Selecting In-Home Caregivers

Marion is in her 90’s. She lives alone, but is across the street from her son and his wife. Her children have hired many caregivers for Marion. However, Marion is never invited to interview or choose her caregivers. So, the result has been that Marion often goes without care because she frequently dislikes who has been selected to care for her and usually fires the person or drives them away with menial tasks unrelated to caregiving (i.e. pulling weeds). This has left Marion in an unsafe situation - without regular care.

Once when Marion was chosen a caregiver she got along well with, the benefits of good communication were obvious. Because Marion was instructing the caregiver in what she wanted and needed done, Marion was happier and more responsive during visits. The caregiver made sure she got up and dressed every day (as opposed to sleeping in bed all day in pajamas). She helped Marion to look presentable, even helping her to dye her hair red. Marion was eating regular meals, looking healthier and feeling better. She boasted how good it felt to have her back scrubbed during her bath. She stopped falling trying to use the restroom during the night (perhaps because she did not sleep all day, she had more opportunities to go during the day.) This caregiver contentedly worked with Marion for over a year until Marion’s son cut her hours back and she was forced to move on.

The lack of communication between Marion and her children has been a losing situation for Marion’s health and wellbeing. Marion does not communicate her wishes to her children because she feels they do not care (likely because she is never included in the decision making). Marion does communicate her concerns to her grandchildren, but they have no control over the finances, Medicaid, or care giving decisions.

As in-home care is highly personalized, communication is key. If a senior is of mental clarity and can communicate for herself, this is ideal. This gives the senior a voice and a decision in the administering of her own care. However, when family members step in and make decisions without the senior’s input or consideration, as Marion’s family did, this is highly destructive to the senior’s sense of independence, as well as the quality of care she receives.

A properly placed caregiver, sensitive to the client’s personal needs, would ensure better care and a greater longevity of caregivers. Simply working in firms that had high turnover rates, one gets a glimpse of the stress that training new people or adjusting to changes in staff creates. I cannot begin to imagine how just how stressful it would be to add a turnover in caregivers to dealing with one’s own personal disabilities or unattended needs. It cannot be healthy for seniors to deal with such turnover, which makes the initial proper placement such a vital step in the care giving process.

Benefits of In-Home Care
• Significant financial savings to seniors and Medicaid
• Staying in one’s own home is generally preferable to entering a retirement community.
• People tend not feel sick if they are cared for at home.
• People are able to maintain some forms of independence, as they address some of their own needs themselves or by delegating difficult tasks to an in-home caregiver.
• Seniors do not have to lose the community they have grown comfortable with.


All content © Village Memorial. 2009-2010.

Dial-a-Ride Requires Good Communication

Dial-a-Ride is just a phone call and short wait away from safe and reliable transportation service for many seniors who cannot drive. However, using dial-a-ride services depends on good communication by both parties. Seniors who call must be able to hear well and speak clearly. They must be able to remember addresses and names of locations of where they are traveling to and be able to communicate that information when asked. Operators and drivers for the dial-a-ride service must be able to listen patiently and speak clearly to seniors in order to ensure destinations and pick up locations are accurate.

A good senior friend, Marie, never drove anywhere, but depended on Dial-a-Ride for many years to run errands safely. She lived in LA County where public transportation was scarce and less reliable. Once when Marie called to be picked up and Dial-a-Ride recorded an incorrect address, she got mugged while waiting outside of a store. Her purse was snatched and she suffered a broken hip and wrist from hitting pavement when the mugger knocked her down. Had the communication between Marie and the dial-a-ride operator been better, perhaps Marie would not have suffered such a misfortune.

From what I was able to find through a quick search online, Dial-a-ride is available in many cities, counties and states throughout the US including: California (multiple cities), Phoenix, AZ., Illinois (multiple cities), Minnesota (multiple cities), Michigan (multiple cities), Florida (Charlotte County), New York (Tioga County), Fort Collins, CO, Oregon (multiple cities), Richland, WA, and many more.

