Long-Distance Caregivers: Making the Most of Your Role

Kate is concerned about her mother, a recent widow who lives alone in Kate’s childhood home in Fairfax County. Although Kate lives in Massachusetts, she grew up in Northern Virginia and it’s where her mother feels most comfortable. Kate’s mother’s decline in health since her father died requires Kate’s help and attention, but due to her job, her husband’s job, and her son’s therapy appointments, she cannot relocate, but visits as often as possible. Kate is beginning to realize that caregiving at a distance presents very real challenges, and she’s beginning to wonder if she can truly be of enough help from afar.

Similar to Kate, approximately 76 million of us are baby boomers, many with parents who are approaching a time in their life that will require aid and assistance. Currently, an estimated 43.5 million Americans provide or manage care for a relative or friend 50+ years or older. And this number is growing every day. The good news is that with so many of us involved in care from a distance, there’s lots of ways to help.

There are many things that Kate, in our example, and others in similar situations can do as long-distance caregivers:

• Arrange for in-home care—hire professional caregivers or home health or nursing aides and help get needed durable medical equipment;
• Provide emotional support and occasional respite care for a primary caregiver, the person who takes on most of the everyday caregiving responsibilities;
• Serve as an information coordinator—research health problems or medicines, help navigate through a maze of new needs, and clarify insurance benefits and claims;
• Keep family and friends updated and informed;
• Create a plan and get paperwork in order in case of an emergency;
• Evaluate the house and make sure it’s safe for the older person’s needs;
• Help with finances, money management, or bill paying;
• Plan ahead and locate care in an assisted living facility or nursing home.

Keep in mind that over time, as your family member’s needs change, so will your role as long-distance caregiver.

How Can I Stay Connected from Far Away?

Even if you’re a long-distance caregiver, you can still stay connected to your loved one from far way. A good first step in doing so is to find people who live near your loved one, such as friends and neighbors, who can provide a realistic view of what is going on.

Many families schedule conference calls with doctors, or the assisted living facility team, or nursing home staff, so that several relatives can be in one conversation and get the same up-to-date information about health and progress.

You may also want to give the person you care for a cell phone (and make sure he or she knows how to use it). Or, if your family member lives in a nursing home, consider having a private phone line installed in his or her room. Program telephone numbers of doctors, friends, family members, and yourself into the phone, and provide a list of the speed-dial numbers to keep with the phone. Such simple strategies can be a lifeline. But try to be prepared should you find yourself inundated with calls from your parent.

Geriatric care managers (also called Aging Life Care Specialists) also may be able to support you in your role as a long-distance caregiver. Visit our trusted referrals of other senior-serving professionals for people who can help.

How can Long-Distance Caregivers Make the Most of Visits?

Getting assistance for when you can’t be there is helpful and provides peace of mind. But what about the times when you are around? How can long-distance caregivers make the most of their short, infrequent visits with loved ones?

First, talk to the care recipient ahead of time and find out what he or she would like to do during your visit.

Then, check with your loved one’s primary caregiver, if appropriate, to learn what he or she needs, such as handling some caregiving responsibilities while you are in town. This may help you set realistic goals for the visit.

Remember to actually spend time visiting with your family member. Try to make time to do things unrelated to being a caregiver, such as watching a movie, playing a game, or taking a drive. Finding time to do something simple and relaxing can help everyone—it can be fun and build family memories. And, try to let outside distractions wait until you are home again.

Where can I find resources for my family member?

Are you a long-distance caregiver? Searching online is a good way to start collecting resources. Here are a few potentially helpful places to look:

Eldercare Locator, 1-800-677-1116 (toll-free)
Family Caregiver Alliance: National Center on Caregiving
Handbook for Long-Distance Caregivers: An Essential Guide for Families and Friends Caring for Ill or elderly Loved Ones
The National Institute on Aging
So Far Away: Twenty Questions and Answers About Long-Distance Caregiving
AARP
Tips for Long distance Caregivers

