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By CK Wilde for 3GenFamily Blog

3GenFamily Blog has moved to a new location on the web.

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Long Distance Caregiving for a Parent While Raising Teens and Balancing Work and Home

The past 16 months has been an amazing and eventful time for me as a long distance caregiver for my 83 year old father, parent of two teen boys, spouse and juggler of work and home life. When I started this blog, I had no idea I would meet so many dedicated and fascinating people also working to get the best information into the hands of readers like you.

Because there is still a huge need for real answers to many of life’s toughest situations, I am expanding this blog to meet those needs. While I am grateful to WordPress.com for having a perfect place to start a blog, it is time to move to our own website.

I’ll be offering you even more honest content and real life ideas that work for caregivers, parents and anyone struggling to balance the conflicting priorities of work and home life.

Please come visit us at 3GenFamily.com

One housekeeping note: If you signed up to receive this blog via email or RSS from Feedburner, you will need to sign up again at 3GenFamily.com. I am sorry for the inconvenience. There isn’t a way for me to just move your settings over to the new website.

Don’t miss a single post. The latest post discusses 110 Tips for Getting Into the College of Your Choice.

Please come visit us at 3GenFamily.com

Articles on Reducing Conflict with Adult Siblings, Getting Into the College Your Child Dreams About, Surviving Long Distance Caregiving

I will be writing more of the types of article you have come to expect from 3GenFamily Blog. And, there will be new features based on requests and comments I have received from our readers. The topics will still relate to being sandwiched in between two generations — our aging parents who increasingly need our help and our children who are not yet ready to fly into the world.

Somewhere in there, each of us also needs to make a space for ourselves for meaningful work and for celebrating life’s small and large personal successes. Buried between the lines is the emotional turmoil of conflict with our adult siblings and the the lack of understanding of bosses and coworkers who haven’t reached these stages of life.

How do you explain an issue to someone who has no frame of reference?

Please come visit us at 3GenFamily.com

Best Regards,

CK Wilde

© 2008 CK Wilde. All Rights Reserved. Please feel free to link to this post but you must have prior written permission to reproduce this post either whole or in part. Please use the comments to request permission.

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Does Your Parent Need A Cell Phone For Emergencies? Here’s The One.

3GenFamily Blog has moved to a new location on the web.

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By CK Wilde for 3GenFamily Blog

Dad rarely travelled outside of a 10 mile radius of his home. The one or two times each year that he needed to go farther, he would enlist someone to drive with him. So, I never pressed the issue of getting a cell phone for emergencies.

When I showed him my newest phone, he dismissed it saying,” The buttons are too small. I can’t read that screen. I’m hard of hearing, you know!”

Then came the accident.

Dad was driving back from the car dealership, took a wrong turn onto the New Jersey Turnpike, got lost and tried to find his way back through a neighborhood he had never seen before. Peering sideways to read the street signs, he veered into a parked car. Crash!!

My father was a very lucky man. The owners of the parked car were looking out their kitchen window when it happened. They rushed to help him.

He climbed out of his car, shaken, but not injured. At first, the police thought he was drunk. When my father told the police he was a diabetic and could not drink, they worried that his blood sugar was too low.

Eventually, Dad convinced them that he didn’t need an ambulance, just someone to take care of his car and give him a ride home. Those good samaritans who witnessed the accident called someone to take care of the car. The car repairman took my Dad home.

My father waited for several days before telling me about the accident. He knew before I said a word that I would urge him to give up driving. He did stop driving shortly after that incident. It had scared him that much!

It scared me, too. What if nobody had been around to help?

I wish that my Dad had had a Jitterbug phone.

Jitterbug cell phones are designed to be easy to use with big, back-lit buttons, large text, and a powerful speaker for loud, clear conversations.

What makes the Jitterbug phone perfect for seniors is the live, 24 hour operator service. The operators will make calls for you, assist you with finding a phone number from a directory or add names to your phone list. (5 minutes are deducted from your minutes for each operator assist.)

The best part is there are no contracts and no long distance roaming fees. You choose the plan that’s right for you (as low as $10 per month.) You can even share minutes with another family member.

If your parent likes to go out and about but you worry, get your parent this phone for the holidays or any gift giving occasion. The price of the phone is very modest — $147. The peace of mind for a caregiver is priceless.

