If your loved one is admitted to a skilled nursing facility, Medicare requires the staff develop an initial, personalized care plan within the first 48 hours. This describes who should be doing what. Then, within the first 14 days, the staff must assemble a comprehensive assessment, which must include your loved one’s needs and strengths. Also their goals of treatment, personal preferences, and a brief life history.

Then, within a week, a formal care plan meeting of all the care team members—including your relative if they are able—is required, to develop a durable roadmap for care based on the assessment. As your loved one’s representative, you have the right to be involved in the plan and meeting.

The care plan lays out what services are needed to support your loved one toward achievable physical, mental, and psychosocial well-being. For example, physical, speech, or occupational therapy sessions. And it identifies dietary guidelines and food preferences. Overall, the plan must tie into and support your loved one’s stated goals.

Here’s how you can help:

• Before the meeting. Ask your relative what’s going well and what’s not. What do they prefer would happen? Help prioritize their questions and requests.
• During the meeting. Help the staff understand how best to communicate and work with your loved one. Keep your relative’s goals and preferences at the forefront. You can ask questions or request changes if you don’t understand or don’t agree with staff recommendations. Take thorough notes. You also have a right to a written copy of the plan.
• After the meeting. Monitor how the care plan seems to be working and definitely talk to staff if questions arise.

Build bridges with a collaborative approach rather than a confrontational mindset. If this sounds daunting, give us a call at (415) 921-5038. We can help advocate for your loved one’s wishes.

Has your relative been admitted to a skilled nursing facility?
If so, you have the right to participate in the care plan meetings and in the development of the care plan. As the San Francisco expert in family caregiving, we at Compassionate Community Care can help make sure your loved one’s needs and wishes are addressed. Give us a call at (415) 921-5038.

It’s important to do the best you can when caring for a loved one. But aiming for perfection can bring on problems. For yourself, in terms of anxiety, depression, and low self-esteem. And for your relative and other family members, who may feel burdened by living under the stress of constant measurement and judgment.

A desire to excel is completely honorable. But research shows that perfectionists actually get less done than other people. That’s because of black-and-white thinking. They see only the options of “complete success” or “complete failure.” That intense fear of failure results in an overfocus on details. What about gray? Maybe Mom did only some—not all—of her prescribed exercises today. That’s not failure; that’s a “good enough” day. If Dad snuck a shake of salt on his low-sodium diet, that’s not perfect, but it’s not failure, either.

Traits of a perfectionist. Do you recognize yourself in any of these?

• Unattainable goals. A perfectionist sets the bar unreasonably high. By contrast, greater success is achieved by starting with smaller goals and building from there.
• Outcome-oriented. A perfectionist focuses solely on the results, rarely the process. They live in fear of a flawed outcome. The alternative: Give it your best. Aim high, but also aim to enjoy the process.
• Judgment. Perfectionists look for flaws in their own achievements and those of others. And judge themselves harshly. Another approach is to honor what is accomplished, even if some goals fall short of ideal.
• Disappointment. A perfectionist is often disappointed. This frequently leads to depression. There is a more resilient option: Identify what worked and what didn’t and note what to do differently next time.
• Procrastination. Fear of failure can loom so large that perfectionists become paralyzed about moving forward. A success-oriented person understands that wins and losses are just a part of life. And you can’t win without daring to try.

If any of these traits feel familiar, don’t assume your standards are all wrong. (There’s that black-and-white thinking!) Consider broadening your focus to be success-oriented while appreciating the journey and the shades of gray between absolute perfection and absolute failure.

Think you may be a perfectionist?
You are not alone! As the San Francisco experts in family caregiving, we at Compassionate Community Care can assure you there are ways to curb your perfectionism and still make sure your loved one is safe. Give us a call at (415) 921-5038.

For many people, a pillbox is just the ticket. But as we age, we may take more medicines. Filling the box requires more concentration. Remembering to take the meds can become more challenging. Many families turn to technology to help an aging loved one.

There are two tech strategies: Reminders issued by a phone, and automated dispensers.

Reminder apps. If your relative does fine setting up the pillbox, try a smartphone reminder app. These require a lot of inputting, however, and updating as medicines change. Quite honestly, setting standard smartphone alarms to go off at the appointed time is much simpler and serves roughly the same function.

Automated dispensers. Although they aren’t very portable, if your loved one has memory issues and five medications or more, consider an automated dispenser.