When More Help is Needed

What happens when your loved one needs more help than you can provide? Nursing homes in Northern Virginia and the Washington, D.C. Metro area cost $10,000 – $14,000 per month (a few thousand less in the Fredericksburg, Virginia area), which can be catastrophic even for wealthy families. By being proactive and helping your loves ones plan for long term care in advance, you can help make sure your loved ones always receive the care they need without worry or financial struggle. You’ll further avoid many costly legal headaches that often result when people are not prepared for incapacity or ongoing care needs. It’s never too early or too late to get started. Reach out to us to make an appointment for a no-cost consultation:

Fairfax Elder Law: 703-691-1888
Fredericksburg Elder Law: 540-479-1435
Rockville Elder Law: 301-519-8041
DC Elder Law: 202-587-2797

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Help for Virginians victimized by student loan servicers

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Critter Corner: Exercise for Seniors with Dementia?

Dear Angel,

My mom has always been into fitness. Every day for years, she would take a mile walk in the morning around the lake. She was diagnosed with dementia a few years ago. I know she would love to continue to exercise. But, now I am afraid she will lose her way. What are some fitness activities that people with dementia can do to reap the benefits of exercise and stay safe? 

Inga Oodshape

—

Dear Inga,

It may not be easy to resume a safe exercise program with your mother who suffers from dementia. But by gradually working safe, simple and customizable fitness activities into her daily routine, the benefits will slowly build and accrue, for an overall enhancement to her well-being.

You are right that it is a good idea to find some exercises that your mother can do, while staying safe. Not only is exercise a good way to stay fit. Exercises for dementia have been proven to elevate the moods of persons with dementia, reducing the depression, anxiety, and aggression sufferers may experience.

One obvious option for your mother would be to have someone accompany her on her daily walk around the lake. Perhaps a friend, relative, or neighbor would like to get some exercise and welcome walking with your mom. If that is not feasible, then here are some suggested alternative exercises:

Stationary Bikes: These are helpful for cardiovascular fitness and a comfortable way to exercise. Recumbent bikes, which offer a lower seated profile, are especially convenient for this purpose and typically better for people any kind of back problems.

On-Property Walks: While it’s never a good idea to allow a person with dementia to wander, having them take walks around the yard is a great form of exercise. Just be sure to stay with them if they can access areas without a fence.

Tai Chi: This Chinese defensive martial art offers significant health benefits and greatly improves balance.

Water Exercise: The buoyancy of water makes it a great low-impact setting for exercises for dementia, while also providing the natural resistance needed to make muscle gains. Local area senior centers, the YMCA, the JCC, and private gyms often offer special programs for seniors.

Simple Strength Training: Your mother doesn’t necessarily need to lift weights, but some form of strength training is helpful to maintain ability and stave-off muscle atrophy. If small dumbbells are too much for her to lift, try using canned goods instead. Weight machines may also help, since they are relatively safe and simple to use, as opposed to free weights, which require constant supervision.

Gardening: Although it can be a fairly strenuous activity that provides good exercise, gardening is also both relaxing and stimulating. Fenced therapy gardens are especially helpful for dementia patients.

Low-Impact Aerobics: Both live classes and instructional videos can offer a wealth of aerobics routines, and this is a good activity for both the person with dementia and the caregiver to participate.

Dancing: This activity may offer both exercise and mental stimulation, while also providing a fun social setting. Senior centers and clubs often hold dances, as well as your local dance instruction studio. Again, this is an activity that both the dementia sufferer and caregiver can enjoy.

Hope some of these ideas help your mother continue to safely enjoy exercise!

Angel

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Fasting to Live Longer

Q. I am so blessed and have so much to live for: an amazing wife, two successful adult children, five grandchildren,  and a home on the beach in Florida that we visit frequently. I am aware that people are living longer these days. I want to do what I can to maximize my lifespan and keep my brain healthy. Are you aware of changes I can make in my diet to increase my longevity and keep my memory sharp for as long as possible? Thanks for your help!

A. Thank you for reaching out to me. I am so glad to hear about all of the blessings in your life, and can understand why you’d want to maximize your lifespan. My situation is almost identical to yours, except I have only 1 grandchild so far! But I also have 4 cats, so they count.

