CARE: GIVING AND RECEIVING…

(Nurturing in the Age of Aging)

A Publication of Senior Outreach Ministries©2020 All Rights Reserved

DISCLAIMER

The information in this manual is for information, education and, hopefully, guidance to help both the care giver and care receiver in their respective roles. It is NOT a replacement for competent medical, legal, religious or accounting advice.

Senior Outreach Ministries (SOM) strongly advocates and believes everyone should perform their due diligence before taking and/or accepting advice and/or information from ANY source.

The information, data, statistics, programs and web sites presented herein are presumed reliable and may have been the source of some of the data presented. If so, they are referenced by web site (url).

Any paragraphs, pages or chapters in which personal experience is quoted is exactly that, the experience of the one quoted. It may or may not be germane to your situation.

Therefore, common sense should be the first prerequisite in selecting a solution to your particular situation. SOM accepts no liability for any and all happenings as a result of information presented in these pages.

All attempts have been made by SOM to offer a balance in the process known by the umbrella phrase Care Giving. Often times the Care Giver receives the short side of the stick in the Care equation. This manual attempts to equalize the importance of both positions while at the same time presenting the total picture as lived by both sides.

SOM fully realizes people have different needs and experiences and is totally open to hearing how these needs and experiences were satisfied. A contact name and address is provided at the end of this manual for anyone wishing to share their story and/or offer ideas, material and/or information for inclusion in any future updates to this book.

Please note this is a copyrighted work under Title 17 United States Code. No form of reproduction is permitted without written consent from SOM.

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SOM Mission Statement

A non-secular, non-denominational non-profit organization dedicated to:

Improving awareness and national recognition of the skills and abilities of elderly and aging people…

Preventing elder abuse…

Educating the elderly and aging on the latest scams, frauds and ripoffs…

Identifying and reporting fraudulent telemarketing, and other, schemes targeting the elderly…

Informing the elderly and aging on how to obtain social security and Medicare benefits and referral to appropriate agencies…

Providing daily money management services such as bill paying, bank deposits, organizing records and paperwork…

Locating care givers particular to their needs…

Finding affordable housing…

Implementing alternative living arrangements…

Teaching the care giver how to make the home senior friendly…

Tailoring an outreach program which includes printed materials, telephone hotlines and other information channels…

Researching state of the art techniques to better serve this growing population…

Supporting the development and testing of innovative programs, services and systems of support responding to the needs of the growing elderly population…

Training personnel in the field of aging…

Becoming recognized as a national clearinghouse and resource center…

Identifying promising programs and practices that broaden understanding of the elderly and aging by audiences of all ages…

Increasing public awareness of the Older Americans Act…

Continuing to help seniors maintain their dignity and individuality…

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This manual is written for everyone to use. It would be presumptive to believe it is appropriate only for those of a particular religious persuasion or set of beliefs. Ministries in its basic sense means to help. Period. There is no limitation on who is to be helped.

Didn’t God Himself say He created us in His Image and Likeness? If this is true, then aren’t we all a mirror of God? All be it, a God of many colors, languages, beliefs, acts, deeds, actions and reactions.

The parts of the whole we call a mystery which really wouldn’t be any mystery at all if we all believed we are a part of the Great Goodness. The Great Goodness who gives us the free will to act or not to act, to do or not to do, to think or not to think, etc.

Maybe, ministering is nothing but helping each other to understand and accept who we are so we can better handle that which is staring us in the face. Hence, a manual from an organization with no proselytizing goals, no monetary enrichment goals through salvation, or damnation, platforms or any other strings attached thought theology.

This manual was inspired by President Reagan who had the best care money could buy. After all, he was an ex-president. Reagan deserved the care he received. SOM believes you deserve as good a quality of care as an ex-president. This manual attempts to be part of your quality care.

And, last but not least, this manual opens your eyes (hopefully) to that activity known as care giving in a way you may not have thought about or even dreamed existed. It is a thorough walk through of the life of a care giver.

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Statistics and Other Eye Opening Information

The scenario known as care giving/care receiving inherently encompasses every facet of our lives at the time the service is being rendered or received. For example, family balance. Is it a child, parent or grandparent who is the giver/receiver?

Are all family members participating in the process? Is there communication between the family members? If so, is it open? Is it forced? Is it affecting the marriage? How about its strain on family finances?

Not to be forgotten are the legal, financial, housing, medical, health care and a host of other issues impacting both the giver and receiver. Each important in its own right. Each deserving attention and possible management.

None of us, to be brutally honest, think about care giving/care receiving until it visits us first hand. Then, and only then, do we begin any sort of program to meet this new demand.

Mind you, we live in a country where information is so abundant we take it for granted. Our county library not only has books on every topic known to man but all of them are available for free. FREE. Yet we don’t utilize this fantastic resource until we are smacked in the face with a crisis.

The following statistics are meant to educate AND prod you into taking action NOW before the inevitable knocks on your door. They come from the U.S. Bureau of the Census, the National Center on Health Statistics and the Bureau of Labor Statistics.

If you decide to research the web, start at: https://www.acl.gov ACL is the acronym for the Administration For Community Living. It is worth your time. Here is what they say on their homepage:

Advancing independence, integration, and inclusion throughout life

The Administration for Community Living was created around the fundamental principle

that older adults and people with disabilities of all ages should be able to live where they

choose, with the people they choose, and with the ability to participate fully in their

communities.

By funding services and supports provided by networks of community-based

organizations, and with investments in research and innovation, ACL helps make this

principle a reality for millions of Americans.

The Social Security Administration reports the major sources of income for older persons was social security (90%), income from assets (59%), public and private pensions (41%)and earnings (22%). Naturally a person could be receiving income from all of these sources so the numbers are over 100%.

10.1% of this population lives in poverty while another 10% were classified as “near poor.”

On the positive side, the Department of Health and Human Services reported a decrease in deaths caused by heart disease, cancer and stroke.

The eye opening information is covered by the statistics. Living longer, for example, means the chances for becoming a care receiver increase geometrically. That care must come from someone. In all likelihood, the someone will be a member of the Sandwich Generation.

This term is used to describe a growing number of adult children who are feeling squeezed between the needs of an aging parent or relative and the demands of their children, spouses and careers. This generation will (supposedly) spend more time taking care of a parent than their own child(ren).

If that does not open your eyes, you may not be willing to address the inevitable. Remember, simply because the statistics address older people, does not mean they will be the care receiver. You may be the care receiver looking for a care giver.

Read this manual and keep it handy. You never know which side of the equation you’ll be on.

I mentioned the ACL above and if you visit this site you may wish to search for information on the National Family Caregiver Support Program (NFCSP). It is a federal program providing money to State agencies whose focus is on seniors.

Before I forget, the ACL website has information on the Older Americans Act. This Act is beyond the scope of this book but it is worthwhile information to have. Searching the various Titles (sections) of this Act may just help you find a source for a service you need. After all, Congress appropriated the money to fund this Act’s programs and help is available through your State and County agencies.

Medicare and Medicaid, as a final note in this chapter, are two programs universally known but probably as universally misunderstood. Medicare is a federal insurance program for people 65+ while Medicaid is an assistance program jointly financed by federal and state governments for needy and low income people of all ages. Visit https://www.cms.hhs.gov for more information.

You should also be aware social security, Medicare and Medicaid, contrary to the politician’s promises, face real funding problems. The statistics quoted above provide part of the answer. As we age, fewer and fewer of us pay into the pot from which the

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money comes to pay for the services. Government spending is at an all time high deficit (meaning it spends more than it takes in) and projected to go higher.

This does not bode well for the Sandwich Generation or the young workers. Neither can afford a boost in income or social security taxes. The solution then lays where it always has, you and me. We have to help each other and rely less on the government and other publicly funded social agencies.

Dissertations along these lines are also beyond the scope of this manual but they are not beyond your research ability to determine the state of these programs. Use the Internet to see what people, and the government, are saying about these programs. That should open your eyes.

NOTE: A special resource section is at the back of this manual.

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FAMILY BALANCE

Communication is the act of talking to one another. This means talking to parents, brothers, sisters and grandparents before the care giving/care receiving scenario visits.

Why?

To keep everyone’s sanity when the visitor visits as you know it will.

This is the ideal, but often not the real, world. Siblings refuse to help, parents don’t cooperate or no one does anything until the situation is (almost) out of hand.

However, you received a copy of this manual so you can prevent the real world from torpedoing your plans to have not only the proper, but quality, care given during the time of need.

This manual is written through the eyes of a care giver because I was once such an entity. I also was once a care receiver as my mother was wont to remind me.

Think about it. All of us enter this world as care receivers. Someone has to be our care giver. The life cycle, in terms of care, could almost universally be described as a three step process:

1. Care receiver 2. Care giver 3. Care receiver

I don’t know who said, “From whence I came” but family balance certainly is susceptible to this process. Therefore, as mentioned above, communication is essential because age isn’t the only determinant for the phase of the cycle in which you could find yourself.

Just visit a children’s hospital or ward. It’s that simple.

If we are to keep balance in and with the family we must have open communication channels. Family is defined as not only your brothers, sisters, parents and grandparents

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but your spouse and spouse’s brothers, sisters, parents and grandparents and your children.

This is the pool, unless you hire a professional care agency, from which the care givers will be recruited. Rest assured not all parties will be eager participants. It is extremely crucial to know this before a plan of action is born.

This seems so obvious you may have chuckled as you read it. Stop chuckling and take inventory. Determine the commitment level of each and every possible worker bee.

Be thankful if brother Bob says he won’t be a part of the helping team. He just eliminated a ton of grief and stress from your life. It is far easier to replace him today rather than tomorrow when you counted on him to be there.

You see, once the routine, some have called it a grind, of care giving begins for real, you’ll lose all sense of self, i.e., you will have replaced you in your life with the personage called the care receiver. You will have discarded your exercise program, your quiet time, your favorite television show, in short, everything you used to probably take for granted. A new set of values takes over.

If this happens to you, grief, stress and burnout are not far away. I’ve known people who did this for years and when the end came for the care receiver, they actually didn’t know what to do with themselves. They had lost contact with “them.” They had shut off their mind to everything and everyone else.

Remember, as a care giver, you are not only responsible for properly administering the care receiver’s medication but your own as well. If, for example, you are taking heart medication, you can’t forget to take it.

You too have to visit the doctor and dentist just like the care receiver. You too are as apt to have a surgical requirement as the care receiver or anyone else for that matter.

You too must keep an eye on your car. You too must keep an eye on your utilities, lawn, trash collection and every other facet of daily life. After all, inherent in being alive are the attendant, what are sometimes called, life’s necessities.

