Senior Spirit Newsletter

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More than 70 percent of adult Americans do not have any form of an estate plan legally filed, according to Good Morning America financial contributor, Mellody Hobson. Yet, the process of setting up an estate plan is actually less complicated than one may think. Seniors come from a generation where it was inappropriate to discuss money and death, and therefore, many adult children may find that their parents do not have the appropriate paperwork in place to manage their estates. Or, the senior may not have formal paperwork because they feel that they will just hand down their belongings to their children so there is no need for it.

What happens to an estate without an estate plan
Without an estate plan, decisions about an individual’s property, medical, and final arrangements will be made without input from the individual. Attending doctors or the hospital will make medical decisions, family members will decide on burial arrangements, and state law will dictate the distribution of assets. These considerations alone may be enough to convince a senior that now is the time to formally organize their wishes for the treatment of their medical care and property.

Becoming proactive toward estate planning
Getting started may feel overwhelming, but keeping it simple and enlisting professionals can help streamline the process and bring peace of mind for the whole family. The conversation about estate planning can be a tough one to start with a loved one, but one that is well worth it in the end because of the time and money it will save the estate and the family members who must sort out the details. Caring.com suggests these initial considerations for anyone who is looking at his or her estate:

• What are my assets and what is their approximate value?
• Which people or organizations do I want to have these assets, and do I wish to give them up during my lifetime or after my death?
• Who should manage these assets during my lifetime if I become unable to do so or after my death if management is needed?
• Who should make decisions about my medical care and finances if I cannot make them?
• After I die, do I want my remains to be donated, cremated, scattered, or buried?

These questions all guide an individual to begin to set up an estate plan. Estate planning is a process where an individual indicates in writing how his or her money and other property should be managed while he or she is alive and after death, and what should happen in the event that an individual becomes mentally incapable of making financial or health-related decisions.

The basic documents that experts recommend that an individual have in an estate plan are a will or a living trust, a durable power of attorney for finances and health care, and advanced medical directives. Depending on the complexity of the estate, other documents may be necessary. Ask professionals, such as an estate attorney, an elder law attorney, a financial planner, and a physician, for guidance with these documents if you are not sure.

A will and a living trust
A will is the most basic estate planning tool and may be all the planning that someone needs. It is a document that names one or more people to manage a person’s estate and declares specific transfer of property. It could be made public and go through probate. A living trust is a more common estate planning document these days. It allows people to control their own assets during their lifetimes and then change ownership of the property in the trust to a named trustee at the time of death. The property is not processed through probate or made public.

Family Education cites three basic reasons why people write wills or create trusts. They want to:

• Pass their assets on to their family members rather than let the government take over their assets.
• Keep peace in the family by identifying who gets what.
• Plan ahead for the costs of incapacity, including the care of their spouse.

Each state has laws regarding setting up wills and living trusts. MetLife has a booklet that helps guide people in creating a will. Download a copy of MetLife’s free booklet on “Estate Planning: understanding distribution of assets and estate taxes.”

Starting a conversation with a parent:
Opening up the conversation with parents about a will or a living trust can be difficult. Express appreciation for the lifetime of saving they have accomplished, and try these approaches: (sources: Family Education, MetLife):
• “You have saved wisely over the years and have many beautiful possessions. I really want to carry out your wishes for the future of all that you have accomplished, but I need to better understand them. Do you want to pass down property to the family? Do you want to be able to draw down money from your assets to help care for you and Mom?”
• Acknowledge that you fully understand that this is their money. Emphasize that advanced planning on their part means that they can keep control over what happens to the possessions they have spent a lifetime collecting. Your goal is to help them keep control – not relinquish it to the government or strangers in a courtroom.
• Stay focused on your parents’ concerns. This is about them, not your needs and wants. They may be worried that they will outlive their resources or that the kids will fight over the estate. They may be struggling with finding a fair way of dividing up what they’ll leave behind without causing problems between family members. Listen to what they are really concerned about and help them find resolution.
• If you feel they’re uncomfortable talking with you, ask them to see a financial planner who is an objective third party.

Power of attorney for finances
With power of attorney document, an individual names a trusted person to handle their financial matters if they become unable to handle them on their own. In the event that this document is not on file when a person becomes mentally incompetent, a judge will then appoint someone to manage the finances for them, even if the person appointed is unfamiliar with the individual or their money matters.