It’s true that we’re living longer these days. In fact, the average lifespan in the United States is 81.1 years for women, and 76.1 years for men. So, what can we need to do to enhance the length and quality of our lives even more? Researchers worldwide are pursuing various ideas, but for Mark P. Mattson, chief of the laboratory of neurosciences at the National Institute on Aging in Baltimore, the answer is a simple change in diet. Mattson and other researchers believe that the key to a better old age may be to reduce the amount of food on our plates or do what is called IF, which stands for Intermittent Fasting, an age-old practice that has recently been getting a lot of new buzz based on lots of new research being revealed about the benefits of this type of dietary practice. I first learned about this just about six months ago, when I watched a documentary about the topic that’s free on Amazon Prime; there’s also lots of free movies like this one on Youtube, and tons of information about IF on the internet, one of the best being this website by Dr. Jason Fung. Since watching and reading all this information, I’ve adopted an IF lifestyle using a 16/8 method – fasting from 8pm till 12 noon every day, which basically just means skipping breakfast. I even did a full 3-day fast and loved it – felt more energy than ever.

But back to the research. Mattson’s research and findings from others around the world has shown that fasting intermittently, or severely restricting calories on a periodic basis, may actually make us healthier and smarter than if we get the standard three square meals a day we’ve long been told are the road to optimal health.

To hopefully live long and without disease, consider these variations on the fasting diet that have been proven to have benefits for seniors (but, be sure to check with your doctor first!):

5:2 diet: This weekly plan has you eating just 500 to 600 calories on two nonconsecutive days and consuming a normal diet the rest of the week. Mattson has published two studies comparing the 5:2 diet with daily calorie restriction, and his findings were that overweight women on the 5:2 regimen tended to lose more belly fat and less muscle mass than those simply cutting their calories. However, they didn’t lose any more weight than normal dieters. Women following the diet also showed greater improvements in blood sugar regulation. Health benefits resulting from the 5:2 diet include weight loss, reduced insulin resistance and decreased inflammation. Blood lipids may also be improved.

Every-other-day diet. This is similar to the 5:2 regimen, but with the every-other-day diet, you choose high-fiber and high-protein foods for your fast-day meals to help to stave off hunger. Similar to those on the 5:2 diet, people on the every-other-day plan lose a higher percentage of fat and lower percentage of muscle than those on typical calorie restriction diets. They also show significant reductions in LDL (bad) cholesterol, blood pressure, insulin and triglycerides (blood fats).

Prolonged nighttime fasting. Also called time-restricted feeding, participants refrain from eating for at least 13 hours per day including overnight hours (16 hours is better and pretty simple, as I mentioned above). A 2016 study of more than 2,400 women, published in JAMA Oncology, found that prolonged nighttime fasting may have protected those with early stage breast cancer against recurrence. Women on this plan who fasted 13 or more hours per day not only reduced their risk of developing new tumors by 36 percent, they also slept longer and had improved blood sugar regulation.

A short fast: If you don’t eat for 10 to 12 hours, you begin to mobilize fat from your fat cells, which are converted to compounds called ketones. “Ketones are a really good thing for your brain,” Mattson says, pointing out that ketogenic diets are used for people with hard-to-treat epilepsy.  Even during short fasts, nerve cells are more active in the brain, researchers are finding. “Also, the cells in the brain respond adaptively to what may be considered the mild stress of not having food for an extended period of time,” Mattson says. “Brain cells do this by increasing their ability to cope with stress, he says: “And, we think, to resist age-related diseases like Alzheimer’s.”

Exercise/fasting: Another thing many don’t realize is that fasting mimics exercise in how it benefits the brain. In both exercise and fasting, the brain increases production of brain-derived neurotrophic factor (BDNF), a protein that encourages new brain cells to thrive. Several studies have shown that BDNF plays a critical role in learning and memory and that these levels decline in the human brain during aging. By boosting these levels through exercise or fasting, older adults can almost trick the brain into thinking it’s younger.

Eat Your Fruits and Vegetables

Whether or not you’re fasting intermittently, fruits and vegetables can help your brain. (But you may need to beware of lectins that are found in may fruits and veggies – we’ll cover the topic of lectins, and the lectin-avoidance diet, in an upcoming article.)

