Many of us regard the Thanksgiving holiday as an annual opportunity for counting our blessings.

There’s good reason for practicing the giving of thanks throughout the year: Research suggests that cultivating an “attitude of gratitude” is associated with

• reducing depression. Gratitude helps you be thankful for what you have instead of focusing on what you don’t have.
• reducing anxiety. Gratitude can help you focus on what’s working in the present. Anxiety tends to focus on fears about the future or ruminations about the past.
• improved heart health. Focusing on gratitude slows the heart rate. In addition, keeping a gratitude journal can drop the diastolic value (the lower, resting blood pressure number). This is the pressure when the heart is filling with blood and the system is at its lowest amount of pressure. (If the bottom number is high, that’s not good.)

Gratitude is a choice. You don’t have to feel deep gratitude welling up in your heart. It’s not about denying the bad things. Being grateful is about making sure you notice the good things too and don’t take them for granted. Gratitude is a perspective. If you can make it a habit, it will pay dividends through thick and thin.

Consider these options: 

• Morning reflection. Before you take up the tasks of the day, pause to give thanks for a past blessing. Perhaps a teacher who influenced you. A special vacation. Or a favorite family dessert. Let the sensation of gratitude soak in during a few minutes of silence.
• Daily log. At the end of your day, take a moment to reflect. What are you thankful for today? Assistance received at the pharmacy? A phone call from a friend? A beautiful sunset? Deepen your appreciation by keeping a written gratitude log.
• Giving gratitude. As you go about your life, look for opportunities to say “thank you.” Was a store clerk extra helpful with mom? Perhaps a neighbor did some yard cleanup for dad. Give that person a call or send a thank you (note, text, or email).
• Weekly check-in. It’s easy to have the days and years go by in a busy blur. Instead, set aside time each week for savoring recent experiences and identifying good things to anticipate. Better yet, strengthen your gratitude by recounting your blessings with another.

Having trouble feeling grateful?
It’s not always easy. But we at Compassionate Community Care notice that gratitude can be cultivated, and to profound effect. As the San Francisco experts in family caregiving, we see the ways a balanced perspective can help families regain a stronger footing despite the challenges of eldercare. Let’s start the conversation. Give us a call at (415) 921-5038.

“Frailty” used to be a rather vague description, like “old age.” Currently, however, it is recognized as a cluster of conditions that deserves medical attention.

The following are signs of frailty:

• Complaints of fatigue
• Physical inactivity
• Slow gait (walking speed)
• Poor balance (frequent falls)
• Decreased strength (for instance, weak hand grip)
• Unintentional loss of 10 pounds, or 5% or more of body weight in the past six months

Between 5% – 17% of older adults can be considered “frail.” There is a continuum of frailty from “prefrail” to late stage. Frail individuals are more likely to become seriously ill from simple infections. They are more likely to be hospitalized and to become disabled. Not surprisingly, they are more likely to die sooner than their nonfrail peers. 

Frailty seems to involve a combination of physical processes in the body that reduces our normal reserves and resilience to bounce back from illness or a fall. Chronic inflammation—the immune system on hyperdrive—is a factor. Also the common reduction of muscle mass as we age. People with multiple chronic conditions also seem to be at higher risk.

No one organ system is to blame. And there are no blood tests, x-rays, or other imaging tests to confirm frailty.

To determine the level of frailty (and how best to approach it), you will want to get a full geriatric assessment. This will involve identifying medical conditions and creating a list of medications. But it also requires a functional assessment (how well your loved one can complete daily living tasks). Fall risk, hearing, vision, mental health, and cognitive impairment testing are also included. A Care Manager can assist you with these assessments.

Some aspects of frailty can be remedied. If your relative is in the “prefrail” or early-frail stage, they could benefit from strength training and balance exercises. Understanding frailty for those further down the continuum can help with decisions about how well a surgery or aggressive treatment is likely to be tolerated, or whether hospice is the most supportive option.

