Q. What is an Elder’s Needs Assessment?
A. Now that your mom is older and living alone, you worry that she may fall or become ill with no one around to help. Or maybe it your elder neighbor that’s always prided himself on his appearance, but lately his clothes are not as clean as they once were. There may be another elder in your life, father-in-law, perhaps, who lives far away, is hospitalized for dehydration; he had been having only tea and toast once a day and no one had realized it. Another sign to watch out for in an elder – does he/she repeat him/herself and cannot remember the word to use?If you’re like me, we face these changes in our elder loved everyday. And you, like me, want them to continue living at home. But you probably have concerns about their safety and well-being – and wonder where the line should be drawn. Fortunately, we have many assessment tools and professional consultants that are available to help older people and family members decide when an older adult needs assistance.

Some Goals of Assessment
An assessment is a comprehensive review of a person’s mental, physical, environmental, and financial condition to establish his or her ability to remain safely independent. It identifies the risks and can determine some good options to reduce those risks that you face. A thorough assessment will result in a comprehensive plan for meeting needs and addressing problems. The findings may help you decide whether change is necessary for your parents’ safety and well-being, such as making new housing arrangements or getting in-home help. The best news about a thorough assessment usually leads to resolving issues, concerns and problems you face. And can lead to your parent’s ability to remain in their home, independently.

You don’t have to worry so much about them having an accident or getting ill. Just remember it important to include your elder in the decision process. You’re going to need their buy-in and cooperation.

What You Should Assess
Professional assessments can take from three hours to several days to complete, and even filling out a form with your parent can take considerable time. What factors should you assess? Although different forms and professionals will offer slight variations, a thorough assessment should include the following topics:

Physical health
Selected factors to assess:

Diagnosed with any chronic diseases (for example, diabetes, high blood pressure, arthritis, and emphysema)?
Other illnesses (for example, bowel or bladder problems, heart disease, stroke, cancer)? Allergies? Fractures or trauma?

Weight loss or gain? Incontinence? Balance problems? Skin growths or color changes? Persistent fatigue or sleeplessness? Swollen feet or legs, or limping? Vision problems (cataracts, use of vision aids)? Hearing problems? Dental problems (gum disease, strong breath, ill-fitting dentures)? Current vital signs. List of health professionals currently being seen. Recent hospitalizations?

Mental health
Selected factors to assess:

Diagnosed with any psychiatric disorders (depression, anxiety disorder, psychosis)? Diagnosed with Alzheimer’s or other dementia? Recent hospitalizations for any of the above problems? Alertness? Mood swings? Forgetfulness or wandering off? Confusion/disorientation? Sadness/ loneliness? Decreased interest in reading, writing, and communicating? Maintaining friends? Interest in life?

Medication use
Selected factors to assess:

All medicines taken (prescription or over-the-counter), with times per day and doses. Ability to take medications as directed and know how to avoid interactions. Barriers to proper medicine use (forgetfulness, expense, poor understanding of purpose or outcome of use).

Daily living
Selected factors to assess:

Mobility or need for adaptive aids. Special dietary needs, favorite foods. Ability to dress, bathe, get up from a chair, use a toilet, use the phone, climb stairs, get help in an emergency, shop, prepare meals, do housework and yard work, drive safely.

Home and community safety
Selected factors to assess:

Neighborhood. Home safety (hazards, adaptive aids, presence of smoke alarms). Ability to avoid telephone and door-to-door fraud. Yard and house maintenance.

Support system
Selected factors to assess:

Names, addresses, and phone numbers of key family members, friends, and neighbors. Does your parent have frequent visitors or see friends?

Does he or she go to a Senior Center? Get out of the house for other social reasons? Belong to organizations, including faith-based groups? Do family members live nearby?

Selected factors to assess:

Overall appearance. Personal hygiene (brush teeth, trim nails, shave, wash and comb hair)? Clothes clean, and dressed appropriately?

Finances
Selected factors to assess:

What insurance coverage is in place? Does insurance cover custodial care? What are your parents total assets? Are there any legal documents such as trusts, living wills, and/or durable powers of attorney? Do your parents have a financial plan? How long will his or her assets last? Any sources of financial assistance? Does your parent pay bills on time and make informed financial decisions?

Interests/lifestyles
Selected factors to assess:

Hobbies, reading preferences, favorite TV and radio programs, exercise, musical instruments played, languages spoken, favorite conversation topics, travel experience, important life events, religious/spiritual background, accomplishments, social activities.

