Caregiver Tip of the Month

Giving a gift that an elderly loved one will really appreciate or use is not as easy as you might think at first. This is especially true for older people with diminished abilities, whether they suffer from some loss of vision or hearing, have moderate or severe arthritis that limits their dexterity, suffer from Alzheimer's disease or another form of dementia, are home bound, or live in a facility. On the other hand, these limitations often provide clues about the types of gifts that would be most appreciated, and most useful.

For example, if your loved one has hearing problems, you may wish to consider an amplified telephone, some of which have a flashing light to let people know when they have an incoming call. If your loved one watches TV with the volume turned up too loud, you may wish to consider TV ears which allows them to make their TV volume as loud as they need it - without disturbing others. You'll find more information on our Hearing Solutions section.

If your loved one has vision problems, a wide variety of helpful gifts are available. On our Vision Solutions section, you will find more information about reading magnifiers, large button telephones, big-button remotes, large number clocks, a talking watch, and big number playing cards.

Large Print Books can make reading enjoyable again for the elderly. Here's a wide selection of novels, humor, non-fiction and bibles. Many also have an audio CD and/or audio cassette version for people with more limited vision.

If painful arthritis makes it difficult for them to use their hands, a wide variety of products can go a long way in easing their discomfort. Among these are large-handle eating utensils, lever door knobs, specialized pens and soft pencil holder grips, big lamp switches, self-opening scissors, large-handle kitchen utensils, ring zipper pulls, adaptive clothing, elastic shoe laces, long handle shoe horns, a toothpaste tube squeezer, etc. You can find more information about all of these items in our Daily Living Solutions section where everything is sorted into convenient categories.

If they need someone to push their wheelchair whenever they go out to doctor's appointments, for example, a lightweight aluminum transport wheelchair may be just the answer. Also called a companion wheelchair, their lightweight aluminum frames usually weigh less than 20 pounds. This makes them much easier to lift into and out of a car trunk than standard wheelchairs. More information is on our Lightweight Wheelchairs page. You will also find useful wheelchair accessories on that page.

If your loved one uses a walker, perhaps they could use an attachable quilted tote pouch or basket to carry their necessities with them (visit our Walker Accessories page). Or, perhaps they are ready to trade in their old fashioned walker for a new rolling walker with a seat, also known as a rollator (visit our Rollators page).

Finally, some words of caution. Stay away from sweets if your loved one has diabetes, alcohol (potentially harmful drug interactions), and hard-to-use items (anything with small print, dials, buttons, and nearly everything that comes with instructions).

Our visitors ask ...

Q. Our elderly parents live in Nevada, and the rehab center that my Mom is in insists that she move into assisted living. They are also suggesting that for my Dad who is wheelchair bound, now that Mom can no longer care for him.

Medicare doesn't cover the cost of assisted living, and they do not have the monthly income (they get just Social Security) to cover the costs. They do have some equity in a house, but that equity would only cover around two to three years in an assisted living facility.

What happens if they move into an assisted living facility, then run out of funds? Will they be allowed to stay there?

Also, how would they get into the assisted living? Our understanding is that their rooms would have to be furnished, that is, they come without a bed or sofa, with no sheets or towels.

All of their adult children, younger siblings, and adult grandchildren live on the East Coast, and all are working supporting families and cannot be out there to help. We'd like to get them back to the East Cost, but so far Mom has refused, although Dad is ready to come at any time. Mom keeps insisting that she cannot fly/drive/ etc for the cross-country trip, and all of her doctors have been elusive, and have not been able to put in writing that she is able to travel. (We have lots of accommodations here, and lots of support.)

What are our options and what is the best way to get our parents here where we can care for them?

A. You will find more information about assisted living in our section Assisted Living Checklist - Choosing the right facility. It includes a worksheet to help you determine the true cost of assisted living (it is probably somewhat lower than you might think). We also recommend that you take a look at our article 12 tips to help you find money (and free resources) for care at home. Several tips may also be helpful for assisted living residents.