If your parent wants to appoint you as their power of attorney, they should inform you of their decision and share with you their financial situation and specific wishes.

Starting a conversation with a parent:
Protecting assets is the main focus here. Given the gravity of the topic – money – emotions can run high. Encourage your parent that it is in his or her best interest to appoint a person whose actions have shown that he or she can be trusted to manage your parent’s finances should something happen. This is an opportunity to assure that the money your parent has spent a lifetime accruing is in the best possible hands.

Advance medical care directives and power of attorney for health care
These documents are crucial when the individual is no longer capable of making decisions about life-prolonging treatments and medical care in a hospital, whether because of a lengthy illness or a sudden unexpected accident.

Advance medical directives specify your treatment wishes, such as a “do not resuscitate order”, tests, surgery, medication, and organ donation. This document clearly indicates which course of action the doctor, hospital and your appointed power of attorney for health care should take with regards to your health if you are unable to communicate that yourself.

The power of attorney for health care, or health care proxy, is someone that is named by the individual who is trusted by the individual to carry out the advance medical directives and to make medical related decisions that would align with the individual’s wishes should the advance medical directives not specifically cover that issue.

The person who is appointed as the power of attorney for health care should be very familiar with the wishes, any religious and cultural beliefs of the individual that could affect health care decisions. It is best to talk at length about all aspects of a potential medical crisis and the types of decisions that the individual would favor.

Starting a conversation with a parent:
Health care and medical conversations of this type are never easy because they focus on the realities of end-of-life. Assure your parent that you want them to be as comfortable as possible in the event of an illness or accident and that you have their best interest at heart. Communicate your willingness to abide by their wishes in the event that you are all faced with this situation.

General rules of thumb apply as an adult child approaches estate planning conversations with parents. Always include as many of your siblings or other appropriate family members as you can, so no one feels like they are being left out of the process. The family may appoint one person to discuss all these estate planning documents with the parents or decide that working as a group would be best.

Keep the discussion focused on how to protect the assets the parents have worked so hard to acquire and how to protect their wishes when their health and comfort is at risk. Ultimately, the goal of estate planning is to allow the individual to feel like they have more control over their assets and their health/medical planning than they did before the creation of documents. Legally that is true, so the approach taken with the senior parents should reflect just that. Once the documents are drawn up, they need to be reviewed and revisited periodically or when there has been a life-altering event, such as a death or divorce.

Make your parents and their goals and wishes the primary focus of every discussion and the estate planning will move forward and provide peace of mind for the whole family.

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Senior Spirit Newsletter

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The American Cancer Society notes that approximately 1 in 4 seniors over the age of 70 are dealing with some form of cancer or have dealt with a cancer in their lifetime. When trying to put together the cancer treatment and recovery puzzle, especially as a senior, rehabilitation is an important piece. Medical professionals agree that rehabilitation aids in successful cancer recovery and helps patients achieve their highest quality of life. The goal of rehabilitation for cancer patients is to obtain the best possible physical, social, psychological, and vocational functioning.

As advances in cancer treatments, such as chemotherapy and radiation, extend lives, cancer often becomes a chronic – rather than terminal – condition. As a result, patients need to perform ordinary activities so that they can care for themselves for long periods of time. Rehabilitation makes this need a reality.

To garner the most out of a cancer rehabilitation strategy, patients must communicate well with their doctors and the other professionals who are involved in their recoveries. Rehabilitative support is most effective when the patient and the medical professionals collaborate and work out a recovery plan. Senior patients may have other health issues that can further complicate rehab, so it is even more important for seniors to talk candidly with their doctors about their limitations.

The National Cancer Act of 1971 first recognized the implications of the rehabilitation approach on the effects of cancer. This legislation declared cancer rehabilitation to be significant on a person’s successful recovery, and it funded the development of training programs and research projects. In the 1970s, the National Cancer Institute (NCI) cancer-control program created and supported many models for cancer rehabilitation.

Surprisingly, there is still a lack of formal cancer rehabilitation protocol in the medical community. A 2008 study of 202 cancer patients at the Mayo Clinic showed that patients may not be receiving proper guidance to get appropriate rehabilitation. Researchers observed that 66 percent of cancer patients reported some kind of functional impairment, mostly with walking or balance. Only 6 percent of these patient deficiencies were documented in the patient’s medical chart by physicians, and only two of those patients received referrals to rehabilitation services.

