Don’t take it personally.
Illnesses such as stroke and Alzheimer’s disease can cause upsetting personality changes. At first, most people think those diagnosed are angry at them but come to realize it is part of physiological changes and an anger at the situation in general.

It’s easy to over-share.
Online “care pages” at sites like caringbridge.org make it simple to update friends and distant family on a loved one’s condition, but you can find yourself getting into details your loved one might prefer to keep private. You can set up different e-mail groups on these pages if you want some messages to go only to caregivers.

Love goes through changes.
If a parent with dementia no longer acts like the person you knew, your feelings are likely to change. This can actually help you cope. Adult children can let go of their parents in small increments as they slowly disappear. The distance acts as a method of self-preservation.

Divvy up the work.
If you’re a hands-on caregiver, your distant siblings can find lots of ways to chip in – especially if you ask. You can also hire a geriatric care manager who will handle a multitude of responsibilities and make the aging process easier on everyone.

By Camille Peri, Reader’s Digest (Dec09/Jan10 issue)

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Looking back, Susan can’t quite remember how she came to be the “designated daughter” for her parent’s care – it all happened so fast. Susan’s father and mother, John and Althea, were happily retired in Maine. But at age 69, three weeks after a checkup concluded with the news that John was in great shape, he had a massive stroke that left him paralyzed on one side.

Althea, who had some medical problems of her own, was quickly overwhelmed. She crashed both of the couple’s cars in a two-month period. By the time an ice storm hit and they were stranded without power, it was clear that something had to change. Fast. “All of a sudden, this charming existence that they had set up for themselves was like a time bomb,” says Susan, 54, who lived in North Carolina with her husband, Gregg, and their sons, then 12 and 8.

“Boom – there they were,” she recalls. “My sister was wheeling Dad off an airplane and I was thinking, Oh, my God.”

Susan set up her parents in an assisted-living residence five minutes from her home. John had always been congenial and capable, mastering everything he set his mind to. Being incapacitated left him depressed. He was not the grandfather her children remembered: He was irritable; they were scared. And his daughter was unprepared for the role reversal that occurs when children are suddenly charged with their parents’ care.

Susan hadn’t anticipated how heavily her parents would rely on her – to take them to doctors’ appts and on outings, to pay their bills and make medical decisions. And she hadn’t realized how quickly the costs would add up. One national survey has shown that caregivers typically spend more than $5000 a year on out-of-pocket expenses. Though Medicare and supplemental insurance covered her father’s medical bills, Susan was the one buying adult diapers, underwear, and other supplies. She can’t even count the number of extra miles she’s put on her car or the unpaid days she’s taken off from work.

Things came to a head seven years into her new role, in the summer of 2005. She was already anxious because her son Robby was by then in the U.S. military, stationed in Iraq. Then her mother got sick and had to be hospitalized. The family dog was diagnosed with cancer. And although her parents had purchased five years of long-term health insurance (“a financial godsend,” Susan says), she discovered that they were running out of money.

The long-term insurance plan had been covering only her father’s medical expenses; after many phone calls, Susan got her mother certified as eligible, too. She was also able to negotiate a lower rate with her parents’ assisted-living residence, in part because they were living in one room. But the whole process, she says, was “excruciating.”

At times, she could barely hold herself together. “Sometimes I thought, Maybe I’ll have a breakdown, and they’ll have to pack me away in a hospital, and I can just get some rest,” she says, laughing. “It sounded kind of appealing, actually.”

It’s been 11 years since Susan began care giving for her parents. Her father has had a seizure and a couple of bad falls. Her mother has been diagnosed with mild dementia. With her sons now in college, Susan works full-time as a teacher’s aide and in a book store during the summer. But her husband lost his job as a general manager of a software company in the economic downturn last December, putting new financial pressure on the couple.

Yet it’s the emotional anxiety that wears her down. “Raising my kids was a snap compared to this,” she says. “Children go through phases, and when you’re in the midst of one that’s not so fun, you think they’ll grow out of it, and sure enough they do. But with my parents, it’s not going to get better.” Still, there are rewards. “I’m trying really hard to do the right thing by my parents, and I guess there’s a certain satisfaction in that,” she says. “And I hope I’m being a role model for my children. At least maybe when their turn comes, they will have a more realistic picture of what to expect than I did.”

By Camille Peri, Reader’s Digest (Dec09/Jan10 issue)

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How Do I Find a Care Manager?

Even the Yellow Pages do not cooperate in helping the public find care managers. To find a care manager in your area, look in the Yellow Pages under "senior services."

Below is a partial list of what a care manager might do:

• Assess the level and type of care needed and develop a care plan.
• Take steps to start the care plan and keep it functioning.
• Make sure care is received in a safe and disability friendly environment.
• Resolve family conflicts and other family issues relating to long term care.
• Become an advocate for the care recipient and the family caregiver.
• Manage care for a loved one for out-of-town families.
• Conduct ongoing assessments to monitor and implement changes in care.
• Oversee and direct care provided at home.
Coordinate the efforts of key support systems.
• Provide personal counseling.
• Help with Medicaid qualification and application.
• Arrange for services of legal and financial advisors.
• Manage a conservatorship for a care recipient.
• Provide assistance with placement in assisted living facilities or nursing homes.
Monitor the care of a family member in a nursing home or in assisted living.
• Assist with the monitoring of medications.
• Coordinate medical appointments and medical information.
• Provide transportation to medical appointments.
• Assist families in positive decision making.
• Develop long range plans for older loved ones not needing immediate care.

As you can see, care managers provide an invaluable service allowing you to enjoy and appreciate the twilight years of your loved ones.

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They go by many names – Geriatric Care manager , Elder Care manager, or Aging Care manager. They represent a growing trend to help full time, employed family caregivers provide care for loved ones living close by or living far away. Care managers are also particularly useful in helping caregivers at home find the right services and cope with their burden.

Services from care managers should be something of which every family takes advantage. In reality, very few families use them. Care managers go a long way toward helping families find better and more efficient ways of providing care for loved ones.

The concept is simple. The family hires a professional adviser to act as a guide through the maze of long-term care services and providers. The care manager has been there many times. The family is experiencing it usually for the first time.

Hiring a care manager should be no different than hiring an attorney to help with legal problems or a CPA to help with tax problems. Most people don't attempt to solve legal problems on their own. The use of professional tax advice can be an invaluable investment. The same is true of using a care manager.

The irony of not using a care manager is that most families, given the opportunity to use the care manager, think they can do it themselves and will not pay the money. Yet the services of a care manager will probably save them considerably more money then doing it yourself. The cost of the care manager might be only a fraction of the savings the care manager could produce. Care manager services can also greatly reduce family and caregiver stress and help eliminate family disputes and disagreements.

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