There is also a hierarchy among physicians, although they will often deny this.  Specialists are perceived better than family practice physicians with neurosurgeons and cardiothoracic surgeons residing at the top of the list. 

Doctors of Osteopathy (D.O.s) are seen at the bottom of the doctor hierarchy and were initially shunned by the medical doctors (MDs) as quacks and phonies as referenced by the article “Dubious Aspects of Osteopathy” by Stephen Barrett, M.D.  They have become increasingly more accepted as society moves towards preventive medicine and a more holistic approach to health care.

So what exactly is a Doctor of Osteopathy and what are the differences between a D.O. and an M.D.?

The practice of osteopathic medicine was founded in 1874 by a medical doctor (M.D.)named Dr. Andrew Taylor Still who was dissatisfied with the effectiveness of 19th century medicine.  He believed that many of the medications that were being prescribed were useless and that physicians should concentrate on wellness rather than illness.  His pioneered the concept of wellness and his practice also included the use of chiropractic principles, manipulation and “laying on of the hands” to promote diagnosis and healing.

Both types of physicians are licensed to practice medicine, write prescriptions and perform surgery.  Both require 4 years of undergraduate study in either pre-medicine or a related science.  Both require 4 additional years of medical training before being allowed to take their medical exams (which are comparably difficult but yet not quite the same).  Both a medical doctor and a doctor of osteopathy may elect to choose a specialty which would require between 2 and 6 years of additional training.

The difference between the two practices is really a differences in philosophy.  While medical doctors (which are based on allopathic medicine) evaluate the disease within their patient in terms of how it affects only certain parts of the body, the osteopathic doctor evaluates the disease within the body as a complex related network. 

The doctor of osteopathy also receives training in the muscular and skeletal systems and is more likely to use alternative medical approaches such as manipulation, meditation, laying on of the hands, and he may recommend consults with naturopaths and/or accupuncturists. 

Doctors of Osteopathy (D.O.s) are less likely to specialize than medical doctors (M.D.s) because their emphasis is on preventative care and of taking time with patients in order to assess their total health needs.  In saying this, I must also say that medical doctors are leaning towards preventative medicine much more now, as well. 

When choosing a physician for yourself or your loved one, you want to be aware that both types of practitioners are equally capable and qualified, so choose one that resonates with you.  For more information on finding a good physician, see “Finding a Good Doctor for Your Loved One.”

Osteopathy has evolved since then

Silently… I gathered the puzzles together. It’s a wrap up… packed my puzzles… said goodbye.

On the drive home… Mary’s video played over and over… tears rolled down.

Flashback: Introducing Mary to Memory Jogging Puzzles

As I laid a 6 piece puzzle on the table in front of Mary, I asked if she would like to work on a puzzle. She… nodded… wanted to do a puzzle.

Gradually, I separated the puzzle… laying the pieces around within her reach.

She eagerly picked up one piece, then another… turning… closely observing, each knob (tab).

Mary knew the pieces went together and tried in every way possible to fit knobs into place. She held the pieces in her hands and adjusted each on edge, flat… trying each opening.

After a bit, I tapped on the table saying it would be easier here and the pieces will stay together. She obediently put the pieces on the table and tried earnestly to find two that went together. (I didn’t rush her… I was pulled into her time).

Discovering a piece she liked… twisted and turned it… measuring each knob and her search began.

Her fingers moved slowly over the pieces, feeling their curves before they made their way into the puzzle.

Mary, like many others, tried to force the pieces into place.. Sometimes she would have the right piece, but couldn’t make it fit because it was on top of another piece (this is common). At this point, I would guide the piece into place… saying… it fits perfect. (When possible I gently guided with one finger… just a little nudge and it falls into place… showing her, you don’t have to force it)

Upon completion… You did a good job Mary… and she pointed for another puzzle.

As Mary started her 2nd puzzle, I moved across the table to observe her from a distance.

This time …she took the puzzle apart and laid the pieces around, just as I did. And then …began her routine.