To learn more about the Jitterbug phone and service plans, click here.

Jitterbug Phones with Feature List

photo courtesy of GreatCall, Inc.

Thanksgiving With Dad — How Do You Convince Someone to Accept Help?

 The mood was relaxed and happy on the five hour flight from California to New Jersey. It was Thanksgiving Day. The sun was just beginning to set on what must have been an unseasonably warm day on the East Coast. I smiled to myself. The plane had arrived ahead of schedule. I would be at my father’s home in time for dinner with him.

The airport shuttle driver let me off outside the patio of my Dad’s place. I could see Dad was sitting motionless in his recliner in the corner of the room. Only the kitchen light was on, but I could easily peer into this tiny garden apartment in an independent senior living community. It had been my father’s comfortable home for the past year.

The TV was off. Dad must have fallen asleep, again.

I knocked on the glass patio door and eventually woke him from his nap. He was overjoyed to see me. But, his mood went from gleeful to glum in only a minute. “I’m sorry. I’m afraid I don’t have dinner for you,” he said.

In our phone conversations over the past few days, my father had chatted cheerfully about preparing his favorite dish, baked turkey legs, for us for Thanksgiving.  He had discovered a great recipe by accident and wanted to share it with me.

“I guess I fell asleep and didn’t hear the timer,” he continued. ” The turkey legs were totally burnt even though I had them in a low, 250 degree oven.”

“How long do you think you overslept?” I asked.

“Oh, it might have been six hours,” Dad said sheepishly.

“That’s ok. You have some hamburgers in the freezer that we can make, right?” I said trying to sound upbeat. (Did I hear that right, six hours?)

I walked into the kitchen to start preparing the hamburgers. The stove was dirty. Pots had boiled over and burnt remains littered the trays under the burners. I peered into the oven. It was just as dirty. The entire apartment smelled like burnt food. This was a major change since my last visit.

I tried to hide my uneasiness as the realization began dawning on me that Dad was not able to safely cook for himself anymore.

“Gee, Dad, it looks like you had a few pots spill over,” I said.

“Yeah, pots boil over from time to time. It’s no big deal,” he growled.

“Looks like you could use some help with the cleaning, Dad. ”

“I’m doing fine by myself! I don’t have extra money pay for cleaners. I have barely enough to live on! ” Dad’s growl had turned into a shout.

Lowering my voice, I turned to him with a big smile, “I know you have done a really great job managing your money. It is looking like you could use a little help here, that’s all.”

That was the beginning of a weekend-long argument.  I gave my father all sorts of suggestions for ways he could get help. He rejected every one.

We met with a non-medical in home care provider.  Dad turned pale when he heard the hourly rate.  I got out the rate sheet for the additional cleaning services that the senior apartment complex offered.

“That’s too much! Dad shouted.

Finally, I hit upon the idea of Dad purchasing the meal plan from the dining room. Together, we figured out how much he spent on food. It looked like buying dinner on the meal plan would not cost much more than he was already spending.

I reasoned and cajoled. Dad finally agreed that he would enjoy getting his evening meal from the dining room.  All that was left to do was for my father to sign up for the plan on Monday. He said he would do it.

I left for the airport on Sunday evening with a light heart.

On Monday, I phoned to remind him to sign up for the meal plan. He began to waffle. Maybe he would wait until December. Maybe he would wait until he finished the food in the freezer. Maybe he would wait until . . .

Of course, I knew these were just excuses. For each one, I countered with a reasonable argument. Dad thought up another.  He wasn’t going to do it and I was too far away to exert the same kind of influence I had when I was physically there.

A November 2007 study by the National Alliance for Caregiving and Evercare found that the long distance caregivers spend an average of $8728 per year out of their own pockets to help an elderly family member. Local caregivers spend somewhat less — approximately $5000 annually.

And, it is no surprise to me that the largest percentage of this expense is going to provide care attendants, followed closely by medical expenses and long distance travel. I had already been spending money for travel to see my Dad. Once your parent needs care, but cannot or will not pay for help, the family may need to provide it. Those of us who work are forced to rely on paid helpers to to assist with eldercare. Bu, this can have a negative financial impact on the family members paying for care.