Studies show brain benefits in people who eat berries. In addition, berries not only fight free radicals – they can also combat cholesterol. And, berries have a lot of soluble fiber.

Not fond of berries? Brightly colored cabbage also has the same brain-healthy phytonutrients. The cheapest, more available and most convenient source of the compound is purple and red cabbage, such as in coleslaw. It lasts for a week in the fridge. It makes a nice, delightful crunch, and with color as an addition to any meal. Cabbage has the most antioxidants per dollar, beating out things like acai berries and other superfoods.

Mattson suggests that plants containing chemicals with bitter or hot tastes – such as caffeine (see our recent article on the alleged benefits of coffee), or chemicals in vegetables like broccoli, or curcumin (in the curry spice turmeric) – may also help build brain resilience.

Just as you should ask your doctor or a nutritionist before you decide to fast to stave off disease and maximize your health and longevity, it is crucial to contact your lawyer to plan for your future and for the future of your loved ones. Our firm is dedicated to helping protect seniors and their loved ones by preserving dignity, quality of life, and financial security. As always, if you have not done Long-Term Care Planning or Estate Planning, or had your older documents reviewed in the past several years (or if you have a loved one who is nearing the need for long-term care or already receiving long-term care), please call us as soon as possible to make an appointment for a no-cost initial consultation:

Fairfax Elder Law Attorney: 703-691-1888
Fredericksburg Elder Law Attorney: 540-479-1435
Rockville Elder Law Attorney: 301-519-8041
DC Elder Law Attorney: 202-587-2797

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VPLC’s 2018 General Assembly Session Legislative Priorities.

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The Secret to Well-Being for Seniors?

Ellie has become increasingly lonely since her husband passed away, and it was beginning to take a toll on her well-being. She began questioning the meaning of life and became depressed. She also found herself to be increasingly unfocused and began forgetting things easily. These symptoms were impacting her life, until a neighbor helped her discover mindfulness, which turned things around for her.

Mindfulness (sometimes also called mindfulness meditation) is gaining tremendous popularity these days, and it’s the subject of many books, articles, and studies. Despite all the hype, research clearly indicates that mindfulness really does have a positive impact on well-being, especially when it comes to seniors.

Mindfulness can be defined as a therapeutic practice where people are encouraged to be fully in the present moment, and it’s often used as a way of managing and accepting thoughts and feelings. The idea behind mindfulness is to pay attention to your thoughts, feelings, and bodily sensations calmly and without judgement. Mindfulness is based on traditional Buddhist meditation practices, and it also incorporates a variety of techniques such as controlled breathing, as well as body awareness activities, such as tai chi and yoga.

The Benefits of Mindfulness

There is strong evidence to suggest that practicing mindfulness can improve people’s emotional and physical well-being. It is being used to help ease stress, depression, anxiety, and chronic pain, as well as improving concentration. Seniors are perfect candidates for mindfulness-based interventions for many reasons, including the following:

1. It decreases loneliness: For many seniors, similar to Ellie in our example, loneliness becomes an increasing problem as loved ones pass on and children move away to live their own lives. Mindfulness and other types of meditation have been found to help decrease loneliness. In fact, a UCLA study found that seniors who engaged in a simple eight week meditation program significantly decreased rates of self-reported loneliness.

2. It offers treatment options with less reliance on medication: Since physicians typically rely on medication to treat physical and mental illness, the elderly often experience side-affects such as drowsiness and imbalance. For many, dependence on drugs develops. As a consequence, more and more older people are turning to non-pharmacological treatments, and mindfulness is a good option.

3. It helps stave off health problems: As people age, their system increasingly wears down, even if they are in fairly good health. This “wearing down” almost inevitably leads to physical health problems and, in many cases, to psychological issues. Typical problems and issues are heart disease, asthma, depression, and anxiety. A study in the Journal of Social Behavior and Personality reportedly found that seniors who practiced meditation were less likely to fall ill and had significantly fewer hospitalizations. According to the study, the meditation group’s five-year cumulative payments to physicians for medical care was 70% less than the non-meditating control group.