• Filling the device. Some are like a pillbox and require a person (you?) to put the pills in compartments for each day and time. Then the machine beeps and opens the right compartment when its dose is due. Others allow you to load each medication in bulk into separate containers. One for each drug needed. The machine fills the individual day/time compartments based on what you have programmed.
• Reminder strategy. Some flash lights or make noise. Others send a reminder alert to your relative’s smartphone. Or make an automated call. Do you want to also receive a reminder?
• Confirmation strategy. Some devices keep beeping or flashing until the compartment has been opened. You can also have a “compartment opened” text confirmation sent to you. (No guarantees the pills made it into the mouth, however!)
• Protection against overmedication. Some devices lock the compartment when detecting that a dose of pills has not been taken at the programmed time. Again, you may want an alert when a medication is not taken.

Is medication management an issue?
As the San Francisco experts in family caregiving, we at Compassionate Community Care see families struggle with how best to ensure that their loved ones are taking what they need at the right times. Not too much. Not too little. Medication errors account for many older adult hospitalizations! If you would like help with this, give us a call at (415) 921-5038.

If you are the person most likely to step in if your loved one is unable to get to the bills—a hospitalization, dementia—you need to get oriented. And organized!

It’s easy to lose track of paperwork, especially someone else’s. Professionals recommend gathering important documents in a file or binder for safekeeping. Put that in a locked and fireproof location. Consider a small home safe. Or a safe deposit box at the bank.

Assembling this packet with your relative’s help ensures that you know about all the accounts that exist. (It’s never too early to put this information together. One never knows when a serious problem might arise!)

Following is a checklist of top-priority health and financial documents. Make sure you have the signed originals. Copies may not be legally accepted. 

• Original will or trust documents. These can also be kept at the lawyer’s office.
• Durable power of attorney for finance. This is a document. Confusingly, it’s also the title of the person named in the document to make financial decisions if your relative cannot. If you are the person gathering together important documents, you probably are, or should be, the durable power of attorney for finance.)
• Advance healthcare directive. This includes durable power of attorney for health and a living will describing preferred philosophy of care at the end of life.
• Ownership documents. Title and loan documents for property and vehicles. Also include documents for assets, such as savings bonds, brokerage accounts, and cemetery plots.
• Bank account information. Account numbers and login information. Don’t forget the key to any safe deposit box (and the number and the bank!).
• Autopay arrangements. A listing of services being paid automatically from each bank account.
• Insurance policies for life, disability, and long-term care. Get the full details, including policy numbers. Be sure you include policies provided by employers and any that were bought personally.
• Health insurance cards. Make a copy of the front and back of each card. You’ll want Medicare A/B, Medicare supplement if they have one, and Prescription Benefit Plan (Part D). If your loved one has Medicare Advantage, there is probably only one card.
• Pension and individual retirement accounts. A person who worked for several companies may have multiple 401(k) accounts. Check for multiple IRAs also.
• Debt and loan documents.
• Past tax returns. You need to keep only the most recent three years of returns.

If it feels awkward to approach your relative for such personal information, mention this article. You’re just following through on an important recommendation!

Are you the stand-in for financial tasks?
Finances can often be a sensitive topic. As the San Francisco experts in family caregiving, we at Compassionate Community Care can help you broach the subject of getting prepared in case you need to step in. Give us a call at (415) 921-5038.

Family meetings won’t cure old hurts or solve every current problem. But if they nurture teamwork, they can provide a solid foundation for the continued well-being of the person in need of care.

Creative solutions often emerge at family meetings, and the burdens of caregiving get redistributed in a more balanced fashion.

Tips for successful meetings

• Decide who should attend. Anyone with a stake in the situation should be invited, but keep it to fewer than ten people. Use technology as needed so that location is not a barrier and everyone can “attend.” Ideally, include the older adult. Consider a premeeting without them, though, to air feelings and establish roles (timekeeper, note-taker …). If the elder has dementia, family meetings may be too overwhelming.
• Create a safe space. Agree upon ground rules so everyone understands that all points of view are important and to be respected.
• Consider a facilitator. A social worker, therapist, or Geriatric Care Manager is trained in family dynamics and keeping group meetings courteous and productive.
• Agree upon overall goals. This is not about the past, but about the future. The point is to find a way to work together to do what’s wisest for your relative so their elderhood is as close to their desires as possible, given the circumstances.
• Set an agenda. Be realistic about what you can cover in an hour and a half. Determine who will be the timekeeper so everyone gets a fair share of time and the meeting ends when planned. You might begin by hearing each other’s assessment of the situation and any concerns. This may bring up a lot of feelings.
• Take notes. Ask someone other than the facilitator or timekeeper to take notes. The notes should identify concerns and the different tasks each participant has agreed to take on. Notes should be sent to everyone soon after the meeting.
• Understand there will be hiccups. When emotions are running high, many of us drop into childhood patterns of interacting. Acknowledge this challenge at the outset and ask that everyone aim to remain in their adult self. Also, forecast that no one is likely to get 100% of what they want. Try to be flexible and open to new ideas.
• Expect further meetings. If Meeting 1 focuses on concerns, Meeting 2 may explore solutions and Meeting 3, implementation. Consider touching base regularly after that.

