President Barack Obama appears ready to announce a set of new initiatives in his State of the Union address to help America’s Sandwich Generation, people caring for both their children and their parents. The initiatives are part of Obama’s White House Middle Class Task Force, which also includes elements designed to create jobs and address the federal deficit. Specific to caregiving, Obama’s plan will call for $102.5 million Caregiver Initiative that will include:

• $52.5 million in funds to the Department of Health and Human Services caregiver support program to allow for temporary respite care, counseling, training and referrals to critical services. These are services typically offered through Area Agencies on Aging (AAA) and organizations that conduct AAA activities.
• $50 million to programs that provide transportation help, adult day care, and in-home services like personal assistance, bathing, cooking, etc. to help elders stay in their homes longer.

If funds in the first bullet follow the traditional pattern, AAAs will receive additional funds to expand outreach services to caregivers and funds to cover respite costs for those unable to afford it. How funds in the second bullet get dispersed and administered is yet to be determined.

Other, unrelated initiatives Obama will propose include:

• Double the credit for middle-class families making under $85,000 per year by increasing their credit rate from 20% to 35% of child care expenses. Families could claim up to $3,000 in expenses per child.
• Limit student loan payments to 10% of Discretionary Income.
• Make student loans more affordable by limiting a borrower’s payment to 10% of his or her income above a basic living allowance.
• Additional student loan expansion and assistance.
• Simplify and expand the saver’s credit to match 50% of the first $1,000 of contributions by families earning up to $65,000 and partial credit to families earning up to $85,000.
• 401k initiatives and reforms.

For additional reports on these initiatives, read how they were reported at MSNBC, Fox and Politico.

There’s a small, but growing trend in senior caregiving, the use of remote video cameras and other electronic monitoring equipment. Here is how it works:

George, an 86-year old man that is getting forgetful and frail, lives alone in his house. His daughter is concerned, because she can’t visit him as much as she’d like. To help monitor his safety, she either installs or has a company install basic, low-cost remote video cameras in his living room and kitchen, then wires them to a computer. Remotely, from her own home, she is then able to log onto her own personal computer and see through the cameras inside her father’s house. She is able to see whether he’s napping in the chair, whether he’s eaten breakfast, etc. If something is out of the norm, she knows to call or visit.

The equipment is inexpensive compared to the caregiver’s peace of mind and elder’s improved safety. Businesses that specialize in helping people do this, if you can find them, will increase the initial and ongoing cost; but if doing so postpones admission to an assisted living facility, the cost pays for itself many, many times over, and George gets to stay in his home.

One small, Maine business that is helping elders and caregivers with this task, Elder Power, was recently featured in a regional newspaper discussing their business model. Elder Power not only installs the equipment, but they also help monitor. Having a business monitor the home of your loved one naturally causes some privacy and safety concerns, but they are no more than the concerns people have when placing a loved one in a facility under the care of others. Such a business model is yet untested on a long-term basis, but given the rapidly growing need for eldercare services, and elders’ overwhelming interest to age-in-place, the potential is huge.

The Alzheimer’s Association estimates that more than 250,000 children in the United States are helping provide care for loved ones with Alzheimer’s Disease. Caregiving for someone with dementia is a stressful duty that will take its toll on anyone, but little research has been done on the effects it has on children that act as caregivers.

In 2007 YouTube held a Short Film competition and the winner was a short called My Name is Lisa. The 6 minute video depicts a child who is attempting to review books on her web cam, but keeps getting interrupted by her mother who has Alzheimer’s. The award brought unprecedented attention to Alzheimer’ Disease and child caregiving. The short film packs a powerful, meaningful punch in six short minutes. If you haven’t seen the video before, you should watch it now:

Deciding to put a loved one in an adult day center for part or all of the day is a decision that is never made lightly. Handing a vulnerable family member over to strangers is difficult for the caregiver and scary for the individual, but eldercare is a growing service industry and adult day services is growing with it.

The person most likely to benefit from adult day services will be physically or cognitively challenged and:

• needs help, but not 24-hour professional support;
• feels isolated and would benefit from social engagement;
• can’t be safely left at home;
• receives care from someone that has to work or needs respite;
• is in the early stages of dementia.

These are not set rules. Some high functioning and alert elders love attending day services, and many of the most reluctant individuals end up benefiting the most. The decision depends on personal circumstances, but adult day services helps many.

You should visit adult day centers in your area (hopefully you have them) and talk with staff and clients. Speak with family and friends. They can help you decide if day services is the right choice, but even then, you may only if you give it a try. Speak with the one you want to take.

Things to consider when selecting an adult day center:

• Client pool – Some centers are dementia specific and offer secure environments with programs specifically designed for dementia. Others are open to people of varying needs.
• Professionalism – Who owns the agency? Are they licensed? Is the space clean and comfortable? Is it well staffed? Are there daily events? Do they offer diet specific meals?
• Transportation – Do you need transportation help? Do they offer it?
• Cost – Daily costs can vary widely depending on location and services. A professional health centered adult day center will cost more than one that’s strictly social. Fees can be by the hour or the day. The center should offer a free visit if you want to try it.