4. It can be taught in senior communities: It’s never too late to learn to practice mindfulness. A study in the journal Geriatric Nursing indicated that teaching mindfulness meditation and related techniques in senior communities can help improve resident health and feelings of connectedness.

5. It provides purpose: As people age, they tend to become more reflective and questioning about their life. As they review their life and its meaning, they may become depressed, suffer from anxiety, or adopt an “I don’t care anymore” attitude. The emphasis during mindfulness practice on paying attention, on purpose, in the present moment, non-judgmentally, may ease these conditions.

6. It may slow Alzheimer’s: A double-blind study performed at Beth Israel Deaconess Medical Center indicates that meditation and breathing exercises may slow the progression of Alzheimer’s disease. Researchers believe that this may work by protecting the brain against anxiety and stress, both of which are believed to worsen Alzheimer’s symptoms.

7. It improves longevity: A study published in the Journal of Personality and Social Psychology suggests that there is evidence that senior practitioners of mindfulness meditation experienced improved longevity. Meditation may improve longevity by preventing cellular aging, a possibility highlighted in a National Institute of Health study.

8. Caregivers can benefit too: Another UCLA study looked at caregivers of Alzheimer’s and dementia patients and found that caregivers who engage in “in a brief, simple daily meditation reduced the stress levels of people who care for those stricken by Alzheimer’s and [other types of] dementia.” Researchers added, “psycho-social interventions like meditation reduce the adverse effects of caregiver stress on physical and mental health.”

9. It’s empowering: Many older adults find themselves in nursing homes or in stay-at-home situations where they have little involvement in decision-making. They are told what to do and when to do it. As a result, they become disengaged in what goes on around them. This is especially true if they were strongly involved in decision-making when they were a parent or working. Mindfulness training by contrast is empowering. It concentrates on abilities rather than worries.

Ways To Work More Mindfulness Into Your Life

When you envision mindfulness, you may think of meditation sessions in which you sit cross-legged on a cushion. But, there is so much more the mindfulness than that! In fact, hobbies and activities that you enjoy can be forms of meditation.

If you don’t want to meditate or find it difficult, you can benefit by working mindfulness into your daily life. For instance, when you become so involved in an activity — such a gardening, painting, yoga, running, or being in nature — that you lose track of time and aren’t thinking about your to-do list, you’re essentially engaged in light meditation. Getting lost in a hobby is an excellent way to be present and mindful.

You don’t have to make drastic changes in order to be more mindful, you can begin in small ways. Here are some suggestions:

Chew your food: Sit down at a table and enjoy your meal. Slow down and be aware of sensations while you eat; turn off all gadgets and think consciously about what you’re eating, how it got to your plate, and how it nourishes your body. Not only will this reduce the indigestion you might get from scarfing down a plate that you barely tasted, but it will also allow you to actually appreciate your meal mindfully.

Breathe deeply: Slowing down and becoming conscious of your breathing not only lowers the heart rate, improves posture, and increases energy, but it calms your nervous system. Your breath is always with you and is a simple way of being present and mindful anywhere.

Notice the good in your life: No matter what’s going on in your life, there’s always good to be found, even if it’s something as small as the sun shining or a bloom on your favorite plant. There was good in your past, there’s good in the present, and there will be good in your future. You just have to take the time to notice it.

Don’t be afraid to say no: Make your happiness a priority. Stay aware when making decisions and conscious of the reasons behind those decisions.

Find a hobby that you love: Everybody already practices mindfulness sometimes, even if they don’t know it. As explained above, when you become so involved in an activity that you lose track of time and aren’t worrying about your bills or shopping list, you are “in-the-moment.” A truly engrossing hobby can focus your attention on the task at hand and bring a sense of calm. This can happen while gardening, knitting, reading, painting, cooking, exercising, or whatever you enjoy doing. And hey – if you happen to like painting (whether or not you’re any good at it) and/or sipping fine Italian wine, please come spend some quality time with me and Jeannie and other Farr Law Firm team members at our Painting with a Purpose event on Sunday, January 21, 2018, to benefit ROSE, a non-profit that I founded to help seniors. This event is NOT a serious art class, but is intended for you to RELAX, HAVE FUN, sip great wine, and actually leave with an AWESOME piece of artwork (regardless of your painting ability or lack thereof — Jeannie and I struggle with stick figures)!

