Long Term Care

The Stresses of a Spouse becoming the Main Caregiver

January 18, 2021Filed Under: Elder Law, Long Term Care

Becoming the main caregiver for a seriously ill spouse can trigger relationship challenges. In the process of change, you can lose your best friend, your love, and your future as you both had imagined it. Promises will change from words spoken in oath on your wedding day to deeds of care in your mostly, but not exclusively, older years. The new caregiver morphs from a loving spouse into their new role, which is an entirely different sort of relationship of primary service. In more tragic cases, the caregiver can become distant to the marital bond, struggling with feelings of loss, fear, anger, resentment, or misunderstanding.

It’s a situation no spouse looks forward to on either side of the equation. A loving couple does not look forward to the day when they either must watch and tend to the mortal decline of their spouse or, conversely, be the spouse who feels wracked with guilt feelings knowing their health problems are placing a tremendous caregiving burden on their spouse. No matter the desire to avoid the experience, very few married couples will elude the complication that serious illness brings to their shared lives. Sadly, the needs of the caregiving spouse are often overlooked at a time when they need renewed strength to support their partner in new ways.

The caregiving pressures exerted on a spouse are significant. According to an analysis of 168 studies, while the caregiving spouse will protect their mate, they report more symptoms of depression, lower levels of psychological well-being, and more significant physical and financial burdens. To cope with the changes presents challenges, and sadly, the longer you have been married, the more difficult the process of rewriting the relationship’s rules and expectations become. Early on in the illness diagnosis, spouses are unclear as to how to handle the short-circuit in communication and productively process their feelings.

Many new spousal caregivers will feel the complications of isolation. Family members and close friends may not visit, not help, or even ignore the couple struggling to create new behavioral norms. Health Affairs reports that 55 percent of older spouses experience their end of life caregiving years without help from children, other family members, or even paid home health aides. The entirely new sort of relationship that becomes forged between husband and wife becomes defined by illness and lost emotional connections.

The need then becomes the focus on what to do to improve the situation. The first is the caregiving spouse needs an accurate understanding of the condition, treatment, prognosis, and needs of their ill spouse, whether they are diagnosed with dementia, cancer, heart failure, kidney dysfunction, or another serious illness. The information needs to come directly from attending physicians and health care providers. Caregivers need to participate in medical appointments and become an active participant in identifying health and wellness issues and potential fixes. Medical recommendations need to be prioritized so that the caregiver can be a positive, encouraging reinforcement rather than a nagging, stress-inducing reminder that can trigger frustrations on both sides.

If family and friends are willing to help lighten the load, it is imperative to accept help. Housekeeping, erranding, providing casseroles, transportation, visiting, anything that can reduce your workload as a caregiver is essential to accept graciously. Review your insurance plans as many give some level of coverage of home nursing services, occupational, and physical therapy. These services can improve your partner’s abilities and safety in your home.

Share as much time as reasonable with your spouse, listen to their thoughts, and spend time in quiet reflection. Follow routines that are established patterns in your life together. A Friday movie night at home with popcorn, walking the dog, or sharing morning coffee as a continued routine helps to keep a sense of continuity in the face of the unknown.

Recognize that you are not alone in your struggle. Authors Barbara Kivowitz and Roanne Weisman have written about their journeys as the caregiving spouse of a seriously ill mate in a book entitled Love in the Time of Chronic Illness: How to Fight the Sickness – Not Each Other. The most poignant recommendation describes shifting the notion of caregiving from a set of daily responsibilities to an act of expressing compassion. Kivowitz encourages couples to “Measure success by how well you connect, love and feel loved.” Don’t let a serious illness shake the foundation of your marriage. Identify your roles and set structure to address the issues at hand, and in the face of the unknown, you both will be better for it.

If you have questions or would like to discuss your personal situation, please don’t hesitate to contact us at 513-771-2444.

Feelings of Neglect due to Isolation Increasing in Elder Americans

December 14, 2020Filed Under: Elder Law, Long Term Care, Senior Health and Wellness

Our elder population is experiencing isolation from their family and extended community interaction, because of the coronavirus, increasing the likelihood of neglect. With the flu season fast on approach this isolation and the possibility of a resurgence of COVID-19, older Americans will likely continue living 2020 in mostly solitary circumstances. Rising instances of loneliness can give way to clinical depression and foster feelings of hopelessness.

