Communicate Openly

1. Allow your elder to discuss his/her deepest thoughts. Facilitate open, honest dialogue. Allow your elder’s feelings to surface. Never try to suppress things he/she wants to discuss. This time is usually filled with reflection and new understanding, and your elder will probably want to talk to someone about it. That someone can be you.
2. If past conflicts arise, face them directly to dissipate the unease. Be extra sensitive about how you bring up unresolved history. Doing so can cause your elder to tune you out or become upset. What happened in the past happened, and people have their own perspective of events. Your elder can become entrenched, and that’s no position to be in now.
3. Talk about positive memories and important people from your elder’s life. Being a caregiver is all about making your elder feel good and establishing a rapport. Find something positive that will increase your bond. If the only fond memory you have is of mom’s chocolate chip cookies, let her know how much you loved them. Honor who she is and who she was.
4. Find the humor in any situation when possible. Believe me; your elder is full of humor and wisdom. You don’t get your needs met for decades without learning how to laugh and how to get what you want. Caregiving is a chance to embrace your elder emotionally and to work together to find answers and harmony.
5. Don’t judge, and don’t arrive with baggage or preconceived notions. I never judge my clients. I know this is difficult to do, but just try, both for your sake and your elder’s.
6. Understand your elder’s values. This is a good way to build trust. Your elder has to know that you understand his/her values, struggles, and identity. When that happens, barriers begin to melt.
7. Be honest with yourself about your caregiving challenge. Caring for an elder loved one can be a stressful job. To have any chance at being a powerful caregiver, you have to be honest with yourself. What are you willing to sacrifice, if anything? Know your limitations, energy level, time constraints, family obligations, work commitments.
8. You have two eyes and ears, and only one mouth, so observe and listen twice as much as you talk. Always make your elder the center of attention. Now is not the time to download your problems on to your elder. Start conversations with chit chat about your elder and the day. Be light, gentle, general, and discuss familiar topics, not the latest hit album.
9. Begin communication with a one-on-one discussion. Ask questions like “Tell me about your childhood, your children, your husband, your wife.” Be careful of sending mixed messages or using slang that may not be understood. Ensure what you’re saying is accurate. If it’s not true, don’t say it, and never exaggerate.
10. Keep your sentences short and concise. Ask simple questions and wait for the answer before rushing to the next subject. You have to give your elder time to process and formulate answers. Limit your vocabulary and stay on one subject, one sentence at a time.

Find Mobility in Disability

11. Encourage your elder to keep using what physical abilities he or she still has. This is especially important since he/she might feel frightened due to diminishing capacities. A sedentary person declines dramatically faster than one who still leads an active lifestyle.
12. Find ways to help your elder remain independent. Restrictions on mobility can have a devastating effect on your elder’s psyche. As a caregiver, it’s now your job to smooth the transition, and I encourage you to make your loved one feel independent no matter what struggles are encountered.
13. Travel can still be an exciting experience for your elder, but it takes a great deal of organization, so plan ahead. Always check for senior and/or handicapped discounts and consider traveling midweek or off-season. State bureaus of tourism, state parks, historical societies, and local chambers of commerce are all excellent sources of travel information.
14. Show your elder how to use the subway, the bus, and the train. Also look into private limousines, taxis, car services, and carpooling. Public transportation also has senior discounts. Many communities provide transportation for the elderly, including senior centers, community centers, and religious groups. It may take some digging to find the resources, but it’s worth the effort to keep your elder moving about.
15. If your elder must have driving privileges revoked, consider buying a three-wheeled bike for transportation, exercise, and fresh air. Your elder could even meet more people this way because he or she is out and about and more visible. Also consider arranging for a bus service and taxi service to take them around town.
16. Be sure that the car insurance is up to date. This sounds like a “no-brainer” but it’s not uncommon for paperwork like this to lapse.
17. Have your elder take a defensive driving class. Even if your elder is still competent behind the wheel, consider having him/her retested at the Department of Motor Vehicles. There might be new laws that your elder needs to know.
18. Buy maps and laminate them so they’re easier to read. You don’t want your elder fumbling for directions when he or she is driving. This can make it much easier to deal with any direction and/or travel problems.
19. When outside the home, be sure to use handicap-friendly accommodations. These include parking spots, toilet facilities, wheelchair exits and entrances, adapted seating in restaurants and movie theaters, and the like.
20. If your elder requires a wheelchair, become an expert wheelchair handler. Put yourself in the wheelchair and imagine what it would be like. Take the approach that you’re going to make the best of the situation, and your attitude will go a long way toward keeping your elder as mobile as possible.