If you are getting the sense you don’t have to be an only child to become the only care giver, you are right. It happens in families with many children. They simply let one assume the whole load.

With that in mind, family balance doesn’t require any more clarity, right?

Some helpful hints to avoid burnout include remembering to take care of you first. No, don’t neglect the care receiver in any manner. Rather, remember to make time for yourself even if it is only in your mind and only for a few minutes.

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As you go about your daily routine, for example, imagine yourself performing these tasks on the beaches of Maui or, if you are a skier, the ski slopes of the Rockies. Laugh at yourself or the situation. Laughing won’t change the chores but it makes them easier to bear.

Here is a real life example. The care receiver had been a healthy, robust male of considerable strength and talent before the stroke. After the stroke, he could still walk and understood what was said but his speech was gibberish except for a few words.

This 6 foot 2 inch 250 pound male also had to wear diapers as he was incontinent. Imagine for a moment being a 5 foot 3 inch 130 pound female and his care giver. If this picture alone doesn’t make you laugh, well, your sense of humor needs an adjustment.

During a normal eight hour shift, this man would go through seven or more diapers. Each time, he had to be washed, dried and changed. This was only possible in the walk in shower because the shower head had been rigged with a hose for just this purpose.

Again, imagine you are the lady care giver. Not only did she have to clean the man but the shower after the “wash down” and most likely the chair in which he was sitting as the normal course of events consisted of him “blowing” out his diaper. Oh, there were times when she needed to clean herself too or, in the least, dry off from the wash down she had just administered.

Are you laughing yet? You should be because this lady used humor to turn a potential “holy cow” situation into one dealing with the situation as it existed.

About the third day of this routine a person has a tendency to start doubting their sanity. Who in their right mind would come back to the same diaper changing routine knowing it will never change?

Recognizing the situation for what it is and leaving all value judgments, blame and emotions out of the scenario is another wonder worker in maintaining one’s sanity. It is, after all, only a situation requiring a solution. You are the solution.

Whether you know it or not, believe it or not, like it or not, you are in a state of conflict. A state from which you cannot run, hide or deny. But, and this is a big but, you can manage it by keeping you in control of you.

If you understand the characteristics and principles of the situation you will manage them and not vice versa.

Let’s tie it together. Communication is the act of talking to one another. This means talking to parents, brothers, sisters and grandparents before the care giving/care receiving scenario visits.

You have just read the secret to family balance.

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FINANCIAL MATTERS

Family balance is the first, and most important, step in the care giving cycle. Family, after all, is what maintains us whether the times are happy or trying.

Proactive communications, as explained, is the glue binding care giver/care receiver and the supporting cast. However, something called money, is the second most essential element in this equation.

President Reagan didn’t worry about money because of his position. You and I, on the other hand, may not be so fortunate.

The prelude to discussing finances, and this is very important, is hearing from the care receiver(s) as to what is important to them and what they perceive as their needs. This presumes it is the parent(s) who are the care receivers.

Should the care receiver be a child, money is no less important but the sibling is probably covered under a parent’s insurance policy. The coverage shortfalls such as deductibles, co-pays, exclusions, etc., are the out of pocket expense items.

Will family proactive communications provide the money? I don’t know your family so I can’t say one way or the other. But I do know the resource section of this book may be where you find your answer.

Returning to the presumption one or both parents are the care receivers leads us directly into a very touchy, yet very important, area. Their financial resources.

When I became my mother’s care giver, for example, she refused to divulge her financial situation. I knew only she received a monthly social security check and her insurance coverage was fantastic.

She made it very plain my job was to drive her to the bank to cash her check, her scheduled doctor’s appointments, the drug store to buy insulin and needles and the grocery store. That was all, she said many times, I needed to know.

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My sister fared no better. I thought mom would “fess” up to her, you know a girl thing, so we could devise a plan for when or if mom lost her mental faculties. Sorry, no brass ring there either.

By the way, there are checklists following the resource section to help you get a handle on the documents you should consider in this scenario. There are site references to glossaries in the various areas such as financial, health, managed care, etc.

Mother would not entertain a will, living trust, power of attorney or any other legal instrument that could possibly make our lives easier. She was one stubborn woman who, from day one, made all the family decisions and controlled the money. She had to. My father was a gambling fool who would bet his last penny on a horse or in a poker game and then worry about paying the mortgage or buying food.

Hopefully, your situation is less strenuous or onerous and your parents cooperate and are actively involved in the decision making process. Ideal, sure, but not everybody is as set in her ways as my mom.

My mom was diabetic for almost 30 of her 76 years. I mention this because each infirmary collects its own special “tax” in the form of expenditures in its own way. Her needles and attendant injection accompaniers (rubbing alcohol, cotton, etc.) were an ongoing monthly fixed expense.

Her insurance picked up all but a small co-pay at the doctor’s office as well as most of the cost of her insulin. She paid a co-pay for her insulin. The benefit was she always knew how much was coming off the top of her check at the beginning of the month.

Should you be a person who utilizes budgets, guess what jumps to the head of the list? Sometimes these expenses aren’t always fixed. This makes the budgeting process a nightmare.

A note on insurance before I go on. If you can not understand the insurancese in the policy, do not hesitate to call the agent for an explanation. Have the agent come to the house to explain the policy and schedule the appointment for when as many of the family can be there as possible.

You do not, repeat, do not, want to be blindsided by something not covered by the policy. The reason is obvious but let me say it: It could prove very expensive.

I remember reading about a retired couple in Florida. The wife contracted cancer. They thought they were covered. They were but for only certain items. They ended up selling their home, dissolving most of their assets and moving into a small apartment.

Read, and understand, the insurance policies.

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Checking, saving, brokerage accounts, etc., all issue statements. If you are statement challenged, sit down with the company’s financial representative and get a thorough explanation.

As a care giver, you are also responsible for your own finances. Keep an eye on your accounts, budget and investments. No law exists saying you must ruin your financial situation because you are a care giver.

Also at the end of this manual is a section on scams, frauds and rip offs so you are cognizant there are people who will take advantage of you without thinking twice and who prey on infirmed individuals as a specialty. I’ve elected to make separate sections for this information and to make the individual chapters overviews for easy reading and use.

My intent is to get your brain thinking and your hands making notes. The reference section, as I call it, is the specialized who, what, where, when and how information.

My experience says people absorb the material covered by this manual easily when it is presented in an easy to read and digest format. In other words, present common sense information first than the specifics.

Remember, while all of this is happening with and to the care receiver, you still have a family you must maintain. Birthdays, holidays, anniversaries, crisis (to one degree or another) are in their lives too.

Hence, it becomes super important to have a financial plan. Proactive communications takes on more of a meaning. Ideally, these matters are discussed before the care receiving scenario begins.

Let me close with something my mom used to drill into my head. She would tell me “money doesn’t grow on

always plan for a

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day.”

I use this cliché to tickle your mind because of its importance.

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LEGAL

Not many people understand legalese. This includes lawyers. And, no, I’m not making a lawyer joke.

This area is delicate to say the least. The wrong instrument and bingo! the income tax people are knocking on your door for a huge percentage or a lawsuit broadsides you or some other legal entanglement ensnares you in years of litigation.

I do not exaggerate when I make these statements. For part of my formative years, I was a legal researcher.

This manual does not contain a checklist on how to interview lawyers but it does contain pointers on page 40 immediately before Checklist 5. Checklist 4 on page 39 is a checklist of the various legal instruments one or more of which a person should consider initiating before care receiving becomes an integral part of one’s life.

The first place to look when searching for an attorney is your local senior center. SOM is located in Reno, NV. Our senior center has an office called Legal Services. If yours has the same service go there first. It will be worth your time.

The yellow pages was the place to begin research. Today it is the Senior Center or online. Google provides the names and addresses of attorneys that specialize in your particular need.

If you don’t know the type of category, i.e. legal specialty, you need type in NAME OF COUNTY Bar Association. Call the telephone number on the page and start asking questions. You should receive the help you need.

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But it may not. You may find it hard to believe that not every bar association is listed but it is true. The rationale behind this seemingly dichotomy is beyond the scope of this manual. Suffice it to say, start your search now.

Start with family members, friends and anybody you can think of. Simply ask who they use for the particular situation in which you find yourself. If you feel comfortable with their information, make phone calls.

Set appointments and ask questions. Generally, the first 30 minutes of a lawyer’s time is free. Always ask before you set the appointment.

Whatever you do, don’t skimp in this arena. The worst that can happen is you will spend several hundred dollars in what you may think is a giant waste of money and it may well turn out that way. If it does, this means NO ONE required care. This is good.

The result you are aiming for is to save thousands in the future. You can’t save in the future if you don’t prepare today.

Believe me, it isn’t pleasant, you won’t feel good doing it and to make matters worse, you’ll encounter many disappointments along the way.

Step over it because it is nothing personal against you so keep searching.

The right attorney is there and will work for you.

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HOUSING

The above graphic symbolizes what can all too easily happen to a once happy home. It goes from a house united to a house divided.

Why?

Think about it. The care receiver(s) has/have to live somewhere, right?

One realizes, after the situation arises, the options are not numerous when it comes to housing the care receiver(s). Their house had to be sold for one reason or another or, luckily, it has become a rental producing income to help pay for the care.

Regardless of how it entered its status, the fact remains the care receivers must be housed. Will it be in your home? Will they be put in a facility? What are the other choices? Good questions requiring excellent answers. Answer them.

If the only option is your home, making them feel a part of the family becomes a huge task. Facts being facts, they have now entered space heretofore entered only for limited time periods. Which, as we all know, is exactly how both parties preferred it to be.

I was a single male when my mom moved in with me. To say it limited my overnight guest list would be an under statement. But not everyone is a single male. Some people have a new born, toddlers, pre teens, teens and almost out of the house young adults.

Now, all of a sudden, enter the geriatric. This manual doesn’t pretend to have the answers to how to handle this situation under all circumstances. Rather, it does contain the one rudimentary principle we all expect to apply to us.

This principle, from the SOM Mission Statement, simply says:

“help seniors maintain their dignity and individuality.”

Substitute me for seniors and my for their and you’ll instantly grasp the principle.

Please remember not one of you wants to be in the situation in which you find yourselves. Truth be uttered, you’d rather it was someone else.

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SPIRITUAL

Spiritual doesn’t mean religious. There are too many religions espousing too many spiritual doctrines. Everything from we are born sinners to cattle are gods is being advertised as “THE” religion.

I don’t know about you but SOM believes God created us in His image and Likeness. Given this is true then we all are a part of God.

As you know, an image is not the real thing but a representation thereof. So, by default, we are what God looks like in His many sizes, shapes, forms, ethnicity, religious leanings, beliefs, etc.

