Elders and Financial Abuse

Seminar on Elder Abuse. As an employee of Seniors’ Choice at Home, I occasionally have the opportunity to attend local presentation on elder care. Recently I attended a presentation on Financial Abuse, Boundary Issues, and Setting Limits with Families. The speaker was Mary Frances Price for the Maser/Amundson/Price law firm. Price was an excellent speaker and gave participants a plethora (I love that word!) of information in an hour. Most interesting for our clients, families and employees, I think, are the reasons Price suggested for why seniors are targeted for scams, cons and fraud.

1. People over 50 control more than 70% of the wealth in the U. S.
2. They often have others involved in their financial matters—either family members or paid advisors.
3. Many seniors have very predictable financial activities (for example, seniors receive Social Security checks on the same day every month and often pay bills shortly after that.)
4. Technology has created new ways to commit fraud.
5. Scammers use the politeness of seniors who find if difficult to say “no” or just hang up the phone.
6. Seniors are less likely to report fraud because they are ashamed to admit they have been taken in by scammers, or they aren’t sure about how to go about reporting it.

People who are at risk are those who are isolated, lonely, depressed, frightened, suffered recent losses, secretive or hesitant to talk freely. Also at risk are those with mental or physical illnesses or disabilities, those who lack familiarity with financial matters (think of the widow or widower whose spouse has always taken care of finances,) those who are helping out unemployed family members or who have family member with substance abuse problems.

“Money request” scams can take many forms. The grandparent scam is where the scammer poses as a grandchild in danger and asks for money. Fake Check/Lottery scams is where the scammer sends a fake check and asks the victim to cash the check and wire a portion back to the scammer for “taxes” of “fees.” There are also bogus charity scams.

To avoid getting scammed:

1. Verify the identity of the person requesting money even if they say they are a family member
2. Verify the identity of unsolicited checks or purported lottery winnings.
3. Verify the authenticity of charitable organizations
4. Do NOT agree to secrecy; tell the solicitor you never make decisions over the phone, tell them to send something in the mail (only if it’s something you believe is legitimate and may want to contribute to) and contact a trusted family member, friend or advisor about the request.
5. Do NOT wire money to strangers; there is not good reason for a stranger to request wired funds.

Some other scams to watch out for:
• Investment/Sales scams—remember, there are NO “get rich quick” opportunities. If it seems like it’s too good to be true, it probably is.
Do not be afraid to hang up the phone or close the door.
• “Phishing” scams are when scammers attempt to obtain sensitive information (SSN, Medicare/Medicaid numbers, credit card/band account numbers, usernames/passwords.)   These requests often sound or look (it is not very difficult to get logos from websites and make documents look like the real thing) legitimate. (If, for instance, you receive a phone call from your credit card company reporting a suspected fraudulent use of your credit card, do NOT give the caller any of the above information. Instead, hang up and call the number on the back of your card and ask to speak to the fraud division.) There are almost no legitimate reasons for someone to initiate contact to request sensitve personal information by email of phone.

Some other tips:

• Shred all personal documents and credit cards before throwing them away. (And yes, thieves do actually go through dirty garbage and put torn sheets of paper back together in order to get information they can use to steal your money.)
• Protect incoming and outgoing mail.
• Obtain a credit report and report any suspicious expenditures
• Equip you phone with caller I.D. Be careful about calls from “unknown” or “private” numbers.
• If something doesn’t seem right, talk to someone about it.
• Use common sense—do NOT make any immediate decisions; tell the caller/solicitor that you always consult with your family/financial advisor before you make decisions.

Some warning signs of financial abuse:

1. Unpaid bills, eviction notices, notices to discontinue utilities
2. Unusual bank withdrawals/transfers
3. New friends who “help” with finance management
4. Changes in spending patterns
5. Missing property, financial documentation, check books/blanks, credit cards, ID cards and implausible explanations
6. Suspicious signature
7. Financial arrangements that the seniors is unaware of or that he/she doesn’t understand or remember signing.

Who to Contact:

In Minnesota, the Common Entry point for your county, the State Office of Ombudsman for Long-Term Care, the Elder Care Rights Alliance, or the police. New Minnesota law now provides not only steep financial penalties for financial abuse, but also includes up to a 10-year prison sentence.