Find the Right Housing Options

21. Try not to separate an elderly couple unless it’s necessary. Most couples who have been together for fifty years would rather be dead than separated, even if they’ve argued a lot. Who else would they spar with?
22. Strive to allow your elder to remain in his/her home, or age-in-place, if possible. Many people erroneously believe that the majority of the elderly population ends up in a nursing facility soon after the first signs of dramatic decline. In fact, only six percent of the elderly population requires skilled nursing care.
23. Be aware that just moving to a room with a window in the same facility or institution can cause an adjustment period called “transfer trauma.” Everything familiar changes and it takes time for your elder to adjust. Take into account such things as the orientation and the new environment, as well as the sounds, smells, and food. So give your elder that time and space to adjust.
24. Carefully consider the physical, emotional, financial, and psychological issues that are involved with leaving your elder’s home environment. Can your elder self-medicate or is help required for dispensing medication? Is his/her food delivered or cooked? How does your elder currently get to the doctor? What are the specific health issues and can they be managed if your elder lives alone? Are you considering moving your elder because it’s best for him/her or best for you?
25. Most elderly want to remain in a familiar environment until the very end, so it’s usually easier on you and your elder if you try to fix and improve the current living space. Talk with your elder and get the real story about what’s going on. How is their health; is he/she safe; are basic needs being met in regards to care, nutrition, and medications? What effect does the current housing situation have on his/her health and happiness?
26. Consider moving your elder to a nursing facility. Seniors who are unable to function independently can benefit greatly from the mental, physical, emotional, and medical services available on site. Nursing facilities are expensive, but could prove to be the perfect fit for your elder. The nursing facility provides them with a vital new community and support system.
27. Consider moving your elder to an assisted living facility. Assisted living provides aides on site, and they’re attuned to the needs of their geriatric population. Household chores are performed: sheets are changed, laundry is done, and food is cooked and served.
28. Your elder may be able to move in with you or another friend or relative. In many cultures and societies, this is the tradition. Are you able to adapt your living space? Can you build an addition or retrofit some square footage in your home? Can your kids double up and give up one of their rooms? Is the floor plan of your home flexible?
29. Your elder may be able to live in the home with an aide or hired help. These services include employing an aide in the home for a set number of hours per day, employing a visiting nurse to pour medications on a weekly basis, or hiring other help to coordinate meal delivery or other services.
30. Your elder may be able to live alone in the current home. Your elder has many positive memories in his/her home, and the smells, the furniture, and the kitchen are all familiar. It’s also more affordable. Familiar surroundings make your loved one feel calm and centered. Neighbors can help you keep an eye on your elder.

