The beginning of a new day

Who doesn't want to have a wonderful, peaceful, warm-feeling holiday season?  We all want to feel comfortable and loved, as much as possible.  We strive to make our holidays especially joyful, even if we can't guarantee this throughout the entire year.  Even those who don't celebrate the holidays get up each day to make it better than the last.  Sometimes, this is easier said than done.  Especially during the short and cold days of Winter.

Add dementia, health issues, and others who are not at their best, and the scale tips fully to the floor.  How does one start over, and try to keep it together for the holidays?  And how can we make it easier for our loved ones who have any of the dementias?

Here are some suggestions to make visiting a family member with dementia better:

• Prepare guests for what to expect when interacting with family who have dementia.  Explain to them that there might be behaviors which they are not used to seeing, but which might happen with more frequency now.  For example, let them know that their family member might eat with their hands, wander, or have bouts of incontinence.  They can look to you or a caregiver for cues on how to deal with certain behaviors, and be supportive, instead of being shocked or upset by what is happening.

• A first visit with family with dementia can be shocking and uncomfortable.  Talking about this ahead of time can help to prepare one to view actions and behaviors they are not used to seeing.  Explain that the loved one may not remember their name; however, they can enjoy their company.  Precious time spent together is more important than remembering everything from the past.  Make new moments together, in the "now."  Also, let them know what the family member can still understand, or still do.  Give them suggestions on how to begin conversations, using eye contact, and saying something like, "Hello Rhoda, my name is John, and we used to spend holidays together."  Ask them to not correct the family member, but to talk about the feelings expressed, or change the subject.

• Help and get help to maintain family traditions and rituals you might have during this season.  It is impossible to "do it all," and I especially say this to caregivers.  Please don't be afraid to ask for help.  Others usually want to be helpful.  Receiving help can feel uncomfortable, at first, so watch how others light-up when being allowed to help you and your loved one.

• Explain how hallucinations might happen, and that the loved one is not trying to be obstinate. Memory loss is part of the disease and is not intentional. Helpers, like redirecting the loved one's attention, or even humor go a long way to make both involved feel that they can continue to move forward during the visit.
  

• Share articles, websites, and other information about the disease with family and friends.  Allow them to find out more about the dementia, and how they can be of assistance.  Sometimes giving information about support groups can help ease any fear and sadness they may have around a visit with family with dementia.

Finally, try to hold family gatherings during a time of day which is best for the family member with dementia.  Keep the atmosphere calm and as quiet as you can in a family setting.  Don't use a loud voice or talk to the family member as if they were a child.  Some people also have hearing issues, but just be aware of your presence in the room and tone of voice.  Respect the family member's personal space, and don't sit too close. 

Tis the season to be aware of things outside of our own selves, and this can be good practise for how to do unto others as you would have done unto you.  Many gifts can come from being in that frame of mind.  It's the magic of the holiday season!  You can feel blessed experiencing it.  Happy Holidays.

nia-infographic-social-isolation-loneliness

Check out these suggestions from the National Institute on Aging on getting past barriers to exercise:

While it is difficult to determine what is a scam and what isn't, it seems that most telephone calls requesting account information can pretty much be chalked up to being inapprpriate. This is especially true when dealing with government agencies, and big corporations, like banks. They will never call to request account information and other personal data.  They will write to you through the U.S. mail. If in doubt, you can always ask to call them back, in order to verify that they are indeed calling from where they say they are calling from. Check out this warning from the Social Security Administration:

https://blog.socialsecurity.gov/inspector-general-warns-public-about-caller-id-spoofing-scheme-misusing-ssa-customer-service-number/?utm_campaign=&utm_content=&utm_medium=email&utm_source=govdelivery" target="_blank">http://https://blog.socialsecurity.gov/inspector-general-warns-public-about-caller-id-spoofing-scheme-misusing-ssa-customer-service-number/?utm_campaign=&utm_content=&utm_medium=email&utm_source=govdelivery

The Centers for Medicare & Medicaid (Medi-Cal) Services have announced that new Medicare cards will be sent to all by April 2019.  They are removing Social Security Numbers from the cards, and a new identifying number will replace it.  You may receive your card at a different time than your neighbor, and this helps to keep mail thieves away.  Mailing begins this April.

The card will be printed on paper, and if you ever lose it, you can always print a new one yourself!  If you have another card for your Medicare Advantage plan, you should still keep it, and carry it with your Medicare card for use during your medical appointments.  Do not share your number with anyone who is not directly billing for a medical appointment.  You should also destroy your OLD Medicare card, once you receive the new one.  Remember, the old card has your Social Security Number on it, so disposing of it properly will guard off identity theft, and keep you safe.

Check out this video about the new cards:

I went to visit a friend who had recently been placed in assisted living.  I had lost touch with her over the last couple of years, becoming too busy in my life to keep much social contact going.  When I entered her room, I came upon a slightly slumped over, little old lady, watching the news in a wheelchair beside her made-up bed.  I touched her shoulder, gently, then came around to the other side of the bed to sit, before bombarding her with social chatter.  She immediately began the conversation, as I always remembered her doing, talking about her day, explaining what she was watching, how much she liked watching current events, how great I looked (I love this woman), why she was in assisted living, on, and on, she went.  She always did.  