Working Caregiver – Why Should You Prepare for Caregiving? Prepare Yourself for an extremely difficult endeavor. Because failing to plan with your aging relative can make a bad situation worse. And the loved ones you tried to protect by not preparing will be the ones who endup suffering the most.While you might think they, your parents or aging relatives are invincible, putting together a caregiving plan with them and your siblings or other family members can eliminate your problems at home and work. In addition to minimizing the ‘up against the wall’ scrambling and family tensions that commonly arise when a once-independent loved one needs more consistent care, a care giving plan can also help reduce a family’s financial strain.The truth is that family caregiving responsibilities take a toll on family finances. A study by the MetLife Mature Market Institute, for example, found that caregiver respondents reported an average loss of $566.443 in wage wealth – all because of the unanticipated consequences of their care giving responsibilities. It’s not just the caregivers who are affected. Without a care giving plan, those family members most affected by the crisis – the care recipients themselves – end up with the least say in their wishes and priorities for the future. It’s hard to imagine not having control over your own future, but too often that is what happens when families don’t ask the important questions ahead of time.Once you have assessed the care recipient’s needs, it’s time to look at alternatives for filling them. Talk with family members and close friends about what they might be able to contribute toward the care giving effort: time, skills, space, equipment, money and moral support. No one can do this alone, ask for help from friends and family members. Ask your children to help too. It’s important to define the tasks and agree upon them in advance to avoid difficulties later. Perhaps one person can prepare meals, one can do the yard work, one can provide beauty treatments and manicures, and another can provide transportation. Other tasks you might want to split up; making home repairs, cleaning the house, paying bills, balancing the checkbook, coordinating healthcare, and filling out tax forms. Someone needs to gather basic information on the care recipient, as healthcare professionals will need this. Include the Social Security number, Medicare ID number, insurance policies and numbers, doctors’ names and numbers, medications, allergies, family medical history, and lifestyle information (smoking, caffeine, alcohol and sleep patterns). Keep the information handy in a wallet or on the refrigerator door. Consider making copies and keeping in safe place. Once family and friends choose their responsibilities, you can tap into community resources to fill the eldercare gaps.

Working Caregiver- Elder Law Attorney

Find an attorney with whom you feel comfortable and who has the expertise to advise you on these matters.

It’s always better to consult with a Texas Elder Law Attorney as early as possible. An elder’s family has more planning options to choose from while the patient still has the “legal” capacity to make their own decisions. This question of whether your loved one has the capacity is definitely a gray one, and can only be determined case-by-case.

Here are several “legal” considerations when a person is (or may become) incapacitated:

• The management of the elder’s financial affairs during his or her lifetime;
• The management of the elder’s personal care: medical decisions, residence, placement in a nursing facility, etc.;
• Arranging for payment of long-term health care: use of private insurance, Medicare, Medicaid, Supplemental Security Income (SSI) when applicable;
• Preserving the family or elder’s assets: ensuring that the patient’s spouse and any disabled family members are adequately protected; and
• The distribution of the elder’s assetson his or her death. (If the person has a disabled spouse, child or other family member that they wish to provide for, special arrangements need to be made.)

Other important issues should be discussed in the process of your family legal planning. For example, a full discussion of housing options is critical in making certain legal and financial decisions; i.e., is the person planning to stay in his home? Is this feasible, both physically and financially? Is he thinking of moving to a retirement facility? What level of care is provided? Is it a rental or a “buy-in” arrangement? Is a move to a nursing home probable

Q. How Do I Plan for a Medical Emergency?
A. Organizing, maintaining and updating personal medical files are vital steps to planning for a medical crisis. Here’s a list of important medical information – have it available!

Names, addresses and telephone phone numbers of your health care providers, such as physician, dentist, pharmacist, medical specialist.

Instructions for the individual you have designated to provide medical information on your behalf, if you are unable.

Special instructions, such as a living will, or a durable power of attorney for health care decision making.

All prescription and non-prescription (over-the-counter) drugs that you take. List should include:

• dosage (amount of medication you take and when)
• name of physician prescribing the drug
• name, address, and telephone number of pharmacy dispensing the drug

Address and telephone numbers of the hospitals that you prefer to use.

Medicare number.

Medicaid number.

Names, addresses, and telephone numbers of your caseworker and/or social worker.

Name, policy number, office location of health, Medigap-supplemental health and long-term care insurance policies.

