The Weather Outside is Frightful!

By Anne Pagnoni
The winter is upon us, fellow New Jerseyans. If you don't believe me, then just look out your window. How many inches – or feet – of snow are still on your sidewalk or driveway? How long did it take for your street to be plowed? How long were you held up in your home with no way to get out? How much worrying did you do about your mother or father being home alone without any way of getting to them? How many phone calls did you place to your mother reminding her to take her medicine and to make sure that she hadn't left the house? These are the times when having a loved one with dementia really takes its toll on the family caregiver. Now is the time to consider a live-in caregiver from Home Care Assistance of New Jersey.

Home Care Assistance is a full service home care agency offering hourly services but with a specialty in live-in caregivers. Our caregivers are specifically trained in our exclusive Balanced Care Method^TM . Focusing on lifestyle and dietary choices, the Balanced Care Method^TM promotes healthy activity, stress reduction, and social interaction to help seniors live their best possible lives – in the comfort of home. But, what exactly does this mean for your mother or father?

1. When it comes to physical hygiene, our caregivers are able to provide assistance with bathing, dressing, and grooming. A little help here can go a long way in improving your loved one's willingness to interact with others.
2. From planning the menu to preparing the meal, the caregiver will ensure that your loved one is eating three, well balanced meals per day. If your mother or father has food preferences or enjoys cooking, then she or he and the caregiver will enjoy doing this together.
3. Exercise. Not a word that most of us like to think about, but it's a necessity nonetheless. Your loved one isn't going to be training for a marathon by any stretch, but the caregiver will work to improve physical stamina. From simply doing stretches and chair exercises to walking to the mailbox or around the block, your mother or father won't be sitting in a favorite chair all day long anymore!
4. You know the old saying, use it or lose it. It applies to short term memory, too! While our caregivers can't reverse memory loss associated with dementia and Alzheimer's Disease, they can provide social interaction, which has been shown to improve cognitive function. A game of cards, anyone?

Don't keep playing the waiting game. None of us can predict when Mother Nature is going to send another Nor'easter our way. Now is the time to take the necessary steps to safeguard your loved one's future. When it comes to caring for your aging loved one, accept help from the live-in professionals. For more information about Home Care Assistance, please visit our website at http://www.homecareassistance.com/. To be directed to your local Home Care Assistance office, please call 1-866-4-LIVEIN.

National Alzheimer's Project Act (NAPA): Take Action!

The Alzheimer's Association reports that there are currently 5.3 million people living with Alzheimer's Disease and that every 70 seconds another person is diagnosed with this terminal disease.  It is predicted that up to 16 million Americans will have Alzheimer's Disease by the year 2050 and that someone will be diagnosed with the Disease every 33 seconds.  Alzheimer's Disease is the 7th leading cause of death in the United States with mortality rates on the rise.  The yearly price tag of Alzheimer's Disease?   $172 billion per year. 

Over the past several years, organizations have been encouraging Congress to take action in the fight against Alzheimer's Disease. Congress has voted, unanimously, to pass the National Alzheimer's Project Act, which creates a plan to combat Alzheimer's Disease with the same intensity as the attacks on cancer and AIDS. The goal of the project is to create a national strategic plan to improve treatments, prevent, and ultimately find a cure for Alzheimer's Disease.

If signed in to law by President Obama., the bill would create the National Alzheimer's Project within the Department of Health and Human Services. There would be a plethora of organizations represented on the Project's adisory council as well as health care professionals and family caregivers of those with Alzheimer's Disease.

Your help is needed to have this bill signed in to law by year's end. Please visit the Alzheimer's Association for information on how you can send a message to President Obama.

Start the Year Off Right with Home Care Assistance of New Jersey

Getting together and celebrating a special occasion with the family can be a wonderful time. It can also be a time when you begin noticing changes in your aging loved one. Perhaps as you celebrated the recent holidays, you noticed that your mother’s hygiene isn’t what it used to be. You may have noticed that her short term memory is declining or that she has been losing weight. Perhaps she mentioned being lonely during the day but being unable to get out of the house on her own due to physical ailments. You are working and taking care of your own busy family and can’t imagine taking on additional caregiving responsibilities even though you want to. So what do you do? Now is the time to call Home Care Assistance.

Home Care Assistance is a full service home care agency offering hourly services but with a specialty in live-in caregivers. Our caregivers are specifically trained in our exclusive Balanced Care MethodTM . Focusing on lifestyle and dietary choices, the Balanced Care MethodTM promotes healthy activity, stress reduction, and social interaction to help seniors live their best possible lives – in the comfort of home. But, what exactly does this mean for your mother?

1. When it comes to physical hygiene, our caregivers are able to provide assistance with bathing, dressing, and grooming. A little help here can go a long way in improving your mom’s willingness to interact with others and her own self-image.

2. From planning the menu to preparing the meal, the caregiver will ensure that your mother is eating three, well balanced meals per day. If your mother has food preferences or enjoys cooking, then she and her caregiver will enjoy doing this together.

3. Exercise. Not a word that most of us like to think about, but it’s a necessity nonetheless. Your mom isn’t going to be training for a marathon by any stretch, but the caregiver will work to improve her physical stamina. From simply doing stretches and chair exercises to walking to the mailbox or around the block, she won’t be sitting in her favorite chair all day long anymore!

4. You know the old saying, use it or lose it. It applies to short term memory, too! While our caregivers can’t reverse memory loss associated with dementia and Alzheimer’s Disease, they can provide social interaction, which has been shown to improve cognitive function. A game of cards, anyone?

When it comes to caring for your aging loved one, accept help from the professionals. While this is new to you, it isn’t new to us. For more information about Home Care Assistance, please visit our website at www.homecareassistance.com. To be directed to your local Home Care Assistance office, please call 1-866-4-LIVEIN.

Using the Holidays to Your Advantage

The holidays are the time of year when even far away family members travel in order to gather together. This makes the holidays the perfect time to do some planning for the future. With parents aging and their health and lifestyles changing, children need to discuss some changes and decisions that will be needed in the near future. Parents should take the time to tell their children where important documents are kept and what their wishes are in the event of needing health care directives or experiencing long term care needs.

For those children who live away, the change they see in their parent's health and mental capacity may be alarming -- whereas siblings that have daily contact are working with these issues constantly. Here is the chance to compare notes and work together as a complete family in the long term care planning process.

For you parents who are well and active, this is a good time to hold a family meeting and share with your children your plan for long term care. Tell them where financial and legal documents are located. Review health care directives, living wills and long term care alternatives.

Experience has shown that even families that are close can quickly grow angry, jealous and hostile towards each other when an aging parent begins to need long term care. If a sibling moves into the parent's home, others can easily be suspicious of ulterior motives and fear losing their inheritance. On the other hand, the child who assumes the role of caregiver becomes bitter and feels there is no support or help from siblings. Meetings for the purpose of making a plan, before eldercare becomes imminent, avoids these types of conflicts.

In its book, The 4 Steps of Long Term Care Planning, the National Care Planning Council provides guidelines and checklists for family planning meetings. Here are some suggestions as taken from the book:

• Get all interested persons together in one place at one time. Taking advantage of the holidays or another special event can be a great way to get everyone together. If this isn't conducive, then perhaps a special dinner might be an incentive.
• Depending on the circumstances surrounding the meeting, the facilitator can be the parent, caregiver, family friend, or a professional advisor. 
• The agenda can be formal or informal. If you want a formal agenda, then a care plan should be prepared prior to the meeting and presented to all attendees. The facilitator should work to encourage input from everyone involved through active discussion.  
• After a thorough discussion of the issues and the presentation of the solutions to the problems that will be encountered, there should be a consensus of all attending to support the plan. It is not always possible to please everyone so there must sometimes be compromise.  
• The end of the meeting should consist of asking everyone present to make his or her commitment to support the plan. GET IT IN WRITING! All good intentions seem to be forgotten with time. It may be years after this meeting before the long term care plan begins.

