Special to The Seattle Times

With the holidays past, it’s a good time to take stock in an older parents’ needs. Because many families are spread far apart these days, we often don’t see each other until it’s turkey time. Keeping in touch by telephone, letter or e-mail just isn’t [...]]]> Liz Taylor, February 2008

Special to The Seattle Times

With the holidays past, it’s a good time to take stock in an older parents’ needs. Because many families are spread far apart these days, we often don’t see each other until it’s turkey time. Keeping in touch by telephone, letter or e-mail just isn’t enough to spot the important signs that someone is beginning to need some help.

When holiday get-togethers reveal what every family doesn’t want to know, there’s no point in ducking the issues. It’s time to have that “little chat” with your parents about something important and difficult: helping them plan for their aging. Since eldercare affects the whole family, that’s where the conversations should begin. People without family need to do this with their friends.

But where to start? The topics aren’t exactly a normal part of what you hear around most dinner tables “Hey, Dad, have you thought about visiting a couple of retirement communities to see what they’re like?” or “Do you have long-term care insurance?” Yet exploring them — and helping your parent explore them — is critical to figuring out what his options are and what he will want.

What’s needed here is common sense — what does it take for a person with failing health to retain as much independence and a good quality of life as possible? There’s no “one size fits all” in eldercare, so each person requires a tailor-made response. Here’s an example.

Pete, age 76, had a devastating stroke over a year ago. His two daughters live on the East Coast, and he divorced many years ago, so he’s pretty much on his own. He gets around by wheelchair, since his left side is frozen. He loves his old house, but it has 20 steep stairs to navigate before he can go anywhere.

A caregiver comes four hours a day to help him fix meals, take a shower, get groceries, clean house and dress. His daughter visited at Christmas and asked me to be Pete’s geriatric care manager — to monitor and advocate for him, to make sure he’s getting what he needs.

He had the basics: an emergency-response system that lets him call for help if he gets into trouble while he’s alone, and his durable powers of attorney are set up to carry out his wishes for care and finances if he can’t communicate.

But his daughters were concerned about other issues. Pete has in-home physical therapy to help him get stronger, paid for by Medicare. But the agency makes no appointments, saying a therapist will be there three times a week. The therapist spends about 20 minutes showing him what to do to get stronger — then leaves, telling the paid caregiver to handle it from there.

We’re now exploring different services to find one that will be reliable, consistent — and hopefully get him up and walking again.

Pete has a hefty pension, thanks to his career, but many people (including me) don’t. So we have to think ahead to how we’ll pay for our care someday — for many, long-term care insurance is a must. In addition, we need to know our options. Pete loves his home, but the stairs and need for daily caregivers have their disadvantages. We’re now visiting retirement communities to see what his options are. He’s in no hurry, so we can take our time. Good meals, good care and a pleasant environment are high on the list.

The point is, wherever you’re starting from, it’s time to plot a course of positive action. Pete and his daughters and I are talking about his choices, exploring what they mean, looking at his finances, weighing the trade-offs — the things that must happen, versus what he might like.

The Eldercare Locator can advise you on how to find the services you or a parent might need. For the nearest office, call 800-677-1116 or go online to www.eldercare.gov. Input your parent’s city, then contact the Senior Information & Assistance office in that area. It’s free, paid with your tax dollars, and can provide unbiased lists and more.

Special to The Seattle Times

If you want to learn how to climb mountains, you’re not likely to start with Mount Everest. If you yearn to become a great cook, your first effort probably won’t be as chef of a huge dinner party.

For all things that are complicated and worth [...]]]> Liz Taylor, October, 2007

Special to The Seattle Times

If you want to learn how to climb mountains, you’re not likely to start with Mount Everest. If you yearn to become a great cook, your first effort probably won’t be as chef of a huge dinner party.

For all things that are complicated and worth knowing, it takes time, education, practice and patience to learn the tricks, absorb the subtleties and understand what’s really involved. So it’s funny that most of us assume it’s easy to grow old — all you have to do is let the days roll by.

But poor health makes aging a vastly different story, and few of us prepare ahead of time. Of course it’s not fun to think about becoming sick, physically or cognitively, or both. But not thinking about it — and not putting into place the systems that will protect us — won’t make it go away. It just leaves us vulnerable, with fewer options and, often, very little control over what happens.

Here are two letters along that line that I’ve received recently:

“My parents have had 60-plus years of a good marriage, but they’re now totally miserable. They’ve gone from complete independence to complete dependence in the space of five months, which of course is deeply upsetting. They could have seen it coming if they had thought about it, then prepared, but they refused. Many options they might be able to enjoy now are closed to them.”

“My husband and I didn’t think about our age when we moved into our two-story home a few years ago. It was our dream retirement home on acreage. But now, what started as mild chronic illnesses have become much more disabling and serious. We have no close neighbors, our kids live far away, and everything we need requires a car. We seem to be on our own, and it’s scary.”

A lot of luck goes into our later years: whether we live long enough to get old, for one, and whether we retain our health and independence, for two.

But the chances are good that most of us will live to an old age. Centenarians now make up the fastest-growing segment of the U.S. population, and about 50 percent to 70 percent of us will need daily assistance someday. (Given what medical science is doing to keep us alive, assume the larger number.)

But luck has little to do with whether we can avoid the angst contained in these two letters. Like anything complicated, aging well takes planning. The ideal age to begin is in your late 40s or early 50s when you’re not in a crisis and can take your time. However, it’s not too late in your 90s. The trick is to do it before calamity falls on your head like a ton of bricks.