Hire Help When it’s Needed

31. Ask about any helper’s educational and professional background as well as references, then check them. It’s always better to be thorough and safe than slack and sorry.
32. Who pours and dispenses your elder’s medication? A clear, daily chain of command has to be established or else you risk under or over-medicating your elder.
33. Does your elder need an aide or companion to live in-home part time or 24/7? Once you determine this, you’ll know who you should try to hire. Don’t start calling for help until you know this answer.
34. Draw up a contract and make sure all duties are clearly understood. Negotiate and sign a contract that explicitly states the terms of the agreement. You don’t want any misunderstandings or ambiguities. Type up a clear list of duties to be accomplished and then post it on the refrigerator. This eliminates any confusion. The list should include timeframes for the work to be completed.
35. Experience matters. Determine if the aide has done this sort of work before, where, and for how long. Can the aide shave a man who can’t hold up his head? Has the aide ever changed an adult diaper? Ask the tough questions so you don’t find yourself in a terrible predicament because you were afraid to approach a sensitive subject.
36. Never abuse hired help. Aides should be hired to perform the agreed upon chores directly related to your elder’s care. Don’t load them up with extraneous duties, even if you see they’re highly competent, unless of course the aide agrees to it and they are financially compensated.
37. Hire help for the most common tasks such as cleaning the home, handyman work, and taking care of trash disposal. You can hire help on a daily, weekly, or monthly basis, all depending on your needs, financial ability, and your elder’s wishes. Search out community and government services as well as family aides and religious organizations.
38. Your elder’s needs can often be met by tapping into your network of family and friends. Look into this before you hire anyone else. Get as much free help as you can, but be clear about your elder’s needs before asking for their assistance. How long will your loved require their help - a few weeks, months, a year?
39. Hiring help or assistance can be time consuming, but it’s well worth the effort. If you’re persistent, you’ll eventually find the right person. After you interview an aide have your elder speak with the candidate to make sure they feel comfortable. It’s your elder’s home and space, and he or she might not take too kindly to “outsiders.”
40. Hire help where and when appropriate to share the caregiving load. Trust me, you’ll need a break. Do research; ask your friends and your elder’s friends for references. Then interview candidates and hire someone who understands the needs of your elder.

Improve the Lifestyle

41. Your elder will greatly appreciate any interest you show in his/her appearance. Often it has been years since anyone else paid attention to your elder’s physical appearance. Take him/her to the hairdresser. Give him/her a regular pedicure and manicure. A facial is a real treat, too, if it’s in the budget.
42. Take your elder out to eat as often as you can. This is a very natural way to keep your elder engaged with the world. If your elder is unable to go out, investigate whether his or her favorite local restaurant will deliver to the residence. What’s better than a knock at the door and a different hot lunch and dinner delivered each day?!
43. Food is one of the few remaining varieties in your elder’s life, so have fun with it. It might be more important now than ever before, so it’s crucial to fill the house with food that your elder likes, as long as it’s approved by the doctor. Consider likes and dislikes and shape a diet accordingly.
44. Expose your elder to entertainment such as movies, books, newspapers, magazines, music, theater, concerts, museums, playing cards, and sporting events. Your elder can become so focused on current hardships that he/she loses touch with the outside world. There’s a limitless supply of things to do, especially in today’s information age. Learn about your elder’s likes and dislikes and go from there.
45. Encourage creative outlets such as painting, drawing, music, writing, and arts and crafts. Recent studies show that stimulating the brain through any creative process encourages other parts of the brain to retain their capacity. Getting in touch with the creative self allows your elder to stay connected to the wonders of life. He/she might even draw on creative impulses and abilities that were never pursued in the past.
46. Facilitate interaction with the local community whenever possible. Often, seniors go to the doctor for a social life. Don’t allow that to happen. Encourage your elder to send birthday cards to family and friends. If he/she isn’t able to write, I’ll have him/her dictate the card, then I send it in the mail. Often, the recipient responds which opens another avenue of contact and interaction for your elder.
47. Many elderly are over-medicated, so take stock of all medications and eliminate any you can with the guidance of a physician. When you take into account what has been prescribed by a doctor, and what your elder may also be taking over-the-counter, the amount of medication can have a disastrous effect on mental and physical well-being.
48. Be sure your elder drinks enough water every day. This will ward off dehydration, and can be the simple cure for headaches, nausea, and even exhaustion. Consult your elder’s physician to be sure about the adequate amount of liquids for his/her age, weight, and height.
49. Exercise relieves stress, augments coping abilities, wards off exhaustion, and keeps weight consistent. It can also increase the power of the natural immune system for better overall health. Encourage exercise at every turn, but be sure to consult with your elder’s doctor before starting any physical exercise program.
50. The body was meant to be moved so encourage your elder to exercise often. Many elderly suffer from a lack of physical stimulation, so naturally the body withers away. Increasing your elder’s physical stimulation is a focal part of your caregiving responsibility. You’re in charge of rekindling life where the flame is flickering.