Each city’s Dial-a-Ride has different restrictions, rules, operating hours and fees to use the service.

In Los Angeles, the ride for seniors and those with disabilities is only $0.75 one-way. Dial-a-Ride service runs 7 days a week. People do not have to pre-qualify or pre-register to use LA Dial-a-Ride services.
LA’s “Public Works provides dial-a-ride (paratransit) services that consist of curb-to-curb, demand response, dialaride services. Most of these are for the elderly and persons with disabilities who reside in unincorporated County areas…In most areas, Public Works provides these services by contracting with adjacent cities to include unincorporated County areas in the city's paratransit service.” (LAcounty.gov, 2009).

Bend, Oregon asks for an application to prove eligibility prior to service, and calling a day ahead to schedule a pick up. Bend’s Dial-a-Ride “provides service to low income seniors not living near a fixed Bend Area Transit (BAT) route” (City of Bend Oregon Website, 2009).

The Wilsonville “Dial-a-Ride is a SMART service providing curb-to-curb transportation for Wilsonville residents who are unable to use the fixed route service. Priority is given to Americans with Disabilities Act (ADA) eligible customers… Eligibility to qualify for ADA level service must be certified by a medical professional” (RideSmart.com, 2009).

References:
LA County Dial-a-Ride: http://ladpw.org/PDD/Transit/Page_01.cfm

Bend, Oregon Dial-aRide: http://www.ci.bend.or.us/bend_area_transit/dial_a_ride/index.html

Wilsonville, Oregon Dial-a-Ride: http://www.ridesmart.com/Index.aspx?page=23

All content © Village Memorial. 2009-2010.

Transitions: Retirement

Retirement is a difficult transition for seniors to adjust to. It is a stage of life in which most aspects of an individual’s life change. Income, social networks, social status, time management and sense of utility or purpose all change (Donovan, 2008). Thus, the transition into retirement requires personal adjustments on multiple levels.

According to retirement coach, Donovan (2008), the five main benefits one obtains through full time work: the paycheck, time management, sense of utility or purpose, status, socialization, are essential to recreate after retirement. “Part of the planning for a vital retirement involves finding replacements for each of these five benefits” (Donovan, 2008). Also affecting the adjustment into retirement life are “activities with friends and family, feelings about rest and tranquility, and activities that fill up free time” (Nussbaum, et. al., 2000, p. 123).

The unique part about retirement as a stage of life is that it lacks the vital elements and expectations that provide fulfillment during the other stages of life. According to Walker (1999):

Youth, adulthood, and old age fit us for the school, the workplace and retirement...But retirement, unlike school and workplace is not a place. It is not an activity like education or work, nor a role defined by the development of skills or exercise of competence, like that of a student or worker. Retirement is defined instead as the cessation of the adult role of worker (p.104).

Retirement is not a destination nor is it an achievement on its own. The cessation of expectations for growing, learning and working into later life can have negative effects on individuals.

As Bartky (1999) explains, “I have seen the effects of professional obsolescence on older men in my profession” (p. 63). When her dissertation adviser retired she says, “he died shortly after” (Bartky, 1999, p. 63).

As seniors transition into retirement, one must consider the “importance of an individual’s social network” (Nussbaum, et. al., 2000, p. 117). The people whom the individual feels close to or comfortable around during his working years are the same people he will wish to spend time with during retirement and this can be a problem “for elderly people, whose close social network may no longer be living” (Nussbaum, et. al., 2000, p. 118). Equally disrupting to the adjustment to retirement is the loss of one’s social network through a post-retirement move. Seniors often choose move to locations that provide a warmer climate, although “the adjustment to retirement is often made easier by the support of families and friends” (Nussbaum, et. al., 2000, p. 123). When one moves to a new community, one loses vital support networks and must build new friendship networks or face isolation (Nussbaum, et. al., 2000, p. 123). As individuals lose friends or acquaintances through retirement, relocation, or death, there is a risk of social isolation if the individual does not find new opportunities to meet people.

