Category Archives: Uncategorized

Tips for Talking to Your Aging Parent

Monday, 21 December 2015 17:47

Jim Schuster, CELA

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This month we’ve been considering communication in the elder law context. In this post I’d like to talk about the most important conversation and that is between the child and the aging parent. These happen often during the Holidays. Children may notice a big change since they saw their parent last. Siblings may whisper “Mom is not doing as well as she usually does.”

How does one have “the conversation” without being shut out by the parent?

Let’s say that Mom is in her mid-80’s. Dad died some years ago from a heart attack. She adapted well to living alone, but the children have noticed problems. Oldest daughter reports that some bills have been paid late. Her housekeeping, while adequate is not as immaculate as before. She seems to have cut back on social activities that got her out of the house many times a week. Finally, she dropped in a conversation that she takes a “memory pill” her doctor prescribed along with her daily vitamin. She said it is just supposed to prevent memory loss.

It is clear that Mom is declining and needs help. She may not be able to live alone much longer, but she says she does not want or need any help. She is just getting old and “needs to try a little bit harder. Old age isn’t easy you know.”

How do you get started? One of the best books I’ve read on the subject of elder care is written by Joy Loverde, called The Complete Elder Care Planner, published by Three Rivers Press.   You might even find it in you local library.  I’ll be writing a review of her book in a later post, but here I would like to bring in some of her practical tips.

Create a partnership:  The first step is to contemplate a partnership, not a takeover. You are the junior partner. Your job is to approach the senior partner. In other words, you are still the child of your parent.

Ask Questions: One of Loverde’s key strategies is to ask questions.  How do you get a conversation started? Ask questions. Frame them in Parent-Child terms.  I’ll quote a couple examples but for more, buy this book!

Ask for advice: “Mom I’m beginning to think about planning for my retirement, and it looks like you are doing well. Do you have any tips for me?”

Refer to experience or authority: relay the experience of a coworker, or print out an article, about a family that had to hire a lawyer and go to probate court just because her mother didn’t have a “power of attorney.” Finish the report with “Isn’t that outrageous?”

Ask for a favor: “Mom, I need a favor. Beth needs money for school. Will you let her clean your house so she can earn some something?”

Ask for the solution:  Finally, Joy recommends using the question method throughout the problems solving process. Once a problem has been identified you might ask “What do you plan to do to solve this problem? “ And “Have you thought about other options if your plans don’t work out?”

The brilliance of her method is that it eases the parent’s natural fear that “the kids are trying to take over” and that it keeps the parent involved in the process. There is much more in her very practical book, The Complete Eldercare Planner. Get it.

Finally I want to note that a good part of Joy’s structure mirrors that of Zig Ziglar. Great minds think alike. More about Zig in an upcoming post.

Wishing you all the best,

Jim

Have “The Talk” and Avoid Court Battles

Tuesday, 08 December 2015 10:25

Jim Schuster, CELA

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The Holiday season comes upon us and it is a time of joy for many families, but it is also a time for arguments for others. My posts this month will look at how to resolve these conflicts and by communication.

How does a lawsuit begin? Most times it is out of an argument – two people disagreeing about who or what is right. Life is filled with difficult conversations. In the aging field these involve parents, children and spouses and these can lead to explosive family court battles. How can one stop a lawsuit before it begins? By having the parties talk to each other and working it out.

But. Too many “conversations” are really two monologues delivered simultaneously. Each person is not hearing what the other is saying. In that vein, I would like to introduce the concept of “active listening.” I do not believe that it is the solution to disagreements. Listening is a necessary part of a conversation, but it is not the whole conversation.

Let’s consider the first step, hearing the other person.
So. Let’s say Mom has had yet another fall in her house. Or, Dad’s car has another dent or scrape. On top of the myriad other little things that are going wrong, we know it is time for them to move to a safer living situation. We know we could file for guardianship in probate court and take control of their lives.  How would that affect our relationship?  What if other siblings still believe the myth that “Mom and Dad” are alright?  We could have a poisonous court battle.  Would it not be better if Mom or Dad would agree?

How do we have that conversation? What are they thinking? At this point “active listening” is essential.  Now what is wonderful about this concept is that it involves more than listening.  In the elder law context, we may call it “respectful listening.” For example, we could probably check our phone for messages while Dad gives the same tired and flimsy explanation about the damage to his car. But, then Dad would likely give our part of the conversation the same consideration.