Are all your family on the same page?
If not, let us help. As the San Francisco experts in family caregiving, we at Compassionate Community Care have experience working with families when members have very different ideas about what is happening and what needs to be done. Let’s start the conversation. Give us a call at (415) 921-5038.

If your spouse is younger than 65 and has received an Alzheimer’s diagnosis, you may feel in a world all your own. You probably don’t know anyone else in this situation and may sense a social stigma. It can be scary. Lonely. And feel just not fair!

Look for a support group. You are not alone. In a support group, you’ll find others who understand, as well as valuable tips and strategies. Check out the Alzheimer’s Association to find in-person, virtual, and hybrid groups. Try to find early-onset gatherings. (This is very different from “early stage.”) You might also check out WellSpouse.org specifically for caregiving partners.

Involve your friends. You need them now—more than ever. And yet they may feel uncertain of what to say or do. Let them know specifically what you need. Perhaps just someone to listen, let you cry when you want. Or maybe you need them to continue including you and your partner in get-togethers. Offer them guidance on best strategies for interacting with your spouse so they can feel more confident about what to expect and how to respond.

Find professionals to help. There are some big issues to tackle, and the time is now to work on them with your partner. A Geriatric Care Manager can help you understand what to expect and guide you as the disease unfolds. Consider the assistance of a therapist to get through sensitive topics with your spouse: Finances, sex, household chores, when to tell others, driving, end-stage care. Finally, work with an attorney to create legal documents for when your partner becomes unable to make personal decisions.

Early-onset Alzheimer’s is challenging and moves quickly. There’s no denying it. But you will experience less stress if you reach out early and often to get the support you need.

Does your partner have early-onset Alzheimer’s?
We can help! Call (415) 921-5038. As the San Francisco experts in family caregiving, we at Compassionate Community Care can provide you with an overview so you know what to expect. We can also provide age-sensitive support for your unique challenges. You don’t have to do this alone.

Dentures need the same level of care and attention as natural teeth do. Bacteria and fungi that grow on teeth can also infect a dental appliance. Pressure spots on the gums can lead to pain and potential infection. Also to problems eating and then weight loss. In addition, poor denture care can result in stains on the teeth and bad breath.

Encourage your family member to develop a solid routine.

• After eating. Remove and rinse denture(s) to clean off any remaining bits of food. Also rinse mouth.
• Twice a day. Brush the dentures using a soft-bristle brush and nonabrasive cleaner. Brush the teeth and areas that are in contact with the gums or where a dental fixative is applied.
• At bedtime. Remove dentures and soak them overnight in a denture-cleaning solution. In the morning, rinse the dentures before putting them back in the mouth. Empty and dry the soaking container. Leave it open for the day.
• Yearly. See the dentist at least every 12 months. He or she can assess mouth health, check denture fit, and clean the dentures professionally.

Keep in mind that dentures are delicate.

• Clean or handle them over a basin that is filled with water or lined with a soft cloth in case they are dropped.
• Use cool or warm water. Water that is too hot can warp dentures.
• Ask your dental hygienist to recommend brushes and cleaners. Regular toothbrushes are too harsh.
• Most dentures should not be allowed to sit in the air and dry out completely.

Call the dentist if your relative complains of pain or has difficulty wearing dentures. There may be a sore on the gums, or the dentures may need to be adjusted because of changing weight, etc.

Continue to schedule regular dental exams. With proper care, dentures can last five to ten years.

Does your loved one wear dentures?
Problems with dentures can result in poor eating, weight loss, bad breath, and other seemingly unrelated problems. As the San Francisco experts in family caregiving, we at Compassionate Community Care can help you address this oft-forgotten aspect of personal hygiene. Give us a call at (415) 921-5038.

Perhaps your loved one has just gotten out of the hospital and needs some meals for a few weeks while recuperating. Or maybe Mom has dementia and it’s become too much for Dad to have to cook on top of caring for her.

Meals on Wheels America serves communities most everywhere in the country, but there are requirements for eligibility. And the choices are limited to what is being served that day.