Picking up one piece… analyzing every curve, then randomly picking up another. Testing each knob in open areas searching for that right fit.

This process was done in her hands not on the table. (I was thinking later perhaps she needed to get the pieces closer to see them clearly or maybe she just wanted to.)

She was extremely focused, not hurried… when she felt the pieces in her hands were correct, she would put them into the pieces on the table.

Every once in a while she would look up at me, not saying anything… her eyes told me… she wanted my help and her hands were stalled in place on the puzzle.

Each time… the piece(s) were correct, sometimes the angle was just a bit off and she couldn’t get it to fit, but she was never frustrated or anxious.

Each time she completed a puzzle… good job… it is perfect. You are great with puzzles!

Immediately… she would reach out for another puzzle… and we would go through the process again.

It took Mary about 7-10 minutes to put a 6 piece puzzle together. I don’t know if she was faster at the end… but her touch became softer placing the chunky pieces down and into place. I could actually see a visual change in her hands while placing pieces down… more relaxed. She handled the wood puzzles great and she was amazing.

On automatic, very intense… full concentration, never taking her eyes off the puzzle or pieces… except when she looked up at me.

After she completed all of the themes I asked if she had a favorite puzzle. Not responding right away, I thought perhaps she didn’t understand or hear me… then… she picked one up and said “this one”. (I had been with her an hour, heard nothing and no facial expression… her eyes were her voice).

Mary’s unique way…

Mary would discover two pieces that went together, by putting them together in her hands, then, laid them down on the table. Find two more pieces, put those together in her hands; tried to maneuver those two pieces (together) into the puzzle on the table. This is rather difficult… the wood pieces hang together making it easier.

She usually had the right pieces, knew where to put them… if she couldn’t put them into place… she would look up… my cue.

After several puzzles it appeared she was studying the picture more, by gliding her finger on the top surface of the knobs.

I was impressed with her focus… nothing distracted her… she was enjoying what she was doing… even though she was silent. Expressing only by her actions… pointing… wanting to do more.

Bingo was being played… in the same room. I kept asking if she wanted to stop and play bingo… shook her head no… pointed to another puzzle.

It was a challenge for her and she loved it. (Mary would have continued all day… none stop). She was experiencing success…

Doctors say that old habits are buried in our memories. That is why puzzles are beneficial exercises for Alzheimer’s and Dementia patients.

Karen Miller is the Owner/Developer of Memory Jogging Puzzles http://memoryjoggingpuzzles.com

These puzzles are specifically made for persons with Alzheimer’s Disease and other dementias.  On her website, Karen states:  

“Inspired by memories of yesterday… and my families frustrations
dealing with the lack of age appropriate activities for mother,
who had devastating strokes and dementia.

Knowing and observing her struggles gave me inside information and guidance
creating activities and games for you and your loved ones.
Proven to capture attention, improve memory, motivate and build confidence.”

Karen has kindly donated a puzzle to be given away to one of our readers.  To be considered for the drawing, simply make a comment on any one of our posts and you’ll automatically be entered.

For instance, when he visited me, he often brought a travel mug of coffee with him. As he continued drinking it throughout the morning, I asked him if he wouldn’t want some hot, fresh coffee. “No”, he replied “I’m used to drinking cold coffee” – this from a man of Swedish/Canadian decent, who always loved good coffee. As I questioned him further, I found that he didn’t know how to use the coffee maker and so only drank coffee if there happened to be some in the pot. Since he was living with my sister at that time, I assumed that she must have had some fancy espresso machine or something similar. I was wrong.

Another clue should have been his weight loss. He chalked it up to the stress of living with my sister and her four kids. In reality, he didn’t know how to prepare meals for himself when she was unavailable and so just didn’t eat.

When considering whether or not your loved-one needs extra help, look carefully at some of the following signs.

Are his or her clothes clean and well-kept. Has he forgotten to add a belt; has she forgotten to change out of her slippers and passes it off as “being comfortable” or is he or she wearing the same outfit over and over again?

Does your parent or loved one show signs of deteriorating hygiene such as body odor, bad breath, unkempt hair?