For couples, the transition into retirement is additionally complicated. Bloir (2007) describes how the adjustment of retired couples takes time. They will first experience a short honeymoon phase with things running smoothly. However, when reality sets in, the excitement will wane and as Bloir (2007) explains it, “many [couples] find they’re not quite as excited about the prospect of being a senior citizen or ‘stuck’ with each other.” Spouses might feel the other is getting in the way. Such issues are compounded when the retirement was not taken voluntarily. However, as couples take on new tasks, hobbies, and interests, Bloir (2007) insists that “communication is essential.” Bloir (2007) suggests that couples remain open and honest in a loving way, about “ideas, opinions, likes, and dislikes” because, “a few minutes of heated discussion is better than weeks of repressed anger and resentment.” Couples can survive the adjustment into retirement with considerate communication and by engaging in both common and separate interests that help generate a new sense of purpose and meaning.

Activities of leisure can open up new possibilities for interpersonal communication among retired seniors, hence assisting the adjustment to retirement life. Nussbaum, et. al. (2000) explores three activities of leisure that can be completely enriching interpersonal experiences: “television, playing poker, and learning about computers” (p. 119). Television provides individuals with current events to discuss. Poker provides a group environment in which the players can have ample opportunity to interact. “The entire context of the poker environment is social” (Nussbaum, et. al., 2000, p. 119). Computer courses allow additional opportunities for communication as individuals share information and help one another. Computer courses also give individuals a chance to discuss information with others outside their class. As Nussbaum, et. al. (2000) explains, their familiarity with computers gives them “practical skills and conversational skills…[that] can lead to intergenerational relationships” (p. 119). Plus, the improvement of seniors’ abilities in computer literacy can improve social status, allow seniors to “remain connected with their larger social development and to develop new relationships with those who have similar interests” (Nussbaum, et. al., 2000, p. 120). Thus, through activities that on the surface appear quite casual, seniors can find abundant opportunities to improve communications and find fulfillment during their post-working years.

Bartky, S. L. (1999). Unplanned Obsolescence: Some Reflections on Aging. In M. U. Walker (Ed.), Mother Time. Women, Aging, and Ethics. (pp. 61-74). Lanham: Rowman & Littlefield Publishers, Inc.

Bloir, K. (2007, October 8). "Honey, I'm Home!" - For Good: The Transition to Retirement. Ohio State University. Retrieved July 9, 2009, from http://ohioline.osu.edu/hyg-fact/5000/5159.html

Donovan, J. H. (2008, October 3). Coaching: Transition into retirement. Keys to success in the next part of your journey. BizTimes.com. Retrieved July 10, 2009 from: http://www.biztimes.com/news/2008/10/3/coaching-transition-into-retirement

Nussbaum, J. F., Pecchioni, L. L., Robinson, J. D., & Thompson T. L.. (2000). Communication and Aging. (2nd ed.). London: Lawrence Erlbaum Associates Publishers.

Walker, M. U. (1999). Getting Out of Line: Alternatives to Life As a Career. In M. U. Walker (Ed.), Mother Time. Women, Aging, and Ethics. (pp. 97-111). Lanham: Rowman & Littlefield Publishers, Inc.

All content © Village Memorial. 2009-2010.

Seniors & Communication - 4 Important Issues

Medical Needs Must Be Communicated
Mr. S., an artist in his 80s, kept communicating to a friend a plaguing pain he was dealing with. Although Mr. S had seen his doctor for other issues he only communicated his current problem to a close friend, never his doctor. Finally, when he became too ill to ignore his problems, he went to ER and it turned out that he had an advanced stage of prostate cancer. Had Mr. S. communicated to his physician earlier of the pain he was experiencing his condition might have been curable.