The U.S Department of Health and Human Services states: "No one wants to think about a time when they might need long-term care. So planning ahead for this possibility often gets put off. Most people first learn about long-term care when they or a loved one need care. Then their options are often limited by lack of information, the immediate need for services, and insufficient resources to pay for preferred services. Planning ahead allows you to have more control over your future."

Whether you plan a formal meeting with an agenda or informally gather for a discussion, when the family is together make it a point to start the long term care planning process. There is a lot to learn and many decisions to make concerning finances, health issues and legal work. It may take research and a lot of time to put a plan together, but if everyone is involved it will work, and be worth it.

For more information, please visit Home Care Assistance or the National Care Planning Council. 

 

Make the Holidays Brighter

The holidays are a busy but wonderful time of the year for most of us. However, for an older adult who has physical and/or cognitive limitations, the holidays can be a confusing, depressing, and very stressful time of year. Here are a few tips for how you can make the holidays more enjoyable for the older adults in your life:

• Reminisce: older adults with memory impairment have difficulty recalling recent events, but often times remember past events clearly. Allow them the opportunity to share their favorite memories. You might just learn something!
• Plan accordingly: some older adults tire quickly or respond poorly to over stimulation. Avoid cramming too many activities in to one day. Allow the time for a nap if necessary. If your loved one becomes easily confused or agitated by noise, then set aside a quiet area for him or her to relax. Instead of having the entire family over for one visit, consider having a couple of holiday gatherings over a few days.
• Physical environment: if older adults are visiting outside of their home, then ensure that the physical environment is a safe environment. Eliminate throw rugs and other tripping hazards. If visiting in the older adult's home, do not rearrange furniture as this can increase confusion.
• Avoid embarrassment: an older adult with early memory impairment may embarrass easily if unable to remember an earlier conversation or the name of a rarely seen family member. Avoid adding to their embarrassment by saying, "Don't you remember?" They don't remember and no amount of prodding will make them remember.
• Involve your loved one: invite them to help make cookies, wrap gifts, or set the dinner table. Involve them in the conversation at the holiday meal.

By making a few small adjustments, you'll guarantee a happier holiday season for all involved!

 

The Perfect Holiday Caregiver: It’s All a State of Mind

by Anne Pagnoni

The holidays are always a wonderful time of year for family gatherings, reflection on what we have and the spirit of giving. The television is packed with specials showing relationships and families coming together for the holidays. But the holidays can also be a time of stress and sadness for those who are caring for family members that are struggling with health problems, frailty, dementia and loss. Those who care for these individuals may feel overwhelmed, frustrated, depressed or resentful as they watch “perfect” families enjoying the holidays. There are many surveys and documents that show that caregivers are highly susceptible to these feelings. If you are a caregiver, there are measures you can take to avoid this.

First: you are not alone.

If you are new to caregiving or have been caring for someone for a very long time, remember that the perfect family on television is not reality for many Americans. You are not the only one with these challenges. A recent study by the National Alliance for Caregiving and AARP found that 44.4 million Americans age 18 or older are providing unpaid care to an adult. In fact according to the survey provided by the National Family Caregivers Association:

• The typical caregiver is a 46-year-old Baby Boomer woman with some college education who works and spends more than 20 hours per week caring for her mother who lives nearby.

• Female caregivers provide more hours of care and provide a higher level of care than male caregivers.

• Almost seven in ten 69%) caregivers say they help one person.

• The average length of caregiving is 4.3 years.

• Many caregivers fulfill multiple roles. Most caregivers are married or living with a partner (62%), and most have worked and managed caregiving responsibilities at the same time (74%).

Second:  find help.

There are many resources available to a caregiver. Some of these include family members, friends, a local religious group, elder care agencies and homecare providers. The internet provides many great resources and help. The National Care Planning Council offers many articles, brochures and local referrals to help caregivers find the help that they need.

“When my husband’s stepfather was released from the hospital in December of 2009, he called us to give him a ride home. Once he was home, we quickly realized that he was not able to care for himself at all. He lived alone and we found ourselves driving back and forth three or four times a day to assist all of his needs. It was overwhelming and frightening to suddenly become a caregiver to a man we weren’t even that close to. With my husband working full time days, I became his primary caregiver. I would pack up my two little girls every day to come with me to take him to the doctor, do his laundry and feed him his meals, do his grocery shopping and help him with his bills. I had no idea what his finances were like or how to pay his medical bills. He was too sick to care or even understand what I was saying to him. I quickly realized I was going to have to find help. First I called his children. They were sympathetic, but gave all kinds of excuses as to why they could not help. Next, I went to the internet. I went to the website for National Care Planning Council www.longtermcarelink.net and found and contacted a Care planner in my area. The Care Planner came to my stepfather’s house and met with the two of us. They helped me get organized and set up time to meet with someone to explain his Medicare services and what my next steps would be. It was such a relief to have a plan and to know what to do.” MH- Salt Lake City, Utah

Most family members are willing to help, but just don’t know what to do. Many caregivers feel that they are the only one who can give the best care. It is important to communicate with other family members about what kind of help you need and let them know specifically what they can do.

A number of organizations and private companies will give you advice and guidance -- many for free. If your care recipient has a very low income, you might get free help from your local Area Agency on Aging. A lot depends on available funds. Click here for a nationwide list of agencies.

A good source for professional advice is the rapidly growing business of non-medical home care companies. Most will offer free consultations and will provide paid aides to help you with your loved-one with such things as bathing, dressing, shopping, household chores, transportation, companionship and much more. These people may also help you coordinate adult day care or other community services.

You may wish to pay for a formal assessment and care plan from a professional geriatric care manager. Even though it may cost you a little money to hire a care manager, this could be the best money you will ever spend. Care managers are valuable in helping find supporting resources, providing respite, saving money from care providers, finding money to pay for care, making arrangements with family or government providers and providing advice on issues that you may be struggling with.

Lastly: it is important to take care of yourself first in order to give effective and loving care.

Stephen Covey tells a story in his book The Seven Habits of Highly Effective People about a man who is sawing a tree. A woman approaches and asks the obviously exhausted man how long he has been sawing the tree. He tells her that he has been there for hours.

She says “Well, I see that your saw is dull, if you would just sharpen your saw you would be able to saw it much faster and with less effort.”

He replies, “I don’t have time to stop and sharpen my saw, I need to chop this tree down now!”

It seems pretty silly that the man just doesn’t stop for a few minutes to make the work easier. It is common for caregivers to do the same thing. They focus on caring for their loved one and run themselves down instead of stopping to “sharpen their saw”.

Covey states that “sharpening the saw” is to take care of yourself by keeping your physical, mental, emotional and spiritual self balanced. There is joy and respite in balancing all of these areas in our life. This is what makes us efficient and happy. Here are some ways for you as a caregiver to sharpen your own saw:

• Maintain a positive attitude. Take time to be grateful for everything that is good in your life. There is always something. Adjust your expectations for the holiday season. If you aren’t expecting that perfect holiday family picture, then you won’t be angry and frustrated that it isn’t something you have right now. It is always possible to change your attitude and perceptions, but it is not always possible to change your circumstances.

• Eat healthy food and be sure to get some exercise. Do this in small increments if it is too overwhelming to plan menus. Drink more water, cut down on sugary snacks, pick up some vegetables and fruit to grab. Walk or do marching in place. Run or walk up and down stairs if that is all the time you have right now.

• Forgive and let go of frustrations, anger, resentment and guilt. These are common feelings for caregivers. The best thing a caregiver can do for their own emotional health is to clear out these negative thoughts and feelings. Get counseling, talk to a friend or family member or simply write down the negative feelings to get them out of your system. Never take your anger and frustrations out on those you care for.

• Take time to do something you enjoy and give yourself a little bit of rejuvenation everyday. Laughter is a great stress reliever. Find something funny to read or get on the internet and find a funny video to watch.