Is his/her home as tidy as it should be? Of course, as seniors age, their surroundings won’t be as neat as they once were, but they should still be clean. One woman I know was surprised to find tiny cockroaches scurrying to the corners when she opened her mother’s pantry. Her mother had formerly been what she called a “neat freak”. Changes in behavior are what matter most.

Speaking of pantrys, check the cupboards to see if there is a good supply of nutritional food items. You might also check the trash to see if any of them are being used. Look in the refrigerator and note the expiration dates on perishable food items. I once found a package of cold cuts that had expired 2 months previous.

Are the bills being paid? This is often difficult to assess because parents rarely wish to discuss their finances and it may require some detective work. One clue: if there are stacks of unopened envelopes on the desk, especially ones marked “overdue” or that have red outlines, this might be a concern. If available, glance through the checkbook.

Is your parent becoming socially isolated? Has he/she been attending church less frequently, avoiding social situations with excuses of fatigue or “other plans”? You parent may be fearful of driving or even fearful of being in a uncomfortable situation. Early dementia patients are especially prone to fears of socialization. Does she seem sad, anxious, confused ?

Are medications being taken correctly? This, too, is difficult to ascertain without some effort. Encourage the use of a compartmentalized medication container and then check to see if they are being taken each day at the correct times. I had thought my father had a good handle on his meds because he could tell me the name of each pill and what it was for but when I looked carefully, the medications were not always correctly placed and on some days, the medications were not taken at all!

Is there evidence of your parent falling prey to a phone or mail scam? My friend, Mindy, upon noticing her mother had numerous silver (colored) chains with crosses on them, commented to her mother on them. “O, they keep sending me those and I send them money, and they send more. Isn’t that nice??” My own father bought a roll of “un circulated, soon-to-be-retired” nickels for $250.00. They were not what they were advertised to be. (And he did this WHILE living with me on a day that I was working.)

Lastly, are there bruises on his/her body? Some medications, like Coumadin or other blood thinners can cause some bruising, but bruising can also be a sign of falls. Elders will often make excuses such as “O, I was working in the garden” and not admit to the falls.

It’s estimated that more than ten million senior citizens require some level of help in their daily living, ranging from simple chores to more complex caretaking.  Always be aware that while it may be time for your aging parent or loved one to receive some type of help, they will probably be too embarrassed to ask for it.  It’s up to us as loving children to begin to discuss and determine what those needs are.

My lawyer was scheduled to attend this court hearing with me and I was also surprised (although I shouldn’t have been) that my father’s lawyer also attended the proceedings.  While I have absolutely nothing against my father’s lawyer (she’s a lovely person and all elders should have their own representation in cases of guardianship and conservatorship), thoughts of  ”I wonder how much additional money this will cost my father’s estate” rang in my head.

You see, once upon a time, families were able to make decisions for their elders without requiring legal representation and all the hoopla and expense that goes with it.  But now, because of privacy laws and because of people taking advantage of our elders, durable powers of attorney for both health and financial affairs, guardianships and conservatorships are becoming more necessary.

My father’s conservatorship became necessary after his dementia increased and  he agreed to sell his lakeside home in Canada for $100,000.oo less than market value.  If you’ve followed this blog for any length of time, you may also remember that he bought a truck while I was at work and had it delivered and later that month called 911 because of concerns over the NASA astronauts in space.  But this conservatorship has cost his estate a few thousand dollars .  Even after his death, there remain legal expenses.

But I think what is really concerning me now is my mother.  As I wrote recently, she is having trouble receiving her social security payments since she has moved to Canada.  At first they told her, it was because they didn’t have her new banking information.  Just yesterday they told her that she doesn’t qualify because she moved out of the country!  I don’t believe that because both she and my father contributed to the social security system in the United States for over 40 years.  But…………..can I talk to them about it?  Nooooooooooooo.  Privacy laws will not allow it.  Please see my post on HIIPA laws  to read more about this.