Nothing changed here.  She was always good at holding conversation, and would, at some point, get around to asking about my life, and remembering things about me that I had shared over the years.  She's around 97 years old, so there is a lot of history about me she knows.  

Then, at some point, maybe about 20 minutes into the visit, my husband and I asked her a question, and she went right into a story about some other topic...just like that.  It wasn't a topic far off one of the others we had been talking about, but off enough that I was taken aback.  I didn't know what to say, except just continue on with the new topic of discussion.  Did she not hear the question?  Maybe, it was too personal a question, and she just didn't want to answer it, so she changed the subject.  For a brief moment, I thought, "What if she's losing her mental capacity?  What do I say?  What do I do?"  Then I thought, "Why do we have to jumpt to that conclusion?  This would have just been called 'old age' a few years ago."  

What is old age, and when should one be concerned about possible memory issues which require another's assistance?  When does mental capacity require a trip to the family lawyer?  I got some relief after receiving an email about memory issues.  Take a look at this infographic from The National Institute on Aging:

When this question comes up, it is usually because of some emergency.  Someone has either had an accident, or surgery, and needs to recover after leaving the hospital.  They usually need more care than staying at home can provide.  Or, they are in an advanced stage of a terminal disease, and need medical care before hospice is necessary.  How does one pay for this kind of 24-hour care?

Until the person is able to be taken care of at home, with less than round-the-clock care, they will need to stay in a skilled nursing facility, otherwise known as long term care.  The average private pay rate for these facilities in 2016 was $8,189 per month.  You can imagine the shear terror some family members face when asking, "How do we pay for that?"  

If the patient has long term care insurance, you can usually breathe a sigh of relief.  One of the great things about this kind of insurance is that it works hard to care for the person in their own home.  The insured will also not need to pay their premium for months spent in a long term care facility in most policies.  If  your loved one doesn't have this insurance, they can rely on Medicare to pay the first 22-100 days of long term care, but if insurance runs out, then what?  

One overlooked area is the Veteran's Administration (VA).  If there is any chance your loved one may have served the U.S. Military, or been the dependent of someone who did, it is well worth the investment of time and energy to apply for VA benefits.  Aid and Attendance and Housebound benefits will help a veteran who needs care at home, is in long term care, or in Assisted Living.  Assisted Living is different than long term care, mainly in that it does not require 24-hour nursing care for it's residences.  Any long term care facility can take VA payments. They do not have to be VA certified.  The patient does not have to be in a VA hospital, or even seen by a VA doctor.  Aid and Attendance is for veterans who need help with activities of daily living (dressing, bathing, transferring, toileting, or eating).  Homebound is for veterans who are substantially confined to their homes because of a permanent disability.  These are benefits that reimburse the veteran, after he/she has paid for the care expenses.

Medi-Cal (Medicaid in the rest of the U.S.) might be able to help for those with little or no assets.  Some assets are exempt, like the home they live in, one vehicle, burial trusts, most household/personal possessions, and most special needs trusts.  Depending on the amount of income the patient has, they will pay the long term care facility a monthly Medi-Cal Share of Cost.  This is usually all of their countable income, minus $35 for a Maintenance Need.  

So breathe a sign of relief, and know there are some avenues to pay for a loved-one's long term care stay.  The word, "long" in "long term care" doesn't usually fit most patient's length of stay in one of these facilities.  If you need help finding payment resources, give Sunrise Fiduciary a call.  We are happy to help ease the stress these moments can bring.

If you are caring for a veteran with Traumatic Brain Injury (TBI), the Veteran's Administration has a tip sheet full of great suggestions:

"Get Protected"

"S.A.F.E. Act 2015"

"...a new Security features that helps you as a tax payer..."

Besides the obvious bad grammer and misspellings, these types of emails should stand out to you that something is not quite right.  The email might have even made it to your Spam Folder, and not your Inbox; another sign that it might not be a legitimate email from the Social Security Administration.  These are usually phishing emails, designed to download malware onto your computer to take your personal information after they convince you to click on a link.  Or, they are designed to send you to a special website where they will convince you to enter your personal information to get credit monitoring or find out about unauthorized users of your Social Security information.  They are not from Social Security.  

You can do a quick test to see if the email is from a phishing site:  Hover your mouse over the link they want you to click on, but don't click on it.  A message box should show you the website's address where you would go, if you actually clicked on the link.  It usually will not say, "http://www.SSA.gov."  If you get one of these emails, use the forward button to send it to the Federal Trade Commission (FTC) at "spam.uce.gov."  Or, you can mark it as "spam," if your email provider has a button to allow you to do so.  

The Social Security Administration has this to say about reporting spam emails to them:  "Your report is most effective when you include the full email header, although most email programs hide this information. To find out the full header, type the name of your email service with “full email header” into your favorite search engine, and include this information in your report. When you’re done, delete the email."

This is what a phishing email might look like:

http://blog.socialsecurity.gov/wp-content/uploads/2016/01/screen2.jpg

If you ever need to know if a government agency sent you an email or not, contact them through your own means (look up the telephone number or email address; don't use links in the original email).  Even if you have to wait on hold, or get shuffled through several people to find your answer, the cost will be much less than losing your credit and identity.  Be safe.