Powers of Attorney can be individualized per client and can include limiting the authority of the agent, if more than one agent, they can be required to “act together,” can prohibit or limit gifting/self-payment, and can require regular accounting.

Bank statements can be sent to multiple family members, and families should hold regular family meetings to discuss/explain financial decisions.

Serendipity In Minnesota

Good Things Happen too often to be  a Coincidence at Seniors’ Choice at Home

Recently at Seniors’ Choice at Home we received a call from the daughter of a former client.  The client had received services from Seniors’ Choice at Home several years ago.  After we had worked with her for quite a few years, her daughter retired and had more time to spend with Mom.  Now, the client, in her early 90s was wanting someone to spend three afternoons a week with her.

During my assessment visit with her and her daughter, the client asked about the care giver who had been her helper in the past.  I told her that Peggy had retired about two years ago, that sometimes our retirees would tell us they wanted to come back to work, and that I would call Peggy and see how she’s doing.  Maybe she’d be interested in taking just one of the three days.  Of course, I added that I couldn’t promise anything. and also that we had a lot of nice women working for us.

When I returned to the office and relayed the conversation to our owner, he said that he would love to call Peggy.  He said he had been thinking about her lately and wondered how she was doing.  Peg answered the phone when he called, and after a brief  “how have you been” chat, Jim told her about her former client.  She laughed and said she was bored silly  and had been thinking about calling Seniors’ Choice at Home to see if there might be the possibility of any work for her.   Not only did she want to come back to work, but she wanted to take all three days with her old friend.  Peg is in her early 80s.

You can imagine the celebration when Jim called the client and her daughter.  The old phrase, “a good time was had by all” comes to mind.   Jim and I have spent a lot of time grinning about this match “made in heaven.”

Seniors’ Choice at Home is based on the idea of a good relationship between the client and the caregiver.  Not every client is interested in more than the  help with whatever they need–cleaning,  cooking, driving–but when it works, it is a delight for everyone involved!  I love being part of an organization whose business it is to make life better for people.

Check out our website at http://www.seniorschoicemn or call us in the Twin Cities at 763-546-1599.

Sometimes Kids Just Have to Take the Bull by the Horns

There is a Point Where the Person With Memory Loss Can No Longer Make Decisions for Him or Herself

In the past week, I have made two home visits to prospective clients of Seniors’ Choice at Home, a non-medical home care service with the goals of:  1) helping seniors stay where they are longer with some practical help; and 2) providing some backup for adult children or other helpers as they try to balance the busyness of their own lives with the help their elderly parents/neighbors/friends need.  In both cases, the elder refused the help because they viewed themselves as OK.  In both cases, the nurse will probably need to involve Adult Protection because of the vulnerable state of the elders and because there is a mandatory reporting law in our state.

It is so common for us as adult children to find ourselves in denial about the reality of a parent’s condition.  No matter how mature and responsible we are, there is still that mystique around our parents being our parents.   It’s even more difficult for adult children who live across the country from  parents.  Sometimes when returning for a visit after a few months, the changes are obvious, but then it’s tempting to chalk it up to “a bad day.”   We want so badly to allow our parents their independence, to respect their right to make decisions about how they live their lives.

David Solie, M.S., P.A., in his book How to Say it to Seniors talks about what he believes is most important to older adults–the ability to be in control of one’s own life.  I agree with him up to a point.  When the decision or change the elder needs to make isn’t a matter of life or death, or when the person is of “sound mind,” it’s wonderful to be able to allow the elder to make the decision.  “Mom, I know this is difficult for you, but you are in charge of your life, you are in control, you can decide what you want to do.”   However, if your mom is lying on the ground struggling for breath, you don’t ask her if she wants you to call an ambulance.

With Alzheimer’s disease and other dementias, parts of the brain are destroyed and no longer function in the way the did in the past.  At autopsy, a diseased brain has lost as much as one third of its normal weight.  There are actually large spaces in the brain where cells have died.  The brain has had a “heart attack” and the person is gasping to think.

When an elder has significant cognitive impairment, when the doctor, the visiting nurse, and/or the neighbors  have serious concerns  about a parent’s safety, it’s time for the adult children to step in and make the recommended changes.   It’s probably one of the most difficult things for an adult child to do.

