|Frequently Asked Questions About Eldercare
What are healthcare directives and why
A healthcare directive is a document your aging
parent signs, giving someone else the power to
make healthand medical decisions if he or she is
unable to speak or make decisions. Everyone
needs such a document because we never
know when or if we will become incapacitated. If
we are in an accident, have a stroke or are in a coma, someone has to be able to
decide what we would want done by the doctors and hospital. If we don’t spell
out our wishes in a healthcare directive, the decisions are up to doctors who may
not know us, or there may be conflicts among our loved ones about what our wishes
would have been.
Doctors who don’t know what a person wants may keep giving life sustaining
measures and using every artificial means at their disposal, even if we are terminal
and the treatment won’t change the course of our illness or injury. The most
important reason for having a healthcare directive is to be sure that our wishes are
honored, even if we can no longer say what we want.
A healthcare directive is free, and the form can be obtained from your doctor,
hospital, or on the internet. If you need help filling out the form, it can be found at
senior centers, from social service agencies, or from an elder law attorney.
The term “legal guardian” has different meanings in different states. I’ll take it to
mean that your question applies to the duties of a person who was appointed
guardian over an incompetent elder by a court. A guardianship is also called a
conservatorship in some places. The guardianship can cover either the aging
person’s money, or the person’s safety and welfare, or both.
The duties of a guardian, generally speaking, are to oversee the welfare and safety
the aging person under guardianship, and to attend to the financial needs of the
individual, using his or her assets wisely. A guardian has a legal duty, called a
“fiduciary duty”, to act in the best interests of the individual. A guardian has total
control over the aging person they are appointed to serve.
They can decide how to spend the elder’s money, where the elder will live, what
medical care the elder will receive, and how much freedom the elder or aging
parent has in his or her life. The powers can be total. An elder under guardianship
loses the freedom to make decisions for himself or herself about all important aspects
The guardian also has a duty to protect the aging elder from abuse, to keep complete
records of all expenditures, and to report regularly to the court which appointed the
guardian, as to the elder’s finances and status. The requirements vary somewhat from
state to state, but generally, the court decides how often the guardian must return to
court to report to the court how money is spent and what the status is of the elder.
Being a guardian is a very heavy responsibility. It is formal, public and supervised.
A Do Not Resuscitate Order is a legally binding physician’s order for a senior patient,
which is signed by the treating doctor, that no steps will be taken to restart a person’s
heart when it stops or to get a person breathing again if the patient stops breathing.
A DNR order is normally a result of a person’s healthcare directive, which says that
he or she does not want measures to be taken to keep the person alive. The decision
to not resuscitate a person must be made by the individual, if competent to do so, or
by the person’s agent for healthcare, on a “living will’” or healthcare directive, if the
person is not competent to do so. The patient or agent must ask for such an order.
The signed DNR order is placed in the patient’s hospital chart. The family of the
patient who does not want to be resuscitated often must remind the doctors and staff
in a hospital about the order, because the first thing doctors and nurses want to do is
to save someone’s life if their patient does stop breathing or their heart ceases to beat.
The DNR order only works if the patient or the patient’s family is clear with the
doctors about it, and is able to be the patient’s advocate in a setting where it is
almost automatic that resuscitation will take place. In other settings, such as
hospice care (care designed to keep someone comfortable in their last days for
a dignified death, rather than trying to fix or save them during their last days),
DNR orders are fully respected without coaching or advocacy by family.
Possibly, depending on your situation. If no one in your family is in disagreement
with the arrangement, it is perfectly legal for your mother to pay you for getting
care she would otherwise have to pay someone else to provide if you didn’t.
The clearest way to handle this is with a caregiver contract between you and your
mother, so that your duties and her expectations, as well as the rate of pay you are
to receive are spelled out in writing. An elder law attorney can prepare such a
contract for you.
Be aware that payment of a salary carries with it tax obligations on your part, and
contribution for you to Social Security, disability and unemployment insurance
on your mother’s part, in the form of deductions from your paycheck. You may
need a bookkeeper to advise you.