So now some sort of power of attorney will be necessary  for one of my sisters or myself to help my mother figure this whole mess out.  Meanwhile, she receives no social security payments.  How much will THIS cost?  How much time will it take?  Because of my experiences with my father, I know the proper paperwork to file, but how many families do not?  How many families cannot afford to add yet another cost to their caregiving budget.

Even my own attorney said that this inability to help aging parents without legal paperwork is a waste of time, energy and money for all concerned. 

Something must change!

Many outsiders feel that caregiving for an aging parent or a spouse is a duty that is handed to you by way of relationship and that it is your obligation to fulfill it.  That is entirely untrue.  Even in the marriage vows the  ”in sickness and in health” part does not state that you must take on the role of caregiver, only that you will uphold your vow to continue to love, honor and cherish. 

Sometimes we forget that our psychological make-up is just as important as our physical make up.  For instance, I am just 5’2″ and weigh about 100 pounds.  No one would ever expect that I could easily work in profession where heavy lifting is involved.  There are times in the garden (many times) when I need help just planting a new tree!  But they might expect that I could be the caregiver of a family member  because I am a nurse.  This assumption might or might not have been true. 

In some families, the role of caregiving is thrust upon the child who seemingly has no connections to prevent them from providing care: a single person with no children.  I know of one caregiver whose siblings told her that it was time for her to do the caregiving because she had been running free all her life! 

Some questions that you should ask yourself before taking on the role of a caregiver (or continuing it) are:

• Am I a nuturer ? What in my life has shown me that I am?
• What is my primary motivation for accepting the role – family obligation, guilt, love, pressure?
• If I need help, is there help available close by and will I ask for it?
• Do I know my limits?  Is there money available for outside help to be called in if necessary?
• Are you able to set boundaries and keep them?
• Do I have my family to care for and how would they handle another person in the home?
• Is your home appropriate for the aging parent or relative? 
• If the home is not appropriate, can remodeling be done to make it so?
• Is there any unresolved anger towards the person for whom you will care ?
• Have you ever been sexually or physically abused by the care recipient?
• Are you physically healthy and strong enough ?
• Are there any special skills needed in caring for this person? If so, are they something you could learn?
• Can your care recipient contribute financially and if not, can you and/or your siblings contribute to their care?
• Are there enough support systems in your community to aid in your caregiving?

When considering whether or not to take on the responsibility of caregiving or to continue the role, the most important question to ask yourself  is what is the most loving choice for the care recipient, for you as  the caregiver and for the families involved?   Do not feel guilty about your decision if you choose a different path.  There are other ways to contribute.

I’m With You

Im standing on the bridge
Im waiting in the dark
I thought that you’d be here
by now
Ther’s nothing but the rain
no foot steps on the ground
Im listening but there’s
no sound

Isn’t anyone trying to find me
Won’t somebody come take me home

it’s a damn cold night
Trying to figure out this life
Won’t you take me by the hand
Take me somewhere new
I don’t know who you are but I
Im with you
Im with you

Im looking for a place
Im searching for a face
Is anybody here
I know

Cause nothing’s going right
And everything’s a mess
And no one likes to be
alone

Isn’t anyone trying to find me?
Won’t somebody come take me home?

It’s a damn cold night
Trying to figure out this life
Won’t you take me by the hand
Take me somewhere new?

I don’t know who you are
But I
Im with you
Im with you

Oh

Why is every thing so confusing?
Maybe Im just out of my mind

Yeah yeah yeah…

It’s a damn cold night
Trying to figure out this life
Won’t you take me by the hand
Take me somewhere new
I don’t Know Who You are
But I
Im with you
Im with you
Take me by the hand
Take me somewhere new
I don’t Know Who You are
But I
Im with you
Im with you

Take me by the hand
Take me somewhere new
I don’t Know Who You are
But I
Im with you
Im with you

Avril Lavigne

You may wonder why I would post a You Tube video and then the lyrics to one of Avril Lavigne’s songs, but I encourage you to reread the lyrics and think to yourself  ”Is this not how I feel on many days???”  There were many times when I was just waiting, hoping, praying…..that someone, ANYONE would come rescue me from caregiver hell, even for just a couple of hours.