To answer your specific questions,

1. While Medicare pays nothing toward the cost of assisted living or nursing home care, it does, however, continue to cover their medical expenses.

2. If they move into an assisted living facility and run out of funds, most facilities will require that they move to a nursing home. A few, however, will accept Medicaid payments if they can qualify.

3. Medicaid pays for nursing home care for the majority of nursing home patients. However, unless your parents are already on Medicaid, qualifying for it has become much harder than in the past. You will find more information in our article, Medicaid Planning - The rules have changed. The good news is that Medicaid, because it costs less than nursing home care, is beginning to experiment with paying for assisted living in a few states for residents who have exhausted their financial resources. To find out if that would be available in the state where your parents will ultimately reside, call that state's Department of Aging.

4. Most assisted living residents furnish their rooms with their own furniture, sheets and towels.

5. After you have selected an assisted living facility that has an apartment available, the facility will want to meet with and evaluate your parents. They will not accept people whose conditions have deteriorated to the point that they need full-time nursing care. If they are accepted, they (or their legal representative) must sign a contract that specifies exactly what type of care is to be provided. Most facilities have an ala carte menu of services; that is, the more services a resident needs, the higher the fees. Some even charge extra for doing a resident's laundry.

6. To convince your mother to move, we suggest that you work with a geriatric care manager where your parents live. This elder care professional is trained in geriatrics, social work, nursing or counseling. They have a lot of experience in convincing patients who need to move into a different living arrangement. If your mother still won't move, he or she will conduct a thorough patient assessment to identify your parents' needs and develop an appropriate plan of care for them. They can also coordinate medical care; pay bills; and act as a liaison with your family. Depending on your needs, they can also review applicable financial and legal issues and offer referrals to other geriatric specialists, if that is most appropriate.

To find a care manager, look at the website of the National Association of Geriatric Care Managers. This is the major national association of health care professionals who oversee long-term care arrangements needed by older people. Their Web site includes a locator to help you find a nearby care manager; click on "Find a Care Manager" in their left-hand menu.

To familiarize yourself with the changing roles and responsibilities your family is going through, we suggest that you review our 2-page article, Elder Care 101 - First Steps. It is intended as a primer - a source of both information and comfort. Each caregiving situation is unique, of course. The senior's medical history, financial resources, personality, relationships with potential caregivers, proximity to services and other factors all determine the best approach to take.

Caregiver Tip #2

— Preparing for the future —

Some older people have prepared in advance for declining health and have the necessary documents and services in place; others may have delayed taking action because they always believed they had more time.

If your parents have put things off, we suggest that you work with them to complete the Personal and Financial Organizers that you will find in our companion website, Today's Seniors. We've prepared 6 different free personal and financial organizers to make the job easier for someone to manage or settle their loved one's affairs by answering questions such as:

Are your personal and financial records in order? What documents do you need to keep? Where? How long? Are your records easy to find? What if you had a serious accident tomorrow? Could someone you trust step in and temporarily handle your financial affairs, even if it's just to pay your bills? What if you should die tomorrow? Could your spouse or heirs easily find the personal and financial records they'd need to settle your estate? Or, will they find a jumble of unorganized records scattered throughout your house? At your attorney's office? In your safe deposit box?

Most people should prepare 4 separate advance directives, each one of which has a different purpose:

• Will

• Durable power of attorney for finances

• Durable power of attorney for health care

• Living will

The best place to start is the Advance Directives page in our companion website, Today's Seniors. Each of the articles described on that page have been prepared by Nolo Press. For 35 years, Nolo has published the most reliable do-it-yourself legal and business tools available.

You may also want to talk with an attorney who specializes in elder law. Check the yellow pages in your local telephone directory, or go to the National Academy of Elder Law Attorneys' web site at www.naela.org. On their home page, you'll find a link in the upper left corner (just below their logo) that will help you locate an elder law attorney.

Recommended Reading and Videos

Many excellent books and videos can help guide you through the caregiving process. For our recommendations, including a brief description of each one, click here.

The material on this site is for informational purposes only, and is intended as a supplement, not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider. More