Are you concerned your loved one may be frail?
As the San Francisco experts in family caregiving, we at Compassionate Community Care see frailty come up time and again in medical decision making. Want to learn what you can do to improve your relative’s resilience? Give us a call at (415) 921-5038.

Imagine that your relative goes to the hospital for an outpatient procedure. That’s no big deal. But their blood pressure skyrockets during the event. So the hospital decides to keep your family member overnight for monitoring. They have a bed and receive meals. You might readily assume they’ve been admitted as an inpatient. In this example, they are on “observation status” only.

Financially, this distinction could be very important. In Medicare terms, patients on observation status are outpatients. This means Medicare will likely cover at least some of your relative’s hospital visit. But for observation, they pay under Part B, which could mean greater copays and additional uncovered expenses. Money out of pocket. Another detail: Only those formally admitted for three overnights are covered by Medicare for follow-up care in a skilled nursing facility (SNF). The cost of SNF care adds up VERY quickly.

Medicare has strict rules about whether or not a patient qualifies for hospital admission. If a doctor is unsure, they must put the patient in observation status. Ideally, when this happens you receive a notification called MOON (Medicare outpatient observation notice). This notice explains why the care is considered outpatient instead of inpatient. It usually also clarifies the difference in coverage for the hospital and for any aftercare.

If you feel your loved one has been wrongly assigned, you can appeal the decision. You may want to talk first to someone in the hospital billing office. They can help you determine what the out-of-pocket costs would be under inpatient versus observation status.

Avoid unpleasant surprises! Anytime it looks like your loved one will be staying overnight, ASK several people if they are an inpatient or on observation status.

Are you confused about Medicare’s hospital coverage?
As the San Francisco experts in family caregiving, we at Compassionate Community Care make it a point to clarify a client’s status when they are in the hospital. If they meet the criteria, we advocate for full admission. You don’t have to do this alone. Give us a call at (415) 921-5038.

For family caregivers, the prospect of the holiday season is often more daunting than delightful. How do you decide what to keep and what to trim away?

Prioritize activities with people you enjoy. Spend time with those who nourish your soul rather than those who criticize or deplete you.

Focus on what gives meaning to the season. Often what we are seeking in our activities is an emotional outcome: Feelings of love and closeness. The comfort of belonging, tradition, and community. A sense of spiritual affirmation.

Cull out low-priority activities. Every time you say yes to one “obligatory” event (perhaps the office party?), you are reducing your time and energy for the activities you truly relish. Strive to cut out half of your holiday tasks. Value quality over quantity.

Prepare for others’ disappointment. Explain that your focus is on caring for your loved one—a noble reason. And to do that, you need to pare back. It may be your relative does not do well with disruptions to routine, or that they lack stamina for the usual activities.

Brainstorm simplifications.

• Meals. Prepare a crockpot soup and sandwich for a lunch gathering instead of a full dinner. Or ask others to contribute instead of cooking a whole meal. Order a precooked entrée, or the side dishes, or dessert. Go out to eat.
• Decorations. Bring out one or two favorite symbols of the season. Use music, or simmer herbs or spices to evoke the holiday spirit.
• Gifts. Get 100% off on Black Friday by foregoing gifts altogether! Let your family know you are opting out of gift giving and prefer to not receive any. Or that you’ll give to children only. Maybe send cards of appreciation to key people or write a letter to all, recounting the events of the past year. Perhaps make a single donation in the name of the family to a cause that all might value. Or if you must give something to individuals, consider an experience (an invitation or tickets for an activity to do later in the year). Experiences are typically more meaningful than objects.
• Gatherings. Especially if your loved one has health or mobility challenges, look for online options to connect without the logistics of travel and bad weather (video calls, online concerts or religious services, etc.).

Are the holidays adding to your stress?
Let us help. As the San Francisco experts in family caregiving, we at Compassionate Community Care have a lot of experience reducing the load for family caregivers. You don’t have to do this alone. Give us a call at (415) 921-5038.

