Tuesday, April 30, 2013

Why Some Siblings Don't Help With Caregiving

Unfair as it may seem, even in families of many adult children, one sibling generally becomes the primary caregiver for the aging parents. In many families, such as mine, this person lives the closest to the parents and/or is most suited to the task of caregiver. In my case, it was both. This fact didn't keep my sister, who lived about 50 miles away, from coming to town nearly every weekend to see our parents and help me out. However, in some families, this relatively short distance would be enough of an excuse to keep the "caregiving" efforts of the distance sibling to an occasional, convenient visit.

Many caregivers ask how to respond to siblings who, after being directly and distinctly asked for help, either skirt responsibility with excuses, or become outright nasty if they are asked for assistance in a direct manner.

Let's look at a few examples and contemplate responses. These can, perhaps, trigger ideas about how to handle your unique circumstances:

"I Don't Have the Time"

This excuse is probably the most often used reason for not helping out. The implication in this excuse is that you, the person who has taken on the role of primary caregiver, do have time.
Caregiving can grow from just running a few errands for the elder into a full-time job. Many people have quit paying jobs, or not accepted a promotion, in order to be available to care for an aging parent. From the outside, it looks as though this person has the time. In most cases, the person has made the time, often at great sacrifice.

Unless there's a family agreement, family caregivers don't get a salary. That not only affects their current financial status, but their future, because family caregivers aren't paying into Social Security if they can't work. Therefore, those of us who have given years to caregiving often find our own later years threatened by poverty. Yet, many of us stay home from a paying job to care for an elder; thus we "have the time."

Having the time is also relative in that caregiving is emotionally, if not literally, a 24/7 job. Most caregivers need a break from the stress of the constant responsibility of being the primary caregiver. Siblings could provide that relief, either in person or by offering to help pay for respite care in the form of in-home help or adult day care.

When this option is suggested to siblings, some jump on board, many don't.
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Doesn't Swallow or Chokes

Possible Causes
Your loved one:
  • Finds it physically difficult to swallow (this is called dysphagia).
  • Forgets to chew.
  • Consumes food too rapidly.
What you can try:
  • Avoid hard foods: popcorn, nuts, hard candy, hard raw vegetables (such as carrots), hot dogs (unless finely diced), grapes, apples.
  • Avoid foods that require a lot of chewing: celery, steak, chips.
  • Avoid sticky foods such as peanut butter.
  • Mash up foods or puree them in a blender or baby-food grinder; finely dice meat and cheese.
  • Choose nonsolids, such as puddings, gelatins, applesauce, small-curd cottage cheese.
  • Try nutritional supplement drinks (such as Ensure).
  • Be sure liquids aren't too thin; they may be drunk too quickly, causing a choking hazard.
  • Choose thicker soups, purees, and smoothies, which are easiest for seniors with chewing and swallowing problems.
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Dementia Signage for the Home


Behavior Triggers Log (Sky Blue) Memo Note Pad Bathroom Door Sign-Temporary/Reusable Wall Skins

Appointment Reminder Notepad Bright Orange Pantry Labels


Calendar Appointment  Reminder Stickers (White) Canned Foods Shelf Sign/ Bumper Stickers

Checklist for Brushing Teeth Wall Decal Daily Pain Journal (Sky Blue) Memo Notepad

Daily Fatigue Journal (Sky Blue) Scratch Pads Do Not Call Reminder Note Pads

Expiration Date Stickers EZ-C Bright Yellow Dry Erase Board

Manual Prescription Notepads Medication Log Notepad (White)


Legal Issues For Caregivers

As people reach old age, they become more vulnerable. Too often, they are taken advantage of. It's not only strangers, but also family members who exploit an elderly person's defenselessness. In addition, the caregivers who are trying to take care of their elderly parents often find themselves in sticky legal situations.