• During the holidays, be easy on yourself. If you enjoy holiday activities, then get out there and do them. Ask someone to help with your caregiving duties even if it is just for an hour or two to shop or to see a concert or movie. There are day care facilities or home care services available for short term care. See www.longtermcarelink.net for a service in your area.

Being a “perfect” caregiver during the holidays does not have to look like the perfect on-screen holiday family. How you handle your circumstance will be the key to creating your own peace, happiness and cheer during the holiday season. The holidays can be a time of reflection on good things. Your attitude and a little care for yourself can make a big difference in the care that you give in the coming year.

Safer Travel for Those with Dementia

December is a time when many families are planning to travel to visit family and friends. Whether you're considering a weekend getaway or an extended stay, traveling with an individual who has Alzheimer's requires additional thought and preparation. 

Additionally, as Alzheimer's progresses, negotiating changes in environment will become increasingly challenging. Be prepared for the individual with the disease to experience some confusion or disorientation. Exercise caution, as wandering and getting lost are more likely during transitional times. The checklist below will help you plan for the trip and make it successful and safe.

Before going persons with Alzheimer's and their caregivers need to be prepared for a change in schedule and environment. Even if it is a trip you have taken before, it may feel new for the person with the disease. 

• Call the Alzheimer's Association chapter in the area you will be visiting. Let them know you will be staying in the area and ask about available resources. You can locate any chapter by calling 1.800.272.3900 or visiting www.alz.org/apps/findus.asp.
• Enroll the person in MedicAlert^® + Alzheimer's Association Safe Return^®, a 24-hour nationwide emergency response service for individuals with Alzheimer's or a related dementia who wander or have a medical emergency. You may also want to consider the Alzheimer's Association Comfort Zone^TM, powered by Omnilink, a Web-based GPS location management service.
• If you are already enrolled in MedicAlert, update your records with temporary contact information (call 1.888.572.8566).

Upon arrival

• Let the neighbors know a person with Alzheimer's is staying next door and ask them to keep their eye out for wandering or other unsafe behavior.
• During the first few days after arrival, keep your schedule light with lots of down time.
• Create opportunities to re-acclimate the person to the new environment.
• Keep familiar things around.
• Limit access to money and credit cards.
• Limit access to driving.
• Be aware that the change can be chaotic for the person.
• Recognize the warning signs of anxiety and agitation.

For more tips on safety for people living with Alzheimer's disease and related dementias, including concerns about wandering, disaster preparedness, home  and medication safety, visit the Alzheimer's Association Safety Center at www.alz.org/safetycenter  or call 1.800.272.3900 to find the Alzheimer's Association chapter closest to you. 

FDA Passes New Food Safety Bill

A new food safety bill passed by the Senate on Tuesday is going to give the U.S. Food and Drug Administration higher authority to stop contaminated food from getting onto our plates.

An estimated 76 million Americans get food poisoning every year, resulting in more than 300,000 hospitalizations and 5,000 deaths, according to the Centers for Disease Control and Prevention. Food poisoning mainly affects seniors, small children and anyone with a weak immune system.

The last time the FDA’s food regulations were updated was in 1938—before penicillin use was widespread. The passage of this bill will benefit everyone and hopefully the number of hospitalizations and deaths as a result of food borne illnesses will go down drastically.

Don’t Ignore Signs of Caregiver Stress

Caring for a person with Alzheimer's disease can cause depression, anger and irritability, in addition to taking a physical toll that results in exhaustion and sleeplessness. These are real issues caregivers shouldn't ignore.

November is National Alzheimer's Disease Awareness Month and National Family Caregivers Month. The Alzheimer's Association offers a number of resources to help caregivers manage stress:

• The Alzheimer's Association Caregiver Notebook offers tips for care and planning for the future, as well as a list of resources to use when additional information is needed. To learn more or purchase the Caregiver Notebook, visit www.alz.org/caregivernotebook.
  
• Caregiver Stress Check, an interactive quiz that helps caregivers to identify symptoms of stress and provides a tailored list of helpful referrals and other support. Take the quiz at www.alz.org/stresscheck.
  
• Alzheimer's Association CareSource™, an easy-to-use, one-stop online portal for everything you need to widen your care options and plan for care for a person with Alzheimer's. Find out how CareSource can help at www.alz.org/caresource.
  

Learn more about Alzheimer's disease and caregiver stress by visiting www.alz.org.

Great Program for Caregivers

Caring for an aging loved one has its fair share of challenges. For the caregiver who is caring for someone with Alzheimer's Disease or another related dementia, these challenges are compounded by difficult behaviors that many times accompany Alzheimer's Disease, i.e. agitation, repetition, hallucinations, and sundowning. The caregiver in this situation is also grieving the loss of the person that they once knew.

On November 16, 2010 at 6:00PM (EDT) the National Private Duty Association is presenting a web conference for family caregivers, who are caring for someone with Alzheimer's Disease. The 45 minute web conference will discuss patient assessment, care plans, caregiver education, safety, and other issues related to caring for someone with Alzheimer's.

While the program is free of charge, pre-registration is required. To register and for more information, please visit the NPDA at http://www.privatedutyhomecare.org/.

Alzheimer's Disease Awareness Day

In 2007 the State of New Jersey passed legislation designating the first Monday in November as "Alzheimer's Disease Awareness Day". This year we observe this day on Monday, November 1st.

The Alzheimer's Association reports that there are currently 5.3 million people living with Alzheimer's Disease and that every 70 seconds another person is diagnosed with this terminal disease. It is predicted that up to 16 million Americans will have Alzheimer's Disease by the year 2050 and that someone will be diagnosed with the Disease every 33 seconds.

Alzheimer's Disease is the 7th leading cause of death in the United States with mortality rates on the rise. The yearly price tag of Alzheimer's Disease? $172 billion per year.

Please join Home Care Assistance of New Jersey as we honor the victims of Alzheimer's Disease and their loved ones by observing Alzheimer's Disease Awareness Day. Wear purple to show your support. Together we can turn New Jersey in to a sea of purple on Monday, November 1st!

Breast Cancer Awareness Month

If you are looking for resources regarding breast cancer awareness or breast health, then please visit the following websites:

Five Risk Factors for Breast Cancer -- And Five Ways You Can Fight Back
http://www.seattlepi.com/sound/428481_sound104971549.html

Breast Cancer Information with Content Provided by the MayoClinic
http://www.bing.com/health/article/mayo-125861/Breast-cancer?q=breast+cancer&qpvt=Breast+Cancer

Nonprofit organization providing current information on breast cancer and treatments
http://www.breastcancer.org/