This song and these lyrics were actually the subject of our lesson at church yesterday and I felt compelled to share part of the lesson with you.  I’m just going to take it in a different direction though and talk about the importance of spirituality in caregiving.

Spirituality means different things to different people.  To some it is simply the belief in a higher power; to some it is faith in the meaning of life and to others it is organized religion. 

Caregiving often causes a  disruption in  faith.  Caregivers can be faced with questions such as “Why me?”, “Why did this happen to my loved-one?”, “What value can my caregiving have?” or “What did I DO to deserve such misery”?  Caregivers can become confused about what to pray for…..and praying for help for themselves can cause guilt over not praying for their care recipient instead.  ( ”Who am I to be asking for help when my poor husband is suffering through this terrible disease?”)

Whether you are religious or not, you may be able to find faith in your existing beliefs about life and God if you become intentional about it.  Studies have shown that spiritual caregivers suffer from less stress and depression than non-spiritual caregivers.  Prayer can be very comforting and can bring a few moments solace and addressing your spiritual needs can help you grow as a person, find acceptance in the situation and find positives in the experience.

If you’re not yet a spiritual person, start by meditating.  Find a quiet spot at a time you won’t be interrupted and just BE.  Concentrate on your breathing and push the thoughts out of your brain. Begin with just 5 minutes and increase as your are able.  (There are many meditation tapes that can guide you and if you have an iPhone, there are some good meditation apps available.)  As you become more proficient, you can ask yourself a question before you begin meditating, for instance “what is the meaning in my role as a caregiver?”

If you are a spiritual person, you may find solace in taking time to pray, meditate or practice spiritual rituals.  You may want to speak to a trusted religious figure to help you to find meaning in your role.

In either case, focus on the positive.  It does no good to dwell on the negatives that can’t be changed. It will only cause more bitterness and anger to enter your heart.  Start a gratitude journal – at first, you might find little to write about but the more you consider (pray over) it, the more you will find to be thankful for.  Be intentional. Pray for growth, acceptance, learning opportunities, peace.  Pray that you are able to help your care recipient enjoy the remainder of their days as best they can.  Concentrate on the happy moments that appear unexpectedly.  Keep in mind how you will feel when they are not there with you.

My father was not a religious man when I was young; it was my mother who always took us to church and who was able to drag my father along on special occasions.  When he came to live with me, I had already begun to attend a church weekly and he began attending with me.  It wasn’t long before HE was the one who couldn’t wait for Sunday and it was probably him who kept me at church when there were times I just wanted to collapse.  On the night he died, our pastor was able to visit him in the hospital just hours before he passed.

Even if you have lost faith, reconnecting with a religious community can end up being a great source of comfort.  There are answers in the teachings of the Lord.  There is also a community of people who may be able to offer comfort, support………and maybe even respite care !  Be intentional in finding that comfort.

I like what Dr. Gerald Trigg wrote in the book “The Fearless Caregiver” by Gary Barg: “All of us who help others do so as wounded healers.  Our task is not easy, but it is needful.  We are at our best when we begin each day with gratitude, offering thanks for yet another day to receive and offer love.  It isn’t always easy; it IS always necessary – if those we care for - are to become better, and not bitter.”

Dr. Trigg……I’m with you.

It is often common to encounter a care recipient who doesn’t quite understand that you might like some time to yourself (okay, let’s face it; they are usually totally oblivious to that), and when the discussion of respite care comes up, the care recipient responds with some of the following objections: “No, I don’t want some stranger in MY house.” or “I don’t NEED a babysitter; I’ll be fine by myself.” or “I’ll just go with you and sit in the car.” or as my father offered “Now I’m going to have to supervise him while he uses my tools and he might get hurt!”  

This is where creative thinking comes into play.  Many agencies, such as Comfort Keepers and Senior Helpers understand this phenomena and offer caregivers who can provide light housekeeping, cooking or transportation.  