Fate took a different turn with my father. Later that week, he developed a nose bleed that the nurses at the retirement community could not stop. His trip to the hospital ended up lasting over three months.

The nurses also reported to the managers that Dad was having trouble keeping up the apartment. The managers said they would refuse to allow him back into his apartment when he was released from the hospital for his own safety.

Now instead of convincing him to eat in the dining room, I had to convince him to move to the next level of care. To be continued . . .

How To Help Your Aging Parents – Medical Billing

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By CK Wilde for 3GenFamily Blog

It wasn’t until Dad mailed me the collection notice that I realized he was losing his ability to track and pay his medical bills. He had complained during our phone chats on several occasions that the hospital had messed up his billing. They kept phoning him to get him to pay his bill.

He insisted that he had paid the bill– $124.34. The hospital billing staff asked him to send a copy of the cancelled check. But, Dad adamantly refused to go through the work of getting the cancelled check. It was the hospital’s mistake for losing the payment.

I was dumbfounded by his vehement refusal to deal with a straightforward problem. Ironically, in his younger days, my father had been a stickler for financial details. As a young adult, I would have gotten a scalding rebuke for failing to take action on something like this.

His unusual behavior was a warning that his dementia was beginning to impair his judgement, while his anemia left him so fatigued that even a trip to the bank seemed like an overwhelming task. I didn’t recognize it for what it was. I thought he was just being obstinate.

Being 3000 miles away, I tried to get my father to read his checkbook to tell me the check number for that hospital bill. Then, I went online to see if that check had cleared. The check number he gave me had been cashed but it wasn’t anywhere near the correct amount for the bill. I looked for another check with the amount $124.34. I didn’t see any in that month that matched.

I told my father that the only thing to do was pay the bill. He refused. No amount of reasoning worked. So I made a deal with him — I would pay the bill and he would reimburse me.

Grudgingly, he agreed.

My father had already signed a power of attorney giving me the authority to handle his finances and one for health care, too. So, I began learning first hand about Medicare, supplemental heath coverage and prescription drug benefits.

Dad had to sign a form to allow me to access his online medical insurance claims and to speak for him to the insurance representatives. I left instructions for them to phone me first since Dad’s hearing was poor.

I paid the bill. Dad eventually reimbursed me. The collection notices and phone calls stopped.

It wasn’t until a couple of months after my father’s death that I found the entry in his checkbook. Dad was right all along. He had paid the hospital within days of receiving the bill. But, he was so certain he remembered the correct check number that he never looked it up. I was too far away at that time to double check it myself.

The story doesn’t end there.

Another billing mistake almost happened today. I started to pay a doctor’s bill for my father’s estate and discovered that it was more than it should have been.

The doctor is supposed to bill Medicare first. After Medicare determines what it will pay, the doctor sends the bill to the supplemental insurance.

Only after the supplemental insuror has completed the claim, should the doctor bill the patient for any balance due. But this latest bill didn’t show any payment from the supplemental insurance, so I checked the online claims information.

The supplemental insuror had rejected the claim because documentation was missing. Well, sometimes paperwork does get lost. You need to follow up to get another copy sent.

I called and spoke to the medical billing person in the doctor’s office. She pulled up the records on her computer. She stated that my father owed this amount of money. I asked if she sent it to the supplemental carrier.

She said, “Yes.” And promptly read my father’s account number for the insurance.

I asked her, “Why do the online records say your claim was rejected for lack of documentation? The amount you are billing doesn’t appear to include any payment from the supplemental insurance.”

People do make mistakes (including me). Where there is an honest mistake, you can hear the surprise in the person’s voice. “How did that happen?” Sometimes, they laugh self consciously.

There was no surprise in this woman’s voice. There was no admission of a mistake. “We understand your concern . . . we will make sure it gets handled.” She was billing my Dad for the entire amount rather than resubmit the bill to the insuror with the information that was needed. Efficient but totally lacking in ethics.

I wish I could say this was the only mistake I have found. Unfortunately, billing mistakes have happened so many times in the past 9 months of settling my father’s estate.

How many elderly patients pay too much because they don’t have the patience or focus to follow up?