American Cancer Society
http://www.cancer.org/cancer/breastcancer/index

National Cancer Institute
http://www.cancer.gov/cancertopics/types/breast

Legal Issues with Veterans Benefits

by Anne Pagnoni
Accreditation
Federal law dictates that no one may help a veteran in the preparation, presentation and prosecution of an initial claim for VA benefits unless that person is accredited. The only exception to this law is that any one person can help any veteran -- one-time only -- with a claim. To help any veteran a second time requires accreditation.
VA recognizes 3 types of individuals for purposes of accreditation.
(1) Accredited attorneys
(2) Accredited agents and
(3) Accredited representatives of service organizations. (Veterans Service Officers)
In order to be accredited to help veterans with new claims, an individual desiring this certification from VA must submit a formal application, must meet certain character requirements and work history requirements and -- except for attorneys -- must pass a comprehensive test relating to veterans claims and benefits. There are also requirements for ongoing continuing education.
Without accreditation no one may help a veteran with a claim more than one time.
What Does It Mean to Help a Veteran with a Claim?
VA interprets its prohibition on preparing, presenting and prosecuting a claim to mean that talking to a veteran or a veteran's qualifying spouse or dependent after that person has indicated an intent to file a specific claim for benefits requires accreditation. Anyone can talk about veterans benefits in general with any veteran and need not be accredited. The point at which discussion narrows down to specific information about the veteran's service record, medical conditions, financial situation including income and assets and other issues relating to a claim specific to a veteran or dependent triggers accreditation. According to VA, discussing the specifics of the claim means that the veteran has expressed an intent to file an application for veterans benefits, and at this point, the consultant helping the veteran must be accredited.
Stated again: An individual cannot advise a veteran or other eligible beneficiary about that person's specific claim for VA benefits unless that individual is accredited.
It does not matter whether physical help with filing the claim is provided or not. The need for accreditation occurs at a much earlier stage than becoming physically involved in the claim. For a better understanding of how VA General Counsel interprets the need for accreditation please go to the VA Office of General Counsel Website -- Frequently Asked Questions about Accreditation at http://www4.va.gov/ogc/accred_faqs.asp
Working under the Umbrella of an Accredited Attorney or Accredited Claims Agent
Many individuals or organizations who are not accredited and who are promoting and helping veterans obtain their benefits are often attempting to work under someone who is accredited. Most of these individuals are doing it wrong and not complying with the law.
These individuals make sure that the application is done by an accredited attorney or an accredited agent. In some cases, non-accredited individuals will refer veteran households to a local veterans service officer (an accredited representative of a service organization).
Unfortunately, most individuals who are not accredited and who are operating with someone who is accredited are still illegal. This is because the non-accredited individuals become involved in the claim by providing advice after an intent to file and in many cases they help gather documents and other pertinent information. As mentioned above, these activities require accreditation. The only way that a non-accredited individual can operate legally to assist someone who is accredited is to immediately refer a veteran or dependent to an accredited person when first understanding an intent to file a claim. No additional help or advice may be given after the intent to file has been recognized.
Many accredited attorneys are also not operating legally. Only an accredited attorney -- one-on-one with the client -- may be involved with a claim. Anyone else, inside or outside of the office, cannot assist with the claim except under certain limiting conditions. Specifically, in order to work under an attorney, a non-accredited assistant must either be another attorney in the office, a certified paralegal in the attorney's office or an office law student or an intern. The client must also sign a consent letter allowing this arrangement. This consent must be filed with the original application. No other arrangement is allowed. Please see 38 CFR § 14.629 for an explanation of this requirement.
Charging a Fee for Help with Filing a Claim
Generally, no individual or organization may charge a fee for help with filing an initial application for benefits. There is only one exception to this rule and that is under the third-party exemption in 38 CFR § 14.636 (d). The requirements under this exception are very specific. In our opinion, no one that we know of, who is charging a fee, thinking he or she is operating under this exception, is doing it legally. Here are the ways these people are violating this law. (In most cases those who are operating illegally are engaging in all 4 of these unlawful activities.)
(1) The person paying the fee is not a disinterested third party as required by law.
(2) The person filing the claim is not submitting the fee agreement to VA general counsel as required.
(3) The person filing the claim is not submitting the disclaimer to General Counsel as required.
(4) The fee is contingent upon a percentage of the amount of the approved benefit.
We are seeing various financial arrangements for filing claims that are disguised fees in one way or another. As a general rule, anyone who would directly benefit financially from helping a veteran file a claim -- whether a direct fee is charged or not -- is in essence charging a fee. We know from numerous discussions with representatives, this is the way VA General Counsel treats these arrangements.
If you are working with someone who is not operating legally as outlined above, you should stop using that person's services. If you yourself are operating in a manner that is not in accord with the conditions outlined above, you must stop doing that. You're not legal. Not only could unauthorized individuals get a notice to cease and desist but in some cases there could be fines or legal action involved as well. It's not worth it. For help with accreditation issues you can contact the National Care Planning Council at info@longtermcarelink.net.

Good vs. Bad Cholesterol

Here are some great additional resources to check out regarding cholesterol: 

Good vs. Bad Cholesterol

National Cholesterol Education Month

High Cholesterol Foods

Low Cholesterol Foods

Eldercare...Planning for Baby Boomers, Providing the Answers You Need

Zarephath Christian Church invites the public to their upcoming panel presentation on Saturday, October 16th at 9:00 a.m. at the church. This valuable program entitled “Eldercare Planning for Baby Boomers– Providing the Answers you need” addresses caregivers who share the common issues of being overwhelmed and under informed when an older adult needs their help. The panel presentation will be moderated by Maryann Porosky, LCSW, Care Management Specialist of Caring Choices and will feature four experts: Michelle Bucci, Outreach Director at the Chelsea of Warren, Kevin McClarren, President, Home Care Assistance; Jeff Knapp, Eldercare Law Attorney of Knapp Law Firm, and Terri Erbacher, LPN, Elder Care Advocate.

The panel of speakers will explain ways to avoid costly mistakes, both emotional and financial by planning now rather than facing a crisis unprepared. They will discuss choosing the right venue for care, whether it be your home, an assisted living facility or a nursing home and minimizing the financial impact it can have on your family and loved ones. You will also have an opportunity to participate in a Q&A session after the presentation.

There is no charge for this invaluable presentation and a nice continental breakfast will be served. Advance reservations are requested by confirming your attendance by calling Terri Erbacher at 908-526-5279. Zarephath Christian is located at 14 Chapel Drive in Zarephath, NJ.

Home Care Assistance of Greater New Jersey Delivers Cost-Free Caregiver Support

By Anne Pagnoni

Being a primary caregiver for another individual is a daunting experience. In addition to making sure that the individual's personal care needs are met, the caregiver is responsible for making financial and health care decisions, managing doctors' appointments, and maintaining a safe living environment for the care recipient. The caregiver needs support, too, during this tumultuous time. Where can the caregiver turn for help? Home Care Assistance of New Jersey is excited to announce its partnership with a free, online, caregiver support program called MyCareCommunity.

Studies show that caregivers find stress-relief in three ways: access to information and tools, support from other caregivers, and the ability to share caregiving responsibilities with family and friends. MyCareCommunity allows caregivers to do just that, by providing a convenient, easy-to-use website that offers:

• Practical advice and expert information
  
• Caregiver blogs, discussion forums and sharing of real-life stories and experiences
  
• Ability to get answers from local NJ professionals on a variety of health and elderly care issues
  
• Search features for care services, care providers and community resources
  
• Access to a private webpage that is focused on the care of a loved one
  

MyCareCommunity has a true Ask the Expert feature. Experts in the field of aging from all over New Jersey have availed themselves to caregivers. Each expert is listed with a short biography which allows caregivers the opportunity to direct their questions to the expert best able to answer their questions.

One of the greatest features of MyCareCommunity is the Personal Communities, which enable users to create a webpage for their loved one and then invite other family members or friends to view it. The caregiver is able to provide updates about their loved one via the personal community, which alleviates the need for the caregiver to make numerous phone calls or send multiple emails with notifications. There is a care scheduler feature, which allows the caregiver to enter appointments into a calendar. All other personal community members are able to see the appointments and offer assistance to the caregiver accordingly.

If you're a caregiver, then take a few minutes and check out all of the features of MyCareCommunity. It's an invaluable resource that will make your caregiving responsibilities easier. By visiting www.mycarecommunityNJ.org, caregivers will find the support and information that they need to assist them in managing their caregiving journey.

Support Groups for Caregivers

By Anne Pagnoni

Being a caregiver for a loved one is an overwhelming responsibility. Many caregivers hold full time jobs; juggle children with their many extracurricular activities; and maintain their own household with laundry, bill paying, meal preparation, grocery shopping, yard work, cleaning, etc. In addition to their own familial responsibilities, they are responsible for the care of another adult individual, who typically has multiple physical and cognitive limitations. While initially the caregiving responsibilities may not be too taxing, as the aging loved one's limitations increase so does the time that the caregiver needs to spend caregiving. Overtime the caregiver will become overwhelmed and will need a support system in place to help him or her through the rough times.