Similarly, a 2008 Mayo Clinic study revealed that only 21 percent of 150 patients who were impaired by metastatic breast cancer received physical or occupational therapies for weakness, swelling, muscle scarring, or shoulder pain.

“We need to raise awareness of the functional problems that cancer patients experience, and our obligation to address them,” said Julia Rowland, director of the Office of Cancer Survivorship at NCI, noting that there are now 12 million cancer survivors in the United States.

Why the gap between treatment and rehab?
Medical experts believe that rehabilitation continues to be widely underused because oncologists do not routinely ask patients about their ability to perform everyday activities and Activities of Daily Living (ADLs), nor are they in the habit of ultimately referring cancer patients for rehab services.

Additionally, while insurance plans typically do not place a limit on a cancer patient’s doctor visits or tests, the plans will often restrict coverage for physical, speech, or occupational therapies.

What is rehabilitation for cancer patients?
Cancer rehabilitation focuses on the most common problems that patients experience after treatment. These include fatigue, pain, balance issues, muscle weakness, swelling in arms and legs, difficulty swallowing, numbness in the hands and feet, and any changes in cognitive condition. Seniors are more at risk for experiencing these problems, and a weakened condition can exacerbate other health issues.

The best approach is one that involves many professional specialties, essentially a rehabilitation team that supports the comprehensive rehabilitation plan. Initial assessments of impairments and disabilities are crucial data for establishing a baseline that professionals can then use to create a rehabilitation plan and goals that are most beneficial to the patient. A treatment plan initially emphasizes restoring independence with ADLs, mobility, cognition, and communication, and subsequently gets the individual back into the community and the workforce as required.

The following professionals typically play a role in the cancer rehab team:

Physicians – Consists of several specialties such as primary care physicians, surgeons, and radiation and medical oncologists.

Care coordinator/case manager – Assists in overall organization and management of the team. The initial evaluation of the patient is usually the responsibility of this professional. Care coordinators or case managers may be nurses, social workers, or professionals in rehab fields.

Oncology and/or rehabilitation nurse – Plays a large role in supporting the patient and the family throughout rehab. He or she is responsible for frequently assisting with the treatment regimen prescribed by the physical, occupational, or speech therapists. Nurses typically have the most contact with the patients and families and therefore are the most in tune with the family’s emotional and adjustment issues. Nurses are also responsible for skin care, bowel and bladder management, and patient and family education.

Social worker – Provides patients and families guidance about community resources, financial options, and lifestyle changes, and they encourage participation in treatment. Involvement varies depending on the patient’s situation and the medical institution.

Psychologist – Helps patients and families deal with the multitude of emotional and psychological issues related to having and dealing with cancer, its treatment, and any resulting disabilities.

Physical therapist – Evaluates the patient’s muscle strength, mobility, and joint range of motion (ROM). Physical therapists also prescribe therapeutic exercises to maintain or increase ROM, endurance, and mobility.

Occupational therapist – Evaluates and assists in increasing patient’s ability to perform tasks related to self care, including ADLs such as dressing, bathing, and meal preparation. Occupational therapists can evaluate home environments and recommend necessary modifications.

Dietitian – Works with patient and family to establish a proper and nutritious diet for ultimate recovery. A healthy diet is crucial in the patient’s ability to participate in a therapy program and is essential for radiation therapy and chemotherapy.

Speech therapist – Evaluates and treats communication insufficiencies, dysphagia, and cognitive dysfunction in cancer patients. Help to train patients to adapt to alternative means of speech and communication.

Vocational counselor – Helps patient adjust to how cancer and its treatment will affect employment. Performs an evaluation of the patient’s suitability for employment and for training, if necessary. Vocational counselors can serve as liaison between patients and their employers.

The healthcare team, patient, and family must develop rehabilitation goals that are realistic within the limitations of the patient’s illness, environment, and social support. Patients and family members are expected to be active participants in the rehabilitation process. Rehabilitation services must be available throughout all stages of illness, treatment, and recovery. Successful treatment plans are individualized to meet each patient’s unique and specific needs. For seniors, many times, that means the rehabilitation team may include other physicians who are addressing other health issues of the senior.