Here are some examples of some of the  legal trouble that elderly people and their family caregivers have had:

"Dad signed his Power of Attorney over to a scam artist"
When an elder lives alone, is too trusting or doesn't have someone watching over their finances, they are easy prey for scam artists.

"My brother is stealing money from our elderly mother"
It's not only scam artists who prey on the elderly. It could be their own child.

"Mom never changed her Power of Attorney. Now she has advanced Alzheimer's and it's too late"
Families should have an honest discussion with aging parents about appointing a POA, before the elder loses the ability to make decisions.

"My mother turned me and my siblings in for abuse"
Whether it is due to dementia or spite, an elderly parent might charge a caregiver with abuse. Even if it is unfounded, the caregiver is in a heap of legal trouble.

"My siblings are suing me for taking care of our father"
When one sibling is caring for the parent full-time, siblings may accuse the caregiver of stealing money, abusing the elder, or mishandling assets.

"My siblings only care about their inheritance…not mom's well-being"
Whenever there's money involved, things can get ugly. Some siblings may be more interested in protecting their inheritance rather making sure mom or dad is getting quality care, living in a good nursing home, etc.
 
"My elderly mother is being taken advantage of by a younger man"
Gold diggers and opportunistic younger men and women look at an elderly person and see dollar signs, starting a relationship to scam money from them.

Must Have Legal Documents for Seniors and Their Family Caregivers

Many people consider information and decisions about their health to be highly sensitive, deserving of the strongest protection under the law. Therefore, when it comes to your parent's healthcare, the law is very strict about who is able to participate in healthcare-related conversations and decisions.
However, many people never think about their views and values regarding end-of-life decisions until a crisis hits – the time when decision-making is most difficult. Not planning in advance means that you might not be able to gain access to the information you need, or act on your parent's behalf if they are unable to do so. In a worst-case scenario, you might be forced to fight in court for guardianship, a time-consuming and costly process. You can avoid this scenario by working with your parent to prepare these documents.

HIPAA Authorization
The Health Information Portability and Accountability Act (HIPAA) keeps a person's health information and records private. Unless your parent authorizes in writing someone else to receive that information, it is illegal for doctors to share any details with you about your parent's health. HIPAA authorization is a simple document that authorizes the doctor to share necessary information with you on your elderly parent's behalf. It's very short and only takes a moment to complete. The doctor's office will have the blank form you need.

Health-Care Proxy
Also known as a medical power of attorney, a health-care proxy is a legal document that enables you to make health-care decisions for your elderly parent in the event they are unable to make those decisions themselves. This document must be prepared while your parent is still mentally competent to do so.

The designated person has the power to make all health care decisions for your elderly parent. However, to avoid the difficulties associated with making joint decisions, only one person can be given authority to act on your parent's behalf. For example, two siblings cannot both be named as a Health-Care Proxy – it must be only one person. An alternate person may be designated at the time the Health Care Proxy is prepared in the event the first person is unable or unwilling to serve.
It is crucial that the person who is named health-care proxy know what the elderly parent's wishes are in the event that they need life support, a feeding tube or intravenous fluids to survive. This is why the patient's living will, known as Advance Care Directive, is a very important document for family caregivers to have.

Advance Health Care Directive
This is commonly known as a living will. An Advance Health Care Directive lets people make their own end-of-life care decisions before a medical crisis strikes, even if they are unable to communicate their own wishes. With a living will, the caregiver and other loved ones don't have to agonize over difficult medical decisions.

A living will should spell out:
  • Whether the person wants to be resuscitated if he or she stops breathing
  • Whether artificial life support should be used
  • Whether a feeding tube should be inserted
A living will may indicate care or treatment the person does or does not want performed under specific circumstances.

Plan Ahead
Once a healthcare emergency strikes, it will probably be too late to prepare these documents, so talk to your parent about getting their affairs in order and spell out their wishes regarding healthcare while they are still healthy.

Consult an attorney specializing in elder law who will prepare these items and can provide advice on additional planning tools, depending on your family's circumstances.
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