Funding Sources for Adult Day Care:

• Medicaid – pays for adult day care if the person has little income and assets, but it may require that the person needs a certain level of care. This requirement varies by state.
• Private long-term care insurance – check your policy if you have this insurance. It is often covered if a doctor’s note is provided.
• Veterans Administration – the VA awards contracts to some adult day centers and they cover the cost if the person qualifies. Check with the VA or the adult day center to learn more.
• Charity care – some centers may offer financial help through their own funding sources. United Way funds some adult day service centers.
• Private pay – paying out of your own pocket always works.

While Medicare (not to be confused with Medicaid) has reimbursed a few experimental, skilled service (nursing and therapy) programs at certain adult day centers, Medicare generally does not cover the service.

For more information visit the National Adult Day Services Association. To find an Adult Day Center near you, contact your Area Agency on Aging through the Resources by State page.

Adult day centers (ADCs) offer services directed at older adults with physical or cognitive impairments. They offer a planned, professional day care program that promotes social and health well-being. The center may be privately or publicly owned, not-profit or for-profit. According to the National Adult Day Services Association, there are over 4,000 adult day care centers across the United States.

There are essentially three types of ADCs:

1. Adult Day Social Care – provides opportunities for social engagement through planned activities, meals and recreational opportunities
2. Adult Day Health Services – provides social opportunities with medical services like medical monitoring and therapies through licensed health professionals
3. Dementia Specific Adult Day Care - provides social and health services specifically to older adults with Alzheimer’s Disease and related dementias in what are typically secure (locked) environments

The elder may benefit from:

• Social engagement with peers
• Delayed admission to a long-term care facility
• Personal care assistance: bathing, toileting, etc.
• Medical monitoring and therapies
• Appropriate exercise activities
• Nutritious meals and snacks
• Planned activities

The caregiver may benefit from:

• The ability to work full or part-time
• Respite from caregiving demands
• Cost effective care
• Support groups and counseling

In most cases the person attending must be able to ambulate on his/her own (not wheelchair bound). If the individual will have the adult day care costs covered by private insurance or a public benefit, he/she must be assessed to qualify for the service.

For more information visit the National Adult Day Services Association. To find an Adult Day Center near you, contact your Area Agency on Aging through the Resources by State page.

Looking for an online support group?

If I’ve said it once, I’ve said it a thousand times, caregivers, family, friends and the individuals themselves fair far better through the dementia process if they’re connected to a support group. For some people, they just don’t have time, or they can’t find someone to act as caregiver while they attend a support group. Others may have a hard time opening up with strangers. While I don’t think an online support group could ever replace the person-to-person contact found in a traditional support group, they are a great first step for private people, or for people that need to take part in a support group at odd times, or lack transportation.

The Dementia Advocacy and Support Network International (DASNI) is one such online support group.

Here’s the interesting part: approximately one-third of DASNI’s members have dementia themselves. Where can you find an online support group like that? If you have dementia, you can speak with people that are experiencing the same thing. Knowing you have dementia, and experiencing it, can make for a very lonely situation. Your friends and family may try to understand, but they can’t.

DASNI states on their site:

The stigma of dementia is very real, very cruel and widespread.  There is also a lack of knowledge about dementias, the impact of new medications, and the support available.  By sharing their hopes and concerns, and participating in dementia-related activities, DASNI empowers people with dementia to actively participate in their own care and treatment. We support a more accepting, more hopeful view of living with dementia. We encourage people to improve the quality of their own life by advocating for others.

Connect with others, ask questions, learn, and make your process easier. Whether it’s with DASNI, another group, or both. Then, as you learn, give back, help others. It will help you find purpose on a difficult journey.

The National Institute on Aging produced an easy-to-use guide on caregiving for someone with Alzheimer’s Disease. The guide is equally suitable for providing care to people with related dementias. This 145-page document covers the important topics any caregiver or aging professional should become aware of. Sections include:

• Understanding Alzheimer’s Disease
• Caring for a Person with Alzheimer’s Disease
• Caring for Yourself
• When You Need Help
• The Medical Side of Alzheimer’s Disease
• Coping with the Last Stages of Alzheimer’s Disease

The guide is particularly useful for caregivers that are new to Alzheimer’s Disease. The reader will learn about the disease, how it changes a person, how to cope with the changes, future planning, managing everyday activities, taking care of yourself, and other resources available such as websites, support groups, adult day care programs, etc. There is no better introductory guide to caring for someone with Alzheimer’s Disease, and best of all – it’s FREE!

Download the “Caring for a Person with Alzheimer’s Disease Guide”

Send a link to this page to other caregivers and professionals you may know. It should be made available to support groups everywhere. Information is crucial to successful caregiving. Caring for someone with Alzheimer’s Disease is a very difficult job that is both rewarding and stressful. This guide will help the process.