Communication among specialists on the team is a fundamental part of an effective plan. Because of the complexity, communication may not occur as quickly or smoothly as it should and can either delay or hinder the start of rehab all together. As the number of people involved on the team grows, the value of having an appointed leader on the rehab team becomes more essential to help coordinate the many kinds of rehab needed. The patient or the patient’s family may have to appoint one of the professionals as the designated leader.

Improvement to cancer rehab has arrived
“We don’t systematically screen for functional problems,” said Andrea Cheville, director of cancer programs in the department of physical medicine and rehabilitation at the Mayo Clinic. Therefore, medical professionals don’t often initially address cancer survivors’ issues that could benefit from rehabilitation. Opportunities for improvement are most significant when functional problems are attended to early on.

Research is just starting to document how much improvement potential exists when cancer patients are prescribed adequate rehabilitation.

Hospitals are also strengthening their efforts to provide patients with better rehabilitation. In fact, Johns Hopkins Medicine has even started a formal cancer rehab program.

“Although we did lots of cancer rehab in an informal way before, we’re offering more structured services and have arranged much more extensive training for staff,” said R. Samuel Mayer, Hopkins’s medical director of cancer rehabilitation. “Without exception, we’re seeing tremendous improvement among cancer patients who take advantage of these services.”

Four hospitals in Rhode Island have recently increased their offering of cancer rehabilitation services for patients. The Rehabilitation Institute of Chicago is introducing access to more formalized rehab for cancer survivors, and Allina, which operates 11 hospitals, is planning to do the same in Minnesota and Wisconsin.

Under guidance from therapists and specialist, patients can learn special exercises, practice walking or maintaining their balance, get deep massages that loosen scar tissue, and obtain devices that help with ordinary activities. That kind of help can mean the difference between surviving cancer and being able to return to work and live independently.

Seniors need to work closely with their assigned rehab team. Communicating often and honestly about the limitations they are experiencing will help create rehab that has the most advantages. Family members can act as advocates by sharing their observations and concerns with the rehab team.

Rehabilitation after cancer and its treatments is fundamental for improving physical, emotional, and psychological functions that were lost or compromised, and for creating the best possible long-term results and independence.

Here is the story of one patient’s cancer rehab experience: Vonda Jones, 41, was grateful that her oncologist referred her to a cancer rehab specialist after undergoing surgery, chemotherapy, and radiation for breast cancer. First, the rehabilitation specialists tackled the fatigue that would overcome Jones after going to the grocery store or taking a morning shower by helping her revise her schedule and prescribing low-impact exercises. Next, they helped her address range-of-motion problems that had developed during her treatment by having her lift a weighted broom handle repeatedly.

After getting advice about proper nutrition and additional therapies for balance issues, Jones didn’t feel so limited by side effects of her illness and treatments.

That was Jones’s goal. “I was so determined to not have this cancer be a major life change for me,” she said. “I’m a very active person at work, at church, and with my friends, and I wanted to have as much of a sense of normalcy as possible. And that’s what I’ve got.”

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http://alz.org/dm/Highlight_a_Researcher/email-Angela.htm

Please take a moment to read this note from an Alzheimer’s disease researcher. Dean M. Hartley, PhD, is Associate Professor of Neurological Sciences at Rush University Medical Center in Chicago. He wrote because he personally wanted to express his gratitude to Alzheimer’s Association donors, who help to make his important research possible.

I hope the note from this premier researcher underscores the wonderful difference that contributions make in our crucial fight against this devastating disease. I also hope Dr. Hartley’s note inspires you to demonstrate your support by sending a generous gift today. We’ll put your gift to work to help us accelerate even more vital research, and provide more critically important Alzheimer’s support services and programs.

Alzheimer’s prevalence is skyrocketing. Today it is estimated that someone develops Alzheimer’s every 69 seconds. In the time it takes you to read Dr. Hartley’s note, somebody will newly confront Alzheimer’s and need the comprehensive support and research leadership that only we can provide.

Researchers like Dr. Hartley count on the Alzheimer’s Association to provide them with the resources to continue their critical work to beat this terrible disease. What’s more, millions of families continue to look to us to provide them with the programs and services they need to comfort their loved ones with Alzheimer’s. Thank you for reading his letter and giving what you can.