God doesn’t create bad in any sense of the human definition because God is only good. Therefore, when we ascribe bad to a situation it is our human selves speaking. Reality says the situation is as it is. Reality applies no value judgment, does it?

Life, or living, is never ending because it cannot be otherwise since God never dies. The body (not God) may die but the spirit (God) lives on. After life, or death, is the reunion of the image with the image producer.

So much, at least for the moment, of SOM philosophy and onto your care receiver’s perspective on death. Are they frightened of it? Do they believe they have a soul? To what particular religion/message do they subscribe? Are you of like mind?

This all makes a difference in the manner of the care provided and the handling of the organic circumstances. By organic, I mean the quality and level of care administered, the quality and level of associated treatments (medical, legal, etc.) and, in general, the quality and level of preparation and its administration.

My mother stood steadfast against organic preparation. Her repeated mantra of no one gets out of this world alive was meant to tell us not to spend a lot of our money on her. She knew she was going to die, accepted death and was ready to meet whoever her Catholic belief said she would meet on the other side.

Is your care receiver of the same mold as my mother? Are you?

On the other hand, do you need to be?

Only you have the answer(s).

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MEDICAL/HEALTH CARE

Please do not confuse medical/health care with the aforementioned health insurance. They are NOT the same.

Care comes from a person. Payment comes from insurance. Big difference.

Does your care receiver(s) like and trust their doctor(s)? You’d agree this is important, right? You bet it is.

Like selecting a competent lawyer, selecting the right doctor is as important. This boils down to another one of those online introduction to the particular specialist and questions thereafter.

On the other hand, your insurance plan may limit the number of doctors from which you choose. My mother could use any doctor as a general practitioner but was limited to only three of the possible six diabetic specialists.

Why?

At the time she was selecting specialists, not all accepted her particular insurance company. Is that important?

It certainly could be if the top gun in the field does not accept your particular company. The good news in this day and age is almost all doctors accept almost all carriers. (So you do not get taken, please read the frauds, scams and rip-off section to learn about a particular health insurance scam that has become a cancer almost beyond our control.)

I mentioned Medicare/Medicaid above. Long term care is becoming prominent in our insurance coverage so here is some information you need to know.

Long term care is a term meaning coverage extended to a care receiver for the duration of an illness or other care requiring condition. This is not exactly according to the dictionary but you get the idea.

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Let’s say, for example, your care receiver must be placed in a nursing home. As you might expect, the nursing home wishes to be paid for services rendered. If your parents had taken out a long term care policy, it probably would be paying for this care.

If no such policy exists, someone has to pay assuming the care receiver is in a care providing facility. The someone paying is the care receiver. How (s)he does it is up to them.

Private insurance, Medicare/Medicaid all have provisions explaining their coverage. Acquaint yourself with those provisions.

There exists a set of care receivers not eligible for Medicare/Medicaid and who do not have private insurance. This group relies solely on family, friends and welfare.

Yes, welfare. The county and state have a pool of money called welfare that is doled out according to certain criteria. Knowing the criteria as it exists in your area may just be the ticket to help a care receiver receive at least the minimum of care.

California counties, for example, will pay the minimum wage to a care giver who administers to a registered county care recipient. If the care giver wishes more than the minimum wage, it is negotiated between her and the care receiver.

Providing minimal medical/health/life sustaining care to those on society’s lowest rung is just one branch on the multi branched welfare tree. Regardless of one’s personal feelings about welfare, it is the only opportunity for many people to receive the very least amount of care the welfare state is willing to provide.

The other welfare state, Spiritual, was touched on in the last chapter. It just may be the most important state in existence. If you are a member of an active and caring church, you may enjoy a care receiving scenario second to none.

I wouldn’t bet my last farthing on it but it could happen. For how long and what quality, who knows but it could happen.

I am not disparaging religion or those who believe in a particular faith. I’m saying only neither health insurance nor religion by itself is a guarantee of any care at all.

Perform your due diligence in both arenas before signing on the dotted line. After all, Mother Theresa herself took care of the body before she cared for the soul.

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RECAP & PERSPECTIVES

The thrust of this manual balances the care giver and care receiver roles so as to maximize the care received from the care giver while making the experience of care giving an as it exists situation and not an all encompassing monster devised to devour the care giver’s life.

The six most important areas in the care giving/care receiving scenario were introduced and discussed. A seed or two was planted in each arena from which a tree, or trees, of thought would germinate.

If you had nothing but proactive communications working for you, both care giver and care receiver would find themselves in the best possible care environment imaginable. Couple that with any one of the remaining five areas and you have a situation you control and not a situation controlling you.

Proactive communications puts everything on the table for everyone to discuss. You learn:

1. What is important to your parents (or other care receiver) 2. The financial situation as it exists 3. Who will be the care giver(s) 4. Who is, and who isn’t, in the support network and to what extent 5. The insurance coverage 6. What, if any, legal documents should be prepared 7. Impact on children, spouse(s), marriage 8. How to deal with death and funerals 9. Depth of religious beliefs 10. How to explain the situation to the children 11. How to help the care giver 12. Probably more than you wanted to about your family

Someone once said, “A smart mind answers questions. A wise mind questions answers.” You will discover an abundance of questions when you enter the care giving/care receiving arena. The essential quality of a wise mind is an open mind.

My friend sent me the definition of success broken down by age. Use it as a catalyst to open your mind and, if you think appropriate, laugh.

Success:

At age 4: not peeing your pantsAt age 12: having friendsAt age 16: having a driver licenseAt age 20: having sexAt age 35: having money

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At age 50: having moneyAt age 60: having sexAt age 70: having a driver licenseAt age 75: having friendsAt age 80: not peeing your pants

He also sent me this piece of wisdom. Time may be a great healer, but it is a lousy beautician.

I think you will agree these are clearly all perspectives. One more perspective. It is from the field of palliative care.

Palliative care is the care of patients, with active, progressive, far-advanced disease and a short life expectancy, for whom the focus of care is the relief and prevention of suffering and the quality of life. It is not, as the practitioners say, elderly care.

The very first area of concern for palliative practitioners is good communication. Makes sense, right? After all, if someone is near death, the communication should be first class. Next on their list is appropriate therapy followed by excellent, comprehensive, consistent and co-ordinated care.

Mind you, they call these factors perspectives on proper care so both the care giver and care receiver are equally integrated into the process without more value placed on either party. These seem to be excellent perspectives to adopt at the onset of care giving, doesn’t it?

Well, guess what we talked about in the previous chapters. It is impossible not to have the best quality of care if everyone is on the same page and doing their part to support the team. In short, good communications.

Keep in mind the above material are perspectives. If they do not integrate into your thought theology, cast them aside. However, they may just begin the questioning of answers you heretofore believed you possessed.

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The National Institutes of Health (NIH) is the nation’s leading research organization focused on issues of aging. Its expenditure in 2002 on aging-related research and issues was $ 1.9 billion. No matter how you cut this pie, almost $2 billion is a lot of money. Their website is: Error! Hyperlink reference not valid. Visit and surf to your heart’s content. You may not agree with all of the projects they fund, but you will get an eyeful of perspective as seen from the national forum.

Another perspective to keep in mind should you (have to) seek a nursing home is the costs, depending on where you live, range from $24,000 to $47,000 a year. Should you need an in home health aide, it could cost up to $36,000 a year. Assisted living facilities run from about $26,000 a year to over $45,000.

By the way, these costs are expected to rise as the population ages. You see, the number of Americans between the ages of 65 and 74 will grow 89% and those between 75 and 84 will increase 119% by the year 2030.

These increases obviously will raise the demand. You don’t have to be an economics professor to know when demand increases, prices follow suit.

Care giving/care receiving isn’t limited to certain ages but it may be to your best interest to understand what gerontologists say happen to us as we age. The beginning of change in the five senses is categorized as follows:

Hearing in the mid 40’s; Vision in the mid 50”s; Touch in the mid 50’s; Taste in the late 50”s; Smell in the mid 70’s.

Aging is an individual experience so all the categorization in the world may not mean anything in your case. And, because hearing diminishes doesn’t mean, for example, vision will deteriorate. Fortunately, some people advance into their golden years with little or no perceptible losses in their five senses.

But, we all know, there are no guarantees. Proof lies in the care giving industry. Something like 40 million Americans receive care across the care giving spectrum, from minor help to 24/7 care.

Perspective has been defined as the ability to see things in a true relationship. Relationship has been defined as the quality or state of being related; connection. Page 8 contains this 3 stage cycle:

1. Care receiver 2. Care giver 3. Care receiver

What could be more related and/or connected?

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COMPLICATED vs. SIMPLE

I believe we have come to a juncture in the road requiring a word or two of explanation before we enter the resource and checklist sections.

I am certain you know people who can take a mole hill (simple) and make it into a mountain (complicated). As a general rule, these people are called and considered frustrating. For the life of you, you cannot understand how anyone could take something so simple and turn it into something so complicated, right?

Care giving/care receiving has the same potential if for no other reason than it involves loved ones suffering. Even an always rock steady person can go adrift. It seems to be the inherent nature of the beast.

When I was writing this manual, I spent many hours researching, discussing points and experiences with my wife and others who had been or still are care givers and came to some conclusions. These conclusions were presented in the above chapters.

One conclusion isn’t there since I elected to place it here. It is a discussion on fear. Fear is the first element to appear on the scene when the care giving/care receiving scenario surfaces.

Fear represents the unknown as well as raising one thousand questions. You can call it worry, anxiety or whatever you choose but the fact remains you are staring into the unknown. I touched upon conflict under Family Balance. Fear, conflict, anxiety, worry, stress all come together.

Before I present a way to consider these elements by dissecting fear, my mom is once again an example. I mentioned previously I was a single male when she entered care receiver status. What I didn’t mention was I was at the end of a divorce and moving into a solitary living style.

My sister, who I also mentioned, was experiencing her own life situation. Why my mother called me rather than her I don’t really know but she did and I had to deal with it. Fortunately my sister and I had an open line to each other. We agreed, if necessary, she would move to where I was living and help in the care process.

That was a comfort but mom had not arrived at my house yet. My mind was racing with all kinds of scenarios. She had relinquished her driver license because of vision problems. Her dental health was impacted as was her hearing. Food (she was on a diabetic diet) doctors (locating both a physician and a dentist) and other essential care (which I could only imagine) were racing through my brain. All of those factors I mentioned three paragraphs ago were first and foremost in my consciousness.

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Luckily, I had had training from the military that helped put a face on what I was about to encounter. Most people do not understand, but learn sometime in the process, FEAR is only an acronym. It stands for False Expectations Appearing Real.

As you might imagine, military members have an increased opportunity to face fear. To make a long story short, the message was to look at the evidence, assess it and move to a solution. My mother’s situation was no different than had I been on a distant shore facing an enemy I knew not.