What I like about the active listening concept is that it combines listening and respect for the other’s position. With those established we can plan for the best possible result. Read about it here. The skill of active listening

In the next post we will discuss other issues in producing positive results through conversation.

Three Minute Screen for Lewy Body Dementia

Tuesday, 17 November 2015 11:23

Jim Schuster, CELA

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Continuing our focus on dementia during Alzheimer’s Disease awareness month, let’s take a deeper look at Lewy Body dementia (LBD). This dementia can be difficult for a doctor to diagnose. Now thanks James E. Galvin, M.D., M.P.H., one of the most prominent neuroscientists in the country, we have a new three minute screen screen for clinicians to judge how likely it is that a patient has LBD. This is good news for spouses and caregivers who are at their wits end trying to understand what is going on. Perhaps more importantly an accurate diagnosis can prevent the situation from getting worse by medication. LBD patients typically have sensitivities to many drugs prescribed for Alzheimer’s and hallucinations. Indeed the Lewy Body Dementia Association reports a “severe sensitivity to medications used to treat hallucinations.”

Here is the news story New, three-minute test effectively diagnoses Lewy Body dementia
and here is the screen (the news story has a link to the screen and the explanation of it) :

Alzheimer’s, Parkinson’s or Lewy Body Dementia?

Tuesday, 17 November 2015 10:00

Jim Schuster, CELA

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During Alzheimer’s Awareness Month, I have been posting here and on Facebook about dementia.  One of the perplexing problems with patients and family members is trying to understand just what is “going on.”  What disease process is happening?  Today I would like to share information on three common forms of dementia, Alzheimer’s, Parkinson’s and Lewy Body Disease (LBD). LBD is reportedly the second most common cause of dementia and not well recognized by physicians, especially primary care and general health care providers.  Thanks to the Lewy Body Dementia Association we have a chart that distinguishes LBD from Alzheimer’s and Parkinson’s Disease.

A Five Minute Dementia Rating Screen

Sunday, 15 November 2015 10:59

Jim Schuster, CELA

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Continuing in our irregular series on dementia during Alzheimer’s Awareness month, I offer a quick screen  to help you with the question of possible dementia of a family member.

When we are confronted difficult behaviors of an aging spouse or parent, we want to find out what’s wrong and get help. Perhaps the biggest problem is “what do I tell the doctor?” Usually we focus on a particularly troubling change in behavior, but wonder “what more should we report?” Now this conversation only takes place in the early stages of the disease process and at that time the “patient” is struggling to control the problem. Their valiant battle results in a denial that they have a problem and he or she will be of no help in making a report to the doctor.

In that spirit then I present the Quick Dementia Rating System developed by Dr. James E. Galvin of the Charles E. Schmidt College of Medicine, Florida Atlantic University. It is copyrighted 2013.

You can use this quick screen to make your report to the doctor. You will see it inquires into the whole range problems that a person with one of the various forms of dementia may have. It covers not just memory but cognitive ability, mood, decision making, communication, concentration, personal hygiene and on. While the caregiver family member may report any one of these areas, very few would think to report on all areas, with comments on how well or poorly he or she does in each one. Dr. Galvin reports that when the breadth of information is reported, a doctor can make a very good assessment of the problem.

Perhaps the most important point to remember to report is how the behavior represents change in behavior. Here is the note from Dr. Galvin:

“NOTE. The following descriptions characterize changes in the patient’s cognitive and functional abilities. You are asked to compare the patient now to how they used to be—the key feature is change. Choose one answer for each category that best fits the patient—NOTE, not all descriptions need to be present to choose an answer.”

The QDRS, Quick Dementia Rating System

1. Memory and recall

0 No obvious memory loss or inconsistent forgetfulness that does not interfere with function in everyday activities
0.5 Consistent mild forgetfulness or partial recollection of events that may interfere with performing everyday activities; repeats questions/statements, misplaces items, forgets appointments
1 Mild to moderate memory loss; more noticeable for recent events; interferes with performing everyday activities
2 Moderate to severe memory loss; only highly learned information remembered; new information rapidly forgotten
3 Severe memory loss, almost impossible to recall new information; long-term memory may be affected