Laughter is Really the Best Medicine

Even When You Don’t Feel Like Laughing…

Some years ago, Norman Cousins, then editor of the notable magazine, The Saturday Review (no longer published,) was diagnosed with a painful, rheumatologic disease that included significant pain, and a not very rosy outcome.  Cousins took his treatment into his own hands, checked into a fancy hotel and spent his days watching funny, old movies like The Three Stooges, Laurel and Hardy and Abbot and Costello.  The story of his remarkable recovery using laughter therapy is the topic of a book (Anatomy of an Illness) he later wrote.

Now, researchers at the University of Maryland School of Medicine in Baltimore, using laughter-provoking movies to gauge the effect of emotions on heart health, have found that laughter is indeed linked to the healthy function of blood vessels.  It seems that laughter causes the tissue that forms the inner lining of blood vessels, the endothelium, to dilate or expand in order to increase blood flow.

When the same group of volunteers was shown a movie that produced mental stress, their blood vessel lining developed a potentially unhealthy response call vasoconstriction, reducing blood flow.  That finding adds evidence to earlier studies which suggested there was a connection between stress and the narrowing of blood vessels.

The recommendation is that we all try to laugh on a regular basis.  Laughter is almost as good as aerobic activity.  Thirty minutes of exercise three times a week and 15 minutes of laughter daily is probably very good for your heart.

Even though our work with clients at Seniors’ Choice at Home, can be heart-breaking at times, we in the office, and our care givers out with clients, find lots of opportunity to laugh and have fun.  One of the skills that persons with memory loss often retain, is the ability to make a joke and to have fun.  We like to think we make good use of our clients retained skills.

CPR for Caregivers

Reviving  Caregivers

Everyone knows what CPR in the medical world is–Cardiopulmonary Resuscitation.  Perhaps you know of someone who has taken a CPR class, or maybe you even know of someone on whom the life-saving technique has been used.  But now I’d like to tell you about another kind of CPR, one you can use to help revive yourself.

CPR for caregivers is a set of principles for healthy communication.  By communicating with yourself and with others in a healthy manner, you can avoid burnout and gain energy to care for a loved one who needs you.

Caregiver communication is based on three principles:  Connect, Project, and Reflect (CPR.)

Connect–Giving effective care depends on establishing a mutual bond with the person for whom you are caring.  This bond is built on trust, acceptance, and respect.  The necessary foundation for developing this bond is connecting with yourself.

Project–the way you communicate with others (what you project,) whether verbally or non-verbally, can enhance or obstruct the connection.  Be aware of what you project so that the connection remains strong.

Reflect–your positive or negative thoughts.  Reflections determine how you project to others Learn to keep your reflections positive.

By using these principles you will have energy to become your own renewable resource and avoid caregiver burnout.

Used with permission from the author, Grant Watkins at:  http://www.grantwatkins.com.

Validation Therapy Continued

Ten Principles of Validation

The following principles are the basis for Validation Therapy as developed by Naomi Feil and listed in the Validation Training Institute website:

www.vfvalidation.org/whatis.

Jan Allen, CSW, MSE gives more information about Validation Therapy along with some interesting examples of conversations with disoriented patients n her website/blog:

www.ec-online.net/community/Activist/difficultbehaviors

1. All people are unique and should be treated as individuals.
2. All people are valuable, no matter how disoriented they are.
3. There is a reason behind the behavior of disoriented old people.
4. Behavior in old age is not only a function of changes in the brain, but reflects physical, social and psychological changes that take place during the whole lifespan.
5. Behaviors of older people can be changed only if the person wants to change them.
6. Old people should be accepted non-judgmentally.
7. Each stage of life has particular life tasks to be completed.  Failure to complete these tasks may lead to psychological problems.
8. When recent memory fails, older adults restore balance to their lives by retrieving memories from the past.
9. Painful feelings that are expressed, acknowledged and validated by a trusted listener will diminish.  Painful feelings that are ignored will gain strength.
10. Empathy builds trust, reduces anxiety and restores dignity.

CPR for Care Givers

Do Your Need Some Occasional Help for Your Caregiving Heart?

Everyone knows what CPR in the medical world is—cardiopulmonary resuscitation. Perhaps you know of someone who has take a CPR class, or maybe you even know of someone on whom the life-saving technique has been used. But now I’d like to tell you about another kind of CPR, one you can use to help revive yourself. CPR for caregivers is a set of principles for healthy communication.