With this in mind, a paradigm of this situation can be developed. If developed, it will look like:

1. The situation exists 2. Accept it as is 3. Keep control no matter how many fronts seem to be attacking 4. Reduce each “attacker” into its parts 5. Attack, or retreat from in some cases, those parts you can, or can not, handle 6. Always remember you have ultimate control and mastery over the situation 7. You will win if you eliminate the complicated and keep it as simple as possible

You can tinker with this paradigm but basically it is right on. Why you will win if you keep it simple is most of us love the simple and detest the complicated. Therefore, we are more apt to involve ourselves in the simple because we see a light at the end of the tunnel.

Said another way, even after we have immersed ourselves into the care giving process, we don’t see anything but success in a manageable environment. FEAR is recognized for what it is and blown out like you’d blow out the night candle.

I am reminded of what Winston Churchill said about fear. He said that 90% of what you

worry about never happens and of the remaining 10%, 90% of it never happens either.

To quote me, we have nothing to fear if we know fear is nothing but false expectations

appearing real. False isn’t real no matter how hard we try to make it that way.

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RESOURCES

My name is Tom Koziol and I am the Secretary for Senior Outreach Ministries. I mentioned at the beginning of this manual you would find the name and contact information of a person in the Resources Section. I am that person and can be emailed at: tom@senior2senior.org or mailed to: SOM, P.O. Box 1234, Reno, NV 89504. At this point because of time demands, I can only accept email or regular mail contact. SOM is available as a primary resource. We do not claim to know everything about everything. We do, however, know how, and are willing, to help.

Keeping matters simple as mentioned in the previous chapter should extend to resource search and selection. Initially, it appears daunting and impossible but with the right tools, the journey of many potential steps could be reduced to only one thanks to the phone book.

Senior Outreach Ministries is headquartered in Washoe County, Nevada. The two major population centers are Reno and Sparks. Total population for the area is approaching 350,000 people with the majority of new arrivals being senior citizens from California.Washoe County is one of the fastest growing areas in the nation as of this writing. So, I will utilize it, and the State of Nevada in my examples.

I have not taken such a survey but I bet if I asked the new arrivals if they researched senior citizen services availability before buying, the overwhelming answer would be no. Fortunately, they have only to turn to their computer and type:

WASHOE COUNTY OF

and locate the subheading:

Senior Services

and they would find the following listings(phone numbers & addresses intentionally omitted):

General OfficeFax

Adult Day CareFood Service DirectorGift Shop – Assistance League – SamplerHome Delivered MealsLegal ServicesLibraryFax

Nutrition Program

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Social ServicesSparks Center BranchFax

Quite an array of services offered by the county and probably your county has the same, or more, number of programs to serve the population. If you cannot think of a starting point, you now have it.

By the way, the State of Nevada has an agency called Aging Services Division with an office in both the capitol, Carson City and Reno. It is listed on their web site under the heading: NEVADA STATE OF and the subheading: Human Resources.

Your state will have similar agencies and offices. The state and county offices make excellent initial contact points as the people have had experience in your particular need and can help you navigate the public and private sector.

Keep in mind, the leg work will still rest on your shoulders. FEAR could be reduced, or eliminated, almost immediately thanks to some helpful advice from these folks.

I am not implying you use only government contacts. Not by a long shot. The same computer offers a wide of research possibilities. SOM says a smart researcher uses all the resources at her command.

Your state’s Attorney General may sound like a place not on your list. That may not be true because of the amount of information available. The aforementioned computeralso contains the AG website and phone number.

All Attorneys General belong to the National Association of Attorneys General and they have a web site at: https://www.naag.org You can click on your state’s link and be taken right to its home page.

NAAG publishes their activities on their site as well as in press releases. They sued a national tax preparer and got a refund for consumers for example. They are especially sensitive to seniors and scams against seniors.

Again, maybe not the initial answer, but the potential for help in the legal arena is there. Take a peek at their site.

Your local library. Besides books, videos, tapes, magazines and other resource material, you will find computers waiting for you. Even if you do not own a computer or are not on the Net, your local library is connected.

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Take this manual with you and look up the referenced sites. If you print from their computer, you may have a small fee to pay for use of their printer. Spend the money because the material is invaluable.

The Consumer Action Handbook is yours for free by making a toll free call. 1-888-878-3256 will bring you a copy of a handbook I used to locate several reference sources for this section. This handbook has information on everything from Automobiles to US Military Commissary and Exchange Offices.

The Health Care/Health Insurance Section is very, very informative and, by itself, makes it worth your time to request a copy. Couple that with its list of state and federal agencies, state utility commissions, state securities administrators, state insurance regulators, state banking authorities, state, county and city consumer protection officers and corporate consumer contacts and you have a book worth the cost of the free phone call.

It takes between 10 and 14 business days to arrive. Once you are on their mailing list, you will receive all future updates without having to lift a finger or spend a dime.

Let me toot Senior Outreach Ministries’ horn. Click on our website:

https://senior2senior.org

and you will find a host of the latest up to datest websites devoted to seniors. It is our mission to keep the resources section as up to date as possible. In fact, bookmark the site so you can get it to it very fast.

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Another Nevada State agency is the Nevada State Health Insurance Advisory Program (SHIP) providing Medicare counseling throughout the state. Generally, a SHIP representative can be found in the local library on a specific day between specific hours.

Your state offers a similar program thanks to the funding provided by the Older Americans Act. If you simply cannot find it any other way, call the Federal Citizen Information Center (FCIC) toll free at: 1-800-333-4636.

Another program providing information and referral services for those seeking local and state support resources for the elderly is Eldercare Locator. Its toll free number is: 1-800-677-1116 and its web site is: https://www.eldercare.gov

A web site with links to all of the known pharmaceutical companies is: https://www.pharmacy.org/company .html All pharmaceutical companies offerprescription drug patient assistance programs. The patient must meet certain guidelines in order to be eligible for benefits. This information is found on their web sites.

The National Association of Boards of Pharmacy has a program called VIPPS that certifies and lists online pharmacies. It will be a mail order pharmacy and probably will sell you the drug(s) for less. The site is at: https://www.nabp.net

The FDA’s Center for Drug Evaluation and Research at: https://www.fda.gov/cderhas information on prescription and over-the-counter medicines and tips for buying medicines online.

Do not forget about your insurance provider. My personal coverage is through an association. Associations are generally membership organizations with members exposed to a great deal of free information.

Using this as a segue, there is an association in existence for your particular situation. Alzheimer’s to Parkinson’s Disease have associations and can be located on the web or in your local library. Utilize them.

The federal government’s gateway to information on health issues, health care programs, health providers and organizations is: https://www.healthfinder.gov

The Mayo Clinic at: https://www.mayoclinic.com has an alphabetical index of diseases and Healthy Living Centers as well as a Consult the Health Decisions Guide for information on medical tests and treatments.

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Links to centers on a broad range of mental health issues and disorders is located at: https://www.mentalhelp.net

The National Committee for Quality Assurance (NCQA) evaluates and accredits HMOs. You can find out whether a managed health care plan is accredited in your state by calling 1-888-275-7585 or your state’s insurance commissioner. The NCQA website is: https://www.ncqa.org

Medicare beneficiaries can compare HMO programs at: https://www.medicare.gov

Do not hesitate to use the various Internet search engines. Simply type in the word(s) or phrase on which you want information and numerous pages should appear before your eyes.

A word of caution about some of these sites. They are purely commercial and offer only enticements to induce you to buy their product(s). Use your judgment and if you are not in the market to buy a product, turn the tables and type that into the search engine and you probably will be rewarded with one or more sources providing the information for free.

Before I forget, search for a care giver support group, or it might be called a care giver exchange, in your area. Remember the county offices I listed above? If one exists in your area, or close by, they will have the pertinent information.

Contact local hospitals and ask if they offer geriatric care on an outpatient basis and if they have a program or course on care giving. They would have a list of agencies and people in your immediate area detailing what each does or is willing to do.

I mentioned your particular religious affiliation above. Does it have a program to help?

Does your location have a specialized bus, or other transportation, service geared to the elderly and handicapped? Call your local transit authority and ask.

Maybe a senior service team exists to provide mental health screening that does a needs assessment and maybe even short term counseling for seniors.

Social service or church groups may have a telephone tree manned by volunteers, usually other seniors, who call the people on their lists offering reassurance, contact and at least a modicum of socialization.

Adult Education Centers provide courses on various topics and cost next to nothing for the student. If they are offering a course on care giving, and you can attend, then go.

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Support for caregivers can be found at the websites listed on senior2senior.org. It is in our caregiver section. Use it.

You should know one or more these agencies will fund volunteers to investigate and resolve complaints made by or on behalf of residents of long term care facilities as well as supporting state efforts to enhance seniors’ access to quality legal assistance programs. It also conducts elder abuse, neglect and exploitation public awareness campaigns.

The U.S. Department of Health and Human Services (HHS) participates in a resource network to bring the federal government, states and consumers together to expand access to quality home and community based services. Visit: https://www.hcbs.org for an expanded explanation.

Visit https://www.cms.hhs.gov to learn about quality measures that provide seniors and their families with information about the quality of care in local nursing homes participating in Medicare and Medicaid.

HHS has a sub agency, Substance Abuse and Mental Health Services Administration, which offers services and other resources to seniors as well as offering guidance to both the senior and care giver understand and locate appropriate services. Visit: https://www.samhsa.gov for more information.

The National Institutes of Health’s National Institute on Aging is in the forefront of a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life for all of us. Visit: https://www.nia.nih.gov or call 1-800-222-2225.

Please do not get the impression your only hope rests with the federal government or a local government entity. The resources listed above, to the best of my knowledge, are the best one can use to begin down the help trail. They offer the widest variety of free, or low cost, assistance one can utilize.

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CHECKLISTS

SOM recognizes no one checklist exists to cover each and every situation. Checklists, in fact, are only means of managing the situation. They are a help and, sometimes, a guide. Kind of like to-do lists or daily reminders.

The first checklist is called:

General Headings Indispensable in Daily Life and/or Care Giving/Care Receiving

1. Personal Care 2. Errands/Shopping 3. Meal Preparation/Special Nutrition Needs 4. Bathing/Dressing/Personal Hygiene/Grooming 5. Homemaking/Housekeeping 6. Companionship7. Medical Appointments 8. Bed/Tub Transfers 9. Rehabilitation Services/Appointments 10. Exercise 11. Respite Services 12. Care Level Review 13. Entertainment

This baker’s dozen blankets our lives no matter what our personal state of health. So, it becomes a start from which we can develop other lists. If you had no access to any other checklist, this in and of itself would suffice to begin an excellent care program.