When seniors do not communicate their issues and concerns to the health professionals treating them, they do not get the proper care they need. This results in less productive office visits, which in turn would likely end up costing them more (financially and health wise) as they might require additional follow up appointments to diagnose problems and if a condition were serious it might not be as treatable upon later diagnosis.

Physical Impairments Preventing Communication = Depression
The National Institute of Mental Health has proved the “relationship between hearing loss and depression” due to the social isolation the impairment causes. Additionally, I would add another couple impairments to this list: walking and writing.

Mrs. R, a good friend and elderly neighbor in her late 70’s, fell on pavement. Her fall resulted in a break of her right wrist and hip. She discontinued writing letters (because of her broken wrist) and shopping, eating out, or getting together with friends (because her walking was impaired by the accident.) It was even a chore for her to walk to answer her telephone. Although her body seemed to have healed several months later, she never returned to writing friends and family from out of state, she seldom answered telephone calls, and she gave up walking to do her own errands (shopping, bank, Laundromat). A once vital and independent person became socially withdrawn and very depressed once she no longer was able to communicate and perform the tasks she once had.

Lack of Communication With Regard to Government Benefits/Programs
It has been proven that “many retirees are not receiving an appropriate level of care or are ending up in nursing homes because they don’t know about services that would have allowed them to remain independent.” On the flip side of this, some seniors might not even be aware of programs or services that can help them afford retirement/assisted living homes, by significantly reducing their financial burden.

Mr. P, a WWII vet who recently moved into a retirement home, found he could benefit from Veteran’s Assistance when he was choosing his retirement home. The small 1-bedroom apartment in the transitional retirement to assisted living facility would have cost he and his wife $4,000 a month. However, because the home communicated the veteran’s discount to him, and provided him the necessary paperwork to fill out, he was able to register for a discount program that cut his monthly rent at the retirement home by 50%. For his $4,000 rental, he pays $2,000. For seniors living on fixed incomes, a financial saving of this proportion is crucial.

Senior Suicides and Mental Health Issues
It was most startling to learn of the number of suicides that take place among the senior population. While their percent of the population is just at 13.7%, they still make up “at least 25-30 percent of all successful suicides.” It is interesting and disturbing, how few senior suicides are brought to the attention of the public. Most news sources focus on suicides up through middle-aged adults. I actually cannot recall having heard of senior suicides before, other than in cases of the terminally ill where the individual chose when to end their life and suffering. This fact is one that should be communicated to society more widely. Without proper knowledge of issues such as senior addictions, senior mental health impairments and senior suicide rates, less attention is being paid to the very individuals who would benefit from the attention most.

All content © Village Memorial. 2009-2010.

Crone Energy: A Blogger

When I think of a crone energy role model who has benefited from her great communication skills, I could think of none other than the ‘blogging granny,’ as she was nicknamed. María Amelia López Soliño dubbed “the world’s oldest blogger,” was 95 when she began her blog in December of 2006. Her blog, set up as a gift from her grandson, quickly became her treasured hobby as she communicated with readers around the world. From Muxia, Spain, “her blog, at amis95.blogspot.com, became a global hit, notching up more than 1.5 million visits” (Kendall, 2009).

Being able to communicate with the world was a life changing experience for Soliño. She explained, “My grandson gave me a present, this blog when I was 95 years old … and my life changed … now, I can communicate and interact with the world” (Kendall, 2009). She described the Internet as "a whole new universe," comparing blogging to “having a conversation, and those who read what I say become my friends" (Burnett, 2007).