Professionally run support groups are an excellent resource for the caregiver. Caregivers have the opportunity to talk with each other and share tips on things that have and haven't worked. Professional facilitators are available to provide useful information on relevant caregiving topics and to steer caregivers in the right direction when looking for additional services. Support groups usually meet for a couple of hours either weekly or biweekly. But what about the caregivers who aren't able to make the meetings or caregivers who need support between meetings? How do they get the help that they need?

Home Care Assistance of New Jersey has teamed up with an online caregiver support group designed to provide resources to caregivers and link them with professionals, who can share insight on particular caregiving issues. On Wednesday, September 1^st Home Care Assistance will be making an announcement regarding this partnership with information on how individuals can begin utilizing the site. Stay tuned for more information!

New Study States that Home Care Following Hip Surgery May Aid Survival

Great article detailing a new study, which found that older adults who utilized home care services following hip surgery had a greater survival rate than those who did not.

Getting Your Affairs in Order

By Anne Pagnoni

If we had a crystal ball and could see into the future, we would not need to prepare ahead for end of life decisions.

James was 62 years old when a stroke made it impossible for him to communicate with his family. Neither his wife nor children knew anything about his financial or medical information. James had always taken care of things himself and left no written directives in his behalf. Besides having to locate important documents, the family was left to make their own decisions about James long term care.

The National Institute on Aging gives three simple, but important steps to putting your affairs in order:

• "Put your important papers and copies of legal documents in one place. You could set up a file, put everything in a desk or dresser drawer, or just list the information and location of papers in a notebook. If your papers are in a bank safe deposit box, keep copies in a file at home. Check each year to see if there's anything new to add.
  
• Tell a trusted family member or friend where you put all your important papers. You don't need to tell this friend or family member about your personal affairs, but someone should know where you keep your papers in case of emergency. If you don't have a relative or friend you trust, ask a lawyer to help.
  
• Give consent in advance for your doctor or lawyer to talk with your caregiver as needed. There may be questions about your care, a bill, or a health insurance claim. Without your consent, your caregiver may not be able to get needed information. You can give your okay in advance to Medicare, a credit card company, your bank, or your doctor. You may need to sign and return a form." National Institute on Aging http://www.nia.nih.gov
  

Preparing Advance Directives or Living Will

Advance directives are legal documents that state the kind of medical care or end of life decisions you want made in your behalf. It is a way for you to communicate your wishes to family or health care professionals. Emergency response medical personnel cannot honor Advance directives or living wills. They are required to save and stabilize a person for transfer to a hospital or emergency facility. Once at the facility a physician will honor the directives.

The Living Will as part of your directives gives your consent or refusal for sustained medical treatment when you are not able to give it yourself. If this document is not in place then a family member or physician will decide such things as:

• Resuscitation if breathing or heartbeat stops
  
• Use of breathing machines
  
• Use of feeding tubes
  
• Medications or medical procedures
  

Advance Directives and Living Wills are legal throughout the United States; however, some states may not honor other states' directive documents. Be sure to check with the state you live in for their requirements.

Review your directives periodically. They do not expire, but your wishes may change.
A new or revised Advanced Directive invalidates the old one. Be sure your family member or healthcare proxy has a current copy.

Choosing a Power of Attorney

General Power of Attorney - authorizes someone to handle your financial, banking and possibly real estate and government affairs as long as you remain competent.

Special Power of Attorney - authorizes someone you designate to handle certain things you cannot do yourself for a period of time.

Durable" Power of Attorney -The general, special and health care powers of attorney can all be made "durable" by adding certain text to the document. This means that the document will remain in effect or take effect if you become mentally incompetent.

Many people do not know the difference between a general and a durable power of attorney. A general power of attorney is a document by which you appoint a person to act as your agent.

Agents are authorized to make decisions for you, sign legal documents, etc. Many people are unaware that a General Power of Attorney is revoked when the person granting that power becomes incompetent or incapacitated.

It is the "Durable" Power of Attorney that allows for an agent to continue making decisions on your behalf no matter what happens to you. A responsible adult child of an aging parent would be given a "durable power of attorney" to act on behalf of the parent. This provides broader authority than just adding the child's name to bank accounts and documents.

You may choose to produce notarized power of attorney documents on your own. If your estate is large and real estate or business is included it is advised to secure a reliable attorney.

National Care Planning Council http://www.longtermcarelink.net/a2cfindattorney.htm

5 Steps To Protect Against Extreme Heat’s Effects On Seniors

Article written by the Co-Founder of Home Care Assistance.  Great tips to consider especially during the dog days of summer, which are upon us! 

5 Steps To Protect Against Extreme Heat’s Effects On Seniors

Applying for the Veteran’s Aid and Attendance Pension: My Personal Experience

My previous blog entry was about this exact government program – Veteran's Aid and Attendance. Read on to learn more about the application process for one family. Please keep in mind that this pension program also exists for a Veteran, who wishes to remain in his or her home with home care services.  –Anne Pagnoni

 

Applying for the Veteran's Aid and Attendance Pension
My Personal Experience
By Melissa Howell

12:20 a.m. The clock was blurry as I rubbed the sleep from my eyes to answer the phone.
"Hello", I said. A weak and frightened voice on the other end pleaded, "Melissa? Is Bryan there? I can't get out of my chair. Could you or Bryan come over?"

I sighed as I handed the phone to my husband and heard him say, "I'll be right over, Dad."
When Bryan left, I pondered on my father-in-law, John, and his situation. John had just come out of the hospital after a serious illness and although the doctor had assured us he would be fine, we quickly learned that he was not able to care for himself. He lived alone in a small apartment and had in-home health care assistance through his Medicare plan. They came once a day to help him with a shower and to aid him with incontinence. Bryan and I came over three times a day to help him with changing his clothes and to make his meals. In addition, we helped him with his bills and took him to his frequent doctor appointments. Tonight was the first time he had called to ask for help in the middle of the night. We needed to do something different. We were both exhausted between working our jobs and caring for our four young children and constantly running out to take care of John's needs. It was becoming more than we could handle. We realized we really needed to get him into assisted living.

John lived comfortably on an income consisting of social security and a retirement pension, but as we visited different assisted living homes in our immediate area, we quickly realized that this income was not enough. Assisted living was really expensive!

John had served in the Navy during the Korean conflict and we had heard through a friend that veterans could receive assistance through the Department of Veteran's affairs for health care. The catch was doing it correctly. Our friend referred us to a Veteran's Consultant from the National Care Planning Council to provide information for the challenging task of filling out the paperwork to receive this benefit. A Veteran's Consultant can provide general information on how a claim is filed. Our consultant told us about all of the necessary supporting documents we would need to make sure it was approved.  The paper work was pretty daunting, but we worked through each form thoroughly to be sure that we were providing all the information Veterans Affairs (VA) would need in order to expedite John's payments.

First, I obtained a medical report from John's doctor -- the most crucial step in the process. This form would prove that John needed aid and attendance. In our case, the doctor described his medical condition and then noted specifically his need for help with incontinence and showers, his lack of motivation to make meals for himself and his inability to leave the house alone. It was, however; important to us that the doctor wrote that John was mentally capable of making his own decisions, because we did not want to go through a delaying process of having VA assign somebody who would need to pay his bills for him (VA calls this person a fiduciary).

Another key thing was that John had to show evidence to VA that his care costs were close to or exceeded his income. Fortunately, John had a small amount of savings and he was able to pay in full for the first month's payment to his assisted living home. This was important, because the statement showing this payment was important evidence needed to present to VA. Since his assisted living cost exceeded his income by $1,000 per month, we arranged with the director, to pay what John could afford until the benefit from VA came in and then the director agreed to pay the remaining debt balance on the account at that time.

An important form was John's original DD-214, which was the official record showing that he had been honorably discharged from the military. I quickly found a certificate of honorable discharge (DD-256) but this was not the correct form. We searched through all of his files and boxes and couldn't find the DD-214. So I got on the Internet and found a website for the National repository where the official forms can be obtained. It appeared that it could take up to 6 weeks to receive an official copy. Fortunately, we found the original document folded in his wallet and we did not have to delay our process.