Because an item is on the above list does not guarantee it a check list of its own. Personal care is not such an item.

Checklist 2: Personal Care

1. Eating 2. Bathing 3. Shaving 4. Skin Care 5. Hair Care 6. Activity/Other Contact 7. Toilet 8. Teeth/Mouth 9. Ears 10. Toenails/Fingernails 11. Mental Health

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I’ll freely admit this checklist simulates a tremendous grasp of the obvious. That is, until you realize the care receiver, like you, needs these items too. These items take on a different hue at that point in time.

Personal care, some call it self care, should be encouraged from the care receiver for several reasons. One, it promotes the idea of independence. Two, it is a form of exercise. Three, including them in the decisions regarding their personal care tells them they are a valued member of the team because their feelings, suggestions and needs are given serious consideration. Four, the more they do, the more time you have to spend on preparing their medically prescribed (if one) diet, monitoring their medication and paying attention to their overall condition. Five, it serves as a barometer as to whether they are progressing, staying the same or digressing in health. In other words, you are aware of their health through their abilities. This is win-win.

As the care giver, you need to remain committed to these items so you can maintain your health and stamina. What good would you be to anyone, yourself included, if you let yourself go? Since this manual isn’t lecture oriented, suffice it to say, stay on top of your personal care needs.

Bathing is an activity usually performed solo. The care receiver is no exception. The exception however is how it is performed on the care receiver. A bed ridden person will receive sponge baths or some other form of specialized bathing like being lifted from the bed and placed into a tub all the while remaining on a harness type piece of equipment. This is not the usual fare in a home but an institution.

A home bound person will be bathed in the tub or shower. Either, preferably both, will be outfitted with special equipment like handles (another name is grab bars) and non skid surfacing to facilitate the bathing.

Using a bath tub means, in some cases, placing the person into the tub and removing, or lifting, the person from the tub. If you are not a trained physical therapist, it would behoove you to learn how to perform this act. You do not want to blow out your back, break a limb or strain your muscles. A consult with the care receiver’s doctor may provide you with the answers for this situation.

Bathing usually means shampooing and for men shaving afterwards. If the care receiver is not ambulatory enough to visit the hair dresser or barber, find one who makes house calls. They exist but you may have to make several phone calls.

Shaving with a razor may produce cuts. Someone on blood thinners, diabetics and hemophiliacs should use an electric razor or shave per their doctor’s instructions.

Skin care may not cross your mind but don’t keep it clean and dry and watch what happens to you. People with bowel and bladder control problems, bedridden people and people who do not bathe frequently are susceptible to an array of problems.

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You, as the care giver, are responsible for the entire gamut on checklist 2. Encourage movement, mild exercise, hand washing after toilet use, adequate fluid intake, adequate nutrition and cooperation and participation in the care.

Remember to look at their heels, feet, hips, elbows and shoulder blades because the skin is prone to break down in the body’s bony protrusions. Watch for redness or a break in the skin. For some care receivers, this may be an extremely important happening requiring doctor’s attention. Don’t be afraid to call the doctor’s office and report it.

By the way, tight shoes, elastic cuffed socks/stockings, tight under garments may be the source of this redness or skin break. Or, they may cause circulation problems which can lead to other more serious problems. Always contact the care receiver’s doctor.

Toileting is another solo act. Solo until a person becomes a care receiver that is. Raised toilet seats, bars or handles around the bowl and maybe a non skid pad in front of the bowl may be necessary.

If the care receiver cannot make it to the bathroom, a portable commode may be the order of the day. A commode may be just the trick at night. If you are caring for someone with bowel, bladder, toilet problems, ask the doctor for suggestions to help retrain the bladder or bowel.

Assuming the care receiver cannot clean themselves after they perform a body function, it is imperative (s)he is promptly and properly cleaned and dried. This prevents infections and other complications.

Remember the care receiver from an earlier chapter who had a stroke and had to wear diapers and how he was changed? You now have the full story.

Well, actually, let’s use him for a discussion on eating. His only utensil was a spoon. Either a knife or fork was too dangerous as he sometimes didn’t always place his food in his mouth. Sometimes he hit his eye or cheek or chin.

When he ate a sandwich, it had to be cut into sections (what we call finger foods at parties) and he had to be watched while he chewed and swallowed as his swallowing ability was impaired. Knowing what to do if he started choking or was having a hard time swallowing had to be incorporated into every meal.

You will admit this isn’t something you think about when you and your family sit down to eat, right? This could change in a heart beat.

His cup had two handles and a lid. Straws were never used and a glass was almost always out of the question as he was just as likely to drop the glass as he was to place it on a solid surface. He wasn’t dropping it on purpose. He merely had no spatial ability so when it hit the floor it was only a misjudgment on his part.

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Another problem the care giver encountered with this person was his eating discipline. If he didn’t want what was in front of him, he would not eat, throw it on the floor, smear it over the table or try to throw it into the trash.

Discipline, like you’d normally perform, was not something that could be done. He, after all, could not speak, had limited reasoning and was not acting like a jerk on purpose. He knew he didn’t want a sandwich but he didn’t know how to express what it was he really desired.

With someone who can speak and still has reasoning ability, attempt to learn the reason for the behavior. Maybe they are only thirsty or they’d rather have a hamburger instead of a sandwich or the food isn’t appetizing or they are not feeling well. Any number of things could be the reason.

A word of caution for those on medically prescribed diets. There probably isn’t much room for dietary supplementation. My mother for example could eat only certain items in so large portions. Her doctor gave her a paper with her allowable choices and their respective portion size.

She was not a happy camper at first but adjusted to it. The times she would “cheat” as she called having something she wasn’t allowed or a bigger portion than prescribed, were not often. She understood her limitations and pretty much lived within them.

Hopefully, your care receiver has the same understanding.

When we speak of Activity/Other Contact, we mean exercise, daily routine and social outreach. Leisure time and sleep are just as much part of one’s daily routine as eating. However, some people tend to ignore self designed leisure and change their sleeping pattern.

Don’t.

The care receiver should have just as much opportunity in this area as they always have had if it is possible. Our stroke victim for example was once an enthusiastic golfer. The stroke eliminated active participation from his routine.

However, he had the fortune of living on a golf course so he could sit and watch the golfers or have his care giver chauffeur him in his golf cart. It was like having chicken soup when you have a cold.

Our stroke victim also enjoyed the company of his friends. Seems his cohorts didn’t pay any attention to his condition but continued to talk to him like he was still one of the boys. When one or more of his buddies showed up and started talking about a “remember when” incident or some other memorable time, he would join in the conversation just like everyone knew what he was saying. He was one of the gang and that was fine with everyone.

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This socialization scheme was great for the care giver as well as he was being engaged by his pals. His potty frequency decreased when they came by and he could chew and swallow without difficulty as they reminisced.

If you enjoy a circle, no matter how wide, of friends, please keep active with them. You need the communication with, and the companionship of, someone able to communicate back to, and companion with, you.

Toenails and fingernails continue to grow no matter what condition the rest of your body is in. If you can not personally perform maintenance on these areas, hire a manicurist. Like other parts of the body, toenails and fingernails can send signals that something isn’t right. Again, if there is any doubt, consult with the care receiver’s doctor.

Mental health is a specialty field unto its own and this manual does not even pretend to cover an iota of it. However, it is the area in which stress, relaxation, emotions, intellect and behavior reside.

Given this is true, it would behoove us to be aware of our, for short, emotional condition. If our condition handles stress via destructive behavior like drinking, drugs, alcohol, overeating, under eating, resentment, etc., we run the risk of spillover.

That is, one of our bouts may cause harm, in the form of neglect or abuse, to the care receiver. This doesn’t resolve the care receiver’s plight but, in fact, is harmful to our health, the care receiver’s well being and may be against the law.

If this is you, care giving shouldn’t be your profession of choice and you shouldn’t be the one to volunteer to take care of mom. The other situation is you have been a care giver for so long you may be sinking into this level of despair because you perceive the situation as hopeless, beyond your control, unjust or whatever.

Regardless, behavior of this nature is beyond the scope of this manual. Please seek help.

On the other hand, if you have a handle on your emotional condition, you will need to keep a handle on it. After all, it belongs to you and you own it. Keep it as healthy as possible through relaxation exercises, regular exercise, outings with friends, visits, parties, hobbies, phone calls, letters, cob web clearing solo activities, imagination tune ups, etc. In general, monitor your state of mind and your care receiver’s state of mind on a regular basis.

Probably the best way to accomplish emotional toning is to keep doing what you’ve always done that has made you happy. If you are a reader, continue to read. If you like TV situation comedies, continue to watch them. If you are a knitter, jig saw puzzle solver, bowler, whatever, continue to pursue these activities.

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Only now, realize them for the helping hands they have become. Treat them as old friends and continue to commune with them. Remember, all the checklists in the world won’t guarantee you a stable emotional condition but they will keep you on track.

Another way to keep the air circulating for both you and the care receiver is talking to each other. The care receiver probably has many memories and experiences just waiting to be put out for consumption.

Sharpen your listening skills and let the care receiver talk away. Hearing her stories will trigger events in your life. Talk about your events and happenings. Pretty soon you two may be so busy laughing you’ll wonder where the time went.

Laughing is supposed to be good for the soul as well as the body. Studies in the field claim many positive effects are associated with laughing. It is touted as a tension releaser, pain reducer, breathing improver and elevator of moods. None of this is scientifically proven as of this writing but do we really need scientific proof if we believe we feel better because we laughed?

If you didn’t know, it takes less energy to smile than it does to frown. Count the number of times you smile versus the number of times you frown or are gloomy. If the number of smiles is greater, you and your care receiver are doing fine.

Although only mentioned earlier, respite care services are another way to handle the stress of the task for both you and the care receiver. Like it or not, believe it or not, accept it or not, your care receiver may want a break from you too.

Enter respite care, a program which provides temporary care so the care giver can have a break. This care can be short term, one or two hours, or long term, up to twenty four hours.

Respite care may be provided in home, at an adult day care center or other facility. Your care receiver will be socializing with peers, meeting other care givers and making new friends all in a supervised setting. Imagine the relief felt by both of you.

Self esteem is a personal characteristic standing the chance of getting wounded in this scenario. However, practicing the above activities and suggestions will salvage any self esteem slumps. Because you are taking care of yourself, you are taking care of your care receiver as well. You both benefit.

A topic no one wants to address is suicide. Unfortunately, the elderly comprise a very high percentage of suicides. This group is not known to make suicide threats or express suicidal thoughts to anyone. They just do it.

According to experts in the field, the number one reason, at least this is what they believe, for elderly suicide is depression. The elderly supposedly feel sad, hopeless and a sense of loss.