Learn to Let Go

51. You’re not alone in your caregiving challenge. You can do it! Reach out for the support you need. Doctor Marion is here to help.
52. Don’t be afraid of death. It’s a natural part of life. Every generation has a one hundred percent mortality rate. Most people give me a weird look when I bring this up. But seriously, death is a certain reality.
53. Grief is an important part of death, so allow yourself to experience it. Grief is healthy, and a powerful way to show love. Grief can be internalized through thoughts and feelings, but you need to allow yourself to externalize grief by expressing it in tears and words. We were given tear ducts to relieve the stress and pressure of life, so use them.
54. After death, notify family members and friends, and then oversee the funeral. You’re also required by law to notify the Social Security department and all banks and other financial institutions. Other legal issues include informing the post office, closing or selling of the home, taking care of any animals, changing the locks on the doors, and dividing assets according to the will.
55. Face the business side of death by preparing final papers, the funeral, and final finances ahead of time. This includes the will, inheritance planning, taxes, gifts, the obituary, and the service.
56. Enjoy the process of helping your elder write his/her obituary. Have your elder answer a few questions such as: I feel deeply passionate about; I’ve learned this from my failures and mistakes; This moment or event was the turning point in my life; The miracles in my life are; I’d still like to accomplish; My mentors and role models have been; And this is my favorite! What’s your single most valuable lesson in life?
57. Prepare for the funeral with your elder and be sure you know what should be done with his or her remains. You might find he/she is much more comfortable discussing the topic than everyone else. If appropriate, pick out the clothing that will be worn at the funeral. What rituals should be performed? If they’re different from your traditions, learn about them and fulfill them.
58. Offer solace and comfort while remaining comfortable in your own value system. Validate your elder’s life. He/she probably needs someone to talk to. Develop personal rituals for health, peace of mind, stress relief, and spiritual outlets.
59. The goal is for your elder to pass on from this world with the utmost dignity, comfort, and respect. Listen to your dying elder. Who was he/she for so many years? Learn about heart breaks and heart throbs. It’s a golden opportunity for your elder to heal rifts and cement bonds forever.
60. Understand your elder’s needs and wants. Try to fulfill his or her wishes if possible. Discuss highlights such as a sweet sixteen, a prom, college, children, service to the country, and his or her career. If Hagen Dazs vanilla bean ice cream is the request, don’t come back with store brand chocolate.
61. Discover your elder’s varied, rich, and valuable knowledge. The elderly are full of wisdom and experience, and you can learn so much by engaging your elder from this point of view.