If you have been wondering how you can help your aging parents, discuss helping them with tracking medical bills. Have your parents collect everything (bills, medicare statements, supplemental insurance statements) in a folder. Set up online access to insurance if its available. Make a regular date to go over the bills each month before anyone writes checks.

You may need to make phone calls for your parents. Be aware that privacy rules prevent the insurors from talking with you about your parents’ account unless your parents have given permission in writing.

You’ll be providing peace of mind and possibly saving money for your parents, too.

Where to Start When The Doctor Says Its Dementia

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By CK Wilde for 3GenFamily Blog

It was during a phone call five years ago with my Dad’s primary care doctor that the “D” word first came up. Dad was in the hospital, again.

He had gastro-intestinal bleeding which the specialists had finally stopped — but not before a series of delirious outbursts about certain marital secrets that had his second wife shouting that she would have him committed to an institution!

As Dr. R explained, people who have lost a lot of blood can become very incoherent. The problem goes away once the patients’ blood levels are stabilized. “Oh, by the way, you know that your father has dementia, right?” the doctor asked.

Whoa! That stopped me in mid-sentence. Was my father’s second wife right? My father needed to be institutionalized?

“Are you going to commit him to a mental institution? I asked with considerable trepidation. The doctor laughed nervously. I took that to mean no.

Dr. R explained that she was seeing some signs of dementia but that they were mild. She rattled off a litany of symptoms. I had noticed many of those behavioral issues, too, but I didn’t know what to make of them.

The questions I should have asked the doctor were, “What is your recommendation for dealing with my father’s dementia?” and “What can I do to help him?”

The doctor’s diagnosis of dementia seemed like a cruel joke. To be truthful, it frightened me. I had terrible visions of my irascible father becoming a vegetable.

But no matter how frightening this seems, the most important thing NOT to do is pretend it will go away on its own. Taking the initiative to learn as much as you can about dementia can give you the knowledge to ask the right questions.

But, where do you start?

A great place to start is wth the basics: the 7 stages of dementia. Here is a link to the list of stages. Not everyone has all of the symptoms. Like my father, a person with mild dementia can continue to function in familiar surroundings. Denial is very common in the early stages of dementia. The person may become anxious, though.

This is the time for the family to plan for the next stages. My Dad was certain that the next day would be his last. As he envisioned it, he would go to sleep and just not wake up. It didn’t exactly happen that way.

Researchers have indicated that patients with dementia can live from 3 to 9 years after the initial onset of symptoms. Patients who develop symptoms at a younger age tend to live longer than those who are advanced in years when they develop symptoms.

Patients who continue to live in their community seem live longer than those in a nursing home or hospital, but this may be because patients who live in the community are in better health generally.

It is important to note that Alzheimers’ disease is only one cause of dementia. There are actually a number of causes including stroke, depression, or a major shock like loss of blood.

It is important to understand what is causing those symptoms for your loved one. By keeping an open mind and a positive attitude, you can help your elder and the doctor find the right combination of medical and nutritional therapies for the best possible outcome.

Other great resources include:

HealthCentral.com resource on Alzheimer’s,

The Dementia Caregiver’s Toolbox

HeartSpring’s section on Alzheimer’s

So what happened to my Dad?

His dementia seemed to be related to his vascular condition rather than Alzheimer’s. The doctor added Vitamins B6, B12, Folic Acid and E to his regimen of drug prescriptions. These nutrients are very helpful for cardio-vascular support as well as mental acuity. My father had a heart bypass operation a number of years ago and currently had a pacemaker. His dementia seemed to be related to these other medical issues.

His relationship with his second wife, however, was never the same. They eventually were divorced.

So, I became his caregiver for the last two years of his life.

Thank You OurAlzheimers.com!

3GenFamily Blog has moved to a new location on the web.

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By CK Wilde for 3GenFamily Blog

When I launched 3GenFamily Blog on WordPress.com, it was with the intention of sharing a wide variety of issues and ideas about long distance caregiving to help others traveling the same road. I’ve tried to focus on substantive information rather than just telling stories of life caring for an elder with dementia.

When I first started searching for answers to my questions, I didn’t always find them. Sometimes I just didn’t know what search terms to use. To make things easier for others, I have tried to use phrases in my titles and content that I would have searched.