2. Orientation

0 Fully oriented to person, place, and time nearly all the time
0.5 Slight difficulty in keeping track of time; may forget day or date more frequently than in the past
1 Mild to moderate difficulty in keeping track of time and sequence of events; forgets month or year; oriented to familiar places but gets confused outside familiar areas; gets lost or wanders
2 Moderate to severe difficulty, usually disoriented to time and place (familiar and unfamiliar); frequently dwells in past
3 Only oriented to their name, although may recognize family members

3. Decision making and problem-solving abilities

0 Solves everyday problems without difficulty; handles personal business and financial matters well; decision-making abilities consistent with past performance
0.5 Slight impairment or takes longer to solve problems; trouble with abstract concepts; decisions still sound
1 Moderate difficulty with handling problems and making decisions; defers many decisions to others; social judgment and behavior may be slightly impaired; loss of insight
2 Severely impaired in handling problems, making only simple personal decisions; social judgment and behavior often impaired; lacks insight
3 Unable to make decisions or solve problems; others make nearly all decisions for patient

4. Activities outside the home

0 Independent in function at the usual level of performance in profession, shopping, community and religious activities, volunteering, or social groups
0.5 Slight impairment in these activities compared with previous performance; slight change in driving skills; still able to handle emergency situations
1 Unable to function independently but still may attend and be engaged; appears “normal” to others; notable changes in driving skills; concern about ability to handle emergency situations
2 No pretense of independent function outside the home; appears well enough to be taken to activities outside the family home but generally needs to be accompanied
3 No independent function or activities; appear too ill to be taken to activities outside the home

5. Function at home and hobby activities

0 Chores at home, hobbies and personal interests are well maintained compared with past performance
0.5 Slight impairment or less interest in these activities; trouble operating appliances (particularly new purchases)
1 Mild but definite impairment in home and hobby function; more difficult chores or tasks abandoned; more complicated hobbies and interests given up
2 Only simple chores preserved, very restricted interest in hobbies which are poorly maintained
3 No meaningful function in household chores or with prior hobbies

6. Toileting and personal hygiene

0 Fully capable of self-care (dressing, grooming, washing, bathing, toileting)
0.5 Slight changes in abilities and attention to these activities
1 Needs prompting to complete these activities but may still complete independently
2 Requires some assistance in dressing, hygiene, keeping of personal items; occasionally incontinent
3 Requires significant help with personal care and hygiene; frequent incontinence

7. Behavior and personality changes

0 Socially appropriate behavior in public and private; no changes in personality
0.5 Questionable or very mild changes in behavior, personality, emotional control, appropriateness of choices
1 Mild changes in behavior or personality
2 Moderate behavior or personality changes, affects interactions with others; may be avoided by friends, neighbors, or distant relatives
3 Severe behavior or personality changes; making interactions with others often unpleasant or avoided

8. Language and communication abilities

0 No language difficulty or occasional word searching; reads and writes as in the past
0.5 Consistent mild word finding difficulties, using descriptive terms or takes longer to get point across, mild problems with comprehension, decreased conversation; may affect reading and writing
1 Moderate word finding difficulty in speech, cannot name objects, marked reduction in work production; reduced comprehension, conversation, writing, and/or reading
2 Moderate to severe impairments in speech production or comprehension; has difficulty in communicating thoughts to others; limited ability to read or write
3 Severe deficits in language and communication; little to no understandable speech is produced

9. Mood

0 No changes in mood, interest, or motivation level
0.5 Occasional sadness, depression, anxiety, nervousness, or loss of interest/motivation
1 Daily mild issues with sadness, depression, anxiety, nervousness, or loss of interest/motivation
2 Moderate issues with sadness, depression, anxiety, nervousness, or loss of interest/motivation
3 Severe issues with sadness, depression, anxiety, nervousness, or loss of interest/motivation

10. Attention and concentration

0 Normal attention, concentration, and interaction with his or her environment and surroundings
0.5 Mild problems with attention, concentration, and interaction with environment and surroundings, may appear drowsy during day
1 Moderate problems with attention and concentration, may have staring spells or spend time with eyes closed, increased daytime sleepiness
2 Significant portion of the day is spend sleeping, not paying attention to environment, when having a conversation may say things that are illogical or not consistent with topic
3 Limited to no ability to pay attention to external environment or surroundings
Cognitive subtotal (questions 1, 2, 3, 8)
Behavioral subtotal (questions 4, 5, 6, 7, 9, 10)
Total QDRS score

Copyright 2013 The Quick Dementia Rating System James E. Galvin and New York University Langone Medical Center.