Make Life Easier with Adapted Equipment

62. Look for easy-to-use medication dispensers. You want to avoid small dispensers that might allow the medication to get mixed up and/or lost. I suggest the bigger the better so that your fingers can get in each day’s box.
63. Stock up on adult diapers and disposable briefs for incontinence. This can be a serious point of embarrassment and shame for your elder, but it can be handled in a delicate manner to avoid most mishaps.
64. Replace shoelaces, buttons, snaps, or zippers with Velcro. Velcro is like magic. It makes many elder care challenges a little easier to deal with.
65. Consider a motorized wheelchair if needed. This area of adapted equipment has improved dramatically in the last decade. Though quite costly, motorized wheelchairs make it infinitely easier for your elder to remain mobile and more independent once they require the use of a wheelchair.
66. Writing aides with a special grip can help. This applies especially for those elderly who are struggling with their manual dexterity. Writing helps your elder stay in touch with the rest of the world, so it’s vital to provide help here.
67. Use adapted gardening tools. Gardening is a favorite hobby for many elderly, but there can come a time when it’s very difficult to use tools like a rake or hoe. Various adapted gardening tools can be purchased online or in your local home and gardening store.
68. Buy walkers that fold in half or that have an attached seat. Often times, you elder will want to take a short break when he or she is out for a walk. It’ll keep your elder more active if he or she has a walker that can facilitate those rest breaks.
69. Add amplifiers to telephones for better hearing. Many elderly suffer from hearing loss as they age. Today’s technologies go a long way to helping those who are hard of hearing. So consider buying a phone with a speakerphone or amplifier attached.
70. Look for double-handled glassware like sippy cups to stop spills. Many elderly have difficulty with regular cups and glasses in their later years. Preventing spills with this adapted equipment can avoid embarrassing situations.
71. Use silverware that’s easier to hold. You can buy silverware that is thicker or lighter or that shaped in a way that makes eating more comfortable. This is especially important if your elder is suffering from decreased manual dexterity.

Manage Financial Issues

72. Rely on a skilled professional such as an accountant, an elder care lawyer, a financial advisor, or a tax expert. How do you find these professionals? You may locate them via the Better Business Bureau, word of mouth, or anyone who is connected to your family. Professional expertise will save you many headaches and could ultimately lead to significant savings of your elder’s finances.
73. A reverse mortgage can be a useful and valuable option. Seniors over the age of 60 are eligible to apply for a reverse mortgage. This is when your elder secures his/her house to the bank after a fair appraised value has been agreed upon. This is a complicated process, so make sure you are fully informed.
74. Have a clear tax plan in place for when your elder passes on. States have various time frames, usually six months to one year, for when the tax bill must be settled. All new tax issues must be understood. Hire a professional to help you understand which assets go through probate and which do not (probate is when the state delays dispersing assets upon death and assesses the estate for tax purposes).
75. Figure out the cash value of all life insurance policies. Start by understanding exactly what your elder’s various policies cover. Get the original documents if possible. Figure out who the agent is or was. You might even find there are multiple policies or duplicate policies.
76. Determine if there are any government programs and benefits your elder should apply for. Apply for Social Security, food stamps, veterans’ benefits, Supplemental Security Income, and both Medicare and Medicaid if it applies. You’ll have a lot of paperwork to fill out, but the resulting funds could make all the difference, especially for your elder.
77. Figure out the best insurance plan. Determine exactly what is covered and the level of coverage. Ask questions and comparison shop where appropriate. Eliminate all excess and/or overlapping insurance, and be sure to fill out all proper forms in a timely manner.
78. Determine if your elder has enough money to live on for the remaining years. Your elder’s financial situation can be a difficult issue to address. The very nature of the discussion calls his/her independence into question. Address finances as soon as possible. The longer you wait, the more likely it is that problems will arise.
79. Add up monthly income. This includes: pensions, current job, interest, bonds, dividends, CDs, annuities, rental properties, other businesses, social security, disability, and unemployment.
80. Add up all monthly expenses. These include: mortgage and/or rent, property taxes, equity loans, parking, home maintenance, condominium fees, utilities, phone, water, food, car payments/maintenance, DMV fees, gas, clothing and shoes, medicine, legal fees, monthly memberships, credit card debt, and all forms of insurance.
81. Add up all assets. These include: checking accounts, savings accounts, stocks, bonds, rental property income, home owner property, safe deposit boxes, IRAs, 401Ks, pensions, vehicles, collectibles, and hidden valuables.