One of the forms my Consultant made me aware of was a VA power of attorney form (VA form 21-22a) that gave me the authority to fill out and submit the forms to VA on behalf of John. Although John was mentally sound, he was weak and tired and didn't really want to do anything but watch television and eat. With this form, I was able to communicate with VA in his behalf.
There were several other forms to fill out and after all the paperwork was finished, my Veteran's consultant gave us the address of where to send all of them. Our particular VA processing office was located in St. Paul, Minnesota.

After about two weeks, John and I each received a letter stating that VA was working on his case and they assigned him a case file number. After another two weeks, we received a letter stating that we needed to fill out some other paper work. I showed these to my consultant, who assured me, in our case, that it was standard procedure and that the paper work I had originally filed was sufficient. Within another two weeks, John received his first payment.
Because his care cost exceeded his income, he was awarded the full $1644.00 per month. VA sent another payment from the date that they had first issued his case number. So in the first month, we received two payments. These were sufficient to catch up the debt he owed to his assisted living and to continue with full payments each month.

Applying for the VA Aid and Attendance Pension was detailed, but it was not terribly frustrating because of the general information on the application process I received from my consultant. It did require extra work on my part, but it was well worth the end result of getting the care that John needed and the relief that Bryan and I needed in the end. I am grateful that we had such a wonderful resource in National Care Planning Council to help us find a capable and informative Veteran's Consultant.

Bryan and I now see John twice a week and visit with his assisted living staff often to help him have a comfortable and enjoyable life in his new home. He is able to enjoy activities and meals with other people, have quality personal care and have the peace of mind that someone is always there to help him. I now sleep at ease through the night, knowing that his needs are taken care of and that there won't be any middle of the night calls asking for help.

The National Care Planning Council wishes to thank Melissa for providing her experience. We maintain a list of consultants across the country which can be found at the following address: www.veteranslisting.com. We also provide a book with instructions to help people who want to file an application by themselves. This book can be purchased online at http://www.longtermcarelink.net/a16books.htm.

Little-Known Government Program Pays the Cost of Elder Care

By Anne Pagnoni
WHAT IF 33% OF ALL SENIORS IN THIS COUNTRY could receive up to $1,949 a month in additional income from the government to help cover their elder care costs? THEY CAN!
Under the right circumstances, a little-known federal program will pay additional income to cover long term care costs for at least 1/3 of all US senior households -- that's how many war veterans or their surviving spouses there are in this country. But the provisions of this program are such a well-kept secret that only 4.7% of US seniors are actually receiving the benefit. The great news about this program is the Department of Veterans Affairs will pay you to hire your family, friends or just about anyone to take care of you (Caregiving spouses can't be paid under this program). The program is called "Veterans Pension."
Most people who have heard about Pension know that it will cover the costs of assisted living and, in some cases, cover nursing home costs as well. But the majority of those receiving long term care in this country are in their homes. Estimates are that approximately 70% to 80% of all long term care is being provided in the home. All of the information available about Pension overlooks the fact that this benefit can also be used to pay for home care.
It also comes as a surprise to most people that the Department of Veterans Affairs will allow veterans' households to include the annual cost of paying any person such as family members, friends or hired help for care when calculating the Pension benefit. This annual cost is deducted from household income and used to calculate a lower "countable income" which in turn enables families to receive this disability income from VA. Even though VA claims the benefit is for low income families, because of the special provision in the regulations -- allowing for deduction for care costs -- households earning between $3,000 to $6,000 a month or more can still qualify for Pension under the right conditions.
This extra income can be a welcome benefit for families struggling to provide eldercare for loved ones at home. Under the right circumstances, this annualized medical expense for the cost of family members, friends or any other person providing care, could create an additional household income of up to $1,056 a month for a single surviving spouse of a veteran, up to $1,644 a month for a single veteran or up to $1,949 a month for a couple.
If the disabled care recipient has been rated "housebound" or in need of "aid and attendance" by VA, all fees paid to an in-home attendant will be allowed as long as the attendant provides some medical or nursing services for the disabled person. The attendant does not have to be a licensed health professional. There is also no need to distinguish between medical and nonmedical services -- all are deductible.
For a disabled person who has been rated "in need of aid and attendance" or "housebound", a family member will be considered an in-home attendant, but that family member has to be paid for services duly rendered. There is potential for fraud here where a family member may move into the home and ostensibly receive payment as a caregiver but not actually provide the level of care paid for. Documentation for this care must be provided to VA, and it is reasonable for VA to question whether the services being purchased from a family member living in the household are legitimate. Such arrangements should be extensively documented and completely arm's-length.
The care arrangements and payment for home care must be made prior to application and there must be evidence that this care is needed on an ongoing and regular basis. We recommend a formal care contract and weekly invoice billing for services. Money must exchange hands and federal law requires employment taxes must be withheld and there must be evidence of this. All of this documentation must be provided as proof to VA when making application for the pension benefit. Costs for these services must be unreimbursed; meaning these costs are not paid by insurance, by contributions from the family or from other sources. VA will allow, however, family caregivers being paid by their loved ones, to turn around and pay the household bills for their loved ones to help defray the cost of the care.
Due to the need for a rating, documentation for annualizing care costs and the extensive proof needed to show the caregiver is indeed an employee of the care recipient, most people should not try this on their own. An expert in this area should be sought to help with the application in order to avoid lengthy delays in awarding a benefit or a possible denial of benefits. For a list of individuals or companies in your area who understand how to get this benefit go to http://www.longtermcarelink.net/ref_veterans_consultants.htm

Aftercare Tips for Elderly Patients Checking Out of the Hospital

Readmission into the hospital after surgery or another procedure is extremely common, costly and time consuming. Since it is one of our main priorities to keep our clients healthy and living at home rather than in the hospital, I wanted to share this article from The New York Times as it provides great tips for hospital checkout and avoiding readmission.
In 2009,The New England Journal of Medicine reported “one in five Medicare patients returns to the hospital within 30 days of being discharged.” Dr. Mark V. Williams, who worked on this study, suggests that part of the issue is due to the fact that doctors place much of their focus on the admission process, when the patient is most sick. When the patient leaves the hospital, they often have more medications and treatments to worry about than when they first entered. Some doctors suggest that this problem may also occur because it may benefit the hospital financially for patients to be readmitted.
Dr. Eric A. Coleman, professor of medicine at the University of Colorado Denver, has developed a program called Care Transitions Intervention to help seniors take initiative in their care after leaving the hospital. The steps of the program include taking charge of your care, checking the medication list for errors, making a comprehendible discharge plan and contacting your primary physician if you have any questions or concerns. To further help the cause, some medical centers are providing financial incentives for lowering readmission rates and are providing guidance for improving the discharge process.

Recognizing Symptoms of Dementia

By Anne Pagnoni

The Brown family reunion has always been an event everyone looks forward to. Family visits, games, stories and everyone's favorite foods are always on the agenda. On the top of the menu is Grandma's Lemon Coconut Cake. Grandma always makes the traditional cake from her old family recipe. This year, however, the cake tasted a little on the salty side - perhaps a half cupful of salty.

Though the family was disappointed over the cake, of more concern was Grandma's confusion with the recipe and her similar confusion about the loved ones around her. Could something be wrong with grandma's mental state?

One might say that for an older adult a little forgetfulness or confusion is normal, but when do you know if there is a serious problem, such as dementia? An online article from FamilyDoctor.org outlines some common symptoms in recognizing dementia:

"Dementia causes many problems for the person who has it and for the person's family. Many of the problems are caused by memory loss. Some common symptoms of dementia are listed below. Not everyone who has dementia will experience all of these symptoms.