The first few times I left my father while I did errands, I left him with a “senior companion” – this is a person, usually a senior citizen who volunteers their time to sit with an elderly person and talk, play cards, watch a movie, etc.  Unfortunately, this companion didn’t work for my Dad. He felt insulted that he had to be cared for and irritated that he had “to entertain” the companion.

In another trial, I invited a lady to come over under the auspices that she wanted to learn to play Cribbage. My father loved to play cribbage and could do so until the last couple of weeks of his life.  This worked well at first but he soon figured out that when she came over, I left the house and he began to resent her visits and started calling her “the babysitter”.

So I decided to hire a “housekeeper”. Fortunately I had had one in the past when I was busy with my kids in school so it was not completely out of the ordinary.  This “housekeeper” swept the floor, put the dishes in the dishwasher, made my Dad a sandwich if he wished and generally just watched to make sure he stayed home and helped him up if he fell.  This way, my Dad could lie down and watch his TV or sit out on the patio and not feel compelled to “entertain” the caregiver.

I recently spoke to another lady (whose husband has Alzheimer’s)  who originally hired her caregiver “to help her in the garden”.  As she went back and forth from the house to the garden, the caregiver spent more and more time chatting with the husband and he became used to her being there.  The caregiver then began to bring her kids by to visit (to the absolute delite of the husband) and now she is an accepted (and paid caregiver) part of the family.  (This person was not hired from an agency, so bringing her children to the house was not against any rules.)

Other sneaky ways that you might get your loved one to accept a respite caregiver are to hire “a handyman”, an “errand-runner”, “a painter”, “a kitchen helper” , even an “exercise therapist”.  Keep in mind that it will probably take about a month for your care recipient to begin to be comfortable around their new respite caregiver and even if/when they do figure it out, the caregiver will have already been welcomed.

We’ve all heard about the benefits of exercise when you have diabetes. But, how much is enough, and what type is best?  These are frequent questions from patients who are trying to manage their blood sugar. 

The American Diabetes Association (ADA) recommends daily exercise. This can be difficult for many people to work into their schedule!  But it’s important because increased movement helps burn more glucose, reduces the amount of insulin or oral medication needed, maintains a healthy weight, lowers blood pressure, builds stronger bones and helps to manage stress.

.

Two types of exercise are recommended when developing a fitness program.  Aerobic exercise helps improve heart health and insulin sensitivity. Resistance training (weights) improves insulin sensitivity to about the same extent as aerobic exercise, but has added  benefits of increasing muscle mass, strengthening bones and increasing your body’s rate of metabolism. All of these things tend to decline with age, so resistance training is especially important in middle-aged and older adults (with or without diabetes).

Here are the ADA recommendations for exercise:

• Physical activity should consist of 150 minutes or more of moderate-intensity aerobic exercise (50-70% of maximum heart rate) and/or 90 minutes per week of vigorous aerobic activity (>70% of maximum heart rate).  This should be done no less than 3 days per week and no more than 2 consecutive days should pass without exercising. Calculate your target heart rate by subtracting your age from 220 and multiplying by the percentages above.
• Exercise more than 4 hours per week to achieve greater cardiovascular risk reduction
• Exercise more than 7 hours per week to achieve long-term maintenance of major weight loss (> 30 lbs)
• Resistance training 3 times a week unless your doctor says no. These exercises should target all major muscle groups.  Supervision by a qualified exercise professional is recommended when you start to make sure exercises are being done correctly and to reduce the risk of injury.

Exercise does not mean you have to go to a gym.  Exercise means “move more. Looking for some motivation? Here are 5 easy ways to get your exercise routine going:

• Many activities can be counted as exercise.  Housework, gardening, walking the dog, yard work, swimming and biking can all count as aerobic exercise.  Just make sure that whatever you choose gets your heart rate up and causes you to break a light sweat.
• Invest in some inexpensive elastic bands or hand weights to use for resistance training at home.
• Find a buddy to work out with…you’re less likely to skip your workout if someone is waiting for you to show up.
• Set small goals…success will keep you motivated and those small victories will add up to big rewards!
• Reward yourself for reaching your goals.