Common Signs of Self-Neglect

Some of the common signs that an older adult is self-neglecting include changes in how they communicate and a lack of interest in family or community events. A loved one who always presented themselves in a put-together manner may suddenly stop bothering to dress for the day, or perhaps they have gained or lost a startling amount of weight. A once tidy home may now be piled high with unopened mail and heaps of garbage. They may stop or have difficulty managing their medications. Their demeanor and mood may change, and often there is the incidence of a fall.

ASA

Neglect is often a person depriving themselves of necessary care, whether it be adequate nutrition and hydration, medical care, hygiene, and a suitable living environment. In some instances, neglect may be an extension of diminished capacity of physical or mental ability to provide self-care. In some cases, negligence can be the precursor to abuse by an active or passive negligent caregiver. As reported by the American Society on Aging (ASA) outside of financial abuse, the National Association of Professional Geriatric Care Managers identifies self-neglect as the more commonly encountered situation than physical or sexual abuse or neglect by others.

Each state has a mandatory reporting law requiring certain people to provide information about suspected abuse to the proper authorities. Typically, these people are nurses and doctors, as well as wellness check programs through CMS services. Some states require any person who suspects elder abuse to report the situation. Know your state law for reporting and be mindful that your elder loved one is isolated from medical professional groups who report signs of neglect.

What to Do if you Are Suspecting Elderly Abuse

If you have not already implemented virtual strategies to combat loneliness for your older adult, do so immediately. There are many communication, safety, health, and entertainment apps designed specifically with seniors in mind. If your loved one cannot manage a smartphone, use a larger tablet device. If that is unachievable, get a smart speaker where voice communication can provide the sorts of contact options, safety, and activity your senior needs.

Contact your loved one routinely. Implement fall detectors and set up video surveillance to identify any problems. Be sure not to create an overly invasive system allowing your senior some degree of privacy to protect their dignity. Always use firewalls, passwords, and other security options to address privacy concerns.

Take advantage of community programs such as Meals on Wheels or identify programs that check-in on independent living older adults or high-risk households. If they are so inclined, set up the technology for your family member to participate in the many religious services currently being conducted live on Facebook. Connect with their neighbors or local friends to request they occasionally check in on your family member.

AARP recommends whatever the legal obligation in your state to report any sign of elder neglect or abuse. If you believe the person may be in imminent danger, call 911 immediately. If not, address the concern with the person directly or with their caregiver or family member. Remember, you may be misinterpreting the situation. After you have raised your concerns, listen carefully to the other person’s point of view. There may be a quick fix for a small problem, or it could be something more profound. Act deliberately but with compassion. If you meet with resistance to change but still believe help is needed, learn how you can report your concern. Your local police department may have an Elder Affairs unit. Nationally, you can contact support through a public service of the US Administration on Aging called the Eldercare Locator (800-677-1116), connecting you with local protective service agencies.

If you believe your loved one can no longer manage their health, safety, and wellness needs, we can help by providing advice on legal options to protect your loved one. We would be honored to talk with you.

If you’d like to discuss your particular situation, please don’t hesitate to reach out. Please contact our Cincinnati office by calling us at 513-771-2444 with any questions.

Who Should Make Financial Decisions For You?

September 28, 2020Filed Under: Elder Law, Estate Planning, Long Term Care

Who should you trust to manage your financial well being when you are no longer able to do so? A power of attorney (POA), otherwise known as an agent to your principal, has the legal authority to represent and make decisions on your behalf. What characteristics should you look for when designating a power of attorney? No matter what type of power of attorney you seek to arrange, your potential agent must be a person you deem to be trustworthy and honorable to conduct your affairs in your best interest.

Often the principal who designates the POA may prefer to choose a family member such as a spouse or adult child. If a family member is unable or unwilling to act when needed you can name a trusted friend or retain professional representation to ensure your interests are well looked after. Some people choose to have co-agents or name a secondary agent in the event another might pre-decease you.

Stipulations regarding the selection of a POA are minimal. Your chosen power of attorney must meet two legal thresholds; be an adult and not be incapacitated. There are no special qualifications regarding financial acumen or legal knowledge, and in fact, integrity is considered the most important attribute when selecting your agent.

Some questions to consider beyond your basic level of trust with this person(s) include:

How does this person manage their own legal and financial responsibilities? Are they financially responsible? Do they lead a steady life? Are they good at making decisions under pressure?
Will the person you select charge you a fee for their service? Generally, family members will not but, if you choose professional representation such as a financial planner or an attorney, there is usually a fee associated with their expertise and service.
Is the person you want to represent you willing to do so? Becoming an agent is a big responsibility to accept, and for many reasons, the person you want may not agree to serve as your agent.