By communicating with yourself and with others in a healthy manner, you can avoid burnout and gain energy to care for a loved one who needs you. Caregiver communication is based on three simple principles: Connect, Project, and Reflect (CPR).

Connect—Giving effective care depends on establishing a mutual bond with the person for whom you are caring. This bond is built on trust, acceptance, and respect. The necessary foundation for developing this bond is connecting with yourself.

Project—the way you communicate with others (what you project,) whether verbally or nonverbally, can enhance or obstruct the connection. Be aware of what you project so that the connection remains strong.

Reflect—your positive or negative thoughts. Reflections determine how you project to others. Learn to keep your reflections positive. By using these principles you will have the energy to become your own renewable resource and avoid caregiver burnout.

Used with permission from the author, Grant Watkins.  Check out information about his book for care givers at his website, http://www.grantwatkins.com.

Dealing With a Dementia Diagnosis

Minnesota Care Givers Learn About Helping Clients and Families Dealing With an Alzheimer’s Disease Diagnosis

When a family member is worried about changes in a loved one’s memory, his or her ability to function and make sound decisions, a good course of action is to have a thorough medical evaluation by a physician. It is so human of us to avoid doing what may be the best thing to do. Let me give you some reasons for seeing a doctor about the above symptoms. First of all, dementia is actually a collection of symptoms that can be indications of many different illnesses, some non-reversible, like Alzheimer’s disease, but some are treatable and can be reversed. Obviously, prompt attention and treatment for the latter (thyroid problems, depression, medication interactions, infections, malnourishment) is necessary for the best outcome. For those illnesses that are irreversible, the knowledge of what is causing the problem can be very helpful in terms understanding what’s going on, finding out about the many resources and avenues of help available including some medications, which while they do not cure, can, in some cases, delay the loss of function, and can start you on the road to important future planning.

Many people with the confusion that is part of Alzheimer’s disease find the world around them a fearful place. They often become suspicious of not only strangers, but also of those closest to them. It is common for them to want to avoid situations where their new limitations might cause them embarrassment and to avoid social gatherings and activities.

Once everyone is aware that the dementia is Alzheimer’s or a related irreversible dementia, how can you as a caregiver offer emotional support and comfort to someone with a recent diagnosis. Here are some suggestions:

* Find out about activities that person has enjoyed in the past and do them with him or her.

* Listen! Listen! Listen! Take time to listen to what the person is thinking about, worried about, afraid of and encourage him or her to talk to you about those things.

* Ask them questions about how they are feeling and what they are hoping for.

* Validate feelings and offer your support unconditionally. Give people the opportunity to talk about concerns without dwelling on negatives the whole time you visit, but dont just try to “sweep them under the rug.”

* Ask the person what you might do to help them feel more comfortable and to give them peace of mind.

* Suggest an early stage support group through the Alzheimer’s Association for the patient and a family group for the family care giver. Some places have the two groups going at the same time, so family members don’t have to worry about someone to stay with the patient while the family member attends the support group.

Keep in mind that offering caring and compassionate help means tending to the person’s physical, social, emotional psychological and spiritual needs.

Care givers that work for Seniors’ Choice at Home amaze me every day with their loving creativity in working with persons with memory loss. For more information about Seniors’ Choice in Minnesota, call 763-546-1599, or check out our website at http://www.seniorschoicemn.com

Comfort as a Goal

Comfort, Respect, Maintaining Independence: Goals for Seniors’ Choice at Home Caregivers in Minnesota

When I orient new employees coming to work for Seniors’ Choice at Home, I spend considerable time talking about our goals.  Basically, we have two:  1) to assist clients with practical tasks, so that they can remain in their home; and 2) to provide some relief to the adult children of our client by helping their parents.

I spend even more time talking about how we want our care givers to interact with their clients.  Seniors’ Choice at Home, from it’s very beginnings more than 13 years ago, has based our service on the importance of the relationship between the care giver and client.  We only hire care givers whom we believe have the ability to establish a positive relationship with seniors.  I think some of the things we encourage our employees to do would be helpful for family care givers as well.

We don’t want our workers to just make lunch for the client and then go in the living room and watch TV.  We want them to sit with them, eat lunch with them, visit with them, so that meal time is a pleasant experience.  If clients are able and want to help with household task, we strongly encourage care givers to engage the client and encourage him or her to do as much as possible for that individual.