Choose activities you enjoy and try to vary your routine so you don’t get bored.

People living with diabetes should consult their physician prior to starting an exercise program to rule out any contraindications to increased physical activity. Conditions such as neuropathy or diabetes-related eye problems may make some types of exercise unwise.

Anna Garrett is a Doctor of Pharmacy who has extensive experience coaching and counseling people who are living with diabetes. She is also the president and founder of the National Association of Women in Health Care (www.nawhc.com).

It wasn’t until I began looking at them as a means of respite care placement for my father that I learned of their costs.  In my father’s case, the daily respite cost was $220 but the monthly cost would have been over $5000.00 for a semi-private room.  This rate did not include medications or transportation to medical appointments. (Rates seem to vary between $4000.00 and $7500.00 per month depending upon the residence.)   None of these facilities accepted Medi-Care and private insurances don’t cover such things.  A couple of them stated that if a person were 2 guarantee private payment for 3 years, then they would not “evict” the resident once their money was gone.  At that time, they would then accept Medicaid reimbursement. 

Recently I have read several articles about assisted living facilities being available mostly in areas of higher income.  In areas of lower income, rural areas and in areas where minorities live (and all 3 of these are equivalent to areas of lower mean income), there are less available assisted living facilities.

In a study at Brown University, a conclusion was made that hispanics would be more likely to use nursing homes than assisted living facilities because they at more likely to be at the lower end of the socio economic scale and did not have the money.  Because of lack of money, they were more likely to be placed in nursing homes with less than desirable facilities, receiving less than adequate care which sent them back to the hospital and began a downward spiral.

I think that another reason that there are fewer assisted living facilities in areas where hispanics live is that their culture has the tradition of elder care being handled by the adult children of the family in a home setting.  My best friend’s mother took care of both her mother and aunt in her home until she was physically unable to do so anymore.

Assisted living facilities vary tremendously; they can contain a myriad of amenities and consist of private apartments with a nurse on duty 24 hours a day or at the other end of the spectrum, they can be closer to a nursing home environment with semi-private areas that consist of 2 beds in a room with a television set.

Assisted living homes are not the right choice for everyone.  Unless a facility has a special unit  (and many are opting to include these), dementia patients should not be placed there.  Sometimes patients have medical conditions that are too complicated for this type of living arrangement, as well.

Nursing homes don’t have much variation.  In MY words, they are simply sad places where lonely people live out their final days. 

In between, there are skilled nursing facilities, but in most instances, these are temporary placements until the “patient” can either be returned home or to a more permanent placement in a different facility.

I’m concerned about what will happen when the aging population runs out of money to pay for these expensive assisted living homes.  At between $ 50,000 and $90,000 per year, who will be able to live there long?  Our elders were a little more prepared but I don’t believe that the baby boomer generation has prepared themselves well enough to be able to cover even a year of living there.  And now that many boomers are upside down on their mortgages, selling their home won’t help to pay for that care.  Not many of us have long term care insurance either. (And in reality, how can long term care insurance continue to exist when almost ALL of us will need it at some point?)

I also think that with health reform, more families are going to be responsible for the care of their elders.  Hospitals will discharge elder patients sooner and before they are able to care for themselves.  This is happening even now !  I literally had to beg that my father be admitted to help remove the 12 pounds of fluid that had accumulated in his legs due to congestive heart failure.  Sure…..they’ll put a defibrillator in an 86 year old man with dementia (because insurance will pay for THAT)  but when it comes to managing the care of that man post procedure, they’ll leave it to the family.   (And they won’t discuss end-of-life care…but that’s a whole other issue.)

Already, a big portion (17% of employees in south Florida, according to a recent study)* are having to leave the work force in order to care for their aging loved ones and another 15% have cut their hours. 

During the past year, as we have experienced a financial crisis, more family members are gathering together under one roof in order to make ends meet.  Do you think that we will return to the days of Leave it to Beaver and Father Knows Best where Moms become the caregivers for the family while Dads return to providing the financial contribution?