Your power of attorney agent can have broad or limited legal authority to make decisions and transactions on your behalf about your property, finances, and medical care. The agent’s power is derived through your permissions, and if you are dissatisfied with your agent, you can terminate the POA/agent relationship and create a new one. Your power of attorney must comply with state law. When you work with us, we will make sure yours complies with all applicable laws.

There are a few misconceptions about the power of attorney. The first is you can create a POA on your behalf after you are incapacitated. You cannot as it is too late. For your power of attorney to be valid, your agent must be appointed before you become incapacitated through illness or disability. If you do not have your POA agent legally in place and are unable to manage your affairs, it may become necessary for a court to appoint someone to act on your behalf. People appointed to represent your interests in this manner are referred to as guardians, conservators, or committees, depending on your local state law. To avoid someone making decisions for you who you may not have chosen, it is imperative to have the proper power of attorney legally in place before you become incapacitated.

Another misconception is that your POA agent can make whatever financial decision they want to about your estate and that all power of attorney documents are the same. Your selected agent, by law, has an overriding obligation known as a fiduciary obligation to make decisions in your best interests. This responsibility is why it is imperative to choose a trustworthy agent as it can help avoid challenges to and litigation of your estate. You must have full confidence in the actions your agent will take on your behalf. You can appoint different agents for different POA document functions. We can help you figure out which powers should be given to particular agents. For example, you may want a different agent to handle real estate transactions on your behalf.

Selecting an agent and preparing a financial power of attorney is an important part of your overall plan. I am more than happy to help you and welcome your call.

Is It Safe for Nursing Homes To Be Open?

August 29, 2020Filed Under: Elder Law, Long Term Care, Medicaid Planning, Senior Health and Wellness

Nurse consoling senior woman holding her hand

As many state officials now begin to ease current Covid-19 restrictions, the May 10th Wall Street Journal (WSJ) reports that the Centers for Medicare and Medicaid Services (CMS) is considering likewise for nursing-home residents and their families.

Since March 13, visitors and communal activities have been banned under CMS restrictions. WSJ obtained a leaked draft of CMS guidelines under which visitors might, at some future time, begin to be admitted to nursing homes. The guidelines reportedly set forth a phased procedure, in which elder facilities able to show lessened or no infection rates could allow group dining and activities, and small numbers of visitors during restricted hours, all with physical-distancing restrictions. It is not yet known when CMS will complete and release these contemplated guidelines.

Covid-19, the disease caused by the coronavirus, is particularly fatal at congregate facilities where the elderly live in a confined environment and are cared for by workers who move from room to room. Data gathered independently by the New York Times (NYT) show that “while just 11 percent of the country’s cases have occurred in long-term care facilities, deaths related to Covid-19 in these facilities account for more than a third of the country’s pandemic fatalities. In 14 states, the number of residents and workers who have died accounts for more than half of all deaths from the virus.”

NYT reporters fear, however, that their totals “almost certainly represent an undercount of the true toll.” Data on residential elder facilities are apparently difficult to obtain because some states release specific information on cases and deaths at specific locations, some states report cases but not deaths, and around a dozen states release very little or no information.

Testing is widely acknowledged to be an important tool in the recovery effort, yet WSJ quotes an expert who reckons that we are around four to six months away from widespread availability. The Infectious Diseases Society of America has published diagnostic guidelines on May 6, but these caution that there are still many unanswered questions. Some of the speedy tests can include false negatives, as to the initial infection, between around 15% and 30%. Click here for more information.

So people who show no symptoms and who have been “cleared” by the faster tests could be walking around thinking they are fine, yet shedding the virus and infecting others. And it is not yet known whether those who have ostensibly recovered from Covid-19 might, or might not, be immune and free to dispense with all precautions. It is crucial, then, that those in the community who might be allowed in to nursing homes should be cleared with the most sensitive test available – and even if so, they could have become infected after having been tested.

There is no telling when these concerns will be addressed with sufficient safety for CMS to release its elder-residence guidelines. Thus, for the moment, the challenge is ongoing to protect our vulnerable elders, many or most of whom are cut off from family and unhappy at having been isolated for more than two months by now.

If you have questions or would like to discuss your particular situation with us, please don’t hesitate to reach out.

The Stresses of a Spouse becoming the Main Caregiver

Feelings of Neglect due to Isolation Increasing in Elder Americans

Common Signs of Self-Neglect

What to Do if you Are Suspecting Elderly Abuse

Who Should Make Financial Decisions For You?

Is It Safe for Nursing Homes To Be Open?

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