Anyway, after a while, being mindful becomes a way of life, and it can change your life for the better. Practicing mindfulness can help bring the body and mind to a better place. It may not take away pain, depression, or loneliness tomorrow, but it can give you excellent coping strategies and increased awareness of what modifies these symptoms. Remember, as you are finding ways to help with your body, one of the greatest ways to gain peace of mind comes with planning for your future and for your loved ones. If you haven’t yet done your living trust estate planning, if you don’t have a comprehensive power of attorney with asset protection powers, or if a loved one is nearing the need for nursing home care, please call us at one of the numbers below to make an appointment for an initial no-cost consultation, or sign up for one of our upcoming seminars:

Fairfax Elder Law: 703-691-1888
Fredericksburg Elder Law: 540-479-1435
Rockville Elder Law: 301-519-8041
DC Elder Law: 202-587-2797

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Access to health coverage matters!

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Don’t get rid of mobile home parks—make them better!

Three hundred people in Manassas almost became homeless because of a faulty sewer system earlier this year.  Almost all of them were homeowners, and none of them had caused the sewer system problem or were responsible for fixing it.  And, had the City of Manassas taken the action they’d threatened to take, most of these three hundred people would have lost their homes.

Fortunately, these homes were saved when Catholics for Housing, a Northern Virginia nonprofit group, purchased the mobile home park where they lived.  But for more than a year, the residents of East End Mobile Home Park lived in fear of eviction.  In August 2016, after years of trying to get the park owner to fix the sewer problems, the City notified East End residents that they had contracted to purchase the park and were going to close it.  All the residents were given until February 2017 to leave.  After a number of other potential buyers appeared and disappeared, Catholics for Housing came forward to purchase the park, fix the sewer system and keep the community intact.

The events at East End Mobile Home Park illustrate the risks of mobile home park living, but for many low -income Virginians, the benefits outweigh the risks.  According to a 2016 study of mobile home communities in the Richmond Metropolitan region, the median monthly housing cost for families living in manufactured housing is nearly $400 less than all other homes in the region.  And the median purchase price of a manufactured home is even more affordable at just $26,000.

Equally as important as affordability is the sense of community that living in a manufactured home park provides.  For seniors living on fixed incomes, this would be an ideal combination if not for the risk of being displaced when the park is sold to someone wanting to convert the property to another use.  Manufactured home park residents in fourteen states have figured out how to have the benefits without the risk by collectively purchasing the parks in which they live.  In Florida, more than 700 of the state’s 5,000 manufactured home parks are resident owned, mostly by seniors, and most of them are luxurious in comparison to the average manufactured home park in Virginia, where none of the parks are resident owned.  In fact, according to a retired economics professor living there, Florida’s resident owned parks “can be thought of as gated communities for people who aren’t so wealthy.”  Resident owned parks in other states also compare favorably to parks owned by non-residents.

There are a number of things the Virginia General Assembly could do to encourage resident ownership of manufactured home parks, and to improve the conditions of parks that are owned by non-residents.  If state law were to require manufactured park owners to give advance notice to residents, or nonprofits acting on their behalf, when they are about to put a park up for sale, these residents would have time to organize and obtain financing to purchase the park if they chose to do so.  And if the law governing the rights and responsibilities of park owners and residents were made applicable to more parks, localities and residents would be able to enforce a park owner’s responsibility to provide clean, safe water and electricity to residents.  Currently, parks with fewer than ten manufactured homes aren’t covered by state law.   Not surprisingly, a study found that the parks in the worst condition were those with fewer than ten homes.

These improvements in the law governing manufactured home parks would benefit everyone involved.  By creating clearer pathways to resident ownership of manufactured home parks and broader applicability of safety laws for parks owned by non-residents, the General Assembly could help transform Virginia’s aging manufactured home communities into safe, thriving, affordable neighborhoods.

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All payday lenders should follow the law

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Your Mother’s Nursing Home Not Treating Her Right? Who Do You Call?

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