Many thanks,

Angela Geiger
Chief Strategy Officer

Although life changes as we age, people who enjoy the company of pets rarely outgrow that trait. Most feel as they become senior citizens they don’t have the patience and energy to care for a young pet. Housebreaking dogs and keeping kittens out of trouble can be exhausting. But, adopting an older pet could be a great solution. In this scenario everyone wins! The human gets a companion and the senior pet gets a new home and a chance to live the remainder of their lives out of the shelter. They are housebroken, trained and calmer than the younger pets. Families with younger members typically desire younger pets, leaving the older ones behind – sometimes destined to live the rest of their lives in a cage or small run.

Studies have shown that not only do pet owners have a constant companion, but they are less lonely, more likely to exercise, derive satisfaction from owning the pet and have lower blood pressures. It also seems to stave off depression. Senior pet owners tend to feel self-sufficient and dependable when it comes to caring for their pet. Not to mention the unconditional love and attention bestowed upon them by the pets, regardless of the owner’s age or amount of gray hair they possess.

It appears that pet ownership among seniors also has some health benefits. Pets allow the individual to escape stress and concentrate on something other than their own health issues. A 1990 UCLA study showed that pet ownership could actually improve overall health and reduce the time seniors spend in a doctor’s office.

Pet ownership can serve as a conversation icebreaker for the senior, especially since pet owners are attracted to one another. Everyone loves to talk about their pets!

There is also the sad realization that younger pets could outlive their owners. Shelters are full of animals that find themselves in this predicament. Matching a senior pet with a senior human could minimize this problem. All the challenges of aging, aches and pains, lack of mobility, memory, hearing and sight loss, make the senior citizens sharply aware of what it is like to get older and makes them uniquely qualified to care for an aging pet. They can sympathize with their pet and go through the challenges together.

Several members of my family had dogs well into their senior years. In these cases, their spouses had passed and they were alone. They would tell me on more than one occasion that if it wasn’t for the pet needing something, they wouldn’t even get out of bed in the morning. The pet’s needs drove them to remain able-bodied and healthy and gave them something to care for. They enjoyed being needed during a time when their own families had moved on and were living their own lives.

Who would benefit from these relationships? In my opinion, both pet and owner would reap the rewards. It is definitely something to consider for the senior in your life.

A recent article on Alzheimer’s from the New York Times presented a unique perspective on living with and treating the disease. It talks about a nursing home called Beatitudes that offers a different approach for their residents. They are allowed to sleep, be bathed and dine whenever they want. They can eat whatever they want, even if would be considered unhealthy—even unlimited chocolate or an alcoholic nip at night! They provide pretty much anything that gives the patients comfort.

This seems counterintuitive with much of the information available on Alzheimer’s where structure and consistency are considered a necessary part of living with the disease. However, Beatitudes is actually following some of the latest science that suggests that creating positive emotional experiences diminishes distress and behavior problems. They encourage their patients to eat their favorite foods regardless of its health benefits, or lack thereof. They have found that comforting foods improve behavior and mood because they send messages they can still understand: “it feels good, therefore I must be in a place where I am loved.” They also go beyond food to create the positive emotional experiences by integrating other pleasurable activities, such as art, music, and exercise. In many cases the cumulative effect was a discontinuation of antipsychotic medications, which come with many side effects for the patients, and focused on medicines that relieve pain and depression.

As a professional caregiver, I found these techniques very interesting and valid, but perhaps somewhat impractical in a home setting. People function around schedules – its part of life. It would be very difficult, without a full staff, to cooperate with the whims of the Alzheimer’s patient completely. Food, dressing, bathing in the middle of the night would be hard on the caregivers. That being said, there is plenty of room for compromise. “Do you want your shower before you go to bed or first thing in the morning?” A change of menu to include the patient’s favorite foods(let them choose), flexibility on meal times, favorite clothes (patient’s choice), familiar activities from their past, favorite scents such as colognes and perfumes, cuddly stuffed animals –whatever brings them comfort, even if it seems insignificant or strange to you. Making them feel it’s their idea, even though you limit the choices to those that work with your lifestyle, could probably have the same comforting effect.

It seems that some of Beatitudes’ techniques could be integrated into the home setting. It takes creativity, imagination, flexibility and a different way of looking at Alzheimer’s care to make these a part of the day. But, I believe well worth the effort. A happy, less agitated and combative (perhaps less medicated) Alzheimer patient would make life easier and be good for everyone!