Put Safety First

82. Keep emergency items in the car such as a spare tire, bottled water, a flashlight, an umbrella, and maps. It shouldn’t take you more than an afternoon shopping trip to buy all of these items, and they could make a real difference in your elder’s life.
83. Take medication along if your elder will be gone for an extended period of time. This is vital when your elder is traveling. You should also equip him or her with extra prescriptions in case the medication is lost or damaged. It’s always better to be safe and plan ahead in case of a medical emergency.
84. Remove all clutter - if something doesn’t serve a purpose, get rid of it. The elderly have gathered a lot of “stuff” over the years, and some of this is just clutter. But make sure you ask your elder about each item before you toss anything. You don’t want to get rid of anything that holds sentimental or monetary value.
85. Make sure all smoke detectors are in perfect working condition. You’d be surprised how many people have smoke detectors with dead batteries. That doesn’t help in the case of a fire emergency. Check each of your elder’s smoke detectors, and replace any expired batteries. The same goes for defective or broken detectors.
86. Program telephones with emergency numbers. Take advantage of today’s technologically advanced phones. Gather your elder’s important contact information including the doctor, local police, fire department, department of water and power, you, and the closest caregiver other than yourself.
87. Add safety rails in the shower and tub, and near the toilet. Doing so makes it much easier to navigate what can often be tight and slippery spaces. Strongly consider hiring a handyman or plumber to help install them, too.
88. Put all appliances, dishes, and silverware where they’re easy to reach. If there isn’t enough room to do this, you must arrange everything according to frequency of use. The last thing you want is for your elder loved one to stand on a step ladder to reach for heavy dishes or sharp knives.
89. Affix non-slip strips on the bathtub floor. This goes for any age, but especially the elderly. You can find them in most hardware or bathroom supply stores.
90. Toss out throw rugs. Throw rugs can easily cause an elderly person to slip, trip, or fall. They are also very difficult to navigate in a wheelchair or when using a walker.
91. Eliminate all potential hazards in the home. No matter how clean or organized someone may be there are almost always safety or hygiene issues that need to be addressed. Many elderly are victims of accidents in their own homes, and most of these accidents can be avoided with a few common sense steps.

Take Care of Legal Issues

92. Legal issues should be handled by a trusted lawyer, accountant, or financial advisor, especially if there are complicated issues outside your expertise. Many of the rules and laws fluctuate on a yearly basis, and vary from state to state.
93. Determine taxes, inheritance options, asset protection, and tax planning in compliance with various federal and state financial rules and regulations. The more you can do ahead of time, the smoother the transition will be once your elder passes away. It can become very complicated, so don’t take all of this on by yourself.
94. Make sure that the will and all legal documents are up to date. Change is a constant in life, and wills are no different. Be ready to execute more than one document over time. Anytime someone signs a will, there must be a witness. The original may be kept with the lawyer, and a copy should be included with your elder’s other legal documents.
95. Name someone as your elder’s beneficiary or the estate will be left to the state. Your elder should have the opportunity and choice to leave his or her worldly possessions to exactly who they want to.
96. Don’t allow your elder to pass away intestate (without a will). When your elder doesn’t have a will, the state takes over all of the assets. It can become very complicated, and you’re sure to lose a hefty percentage of the true value of the estate.
97. Execute a do not resuscitate (DNR) orders if so desired. Discuss this with your elder at length so you know his or her wishes will be carried out should serious health complications arise.
98. Assign durable power of attorney. This authorizes someone to act on behalf of your elder if he/she becomes unable to make decisions. It differs from power of attorney in that it can be enforced even if your elder becomes mentally disabled, so abuse is more frequent due to the greater power transfer. Use caution!
99. Collect all legal papers in a lock box, safety deposit box, or fireproof safe. After going over financial and insurance details, it is wise to collect and keep your elder’s legal papers in a safe spot. But don’t place legal documents that need to be accessible 24 hours a day in a bank safe deposit box.
100. Have all possessions professionally appraised, catalogued, and videotaped for inventory and insurance purposes. This gives everyone involved great peace of mind. It can be a long process, but in the end, you and your elder will be very comforted.
101. Execute a legal plan for your elder’s estate. Face things and solve issues now so your elder can better enjoy his/her remaining time, and so you can be more at ease in your caregiving role. Once everything is put in order, review all legal issues every five years, or more frequently if your elder has a particularly complicated situation.