If you decide to look into private meal services, consider the following:

• Special diets. If your loved one requires it, can the service accommodate low-sodium, diabetic, or other special diets?
• Frozen or fresh. If frozen, is there room in your loved one’s freezer for the minimum order? If fresh, what is the shelf life?
• Preparation. Are heating instructions within your relative’s capabilities?
• Payment. Most services are private pay, but some may participate in a Medicaid waiver program.Or does your loved one’s insurance cover meals for special diets?
• Shipping fee. What is the shipping or delivery charge? Flat rate or per meal? Shipping is expensive, thus larger orders are more efficient.
• Minimum orders. Some services require bulk orders of five, ten, fifteen, or twenty meals at a time.
• Weight of the package. Large orders may be difficult for your relative to lift and carry into the house.
• Scheduling. Can you determine delivery days and times, or do they have a fixed schedule? What if your loved one is out when the meals arrive?

If you are looking for a long-term solution, it is wise to try a few services. Perhaps order for yourself first to get a sense of the process and the quality of the food from each vendor. Also, look for discounts. Many regularly offer coupons for 10%–20% off. They add up!

Are you worried about meals?
Food is so basic to health and giving/receiving love. As the San Francisco experts in family caregiving, we at Compassionate Community Care understand how distressing it can be when you are worried about a loved one’s nutrition. Let us help. Give us a call at (415) 921-5038. You don’t have to do this alone.

If you care for a loved one with moderate to advanced dementia, it’s likely the idea of placement in memory care has come up. Maybe a friend has nudged you. Or it’s been suggested by your relative’s doctor or care manager. Perhaps you know you are exhausted. Most families eventually investigate this option because it’s staffed 24/7 by people trained in dementia strategies.

The most common reasons families make the shift

• The person is in danger of harming themselves or others (for instance, wandering, or aggressive outbursts).
• The family caregiver’s mental or physical health is going downhill.
• The person is incontinent.

Your feelings may cloud wise judgment. People with dementia don’t recognize their need for help. It is up to you to make a wise decision for them. But strong feelings may hold you back:

• Guilt or betrayal. You promised you’d never send them to a nursing home. Sometimes we can’t keep every promise. Who knew dementia care could be so hard? Visit a few memory care communities. Given their focus on keeping residents happily engaged in activities, they are generally much sunnier than a nursing home.
• Shame or embarrassment. Others may judge you. None of them have walked in your shoes. Go to a support group of family caregivers and hear their feedback. Your decision addresses the need for safety and good health for everyone involved.
• Worry your relative will get worse. No one can care for them as attentively as you can. That’s true. And an uptick in confusion and disorientation is common at first. About six weeks in, however, you’ll likely see them more engaged as they join others in activities.

If you are struggling with this decision, consult with a care manager or social worker. They can even facilitate a family meeting to get everyone on the same page.

Can you really keep up the current level of care?
As the San Francisco experts in family caregiving, we at Compassionate Community Care frequently see a family member’s health plummeting as they care for a loved one with dementia. You can’t stop your relative’s decline. But you don’t have to be a casualty to it. Let us help you make some changes. Give us a call at (415) 921-5038.

If someone else in your family has primary responsibility for the care of your loved one, that doesn’t mean you don’t have anything to contribute. Far from it! Caring for an older adult is more than one person can do alone. There are many ways to lend a hand (even if you don’t live nearby).

Consider:

• Managing finances, talking with the doctors, doing yardwork, running errands. If direct care isn’t your thing, address other needs. Anything you can take off the plate of the primary is a help.
• Contributing money. If you live far away and have the means, pay for outside help to give your sibling some relief.
• Providing emotional support. It’s often very lonely to be the primary caregiver. Having a good listener to talk to for safely blowing off steam can ease the load.
• Giving them a break. Gift them a “spa day” where you make all the arrangements and they just enjoy. Spend some of your vacation time caring for mom or dad so the primary can have an extended rest.

“My sister would never go for that!” The biggest complaint in many families is that the primary caregiver is so particular, it’s impossible to help. True. They may have trouble letting go of control. As long as there is nothing medically dangerous about what you propose, however, you may need to assert yourself and express your right to participate in your parent’s care in your own style.

If you get resistance, consider a facilitated family meeting. Family dynamics are decades old. A counselor, social worker, or Care Manager can guide a conversation constructively. Families are an ecosystem and each member inhabits a niche. It will be better for your loved one, and for you and your siblings, if everyone has a chance to contribute, each in their own way.

Do your family roles seem locked in place?
They have been finely honed since childhood. But that doesn’t mean things can’t shift to be more appropriate to family needs when mom and dad require help in their older years. As the San Francisco experts in family caregiving, we at Compassionate Community Care can help you rebalance the roles. Give us a call at (415) 921-5038.