So, it was a very pleasant surprise to discover that HealthCentral.com’s website — OurAlzheimers.com — named 3GenFamily Blog a Top Alzheimer’s Site for 2007.

Thank You!

If you are a caregiver or family member of someone with dementia, Alzheimer’s being the most common form, please check out the resources available on all of the top sites in the link above. There is great information and commentary on the sites. Check them out!

Is It Time for an Estate Planning Checkup for Your Parents or You?

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By CK Wilde for 3GenFamily Blog

Is your family like most others? Have your parents (or you) done some estate planning (see below for resources) and then filed the documents away to gather dust and cobwebs until they are needed?

Why do I ask? Because if an illness or accident suddenly happened, you just might discover that those documents are out of date and don’t do the job they were supposed to do!

In spite of the changes that my Dad made in recent years to his documents, he didn’t update all of them. Now as his executrix, I am discovering that some of the documents don’t do what he and my mom originally wanted.

As you may know from my previous posts, my father was frugal beyond belief. He never understood why attorneys got paid so much and tried to avoid using them whenever he could. But, he didn’t totally ignore estate planning.

Urged on by my mother, he got the requisite documents done. And, life events (my mom’s death, remarriage, divorce) forced him to update his will, financial power of attorney and medical power of attorney several times.

But, he never got help with the total picture. So now, I’m looking at estate taxes that wouldn’t have to be paid if Dad had just gotten someone to review his entire estate periodically.

No, not Federal Estate tax. Congress changed the law to increase the amount that is exempt from tax. I’m dealing with NJ Estate tax.

You see, when Congress changed the the federal tax, it threw the states into a tizzy at the prospect of losing desperately needed tax revenue. Every state has dealt with it differently. NJ did something unique — kept the tax rules that were in effect in 2001.

So what should my Dad have done?

Sit down every few years and double check that all of these estate planning documents still met his needs. And, he really should have had an attorney look at them.

What documents am I talking about?

1. Your will – Everyone should have one even if you think you don’t have many assets. The laws of Intestacy (dying without a will) in your state will dictate how your property should be distributed. But, it may not be the way you would want it. Why chance it?

2. Name beneficiaries for all bank accounts, IRAs and securities — The accounts will go to the person you name rather than into your estate and may save grief later. My father had several accounts that did not have beneficiary designations. Bank employees seem to be totally clueless about this.

3. Buy life insurance if people depend on you for support — Keeping small policies in force for elderly parents could help pay the funeral and other expenses if they are paid up policies. Accident policies are a waste of money for most seniors because the majority of our elders die from medical problems, not accidents. My father had 3 accident policies that were worthless.

4. Make out a Living Will or medical power of attorney — I discussed the importance of this in my previous post about getting a Living Will.

5. Make a financial power of attorney — When my father was rushed to the hospital and bounced in and out of rehab for 3 months, I was able to step in to pay his bills and handle his affairs because the power of attorney was in place. It’s a good idea to talk with your parent about bills and taxes before a crisis happens. Know what’s due when and where the banking records are.

6. Plan for children with special needs — Along with the will, you may need other arrangements to care for a special needs child. Don’t assume that the executor will know what you intended. Few of us read minds very well. Siblings don’t always get along. Spell it out.

7. Let your executor know where everything is located — Whether you use a specially designed estate planning organizer or just a spiral bound notebook, mark down where all of the documents are. Organize and label them. Write down the names and addresses of your attorney, accountant, banks and other key contacts. Document everything that is pertinent to your finances and life.

Here are a few resources to help

Wills and Estate Planning Information at NOLO.com

Get Organized Now” on the Nolo Press website

Find an attorney who specializes in Elder Law

Estate Planning 101 from FindLaw.com

Don’t put off asking your parents about this. You aren’t prying. You are helping them achieve their final wishes.

Do be respectful if you are not designated to handle their affairs. Circumstances change. Your aging parents may need your help in the future if the other person can’t be there. You want to remain on good terms with your family.

Most important, toss away the urge to daydream happily about your future inheritance. If you are in charge of the estate, your elders come first. You may need to make decisions to spend that money for home health care, assisted living or a nursing home. Your focus must remain on doing your utmost to meet your parents’ needs.

After it’s all over, you’ll be very glad you did. (more about the tough decisions I faced in the next post)