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Terminally ill or chronically ill people simply do not see any reason to continue living. Depression sets in and they go out.

The best remedy to suicide, these same experts say, is to ask the person if she is thinking of suicide. Actually verbalizing the thought brings relief as the person can now talk openly about their feelings. They no longer feel hopeless because someone is listening.

Sharpen your listening skills. I said it above and I’ll say it again. Listening differs from hearing in that hearing means the sound went in while listening means you understood the meaning in the sound and can respond to the meaning in the sound.

Some of depression’s warning signs are:

Withdrawal and isolation from family, friends and people close to them… Behavior changes like an absence of enthusiasm for once valued activities… Sadness spells lasting longer than usual…Crying spells for no apparent reason…Feeling tired most of the time, even with adequate rest… Problems with sleeping…Loss of appetite…

This list is by no means complete but it is a start. Said another way, it is up to you to pay attention to you and your care receiver in both the physical and mental arenas. If you take the time, you may develop a 6th sense. Some call it a gut feeling. Pay attention to it, the worse that can happen is you are wrong and waste a visit to the doctor.

Checklist 3: Assets, Important Papers and Liabilities

1. Social Security Number(s) 2. Driver License Number(s) 3. All Insurance Policies/Cards 4. Jewelry 5. Warranties 6. Precious Metals 7. Art 8. Promissory Notes 9. Real Estate Deeds 10. Bank Accounts – Saving and Checking with attendant statements 11. Certificates of Deposit with attendant statements 12. Security Brokerage Accounts with attendant statements 13. Post Office Box 14. Retirement/Pension Benefits 15. Money Market Funds if not held at bank or brokerage house 16. Contracts 17. Birth Certificates 18. Death Certificates

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19. Divorce Decrees 20. Property Settlements 21. Income Tax Returns – State and Federal 22. Attorney’s Name and Address 23. CPA/Accountant Name and Address 24. Business Paperwork if person owns or has an interest in a business 25. Credit Card Statements 26. Titles/Registrations for property and vehicles 27. Any other perceived matter of importance

Legal document checklist follows this one. It is important to note the above checklist is encompassing but as number 27 states, there may be matters of importance particular to the care receiver’s life.

One example is prepaid burial plots. My mother, for example, paid for both hers and dads at dad’s death. We considered this important and it made our list.

While membership in an organization like the Moose, Elks, Kiwanis, etc., may not be of prime import, these organizations may be able to provide help. It would be a wise idea to inform the chapter’s Secretary of the situation.

I have mentioned earlier about contacting bankers, insurance agents, brokerage personnel and other people for an explanation of the holding and/or terms of the contracts, if any, the care receiver has with such organizations.

By the way, item 24 deals with sole proprietorship, not publicly traded corporations, partnerships and other legal entities. This is an area with potential for reward or disaster. Understanding the legal obligations, contracts, agreements could mean the difference between salvaging the business or losing everything. Consult a competent attorney should this be the case with your care receiver.

Checklist 4: Legal Affairs and Documents

1. Will 2. Trusts – There are many different types. Determine which is in force and where

you stand regarding its provisions. 3. Personal Care Contract 4. Durable Power of Attorney 5. Probate Conservatorship 6. Durable Power of Attorney for Health Care 7. Advanced Directive 8. Power of Attorney 9. Any other legal document as pertains to the care receiver

This area is a very touchy one because the implications are so enormous. Consulting with a competent attorney specializing in this field is a must.

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The laws regarding the above instruments vary by state adding to the complexity of an already what seems like overwhelming situation. The best advice is to do the best you can and never stop asking questions until you are completely satisfied with the answers and/or results.

Do not be hesitant about questioning several lawyers about the matter. It may cost you several hundred dollars, but like I said in a previous chapter, you save thousands in the end or maybe you keep the estate from being sold at auction, in probate or in foreclosure.

*********Hints for interviewing a lawyer include:

1. Fees, charges, billing procedures and expenses should be discussed up front with an estimate of total cost if matters progress as discussed

2. Be sure all conversations are confidential 3. Ask if other means exist to handle matter and, if so, what are they 4. Ask the length of time this type of matter takes to completion/resolution 5. Ask the potential outcome/results 6. Anything else for which you want the answer, ask

*********

Checklist 5: Quick reminders

1. Know the location of personal documents and financial records with the documents in a fireproof, or safe deposit, box

2. Consider automatic payment of bills from care receiver’s checking account 3. Become a joint owner on care receiver’s checking account 4. Direct deposit care receiver’s retirement, pension, benefit checks 5. Consider creation of legal instrument appropriate to situation 6. Always ask questions 7. Don’t be timid about asking for help 8. Put original documents in plastic covers to protect from damage and the

accidental giving away 9. Create copies of important documents should you need them later 10. Don’t forget power, light, gas and other utilities

Behavior problems, while not actually checklist material, are listed, with brief explanation, for your awareness. Again, always address the specifics with your care receiver’s medical team.

Wandering – People wander no matter where they are housed. They do it for their own reason so it is important to understand the why. Maybe adjusting the environment or activity level will relieve the cause. Unless medically prescribed, restraint is not appropriate and in some locales may be against the law.

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Pacing – Just as the name implies. The care receiver paces around the room or throughout the house. Too much pacing by an ill person or frail senior can produce medical impairments. Always ask the medical team for ways to reduce pacing so as to prevent possible health risks. Remember too, someone pacing may make it outside and get lost. This obviously is not a good situation.

Perseveration – This big word means a person persists in a particular activity without the

ability to shift easily to another at a change in stimulus. This requires medical attention.

Incontinence is not a behavior problem per se. Rather, it is a body function requiring continual attention. Diapers not changed can lead to a number of medical problems.

Lack of motivation could be a behavior problem given the care receiver absolutely refuses to work with the care giver, medical team or anyone else.

Memory, or loss thereof, and if severe, leads to constant monitoring. The area of most impact would be in medication intake. Therefore, it is crucial to keep on top of medicine intake times, doctor’s appointments and treatments.

Screaming – If your care receiver is screaming almost all of her waking moments, immediate medical attention is required. Pain, depression, hearing loss, vision impairment or any other number of causes are at the root.

Sexual aggression – Believe it or not, because a person is 80 or 90, doesn’t always guarantee sexual inactivity. My wife tells the story of one her care receivers in his 90’s. He was constantly making sexual advances at all of the female personnel and exposing himself. The doctor had to take command of the situation. Be aware it happens and take steps to deal with it as early as possible.

Gathering/Hoarding – Some seniors constantly rearrange household objects and/or hoard possessions and objects, even ones with no apparent, inherent or actual value. At the least, it is a disruption. At the worse, it could mean the loss of an important legal document. One of the easiest solutions is to provide the care receiver with her own “special” place where to store items.

Hallucinations/Illusions – Probably a symptom of psychiatric problems and/or behavioral

symptoms associated with a particular ailment. Needless to say, consult the medical team.

Should you notice a behavior/activity not mentioned above, don’t hesitate to speak with the care receiver’s doctor. It is up to you to be the medical monitor. It is up to the doctor to be the medical answer.

Checklist 6: Senior House Proofing

Sounds funny to say a home must be senior proofed until you see first hand an injury

from something as innocent as a throw rug. A typical scenario could be something as

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innocent as a throw rug she has walked over a thousand times. Only today, her feet get tangled, she falls and breaks her hip.

Falls are the most common life-threatening hazard to adults over 65. Given the size of this age group, falls have become almost epidemic since one out of three persons falls each year.. Over 80, the rate climbs to 50%.

A study published on https://www.archstone.org says:

“The most important risk factors for falls include leg weakness, gait and balance problems, previous falls, general functional impairment, visual deficits, cognitive impairments, depression, taking psycho-active medications, and taking more than four different prescription medicines.”

I believe that has conclusively said a care giver has her work cut out. To add another measure of complication, medications not only add to the fall possibility but to poisoning. More on poisoning after we seniorize the home.

A typical house has bedrooms, bathrooms, living room(s), garage, outside area and a kitchen. Stairways exist in 2 or more story houses as well as a means to enter the basement, whether the house is one or more stories.

Looking at the home from an area point of view we should consider:

Bedroom:

1. Light switch accessible at room entrance 2. Sturdy night stand or table with a non tip lamp and room for eyeglasses 3. Phone located near the bed 4. Rugs with non slip backing 5. Night light between bed and bathroom 6. Clear pathways 7. Comfortable arm chair for rest or use when dressing 8. Temperature adequate for the time of year 9. Space heaters

Bathroom:

1. Grab bars in bathtub and shower and near the toilet 2. Hot water heater set to prevent scalding 3. Tub and shower with non skid surfaces 4. A place to sit in the tub 5. Shower head equipped with extendable hand held hose 6. Night light 7. Tripping hazards removed 8. Cords out of the way

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Kitchen:

1. Frequently used items available without use of stool 2. If stool required, is it sturdy with only one step 3. Fire extinguisher within easy reach of stove 4. Floor absent of wax and throw rugs 5. Lighting bright 6. Night light 7. Work area big enough to sit while preparing food 8. Space heaters

Living Room;

1. Light switch at room entrance 2. Night light 3. Carpets lie flat 4. Walkways free of clutter, cords, throw rugs 5. Chairs with strong arm rests 6. Space heaters

Garage:

1. Adequate lighting 2. Walkways free of clutter 3. Non skid floor 4. Oily rags, gas cans and batteries 5. Doors close properly

Outside Area:

1. Lighting illuminates entrance and exit areas 2. Windows 3. Security locks on outside doors 4. Trash can storage 5. Fencing condition 6. Gates 7. Driveway condition/accessibility 8. Weeds, grass, brush, trees around house 9. Rain gutters cleaned and repaired 10. Foundation

Stairways:

1. Adequate lighting at top and bottom 2. Handrails securely fixed with hand being able to be wrapped completely around 3. Switches easy to operate

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4. Stairs in good repair 5. Throw rugs on stairs 6. Stairs free of clutter 7. See outline of step as you descend and ascend 8. Outside stairs free of ice, cracks snow or other material

Homes can be made adaptable for people with specific disabilities. Arthritis, for example. Replace door knobs with lever handles. Replace twist faucets with lever action faucets in sinks. Electric can openers, sliding drawers, wheel chair ramps, raised/lowered cooking and food preparation surfaces are just some ideas.

A discussion with an occupational therapist and contractor will probably yield a host of improvements that will make life easier for all parties. The above suggestions are just immediate items to be checked for and corrected, replaced or installed. They are not a substitute for common sense.

Safety is a full time business. People have a tendency to do things the way they have always done them. This carries over to old age and could be the person’s undoing, accident wise.