There are many factors to consider, but I think these are the top five:

1. How can you make sure the people you trust will watch out for your health and finances when you become ill?

2. Are you living in a home that will allow you to live comfortably as you age?

3. How will you get groceries or visit friends if you can no longer drive?

4. Who will care for you when you need assistance?

5. How will you pay for your care when family and friends can’t?

Two excellent books to help you begin this journey are Virginia Morris’ “How to Care for Aging Parents” and Joy Loverde’s “The Complete Eldercare Planner.”

What will surprise you is how interesting it is to plan for your aging. The more you know, the more you’ll see how interconnected the pieces are. But most surprising is the freedom that planning for your aging gives you (or for a parent who refuses to think about it).

None of us ever has total control over our lives, but there are things we can do while we’re healthy that will protect our interests when we’re not. Once you start, I promise, you’ll look at the world differently.

Special to The Seattle Times

If you’ve ever fallen flat on your face, as I have, you know how devastating a fall can be. Three times in the past two decades, I’ve landed on my nose, tripped (literally) by a sidewalk or stair that was unusually lumpy or high. Amazingly, [...]]]> Liz Taylor, Sept 10, 2007

Special to The Seattle Times

If you’ve ever fallen flat on your face, as I have, you know how devastating a fall can be. Three times in the past two decades, I’ve landed on my nose, tripped (literally) by a sidewalk or stair that was unusually lumpy or high. Amazingly, I’ve broken no bones, though twice my face looked like I’d walked into a meat grinder.

Falling can happen to any of us at any time, but the likelihood increases with age. Each year, a third of people 65 and older fall, mainly inside or near their homes. Two-thirds who fall once will fall again within six months. One in 40 are hospitalized. Of those who are hospitalized, only half are alive at the end of the year. Falls are the leading cause of death from injury among people 65 or older, accounting for nearly 500 deaths among older adults in 2005 in our state, 15,000 in our nation.

But it’s not death that worries me. It’s long-term disability. According to the experts, the most profound effect of falling is the loss of independent functioning. About 50 percent of older people who sustain a fall-related injury are discharged to a nursing home rather than their own home.

Then there are the costs. They’re enormous — $27.3 billion nationally in 2003 to care for fall-related injuries, rising to an estimated $43.8 billion by 2020.

But even if you’re not badly hurt, one of the worst effects of falling, as I can attest, is the fear of falling. The psychological impact can become its own prison.

Here’s the punch line: Much of this is preventable.

“Falls are not a normal part of the aging process,” says Dr. Elizabeth Phelan, director of the Fall Prevention Clinic at Harborview Medical Center and a UW assistant professor of medicine. “While some risk factors are more common as we get older, we can reduce the likelihood of falling by taking preventive measures.”

Steps you should take

The top risk factors: being female (though men are more likely to die from a fall); having fallen in the past year — especially if medical attention was required; having problems with gait and balance when you walk (may require professional evaluation); vision problems, like cataracts or macular degeneration; taking numerous medications that interact or make you wobbly; and living in a home with trip hazards, which almost all of us do because we’re not trying very hard to avoid these problems.

From my research and personal experience, I’ve come to believe that falling is as much a public health menace as smoking or drunken driving. The consequences are often just as life shattering, expensive — and avoidable. In a rapidly aging nation, it’s time to embark on a major public-education campaign to prevent falls. Then, we must each take personal responsibility to protect ourselves from falling.

Prevention isn’t brain surgery, but it takes some effort. There are four critical elements:

• Regular exercise for balance, strength and flexibility. Strong muscles help you keep your balance as you move, and a strong core (your trunk) keeps you upright and more likely to correct your balance if you trip. No one is too old or frail to exercise, yet only 31 percent of older Americans are regularly physically active today. Being a couch potato is a major reason so many older people fall and hurt themselves.

• Ask your doctor or pharmacist to review your medications (over-the-counter and prescription) to reduce their side effects and interactions. Of particular concern are psychotropics, diuretics, anti-arrhythmics and digoxin.

• Have your eyes checked by an eye doctor once a year.

• Reduce the hazards in your home. Improve the lighting, get the clutter off the floor, add handrails in the bathroom (the most dangerous room in the home), get rid of slippery rugs.

For further ideas …

“Although many studies have occurred to show what causes people to fall,” says Phelan, “very little effort has gone into translating this body of evidence into practice. We’re seeing more and more people coming to us with injuries from preventable falls.”

This is beginning to change. The University of Washington’s Fall Prevention Clinic — possibly one of only a handful of such centers in the nation was set up to assess older people for fall risks and improve their safety. This month, the University of Washington is holding free public fairs at 10 locations around Puget Sound to educate the public about fall prevention.

Each site will offer ideas and hands-on demonstrations of fall-prevention strategies, including home safety, exercise, medication management and vision checks, plus professional evaluations of balance and gait.

These fairs will be held at Harborview Medical Center, UW Medical Center and senior centers in Seattle, Maple Valley and Edmonds on Sept. 20. In Mount Vernon, a fair will take place Sept. 21. For specific times and locations, visit www.harborview.org (type “fall prevention fairs” in the search window at lower left) or call 206-598-5395.

There’s a wealth of information on the Web about fall prevention. A good place to start is the Fall Prevention Center of Excellence at the University of Southern California in Los Angeles at www.stopfalls.org.

For more information about Liz Taylor’s services, see her website.