Web savvy caregivers are increasingly turning to online communities, blogs and web sites for information, resources, and just as a simple way to connect with other caregivers. I peruse these “communities” periodically looking for post ideas or advice to offer. I did this just recently for Tara over at Caregiving.com, a site that specializes in helping caregivers connect and share thoughts. You can read her dilemma and my thoughts on the matter at her post right here. Perhaps YOU can offer her additional advice. Perhaps there’s something I overlooked. Got experience with Depends and incontinence? She needs your advice.

While the web is a wonderful place to connect and gather information, one must always remain mindful of the source. Anyone can throw a web site up and profess to be an expert on anything, and if they’re good with web design (or hire someone that is), they can even look like one. Use the web, but don’t rely on it as your sole source of information, because much information – particularly program eligibility and resources – is very specific to an individual’s particular case and the state in which he/she lives. No state is the same when it comes to aging resources and program criteria.

Does this mean I don’t think you should seek aging information on the web? Hardly, here I am trying to provide some. What I’m trying to say is that when you’re looking for hard facts about aging resources and program eligibility – nothing beats a local professional, whether it’s your Area Agency on Aging, a local residential care facility, or someone in your State’s Office on Aging. That means either visit those specific sites or contact someone by phone in or in-person. As useful as the web is, person-to-person contact is still the best, especially for important matters.

Use ALL resources available to you. Ask the same questions of various people, because even if you’re speaking with local professionals, chances are you’ll still get different answers.

There is a whole plethora of jobs being created that relate to our nation’s elder wave, so it’s little surprise that “Senior Mediators” have joined the ranks.

Got problems with Gramps not giving up the car keys?

Got issues with adult children thinking you can’t manage your finances?

Hire a senior mediator!

Or not, there are people that provide the service for free if you can find them. You can start by contacting your Area Agency on Aging through the Resources by State page. They may be able to connect you with someone at low or no cost. There is no problem with hiring someone to act as a mediator, but know that the industry is not regulated. Anyone can call themselves a mediator and advertise their services. I could advertise, you could advertise, George, Fred, Nancy or Mary. Just because someone calls themselves a senior mediator doesn’t mean anything, and while some may have mediation experience in one area, that doesn’t mean they’re well suited for elder issues.

Licensed Social Workers working in the field, particularly in long-term care, often have a lot of experience helping elders and family members find common ground. It’s amazing what sibling rivalries and family dynamics arise when mom, dad, grandma or grandpa needs help. These social workers have seen a lot, and helped families resolve their differences. It’s entirely likely you can find a social worker at a facility that would be willing to help. All you have to do is ask. Heck, if the problem isn’t overly involved, maybe I’ll even help for free!

FREE!

But if your problems are complex, and you can’t find someone for free, or would just as soon hire someone, EldercareMediators.com is one place to look. The Association for Conflict Resolution is another.

Good luck resolving those issues – and remember – it always takes two to tango!

I have written about how physical modifications to one’s home may permit aging in place longer and more safely. Another important factor in determining a person’s ability to remain in the home is caregiver support, Meals on Wheels, volunteer drivers, etc. Many are familiar with Lifeline, which provides 24/7 emergency help when the button is pushed, typically worn as a necklace or on the body somewhere in the event of a fall. Technological support systems such as Lifeline represent another tool to keep seniors home, but there is another system you may not be as familiar with.

eNeighbor was developed under the direction of the National Institute on Aging. The system, developed by Healthsense, is an “automated personal emergency response system.” You see, the problem with Lifeline is that it requires user activation. This is great IF the senior is alert and conscious, but what if they’re not?

The eNeighbor frequently asked questions brochure on the product states:

The eNeighbor system has an emergency call button, but in addition it uses small, wireless sensors placed throughout the residence to automatically call for help if the senior cannot. The eNeighbor system provides safe coverage of the entire residence 24 hours per day even if the senior cannot activate a call button. The eNeighbor system also provides valuable information on the health of the senior that call buttons alone cannot provide.

A variety of sensors are used together to determine the safety of the individual, and these sensors can and are placed on the toilet, beds, chairs, doors, refrigerators and motion sensors. The senior designates who should be contacted in the event the system goes off. The system also generates reports to determine changes in behavior, something that could be exceptionally beneficial to out-of-state kin trying to coordinate care. Particularly interesting is that the system is supposed to alert the senior or caregiver should he/she miss an event such as taking medications.

The system qualifies for medical reimbursement, and is reported to cost around $100 a month with a government subsidy. I cannot speak to the effectiveness of the system as I have never seen it installed or in use.

Photo by mhofstrand – some rights reserved

The problem with such advances in technology is that caregivers, doctors, and neighbors may become less engaged, more reliant on electronic assistance, which can never replace human interaction.