We want our care givers to take direction from the client where possible, so that tasks are completed the way the client wants them done.  When a client asks a care giver to do something, I tell the new employee that the best answer he or she can give is:   “I’d love to!”  It’s so hard for folks of the generation of our clients to ask for help.  An enthusiastic reply makes it easier to ask the next time.

In the book, How to Say it to Seniors, the author, David Solie, says he believes there are two things that are very important to remember.  One is that many older people want to leave some kind of legacy.  More interesting to me was Solie’s belief that Seniors really want to keep from losing control.  He suggests that whenever possible, mainly by the words you use, you give seniors the message that they are in charge.  “Mom, you can decide about this; you are in control.”  “Dad, this is your decision; what would you like to do?”  Very few decisions are life and death matters; most of the time, even in very serious matters, the person can at least be given a little time to think about what he or she wants.

We also spend a good deal of time talking about special ways of working with persons with memory loss.  I tell people don’t argue. After a certain point in the disease process, orienting to reality isn’t always helpful, go with the flow, if the person tells you the sky looks green today, don’t try to talk him or her out of it, just go along, “Wow!  I’ve never seen the sky that color before!”  Do everything possible to decrease the frustration level.  If someone asks for the salt for his cereal, don’t correct him, just pass the sugar.  Here I think the very best goal is to provide comfort.  Do whatever it takes to help the person remain as comfortable–in every way–as possible.  Therapeutic fibbing is acceptable.

One wife, caring for her husband with Alzheimer’s was greatly relieved when a friend helped her understand that it was no longer in her husband’s best interest for her to consult him about business matters.  Even though he had always been the expert, the damage to his brain made it very difficult for him to think through certain financial or legal matters.  While she was trying to be respectful to him, he became uncomfortable and agitated when she tried to include him in these decision.

Some years ago, I taught private piano lessons.  After both my daughters began violin lessons with a Suzuki teacher, I started thinking about how I might change my teaching methods to incorporate some of the Suzuki method.  I attended a weeklong seminar at the U. of Wisconsin where I was able to participate in classes about the method and observe master teachers working with their students.  Probably the most valuable idea I came away with was that children should feel better about themselves when they leave a lesson than when they came.  I’ve thought about how beautifully that idea can be implemented in the work place, and even in our home.  If our customers, our patients, our clients, our students, our employees, our family members are helped to feel better about themselves after we interact with them than they did before, we will have been successful.

Think about it.  If you are caring for someone, see how you can help him/her  feel comfortable about whatever is going on at that particular moment, and how you can help him or her feel better about themselves after you’ve spent time with them than they did before.

Lonely Elders and the Holidays

Seniors in Minnesota and All Over the US Experience Loneliness During the Holidays

There are many seniors that have no family contacts.  Many have
never married, or, if they did, had no children.    Some who have had siblings have experienced brothers and sisters preceding them in death.  With our mobile society, some who have had children, have kids living in other parts of the United States or even in other parts of the world.  Holidays are particularly difficult for seniors who are alone.

In our present economy, many people are looking for ways of giving their time instead of spending money for gifts.  Doing something for a lonely senior is a possibility that will give you satisfaction and teach your children the importance of thinking of others.

1. Take a senior for a drive to see the Christmas lights.
2. Visit a nursing home or assisted living.  Call ahead and ask staff if there is a resident who would enjoy a visit:  help a person who is visually impaired play bingo; take a resident to a Christmas music presentation at the facility; bring a baby for a resident to just look at, or even to hold.
3. Help someone address holiday cards
4. Volunteer to help serve a holiday meal at a church or charitable organization
5. Bring a lonely neighbor a plate of cookies
6. Bring a small assortment of fresh fruit to a senior
7. Bring small children to sing favorite holiday songs for a senior
8. Offer to drive a senior to a holiday religious service

Consider how you might use some of the above ideas at other times during the year.  If you are a family member who lives away from a senior loved one, think about how you could arrange for a professional care giver to spend some time with your parent.

Seniors’ Choice at Home  usually provides regularly scheduled help for seniors, but we also do one-time-only visits.   One of our Homemaker’s is making it possible for  a client to spend Christmas Eve with a cousin by driving her to and from the cousin’s home.  If you have family in the Twin City area, and would like information about help for your loved one, call us at 763-546-1599 or check out our website, http://www.seniorschoicemn for more information.