• Recent memory loss. All of us forget things for a while and then remember them later. People who have dementia often forget things, but they never remember them. They might ask you the same question over and over, each time forgetting that you've already given them the answer. They won't even remember that they already asked the question.
• Difficulty performing familiar tasks. People who have dementia might cook a meal but forget to serve it. They might even forget that they cooked it.
  Problems with language. People who have dementia may forget simple words or use the wrong words. This makes it hard to understand what they want.
• Time and place disorientation. People who have dementia may get lost on their own street. They may forget how they got to a certain place and how to get back home.
• Poor judgment. Even a person who doesn't have dementia might get distracted. But people who have dementia can forget simple things, like forgetting to put on a coat before going out in cold weather.
• Problems with abstract thinking. Anybody might have trouble balancing a checkbook, but people who have dementia may forget what the numbers are and what has to be done with them.
• Misplacing things. People who have dementia may put things in the wrong places. They might put an iron in the freezer or a wristwatch in the sugar bowl. Then they can't find these things later.
• Changes in mood. Everyone is moody at times, but people who have dementia may have fast mood swings, going from calm to tears to anger in a few minutes.
  Personality changes. People who have dementia may have drastic changes in personality. They might become irritable, suspicious or fearful.
• Loss of initiative. People who have dementia may become passive. They might not want to go places or see other people."

Dementia is caused by change or destruction of brain cells. Often this change is a result of small strokes or blockage of blood cells, severe hypothyroidism or Alzheimer's disease. There is a continuous decline in ability to perform normal daily activities. Personal care including dressing, bathing, preparing meals and even eating a meal eventually becomes impossible.

What can family members do if they suspect dementia? An appointment with the doctor or geriatric clinic is the first step to take. Depending on the cause and severity of the problem there are some medications that may help slow the process. Your doctor may recommend a care facility that specializes in dementia and Alzheimer's. These facilities offer a variety of care options from day care with stimulating activities to part or full-time live-in options. Sometimes if patients tend to wander off, a locked facility is needed.

In the beginning family members find part time caregivers for their loved one. At first, loved ones need only a little help with remembering to do daily activities or prepare meals. As dementia progresses, caregiving demands often progress to 24 hour care. Night and day become confused and normal routines of sleeping, eating and functioning become more difficult for the patient. The demented person feels frustrated and may lash out in anger or fear. It is not uncommon for a child or spouse giving the care to quickly become overwhelmed and discouraged.

Family gatherings provide an excellent opportunity to discuss caregiving plans and whole family support. It is most helpful if everyone in the family is united in supporting a family caregiver in some meaningful way.  "The first step to holding a family meeting, and perhaps the most difficult one, is to get all interested persons together in one place at one time. If it's a family gathering, perhaps a birthday, an anniversary or another special event could be used as a way to get all to meet. Or maybe even a special dinner might be an incentive. The end of the meeting should consist of asking everyone present to make his or her commitment to support the plan. This might just simply be moral support and agreement to abide by the provisions or it is hoped that those attending will volunteer to do something constructive. This might mean commitments to providing care, transportation, financial support, making legal arrangements or some other tangible support." The Four Steps of Long Term Care Planning

 Professional home care services are an option to help families in the home. These providers are trained and skilled to help with dementia patients.

The National Care Planning Council supports caregiving services throughout the country. Visit www.longtermcarelink.net for more information.

Why Any and All Activity Matters

By Anne Pagnoni

The health benefits of exercise are extraordinarily well documented. Regular exercise lowers your risk of a stroke by 27%, reduces instances of both high blood pressure and Alzheimer's disease by 40%, cuts your chance of developing diabetes by 50%, and lowers your risk of developing colon cancer by a whopping 60%. As well, it obviously helps maintain a healthy weight. Plus, exercise has been shown to be just as effective at fighting depression as both SSRIs (like Prozac) and therapy.

A recent study from the Appalachian State University's Human Performance Lab even showed that people who took a brisk walk five days a week had fewer and less severe colds and flus than sedentary control subjects. So it's not just long-term chronic and fatal conditions that being fit staves off – regular exercise actually helps you battle the common cold, too!

Beyond full-on exercise, however, a recent study out of Australia also shows the health risk of being inactive. The study from the physical activity lab at the Baker IDI Heart and Diabetes Institute in Victoria, Australia found that the more television its subjects watched, the greater risk they had of dying at a younger age, particularly from heart disease.

Subjects in the study who watched four hours or more of television per day were 80% more likely to die from heart disease and 46% more likely to die from all causes, even when factors such as: education levels, overall health, age, past smoking, waist circumference, cholesterol levels, and blood pressure of the subjects was taken into account.

The study concluded that the real problem with television watching is that it is done while sitting, and sitting with extraordinarily little muscle movement. Such "extreme" inactivity affects metabolism overall, not just during the time spent inactive. A study from July 2008 showed that standing engages muscles and promotes the distribution of lipase, a fat-absorbing enzyme that triggers the body to process fat and cholesterol. Most important, the benefits of this regular, unremarkable movement are independent from the amount of time subjects spent exercising.

That same study found that the health consequences that develop from too much sitting are very different and independent from those that result from too little exercise. Along with the recent Australian study, it found that the negative health consequences of prolonged periods of sitting – larger waistlines, higher bad cholesterol levels, lower good cholesterol levels, heart disease risks – were not fully counteracted by regular exercise.

In other words, regular exercise – beneficial as it is – doesn't counteract the negative effects of long periods of inactivity.

Part of the issue is that television watching is fundamentally inactive. Harvard Health Publications estimates that, when it comes to calories burned, watching television (56 calories per hour) is closer to sleeping (46 calories per hour) than it is to sitting and reading (84 calories per hour), which itself is more akin to standing in line (94 calories per hour) than it is to watching television. (Note: calorie counts are for a 155-pound person.) In other words, watching television is an inactive as a person can get without sleeping.

Along with limiting television watching, these studies point to the importance of remaining active throughout the day. The good news is that it ends up that the simple physical movements of standing and moving between rooms has significant health benefits. When watching television, standing up during commercial breaks, going to get a glass of water, or even putting down the remote control and getting up to change channels and adjust volume the old-fashioned way can help people from staying in one extremely inactive position for extended periods of time.

Light household tasks and self-care – activities encouraged by the Balanced Care Method™ whenever clients are physically able – can help keep people moving. Not only does such daily activity help keep people physically active longer, we now know it also can help fight heart disease and other health risks.

 

