy about to be described, there is a bit of the ironic. Something that may elicit a smile or two even as it evokes the tears. Here’s what happened. One day in 1990, Minnie and Sidney Sweet decided to go to a nearby Sears & Roebuck store. It was early and the store just opened. They entered the store and, as they walked toward the escalators, Sidney died. That’s right, he died. On the spot. One minute he was walking alongside Minnie and the next he was laying face down where he had pitched forward onto the floor. With no sound, no cry of pain, nothing. His complexion was grey, and he was gone.

Later, a doctor was to say it was a massive heart event, that Sidney had felt no discomfort and never knew what happened. The doctor said it was a good way to die, easy on the deceased, but hard on his loved ones. It was indeed very hard on his son (and I should know), but it was hardest on Minnie. Imagine her horror. She had spent all of her married life almost totally dependent on her husband. She didn’t drive (more about that at another time), was rarely separated from him, and drew her emotional strength and most of her identity from him. It was not an uncommon role for women of her generation.

Also, her dementia had started. Not that anyone close to her, or she herself, recognized that her exaggerated personality quirks and her growing memory lapses were due to illness. They were just “Minnie,” and what could you do? Perhaps Sidney knew something was amiss. Perhaps not. But without him to “cover” for her behavioral idiosyncrasies, she would become more and more exposed.

In any event, Minnie never really expected to have to face life without Sidney. Oh, she knew that they were getting into the dangerous years, and they had even talked about it. But that was an abstraction, not something that could really happen. Until that morning at Sears, when it did. And what a way to have to face it. Alone among strangers, in a department store, sudden death. A catastrophe. She screamed and cried and couldn’t be consoled. She was seventy-seven.

Why, you ask, were they in a Sears store that morning? You guessed it. They were returning a small rug they had purchased the day before for the floor of their bathroom. It didn’t look as nice as they had anticipated. Twelve years after the event, at eighty-nine, Minnie would smile when asked whether Sid died before or after they returned the rug, and whether they were able to get their refund. She would chuckle at the thought, but could not recall the answer. A year later, at ninety, she would struggle to remember who Sidney was—and she would ask the visitor to tell her how her husband died.

End of Chapter

If you'd like to buy a copy of the book, it's easy. Just click the "Buy Now" badge on the right, or the link to my website just above my Wellsphere photo. And feel free to post your comments below.

Bob Tell
Author, "Dementia-Diary, A Caregiver's Journal"
http://www.dementia-diary.com