Long Term Care Planning: Bridging Home and Community

We were invited to write a series of brief articles for the monthly newsletter of our friends at MDK Insurance Services, describing the continuum of long term care, and how to navigate oneself through it. You can sign up for the newsletter on their website, and each month we provide a copy of the article here as well. Please share the information with someone you know who is thinking ahead about how to plan for (and pay for) their own or a loved one's long term care.

Volume V: Bridging Home and Community

In previous issues, we’ve outlined the resources that are available when planning for the care at home of a disabled elder. It’s important to remember that those who lose connections with friends, community organizations and social groups, or who fail to build new connections and participate in engaging activities are at risk of social isolation, known to negatively impact physical and mental health. Fortunately there are community-based programs available to help those living at home with physical or cognitive impairments to remain socially connected, physically active, and mentally stimulated well into their old age.

Adult day health care programs are licensed centers that provide medical services and a variety of therapies, social services, and stimulating activities, as well as meals for the participants, who usually attend the program between 4-8 hours per day, several days per week. Adult social day care provides a similar structure, but does not offer skilled medical services and emphasizes socially, physically, and intellectually stimulating activity. Senior centers are neighborhood-based facilities that offer an array of social and educational opportunities, often offered on a drop-in basis. Many provide exercise programs and nutritious meals for participants on the days that they attend. For those who are no longer driving, it is essential to plan for transportation alternatives, to ensure access to all of the types of services that have been described. To find transportation and other resources in your community, contact your local Area Agency on Aging, or log on to the national Eldercare Locator: www.eldercare.gov.

The above resources can supplement a care plan that provides safety and support at home while keeping the elder connected and engaged. Next month, we’ll discuss the different levels of community care that are available for those who are considering making a move from a private home.

Looking "Up"

On a recent cross-country flight, I enjoyed the opportunity to watch Disney/Pixar's most recent animated feature, "Up." The main character, Carl, is an elderly and childless man who, upon losing his wife Ellie with whom he'd led a long and happy life, finds himself being forced out of their beloved little house and into a retirement home when he is deemed a "public menace." He and his wife had an unfulfilled, lifelong fantasy of moving to a place called Paradise Falls in South America, and on the day the staff from the retirement home come to take him, Carl ties hundreds of balloons to his house and flies away in pursuit of his and Ellie's dream. Once in the air, he realizes he's accidentally taken along a neighborhood boy, Russell, who had been on his porch attempting to earn a merit badge for "assisting the elderly." The movie is focused on the adventures that Carl and Russell experience while in South America (and I won't spoil the plot, for those who haven't seen it!), but it brought to light some issues and themes about which I often reflect both as a professional geriatric care manager, and as a person who cares deeply about the inner lives of our elders.

Carl is a cantankerous old grump of a character, and Russell is a loud, high-energy schoolboy and "Wilderness Explorer" scout. Through the course of their journey, we learn that Russell is being raised by his single mother, and wishes he spent more time with his re-married father. Russell eventually endears himself to his aged traveling companion, and a deep friendship is born. They learn about the world and about life from one another, and fulfill important roles in each other's lives. It is a sweet demonstration of the value of intergenerational relationships, and I hope that "Up's" younger audiences will internalize this lesson and seek out friendships with the elders in their communities, and value time spent with their own parents, grandparents, aunts, and uncles.

When Carl and Russell's balloon-powered house lands in South America, they realize that they've made it close to Paradise Falls, but have an arduous journey ahead of them, to relocate the house to the precise spot about which he and Ellie had dreamed. When faced with a difficult choice, Carl comes to the realization that "it's just a house." Until then, he had been very focused on it, and the things therein, as essential to his happiness and to the fulfillment of this particular dream. This brings to mind the complex relationship that many elders have with their family homes, as symbols of independence and a source of connection to memories and former roles and relationships. For my own grandmother, leaving her house meant not only accepting a new type of dependence on others, but relinquishing an important role - her home would no longer be the gathering place for celebrations and holidays, and she would no longer be able to provide a warm meal or a bed for visiting friends and family. Warm hospitality was a central feature of my grandmother's character, and looking back with hindsight, I wish we'd found more ways as a family to continue to foster that part of her after she moved into her assisted living apartment. For my grandmother, and for many others, letting go of her house felt like a loss of independence, but was in reality only a shift to a new type of interdependence.