Caregiver Stress: Hazardous to Your Health

By Anne Pagnoni
UNDERSTANDING CAREGIVER STRESS
A 2003 study of caregivers by a research team at Ohio State University has proven the off-repeated adage "stress can kill you" is true. The focus of the investigation was the effect the stress of caregiving had on caregivers. The team, led by Dr. Janice Kiecolt-Glaser, reports on a 6-year study of elderly people caring for spouses with Alzheimer's Disease. The study not only found a significant deterioration in the health of caregivers when compared to a similar group of non-caregivers but also found the caregivers had a 63% higher death rate than the control group.
The demands on a caregiver result in a great deal of stress. It is often observed in aging publications that stress can induce illness and depression. The resulting poor health can further decrease the effectiveness of the caregiver and in some cases, as proven by the study mentioned above, even cause premature death.
Stress can be defined as a physiological reaction to a threat. The greater the threat -- the greater the level of stress. A threat is a real or perceived action against our person. Threats may include the anticipated possibility of death or injury but may also include challenges to our self-esteem, social standing or relationships to others or a threat may simply be a potential or real disruption of our established routines. What is stressful to one person may not be to another. For example, bumper-to-bumper traffic might be stressful to the woman executive who is late for an important meeting but to the delivery man who has no deadline and is being paid by the hour, it may be a welcome respite to relax and listen to the radio.
Stress produces real physical changes. In some unknown way the fears in our mind, both conscious and unconscious, cause the hypothalamus and pituitary glands, deep in our brain, to initiate a cascade of hormones and immune system proteins that temporarily alter our physical body. This is a normal human physiological response inherent to the human body when a threat is perceived--real or not. It is often called the "fight-or-flight response" or the "stress response". The purpose is to give us clearer thought and increased strength as well as to activate the immune system to deal with potential injury and to repair potential wounds. When the perceived threat is removed, assuming no damage is done, the body returns to normal.
A team of researchers at Ohio State University Medical Center has found a chemical marker in the blood that shows a significant increase under chronic stress and is linked to an impaired immune system response in aging adults. The team, led by Dr. Janice Kiecolt-Glaser, reports in the June 30, 2003 issue of Proceedings of the National Academy of Sciences on a 6-year study of elderly people caring for spouses with Alzheimer's Disease. With the caregivers, the team found a four-fold increase in an immune system protein -- interleukin 6 (IL-6) -- as compared to an identically matched control group of non-caregivers. Only the stress of caregiving correlated to the marked increase of IL-6 in the caregiver group. All other factors, including age, were not significant to the outcome. Even the younger caregivers saw an increase in IL-6.
The study also found that the caregivers had a 63% higher death rate than the control group. About 70% of the caregivers died before the end of the study and had to be replaced by new subjects. Another surprising result was that high levels of IL-6 continued even three years after the caregiving stopped. Dr. Glaser proposes the prolonged stress may have triggered a permanent abnormality of the immune system.
IL-6 is only one cytokine--an immune system mediator protein--in a cascade of endocrine hormones and cytokines that are released when the brain signals a person is threatened with harm, injury, undue mental or physical stress or death. The hormones prepare the body to react quickly by increasing heart rate, making muscles more reactive, stimulating thought, altering sugar metabolism and producing many more changes that result in the "rush" people experience when they think they may be harmed.
The cytokine release is mediated by IL-6, which takes the role of directing the immune system to gear up to prevent infection, promote wound healing and repair organs and muscles from any injury that may result from the imminent danger. The release of cytokines such as IL-1, IL-6, IL-8, TNF and other proteins such as CRP (C reactive protein) also promote development of inflammation, which is essential for blood cells to home in on injury or infection. In addition, these chemicals promote development of various types of immune system blood cells in bone marrow. This response to harm -- either real or perceived -- is an important and beneficial life-saving activity of a normally functioning body.
The problem is if this response is initiated over and over again, frequently, and over a long period; it can have a dangerous effect on the body. This constant initiation of the stress response is common among caregivers -- especially those caring for loved ones with dementia. Providing supervision or physical assistance many hours a week and over a period of years turns out to be extremely stressful. This type of stress is often unrelenting, occurring day after day and week after week. And the long-term effects of this stress are more pronounced in middle-aged and older people who are precisely the group most likely offering long term care to loved ones.

In most younger people, when the threat lessens or disappears, the body reacts fairly quickly to shut down the stress response and return things to normal. But numerous studies have shown, as people age, the chemical cascade from stress lingers. Over a period of time, this constant chemical stimulus impairs the immune system and results in early aging, development of debilitating disease and early death. In this altered state, the body maintains high, potentially harmful levels of IL-6. The body does not return to normal without intervention.
Prolonged high levels of IL-6 and the accompanying hormones and cytokines have been linked to: cardiovascular disease, type II diabetes, frequent viral infections, intestinal, stomach and colon disorders, osteoporosis, periodontal disease, various cancers and auto immune disorders such as lupus, rheumatoid arthritis and multiple sclerosis. Alzheimer's, dementia, nerve damage and mental problems are also linked to high IL-6. Wounds heal slower, vaccinations are less likely to take and recovery from infectious disease is impaired. People who have depression also have high levels of IL-6. Depression in caregivers is about 8 times higher than the non-cargiving population.
This debilitating response to chronic stress is not unique to humans. Animals are affected as well. A 2004 PBS Scientific American Frontiers Special entitled "Worried Sick", explored the effect of chronic stress on animals. Observations in the field and experiments on animals exposed to chronic stress, uncovered the same phenomenon of debilitating disease and early death found in humans. Blood tests on the affected animals confirmed high levels of IL-6. The work of Dr. Janice Kiecolt-Glaser's team was also followed in the Special.

STRATEGIES TO REDUCE CAREGIVER STRESS
Ask for help.
Most caregivers are reluctantly thrust into their role without preparation because the need for care usually comes with little warning. Caregivers end up operating in a "crisis" mode--arranging medical care and living arrangements, scheduling care time, providing meals and household chores and so forth. Because they are so stressed and burdened, they rarely take time to find out what resources are available to help them. Ironically, caregivers often sever ties with family, friends and support groups about this time just when help from these people is most needed.
As a caregiver you must ask for help. The stress of going it alone is dangerous to your health. If it's difficult to ask for yourself, use an advocate--a sibling, friend or professional care manager --to arrange a meeting and get formal, written commitments from those people who are willing to help you. The extra help will give you breathing room to find all those resources that are there to help you.
Seek care management advice.
A number of organizations and private companies will give you advice and guidance -- many for free. If your care recipient has a very low income, you might get free help from your local Area Agency on Aging. A lot depends on available funds. Go to http://www.longtermcarelink.net/eldercare/ref_state_aging_services.htm for statewide lists of agencies.
A good source of free professional advice is the rapidly growing business of non-medical home care companies. Most will offer free consultations and these companies will also provide paid aides to help you with your loved-one…such things as bathing, dressing, shopping, household chores, transportation, companionship and much more. These people may also help you coordinate adult daycare or other community services. Go to http://www.longtermcarelink.net/a7homecare.htm for a nationwide list.

You may wish to pay for a formal assessment and care plan from a professional geriatric care manager. Go to http://www.longtermcarelink.net/a2bfindmanager.htm for a nationwide list of these valuable care specialists. Even though it may cost you a little money to hire a care manager, this could be the best money you will ever spend. Care managers are valuable in helping find supporting resources, providing respite, saving money from care providers, finding money to pay for care, making arrangements with family or government providers and providing advice on issues that you may be struggling with.
Take time off--find temporary substitutes.
Taking a break from caregiving is just as important as taking a break at work or taking that long-awaited vacation. A care manager may be of help in selecting the best temporary help to give you a break. Or you may make arrangements with family or friends to give you a break from caregiving.
Make plans for funding future care arrangements for you or for a healthy parent.
The analysis of data from three national surveys (Mature Market Institute, National Alliance for Caregiving and LifePlans, Inc) points out that employees caring for disabled elders who have long term care insurance (LTCI) are nearly two times more likely to be able to continue working than those caring for non-insured relatives. In addition, working caregivers of those with long term care insurance said that they were less likely to experience some type of stress, such as having to give constant attention to the care recipient or having to provide care while not feeling well themselves. Also, the group with insurance devoted more "quality time"--more companionship and less hands-on assistance--than the group without.
See if your healthy parent can still buy insurance. If he or she can't afford it, see if other family members might contribute to premiums. There are also useful strategies using a reverse mortgage to buy long-term care insurance and life insurance for your loved ones. You should also consider insurance for yourself so when you need care someday, it won't be so stressful on your caregivers. To learn all about long term care insurance and reverse mortgages go to www.longtermcarelink.net.
Use assistive technology.
There are a number of technologies to make sure your loved-ones are safe while you're away. Such things as emergency alert bracelets and pendants, GPS tracking for wandering, remote video surveillance, telehomecare, sensory augmentation and all sorts of assistive devices to help disabled people cope on their own. Go to www.longtermcarelink.net for more information.
FINDING RESOURCES FOR CAREGIVERS
The free resources of www.longtermcarelink.net are designed to provide you with government provider lists, free care assessments, information and care provider lists for reducing your eldercare burden and the attending stress. The site is a non-commercial source of help. It is the largest and most comprehensive free source of long term care information on the Internet. There are no ads or solicitations or pop-ups. A related site for the veterans aid and attendance benefit is found at www.veteransaidbenefit.org. This is a benefit that could be available to up to one third of all US residents over the age of 65 under certain conditions. It could provide an additional monthly income of up to $1,843 a month for qualifying veterans households.
Stay tuned for additional options that are available to managing caregiver stress!