Rising from a chair is so easy it could be called child’s play. As we age, child’s play becomes adult work. Checking our vision and hearing should be on our schedule but it isn’t.

Testing the surface when exiting a car may seem to be a no brainer but how many people do it? Curbs, ice, escalators, elevators all present challenges even to the most alert.

Foot wear with heels and soles providing traction and support is a good idea no matter

what your age. Seniors unsure of their footing may have to use a cane or walker.

Even the phone ringing can be a challenge. At some point, one has to decide running to answer it is not the best idea. Let it ring and walk is the more prudent means.

Senior proofing the home and practicing safety are covered to a great degree. All that remains is putting these suggestions into practice and implementing those peculiar to your situation.

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POISONING

The Center for Disease Control at:

https://www.cdc.gov/

is source for the following

Poisoning Prevention: Prevention Tips

Safety Tips for You and Your Family

Unless otherwise noted, the safety tips below were adapted from the American Association of Poison Control Centers, Poison Prevention Tips, 2002 and the CDC Perspective in Disease Prevention and Health Promotion National Poison Prevention Week: 25th Anniversary Observance MMWR, 1986.

Make your home safer:

• Post the poison control number 1-800-222-1222 on or near every home telephone.

• Store all medicines, household products, and personal care products in locked cabinets that are out of reach of small children.

• Know the names of the plants in your house and yard. Identify poisonous plants and place them out of reach of children or remove them.

• Be aware of any medicines that visitors may bring into your home. Make sure your visitors do not leave their medicines where children can find them easily, for example in an unattended purses or suitcase.

• Monitor the air quality in your house. Place carbon monoxide monitors near the bedrooms in your house. (CPSC, 2002)

• All combustion (fuel burning) appliances should be professionally installed and inspected annually. (CDC, 1995)

• Check your house for lead-based paints. Contact the National Lead Information Center at 1-800-424-LEAD to receive more detailed information.(CDC, NCEH 2002)

Use poisonous products safely:

• Always store household products in their original containers. Do not use food containers such as cups or bottles to store chemical products such as cleaning solutions or cosmetic products.

• Always read the labels before using a potentially poisonous product. Never leave the product unattended while using it and return the product to the locked cabinet when you are finished.

• A light should be turned on when giving or taking medication. • Avoid taking medicine in front of children because they tend to imitate adults. • Do not call medicine candy. • Follow directions on label when taking medicines. Be aware of potential

interactions with other medicines or alcohol and never share prescription drugs.

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• Turn on the fan and open windows when using chemical products. • Wear protective clothing (gloves, long pants, long sleeves, socks,

shoes) when spraying pesticides and other chemicals. • Never mix household and chemical products together. A poisonous gas may

be created when mixing chemicals. • Do not burn fuels or charcoal or use gasoline-powered engines in confined

spaces such as garages, tents, or poorly ventilated rooms (CDC, 1982).

What to do if a poisoning exposure occurs:

1. Remain calm 2. If you have a poison emergency and the victim has collapsed or is not

breathing call 911. If you have a poison exposure and the victim is alert call 1-800-222-1222. Try to have the following information ready if possible:

• the person’s age and estimated weight • the container or bottle of the poisonous product, if available • time that the poison exposure occurred • your name and phone number

3. Follow the instructions from the emergency operator or the poison control center

The sad fact of life is older people as are apt to suffer from poisoning as children. The statistics show it is about even.

Seniors take not only a number of medications but a variety of medications and often at a frequency of more than one a day. It is estimated something like almost 60% of people on five or more medications are not in compliance with their medication intake regimen.

This results in about 10% of all hospital admissions being the result of medication noncompliance. This means of the roughly 32 million Americans taking three or more medications daily, about 3.2 million are admitted to the hospital.

Staggering is one adjective and is probably the only adjective that can be used to describe this phenomenon.

It is very important a care receiver’s primary physician and pharmacist know all of the medication being taken. This includes over the counter and herbal or natural remedies. Sometimes these interact with each other and impact your health negatively.

Pay close attention to food and alcohol restrictions. Side effects are real and sometimes deadly or paralyzing. If you miss a dose, don’t double up to catch up. Medications are not designed that way.

Also, don’t arbitrarily stop taking a medication or change its dose. Always, always address your concerns to your physician before instituting any changes.

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Pay close attention to expiration dates and how you dispose of the ones no longer suitable to take. You want to keep them away from young hands who have witnessed you take them so they believe it is OK for them to take.

Use pill dispensers as reminder tools and not substitutes for the original container. Never empty the bottle and then attempt to replace them into the bottle. Fill the dispenser for, at most, only one week’s supply. It is wise to have a pill dispenser for each type of medication taken and to keep them segregated.

The plan is to NOT become a medical overdose statistic. The plan IS to take the medication as prescribed to get the relief sought.

As with every topic presented in this manual, use common sense. Let it be the overriding veto, to borrow a political term, if you are not sure. Remember, the answer to your question is only a phone call away. Make the call.

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ANOTHER SENIOR CITIZEN HELPING HAND

The Reverse Mortgage did not gain acceptance as a viable tool to help seniors until FHA and Fannie Mae developed federally insured products. The FHA has the most popular program.

The FHA Home Equity Conversion Mortgage Program (HECM) and the Fannie Mae Home Keeper reverse mortgages are numbers one and two in the market. They provide seniors with a way to convert the equity in their homes into cash.

The reverse mortgage reverses the payment stream, i.e., the homeowner receives the payments rather than the mortgage company. While a reverse mortgage is in effect, you continue to own the house and hold title to it.

No restrictions are placed on the use of the funds. In other words, pay medical bills, buy medicines, travel, go to school, whatever.

You must be, at this writing, at least 62 and own your home to qualify. No income or medical conditions are necessary to qualify since you are not borrowing money or purchasing insurance.

These mortgages are even packaged as a line of credit against the home so you can draw on the proceeds at any time and are not obligated to take a monthly check. There are costs associated with getting a reverse mortgage and you will have to pay them. The payor does not.

Costs like an origination fee, appraisals, document preparation and title and escrow fees are usually associated with this type of mortgage just as with a regular mortgage. One main drawback is funds received from a reverse mortgage may affect your eligibility for Medicaid and state assistance programs.

The money you receive is tax free and does not affect your regular Social Security or Medicare benefits however.

The U.S. Department of Housing and Urban Development (HUD) has a list of approved counseling agencies on their web site: https://hud.gov or you can call the ACL at 1-800-677-1116 for a list of reverse mortgage counselors in your area.

The above data is presented for your information and in no way is an endorsement of this type of program. You should always perform your due diligence and talk with your attorney and/or financial advisor. The above web address and phone number are good starts to learn the questions you may wish to ask.

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Remember, because this plan may be suitable for your next door neighbor, does not make it suitable for you. Ask questions until you are satisfied you understand whether or not the program will meet your situation as it exists.

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AVOIDING OUTRAGEOUS HOSPITAL CHARGES

All of us would agree a hospital is our institution of last choice in the chain of care. However, when needed, in we go.

What happens to us on the inside medically is always translated into a financial statement called a bill. Most of us don’t have a clue what we are reading when we look at those pages of numbers and codes. Oh, we can read the total and even comprehend that huge number. But, when it comes to knowing how much we paid for what service, well, you have to be an expert in hospital bill reading.

So, the first step is to ask for an itemized bill, a step which in no way guarantees receiving a document written in easily to understand services and numbers. To complicate matters, health insurance plans have different contracts with differing payment schedules.

This means no single rate sheet with easy to read explanations. This also means, at least according to consumer advocates, hospitals will pack your bill with all kinds of charges whether dispensed or not.

One example is the $129 box of tissues. A story on one of the network expose shows (Dateline, 60 Minutes, etc.) told of a lady who was charged $129 for a box of tissues. A similar box of tissues could be purchased for one dollar at any of those everything under a dollar type stores.

When called on this exorbitant charge, the hospital reduced it to something like three dollars. Another part of their story told of the man being charged for newborn blood tests and a crib mobile. He didn’t remember being admitted for the purpose of having a baby. Those charges disappeared entirely.

Given hospitals have to find a way to make up for the services they render for free by law and services given to indigent people and for waste and mismanagement, they charge you, me, the insurance company and anyone else who will pay. This means we have to become our own investigator.

If you do not review your bill, some of the overcharges will come out of your pocket in the forms of co -pays and deductibles. Worse, if you have no insurance at all, you will shoulder every last cent and hospitals are very aggressive in pursuit of payment.

Always asking for an itemized bill is remedy number one. Number two, and in some cases number one, is knowing what your policy will cover and how much it will pay. An emergency may be covered totally but if you are there on other than emergency conditions, you must have a handle on the coverage.

Ask the hospital’s billing department what you will be charged for your room and exactly what those charges cover. You don’t want to be charged $129 for a box of tissues, right?

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Speak with your doctor about his and other attendant physician charges. Get an estimate in advance and ask him if you can bring prescriptions from home to avoid hospital administered medications.

While speaking with your doctor, ask if all of the attending physicians accept your plan.If not, which ones do they accept and if there is a doctor who accepts your plan, can he be substituted onto your treatment team.

Never pay your bill before leaving the hospital. You want an itemized statement first so you can compare it with a document called an explanation of benefits. The EOB comes from your insurance company. Do not throw away the EOB. It is important.

If you see items like lab fees, testing fees and/or miscellaneous fees, call the hospital billing department and demand an explanation. Call your insurance company and ask them for help.

If you had the presence of mind to keep a log of tests performed, medications received and treatment received, you can now compare your log with what is claimed on your statement.

A group of people exist who know how to read and decipher hospital bills. A good place to begin your search is on https://senior2senior.org. We have several excellent articles on hospital charges.

Your local district attorney may have a consumer help division with someone knowledgeable in this field or, at least, can direct you to another county or state agency that provides this type of help.

By the way, every state has mandated that hospitals must provide an itemized bill to everyone who requests one. Don’t let the billing department tell you otherwise.

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TANSTAAFL

My uncle had a sign over his bar reading:

Free lunch.Tomorrow.

He had another sign on the opposite wall right above the jukebox reading:

There Ain’t No Such Thing As A Free Lunch.

The acronym, TANSTAAFL, originates from this saying and has come to symbolize frauds, scams and ripoffs. If you remembered nothing than my uncle’s two signs, you’d almost insulate yourself from being scammed.

The perpetrators know all of us are looking for something for nothing, the proverbial free lunch. They also know no such thing exists unless they manufacture a demand in your mind.

The federal government on their website, https://www.ftc.gov , has excellent explanations and descriptions of the latest frauds in circulation. Your state attorney general also has a web site with fraud information. (See above for how to easily locate your attorney general’s web site.)