Difficulties sometimes arise with getting paid for care giving, as it may cause
conflict with siblings or others in the family who want to inherit the funds your
mother is paying for your care taking. Before arranging such compensation, it is
wise to seek the advice of an elder law attorney, to be sure there is not a problem
with doing so. Such factors as available long-term care insurance, if your mother
has such a policy, trying to become eligible for Medicaid, and other factors can
complicate the arrangement of your mother paying you for caregiving. Her
competence to decide to pay you out of her assets is also a consideration to
discuss with the elder law attorney.
Depression is the most common of mental conditions which can be treated,
but among the aging elderly, it is one of the most overlooked. Sometimes, it’s
because physicians don’t recognize the signs and symptoms. Sometimes it’s because
of an overall attitude of
society that perhaps feeling low is just part of getting old. The danger in overlooking
depression is twofold.
First, quality of life that could be improved isn’t, and unnecessary suffering goes on.
Second, the alarming fact of elder suicide looms. Depression is both an emotional
occurrence and a physical event. The physical component is triggered by brain
chemistry, and can be helped.
Feeling low doesn’t have to be a permanent part of getting older. There are many
aging elders and aging parents who are able to take aging in stride, and accept the
many limitations that accompany getting along in years. Aging is frequently marked
by losses. Loss of spouses, siblings and friends, as well as losses of physical strength
and abilities can lead to sadness. The sadness associated with loss can often be
lessened with time. But what if Dad, who lost his wife last year, just doesn’t seem to
care about anything anymore? If more than a year has passed since loss of a spouse,
and an aging parent still seems unable to move forward, it may to be time to see the
doctor for a checkup.
If you are able to accompany Dad to the doctor, mention the problem specifically.
Loss of enjoyment of things one normally likes is one of the symptoms of
depression. Other symptoms include feeling sad for extended periods, loss of
appetite, sleeping too much or not enough, eating too much, difficulty making
decisions, steady weight loss, or unusual weight gain, irritability, outbursts of
temper which are not normal, and withdrawal from friends and family.
Depression is one of the most treatable of all mental health problems. Many
excellent medications can make a great difference in one’s mood and ability to
participate in life.
Counseling or talk therapy can also be a great help in managing feelings of loss
and grief and in helping an aging parent to get through the grieving process.
If Dad is just not getting back to the way he was, and has an alarmingly long,
ongoing period of sad mood and other symptoms, encourage him to see his
doctor. Plan to go with him to be sure he doesn’t gloss over the problem. Many
elders are unaccustomed to talking about their feelings. They may lack the basic
vocabulary to describe them. The adult child can offer gentle assistance with this
difficult area. If unchecked, depression can become a downward spiral with no
end. It can become worse and more miserable for the depressed person as time
Addressing depression in an aging parent can lead to relief, and improved
quality of life. It is a loving act to suggest that the problem can be improved.
It may take the initiative of a son or daughter to get help for Dad, but the effect
of help if well worth your effort.
(originally published on http://www.50fabulous.com/)
Many caregivers suffer from burnout. While you can’t change your aging
parents’ condition, you can do things for yourself.
First, I’d recommend a physical exam. Report your symptoms of feeling
overwhelmed and anxious. Sometimes a physician will recommend medication
to help control the things that make it hard for you to function day to day.
Medication is a kind of support, and is worth a try if your doctor thinks it will help.
You may need to ask for it. It can certainly help with anxiety.
Next, it might make sense for you to have the support of others in your situation. Is
there a support group in your area? Can you join an online support group? As an
example, the Alzheimer’s Association offers such groups, as does the Family
Caregiver Alliance and other, similar organizations. Search for caregiver support
groups and try one out. It can be a big relief just to share the everyday burdens
with other caregivers who may be feeling as you do.
Also, consider respite for yourself. You need and deserve time to “recharge your
batteries”. No one has to feel guilty about taking time off. We all need it. Is there
someone who can take over for you for a few days off? Can you get away, even if
it’s just to turn off the responsibility for a period to rest and not think about your
job of caregiving? Periods of rest are essential to doing a good job of caregiving.