Adapted from the Children of Aging Parents Organization

Caregiver Answers to Advocacy

Q. What are the Skills Needed for Advocating for your Loved One?

-Educate yourself regarding your loved one’s illness and/or disability.

-Communicate efficiently and succinctly with healthcare professionals.

-Recognize you are a healthcare consumer deserving quality healthcare.

-Embrace your importance as a member of the healthcare team.

-Always provide input and ask as many questions as needed.

-Pick your battles; don’t sweat the small stuff. Identify inconsequential matters and focus your attention elsewhere

-Be an advocate–speak up. The squeaky wheel usually gets the grease.

With a major role change such as the one associated with becoming a family caregiver, emotions can and will run the gamut. There are in fact five stages of grief that are widely accepted in the scientific community to occur as denial, anger, bargaining, depression, and finally acceptance. Living and coping through each of these stages composes the learning framework for us to be able to adjust to witnessing someone we love fall victim to a debilitating illness.

At the end of each day, post your questions, and also, what works for you.

Network with family support groups.  Those real bad or rough days-you need to vent and get it  out.  Or call or email another caregiver. Advocacy is being there through thick and thin of your senior’s aging life. WorkingCaregiver.com pushes you, the family caregiver, to advocate effectively for your loved one and yourself, putting you on the road toward a less turbulent lifestyle. Adopting a proactive, resourceful, and even creative approach will empower you to acquire help and information you may need.

Q. How do we select a new physician for our aging parent? A. Your aging parent’s or relative’s health may be changing and require help to find a new primary care physician. My family was tasked in finding my dad a new physician when he changed nursing homes due to his Alzheimer’s disease. We spoke with many friends and colleagues for referrals, and interviewed doctors before making a selection.One of the things we looked for was ease and thoroughness of communication between doctor, our dad, and the family. We looked to see if the doctor was willing to spend adequate time with dad, the care recipient, to help him (and the family) understand the problem and to discuss courses of action. Some of these suggestions are not subtle and unless you spend some time in the interview process, may never learned. But if you asking friends about the referred doctor, find out; if the doctor support the patient’s wishes regarding medical procedures and extraordinary measures? What’s the doctor’s philosophy of prescribing drugs for symptoms vs. determining and treating root causes? Who covers for the doctor when he/she is out of the office, on vacation? Does the doctor show respect for the patient and you? I can tell you right off, if the doctor does not show respect for the famil and if he/she thinks they know best… WATCH OUT! This attitude will bite you when it really counts. Also check to see which health plans is the doctor associated with? Is the doctor willing to battle with an HMO or insurance company if necessary?  These are some important points to keep in mind when searching for a new physician.Q. What legal matters should be discussed when a family member has a health condition that affects his ability to function independently? A. There are several legal issues to consider when a person is (or may become) incapacitated:

• The management of the person’s financial affairs during his or her lifetime;
• The management of the person’s personal care: medical decisions, residence, placement in a
  nursing facility, etc.;
• Arranging for payment of long-term health care: use of private insurance, Medicare, Medicaid (Medi-Cal in California) and Supplemental Security Income (SSI) when applicable;
• Preserving the family assets: ensuring that the patient’s spouse and any disabled family members are adequately protected; and
• The distribution of the person’s assets on his or her death. (If the person has a disabled spouse, child or other family member that they wish to provide for, special arrangements need to be made.)

In addition to issues that are clearly “legal,” other important issues should be discussed in the course of legal planning. For example, a full discussion of housing options is critical in making certain legal and financial decisions; i.e., is the person planning to stay in his home? Is this feasible, both physically and financially? Is he thinking of moving to a retirement facility? What level of care is provided? Is it a rental or a “buy-in” arrangement? Is a move to a nursing home probable?

Q. When should an attorney be consulted?
A. Consult an attorney as early as possible. The maximum number of planning options will be available while the patient still has the legal capacity to make his or her own decisions. The question of capacity is a gray area, and must be determined on a case-by-case basis.

Q: What are the options for managing assets?
A. Options for managing assets include:

• Durable Powers of Attorney;
• Revocable living trusts;
• Designation of a representative payee; and
• Guardianship of the estate and of the person.

Each of these has advantages and disadvantages, which should be discussed thoroughly with an attorney. Further, for making medical decisions, you should discuss the use of a durable power of attorney for health care, directive to physicians, and guardianship of the person.

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