The most important message I received from "Up" was that setting goals and achieving dreams is an ongoing process that should take place throughout our lives. Carl and Ellie had dreamed of children - and did not have them. They had dreamed of Paradise Falls - and did not get there. But they adapted to their circumstances, set new goals, and lived a happy and full life together. When things are looking grim in South America, Carl finds a message that Ellie had left for him before her death, which reads "Thanks for the adventure - now go have a new one!" and is renewed in his efforts. Carl's dreams of a life in South America with his beloved Ellie were not realized, but through the journey and his friendship with Russell, a new purpose for his later life was revealed. We see this in our work with our clients, and know it to be true: we are always growing, it is never too late to set and achieve goals, and there is purpose in every moment lived.

Our Greatest Teachers

Last Thursday September 17th, we celebrated five years of service to San Diego County with several dozen of our friends and colleagues from the community. We enjoyed a beautiful late-summer evening on the promenade in Liberty Station, with food, wine, networking, and our delightful guest speaker, Marsha Kay Seff.

When we created Elder Care Guides in July of 2004, our goal was to design a care management system that does more than simply respond to the needs of the aging population. A skilled care manager can assess an unrecognized need before it becomes a crisis, and we have worked hard to remain flexible and nimble in the face of the constantly-changing needs of our clients and their representatives, and as the larger landscape of long term care undergoes significant changes. We provide services with a spirit of support and collaboration, and our community has responded.

When I asked Marsha to speak on the topic of the hidden powers of elders, she replied with the question, "What is hidden about their powers?" Through beautiful stories about her own parents, as well as the others she has had the good fortune to know through her quarter century of working and writing in San Diego's elder care community, Marsha painted a portrait of "geysers" (not "geezers") who continue to learn and teach, volunteer and contribute in their communities, participate politically, and leave important legacies to their families.

Through the years, we have learned that the challenges of aging are not something to be simply "managed," but that they are a gift, a set of strengths and resources from which we and our clients can learn and continue to grow. We thank everyone who joined us for being a part of an evening that was very special to all of us, and held those who could not be with us close to our hearts.

Preventing Suicide Amongst Elders

National Suicide Prevention Week is observed September 6th through September 12th, with World Suicide Prevention Day falling on September 10th.

Older adults are at great risk for depression and suicide. Consider the following statistics from the National Strategy for Suicide Prevention:

• The highest suicide rates of any age group occur among persons aged 65 years and older.
• Suicide disproportionately impacts the elderly. In 1998, this group represented 13% of the population, but suffered 19% of all suicide deaths.
• Firearms (71%), overdose [liquids, pills or gas] (11%) and suffocation (11%) were the three most common methods of suicide used by persons aged 65+ years.
• In 1998, men accounted for 84% of suicides among persons aged 65 years and older.
• It is estimated that 20% of elderly (over 65 years) persons who commit suicide visited a physician within 24 hours of their act and 41% visited within a week of their suicide.

Older adults as a group have special characteristics that contribute to a their risk for suicide:

• Suicide rates in the elderly are highest for people who are divorced or widowed.
• Elders have a higher prevalence of depression versus the general population, putting them at higher risk for suicide.
• Older adults are frequently isolated due to physical disability, lack of transportation, or separation from family, which can contribute to feelings of loneliness and depression.
• Seniors use more lethal methods for suicide, resulting in more deaths from suicide.

Health care providers and families can be alert for the following signs and symptoms of depression or possible suicidal ideation:

• Talking about suicide or death.
• Giving verbal cues such as "I wish it were all over," or " What's the point of going on?"
• Isolating oneself from friends of family, or not participating in activities that were once meaningful.
• Giving away personal belongings that have value to that person.
• Neglecting hygiene or personal appearance.
• Demonstrating a sudden improvement of mood or outlook after a period of "the blues" or depression (this can indicate that the individual has created a plan for suicide).
• Having firearms, medications, or other toxic substances on hand.

If you notice a loved one or someone close to you with these symptoms, you should talk to them about their feelings. It is a common misconception that talking to someone about suicide will lead that person to hurt themselves.

If you are having symptoms of depression or thoughts of suicide, talk to your doctor, another health or mental health provider, or call the San Diego Suicide Hotline at 1-800-479-3339. If you need help urgently, call 911.