Maintaining your own mental health in this way will reduce your anxiety
and allow you to recover from the sources of your distress, from time to time.
Finally, I’m a firm believer in walking as therapy. It’s purposeful exercise, gentle,
stress-relieving and it can be your mini-respite work that you can do daily. If you
have any mobility problems yourself, there are substitutes just about anyone can
use. The point is that some exercise every day, even for 20 minutes, can do a
great deal to reduce the anxiety and alleviate the feeling of being overwhelmed.
It changes the stress-induced metabolic response your body goes through when
you’re feeling uptight. Think about building some form of exercise into your
busy schedule. By protecting your own physical and emotional well-being, you
will be able to focus better and continue to do your best for your parents.
Mediation is a way to resolve disputes by discussion and negotiation, using
the help of a neutral person, the mediator. It is usually voluntary. Disputing
parties agree to use mediation to avoid continued conflict, to avoid or end
lawsuits by settlement of the dispute, or to “clear the air” of ongoing
disagreement which has reached the point of stalemate.
Anyone who wishes to resolve a disagreement or conflict by meeting,
talking, and accepting the guidance of a mediator can use mediation.
It requires a willingness to come together in a neutral place and spend
the time working to get the dispute resolved. It also takes a willingness
to listen to the other party or parties to the disagreement, and to make
some compromises or agreements with them.
Many families experience conflict over what to do for an aging loved one.
Some fight over who is doing the most work. Some argue and criticize the
choices and work one sibling is doing for an aging parent. Others are in a
constant state of disagreement over where their elder should live, or who
should take care of the elder. All of these areas of conflict can be
successfully addressed. If the family is unable to resolve their own disputes
by talking them over in the family, it may be time to consider an outside
source of help: elder mediation. This is a process in which people who have
a dispute choose an outside neutral person to work with them to air their
differences and make a guided effort towards agreements. The parties sit
down with the mediatior, who is a trained professional, to negotiate
solutions to the problems that are causing distress among them.
Sometimes, the process only takes two or three hours. If there are mulitple
issues, the parties to dispute, may need to have two or more sessions with
the mediator. The mediator does not tell the parties what to do, or decide
the solutions for them. Rather, a mediator helps people to see things from
a different point of view, and to reach their own negotiated agreements.
Mediation can save untold grief and stress, and can prevent things from
boiling over into lawsuits and destructive actions by one family member
against another. At AgingParents.com, we work as co-mediators to
help familes in dispute. We can also help you to find a mediator in your area.
Arbitration is a process somewhat like a trial. A neutral party, the arbitrator,
sits and listens to the facts and evidence presented by both sides or all sides
to a dispute, considers the law, and makes a decision as to what the outcome
of the dispute is going to be. The power to decide the outcome is entirely in
the hands of one person: the arbitrator. The arbitrator can take the place of
judge and jury in making a decision about a conflict. The parties to the conflict
can only present the facts and evidence. They do not have any choice about
what the arbitrator decides. They leave the decision up to the arbitrator. Courts
can use arbitrations as a way to lighten the load on the courts. Parties to a dispute
can agree to arbitration, or a judge can assign a matter to arbitration. Arbitrations
take place outside the courts.
Mediations also take place outside the courts, but they are not “ordered”
by judges. Mediation is chosen by the parties to a dispute as a way to try
to resolve it informally, through guided discussion. The mediator does not
decide what is going to happen. How the dispute turns out is up to the
parties, with the help of the mediator urging them, and guiding them toward
settlement. Mediation involves choices. Arbitration does not. Mediation can
be creative, and can go in any direction. Arbitration goes in the direction of
presenting evidence before an arbitrator, and the parties do not control what
happens with the arbitrator’s decision. Arbitration is usually binding if it is the
result of a requirement to use arbitration, such as a contract. Mediation, on
the other hand may or may not resolve a dispute. No result is forced on the
parties, and no one decides how the conflict will turn out except the parties
to the dispute.
|Last Updated ( Wednesday, 25 August 2010 13:01 )|
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