All scams have four basic core beginnings. The medium used to perpetrate the scam has progressed with technology. The scammers haven’t abandoned the telephone, newspapers, magazines or junk mailings, they just evolved them to fit the Internet.

The first core scam is the prize offer. You are contacted saying you have won a free prize. Sometimes they say you have won a sweepstakes. Either way, you are a winner and all you have to do to claim your prize is buy something or give them your bank or credit card number. They say once they know you can pay the small fee, you will receive the prize. The prizes either do not exist, are overpriced or are worthless. Regardless, you never receive any prize.

The second scam is the travel packages. You are offered a low priced vacation to some exotic or popular spot. You must pay in advance and adhere to the preset rules. Generally, if you had contacted your local travel agent, you would have received a much better deal without any restrictions.

The third scam is the investment deal just for you. You get a call from someone telling about this fabulous get rich stock, land, precious metals, art, rare coins, oil etc., deal. All you have to do is send the caller a check for such and such amount and you are in.

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The fourth scam is the vitamin, health products, office supplies products scam. They contact you with enticements so you will pay hundreds of dollars for products worth very little.

This should all sound familiar because, if you have a phone or a mail box, and now an email address, you have received such garbage. Most of it pure worthless nonsense designed solely to separate you from your money.

Deep discounted international telephone services has exacerbated the fraud problem. Toronto, Montreal and Vancouver, as of this writing, are the homes to telemarketing boiler rooms that take, according to the FBI, Americans for about $100 million a year.

Senior citizens are the main targets because they are lonely, want to talk with someone, and generally don’t believe someone would call them and bald face lie to them. But, as they are learning, it happened, is happening and will continue to happen.

The best remedy is to simply hang up. If they contact you by mail, throw it away. The less you respond the quicker you will be off their contact list. You see, these people have lists of people who respond to calls and mailers.

One scam, in fact, is called a Recovery Scam. After one con artist fleeces you, he sells your name to another con artist who calls you saying he can recover your money plus maybe even some interest from the bad guys. All it costs is such and such amount upfront. If you send it, you’ve just been taken again.

Don’t respond.

Care givers with financial responsibility should be alert to the care receiver’s bank, brokerage and credit card statements. Monitor them each month and always inquire about unusual withdrawals or charges.

Sometimes a bank clerk is involved either directly or by selling the bank customer’s personal information to the scammers. It is a never ending vicious arena that requires diligence.

Some of the tip offs to fraud include:

“You have to act ‘now’ enticements or the offer won’t be good.”“You’ve won a free gift, vacation or prize and you pay only such and such for postage and handling or other charges.” Note: If you didn’t enter any contests, you didn’t win any prizes.

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“You must send money, give a credit card or bank account number, or have a check picked up by a courier, before you’ve had time to carefully consider the offer.” Pressure tactics are always used to get you to act now.“You are told you don’t need to check out their company with anyone, including your family, lawyer, accountant or consumer protection agency.”“You are told you don’t need any written information about their company or their references.”“You can’t afford to miss this high-profit, no-risk offer.”

These, and, similar statements are usually pressure remarks made so you will think if you

don’t act now, you will lose out. And, that, is precisely what will happen if you do act.

The caller speaks fast or in a low tone on purpose so you have to pay attention to his words. Ask them to slow down or speak up so your mind can focus on the call. Once you actually are able to listen to the spiel, you will probably recognize it for what it is. Then hang up. Hanging up is not against the law.

Here are a few tips to protect yourself. First, don’t buy by phone from unfamiliar companies. Always ask for and wait until you receive written material about the offer.

Second, check out unfamiliar companies with your local consumer protection agency, state attorney general or district attorney consumer advocate.

Third, always take your time making a decision. It is not against the law or rude to wait and think about the offer.

Fourth, never respond to an offer you don’t thoroughly understand.

Fifth, never send money or give out credit card or bank account numbers to unfamiliar companies because such information may be sold to other companies.

Be aware collection companies may have in depth medical information about you in their data bases even though you’ve never been late or missed a payment. These companies sue the data bases of credit bureaus and other such organizations to get their information.

Given Identity Theft has grown to immense proportions, you must do everything you can to protect yourself. The government’s site at: https://www.ftc.gov has excellent information on how to protect yourself against ID theft. If you do not have a computer, go to your local library and log on to this site.

The FBI estimates this crime now dwarfs every other type of crime committed against people, at least in the U.S. It can literally cost you your life’s savings and take years to clear up. It is insidious and, finally, the law makers are putting teeth into its prosecution.

The National Fraud Information Center, an excellent resource, has a toll free number: 1-800-876-7060. They are open 9 a.m. to 5:30 p.m., EST.

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The big three credit bureaus are:

TransUnion – 1-800-680-7289Equifax – 1-800-525-6285Experian – 1-888-397-3742

If you are a victim of ID Theft or credit card abuse or fraud, call these bureaus immediately and ask what forms they require for you to make official notification of your situation. The earlier you contact them and file their forms, the quicker (hopefully) you will enjoy relief.

After this initial phone call, put everything in writing and send it certified registered return receipt requested mail. If you are unfamiliar with this type of mail, ask your postal clerk for assistance.

You can also place your name on the National Do Not Call Registry located at: https://www.donotcall.gov Telemarketers are not allowed to call any number listed on this registry.

The above is exploitation and it is done by people unknown to the senior. However, people known to the senior are also exploiters.

Family members, acquaintances and fiduciaries all have been caught perpetrating exploitation against a care receiver. Everything from outright mismanagement of assets, signing checks or using the senior’s ATM card without the senior’s consent, charging excessive fees for rent, care giving or other services, theft of money and/or property to obtaining money or property by undue influence, misrepresentation or fraud.

The Nevada State Attorney General offers these signs of elderly financial exploitation:

* Unusual activity in bank account(s). ATM withdrawals when the person cannot walk or get to the bank; accounts changed from one branch to another; several withdrawals in short time for large amounts of money; request for large cash withdrawals inconsistent with customer's normal banking practices. * Unfamiliar signatures on checks or other documents. * Different or inappropriate people coming to the bank coupled with changes in signature or unusual account activity. Home health aide, housekeeper, or other person puts their name on account. * Older customer isolated from friends and family. When you call the house you are told the older customer is unable to speak to you; matters are handled by third party, who has gained control of account. * Power of Attorney, or Will, drawn up when older customer seems unable to comprehend the financial situation. * Older customer signs papers without knowing what they are.

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* Refusal to spend money on behalf of the elder customer, especially on their care. Numerous unpaid bills, such as overdue rent, utilities, taxes. Lack of amenities, i.e. television set, personal grooming items, clothing, food. * Checks bounce when there should be adequate resources. * New acquaintances expressing gushy, undying affection. * Accompanying person is angry towards older customer and refuses to provide necessary assistance. * Recent change of title to house in favor of a "friend", when the older customer is incapable of understanding the nature of the transaction, or eviction notice arrives when person thought he/she owned the house. * Canceled checks no longer sent to older customer's house. * Promises of "Lifelong Care" in exchange for willing or deeding property/bank accounts to caregiver. * The older customer is placed in a nursing home below his or her financial means. * Checks and documents signed when older customer cannot write. * Older customer complains that he/she used to have money, but does not have it any more. * Caregiver evasive about financial arrangements. * Older customer fearful of household member or companion. * Older customer seems afraid to speak in front of other. * Accompanying person seeks to prevent older customer from interacting with others. * Household member or caregiver refuses to permit transport for essential services. * Older customer is isolated, in unhealthy or unsafe environment. * Changes in personal hygiene/inappropriate clothing. * Older customer and household member or caregiver give conflicting accounts of an incident, expenditure, or financial need; account is inconsistent with person's financial profile.

The above tips were offered to bank tellers to assist bank employees in recognizing, responding to, and possibly preventing financial exploitation of the elderly since, according to the AG, they are in a unique position to have early (and often the only) knowledge of financial abuse.

I believe everyone should have access to these tips so as to hopefully arrest this type of exploitation in its early stages.

I mentioned at the beginning of this manual there is a fraud of such despicable magnitude happening I would mention it in the scam section. Actually, there are two. The first, Identity Theft, was already covered.

The second is phony insurance companies. Since 2001, according to government press releases, four unauthorized plans have left nearly 100,000 people with approximately $85 million in unpaid medical debts and without health coverage.

The scammers prey on small business people and those who find it difficult, like seniors, to obtain health coverage. They use assurance or mutual in their names, their companies

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or associations like the names of well, legitimate businesses or professional organizations.

They set the hook by offering low, low premiums. Sometimes, and especially if you’ve been insurance shopping, these rates are so good, you sign up.

The applications are no brainers asking few, if any, real tough health questions. A legitimate plan asks those questions because the person’s medical condition is the basis for pricing the policy.

If asked if the agent is licensed, the answer is typically she doesn’t have to be because their insurance is exempt from regulation. No life, health or disability insurance programs are exempt from licensing. Licensing is one of the state’s ways of policing the field.

If you are approached by such an offer, contact your state’s insurance department. Every company selling insurance must be registered with your state’s insurance department.

If you are approached by someone selling union insurance and you are not in the union, be aware. Union insurance is for union members and generally sold by union representatives who may, or may not, be licensed by state. If not licensed, they have union credentials and is regulated by the Department of Labor. Your state insurance department will know if it is, or isn’t, a union offering.

Another ploy is someone selling ERISA plans. ERISA is the acronym for Employee Retirement Income Security Act and is regulated by the U.S. Department of Labor. ERISA plans can only be sponsored by employers for their employees. They are not sold by insurance agents nor are they sold to individuals.

While this scam is becoming more recognized and the authorities are beginning to prosecute the perpetrators, no guarantee exists it’ll happen in your case. The problem is still mostly in the investigatory stage.

So, it boils down to the telephone. Call your state insurance department and start asking questions. An ounce of prevention is worth a pound of cure.

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CONCLUSION

You have just read what we believe to be is the most complete manual in existence balancing both the care giver and the care receiver function. The information is easily cross pollinated.

Pick any arena and its information is as applicable to the care giver as it is to the care receiver within its inherent limits. Medication taken by the care receiver won’t be taken by the care giver. However, the administration of the medicine is universal. Each party needs to know, and obey, the rules associated with that medicine.

Scams, frauds and ripoffs don’t happen only to care receivers. Care givers are as susceptible as care receivers.

I believe you get my drift. If you have a comment, suggestion or knowledge in an area not covered or not covered to your satisfaction, please contact me at tom@senior2senior.org or write:

Senior Outreach MinistriesP.O. Box 1234Reno, NV 89504

I will respond. It may take a few days but I will respond.

Thank you for your interest in our first manual. More will be published in the near future.

Tom Koziol

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