Soliño used her blog to communicate lighthearted “humour, warmth, optimism [and] nostalgia” (Tremlett, 2007), and “touched on many aspects of her long life, from political memories of the Franco era to intimate musings on her increasingly fragile state of health.” (Olive Press, 2009).
Soliño also used her blog to comment on important issues related to aging and seniors’ rights. She joined “Facebook to…set up a group…to defend the rights of the elderly” (News Bizarre, 2009). She also discussed her opposition to retirement and assisted living homes, which she criticized “for drugging their clients so they spend their final days snoozing quietly in front of the television” (Tremlett, 2007). While she said she blamed the children of the elderly for not personally helping their parents, she also blamed the retirement homes themselves for their "do-nothing and wait-to-die" (Tremlett, 2007) culture and the lack of Internet provided to older people (Tremlett, 2007). Soliño said, the "Internet has given me a new lease of life, but I don't see any old people's homes offering their residents Internet" (Tremlett, 2007). Soliño believed and preached that seniors needed to use the Internet saying, "Elderly people like me - and there are a lot of old people who are younger than I am - should all have someone who shows them how to use the Internet…You have to stay informed" (Burnett, 2007).

When Soliño received criticism from the other seniors in Spain who opposed her blog, she did not shy away but wittily addressed it. "To all the little old women in Spain, and those who think that I am not well [in the head] … This old woman is on her own right now, but she is chatting on the internet and having a fantastic time" (Guardian, 2009).

Soliño’s blog gained worldwide respect. Although “much of her traffic comes from Spain and Latin America, … newspaper and television interviews, …[and] YouTube links given on her blog, have spread her name beyond the Spanish-speaking world” (Tremlett, 2007). Posts came in from “fans in Alaska, Australia, China…Nigeria” (Tremlett, 2007), “Chile, Venezuela, Russia, and Japan” (Burnett, 2007). She also received national attention from Spanish Prime Minister José Luis Rodríguez Zapatero, whom she was eventually granted a meeting with. “A letter from his office is one of many documents that she has posted on the website. ‘May you keep going with this for a long time,’ the prime minister told her” (Tremlett, 2007).

Soliño successfully kept her hobby going by communicating with others in her life. Due to the impairment of her vision by cataracts (News Bizarre, 2009), she would dictate her blogs to her grandson Daniel (Burnett, 2007). “When Daniel is not to hand, other assistants pop up on her blog, be they friends or hotel cleaners in Brazil” (Tremlett, 2007). Soliño did her best to reply to as many people as she could, but noted, “So many people write to me that I can't hope to reply to them all, though I want to" (Tremlett, 2007).

Soliño not only used the Internet to communicate with others, but she also made use of the Internet for her own personal entertainment and information. She liked “to read online newspapers…and stay up-to-date with medical and scientific advances” (Tremlett, 2007). Oftentimes she had her grandson print out pages in larger type for her. “He prints out biographies and news articles from the Web for her to read, as well as responses to her blog…she says she tires quickly of reading text on a computer screen” (Burnett, 2007).

Soliño found fulfillment in her communications over the web, highlighting how beneficial Internet communications could be for seniors. “She wrote frequently of the benefits of the online community she had created” (Kendall, 2009). She blogged once that the Internet “took 10 years off my life...the Internet makes me feel less lonely" (Burnett, 2007). She later wrote, "It took 20 years off my life…my bloggers are the joy of my life" (Associated Press, 2009). In February 2009 she said, "When I'm on the internet, I forget about my illness. The distraction is good for you – being able to communicate with people. It wakes up the brain, and gives you great strength" (Kendall, 2009).

Soliño’s savvy communication skills led to her success as a blogging senior, bringing worldwide attention to seniors’ issues and illustrating the benefits of Internet communications for seniors. Her communications with friends and family also allowed her to function fully as visually impaired blogger. Through blogging, Soliño found solace, friendship and was able to live a fulfilling life. Soliño once said, “I've had 1,570,784 visits from bloggers from 5 continents who have cheered up my old age" (Reuters, 2009). Soliño is true inspiration to all. She illustrates how fulfilling communication is at any age. Soliño also said, “You have to live life…not sit around in an armchair waiting for death" (Guardian, 2007). Soliño did just that until her passing on May 20, 2009.

All content © Village Memorial. 2009-2010.