Living with stiff or arthritic hands can significantly diminish joy, confidence, and freedom. Among those over age eighty-five, about half of all women and one-quarter of all men are afflicted with the pain of osteoarthritis in the hands. To support your loved one’s independence, try these expert hacks and gadgets:

Equip the kitchen. Look for specialized grippers for opening containers: An electric can opener or spring-loaded scissors for opening food pouches. For carving or chopping, an electric knife or vegetable chopper. Choose tools, spatulas, and the like with cushy, large handles. Add “foam grip tubing” to utensil handles (also useful with pens, toothbrushes, etc.).

Modify the physical environment. Exchange doorknobs for levers or add slip-on, lever-style doorknob adapters. Install faucets with sensors that allow taps to control water flow and temperature. Try easier to grip, dimmer-style light switches. Go hands free with a robot vacuum!

Seek out adaptive devices and clothing. Look for adaptive “turning tools” to assist with keys and other small items. Purchase looser, slip-on adaptive clothing. Avoid zippers in favor of large buttons and elastic waistbands.

Update the computer. Add an ergonomic keyboard or try a table or touchscreen monitor for easier mousing and keyboarding. Easier yet, use voice dictation software whenever possible.

Add smart home features. Smart door locks with a keypad, voice activation, or biometric identification (fingerprint) can take the place of keys. The need to pinch and turn small dials can be replaced by smart lights and a smart thermostat coordinated by voice assistants such as Amazon Alexa. There are even smart stoves and ovens that can be controlled by a smartphone app.

Consult an occupational therapist. A home visit can provide tailored strategies and tools based on individual needs.

With the right devices and support, your relative can have a life that’s more manageable and less limited.

Does the person you care for have arthritis?
This disabling condition can make independent living painful and discouraging. As the San Francisco experts in family caregiving, we at Compassionate Community Care understand how arthritis can transform simple tasks into significant challenges. We have many practical ideas for addressing the limitations of this disease. Give us a call at (415) 921-5038.

If you are caring for a relative with serious health problems, you are probably in unfamiliar territory. For most of us, the shaky feelings of uncertainty are very unpleasant. We feel vulnerable outside our comfort zone. We worry we will do something wrong.

According to noted researcher Dr. Brené Brown, to protect ourselves we often turn to three strategies:

• Perfectionism. Believing that if we work hard enough, we can get it right.
• Future casting. Thinking about all the possibilities and things that could go wrong.
• Numbing. Pushing our feelings down and aside.

Although these strategies might help short circuit the discomfort of vulnerability, Dr. Brown warns that they also rob our lives of meaning. When we are vulnerable, we are emotionally exposed. This type of openness is frequently the springboard to life’s most meaningful moments: Changing careers, falling in love. In the context of family caregiving, it might be starting a difficult family conversation or caring for a relative in their last few weeks of life.

It is when we take risks and navigate terrain outside our comfort zone that we experience courage, growth, creativity, joy, and self-esteem.

Here are tips for embracing vulnerability as a family caregiver and getting to the other side:

• When you feel shaky inside, pause, take a breath. Consciously remind yourself that none of us is perfect. You are not alone. We are all worthy. All you can realistically ask of yourself is to show up and do your best.
• Consider feelings of uncertainty as an opportunity rather than a threat. Think of one step you can take. Something that feels a bit risky but not overwhelming. Maybe ask a question or ask for help. Or allow something to be done “well enough” rather than strive for perfection.
• Give yourself mental accolades when you have faced your fear. Many caregivers, in hindsight, take pride in the ways they had to grow to meet the challenges of caregiving. It takes courage to be open to change. Let it sink in that you have this capacity. And then take your next risk!

Are you caring for someone who is seriously ill?
That can be challenging indeed. You don’t have to do it alone. As the San Francisco experts in family caregiving, this is very familiar territory for us. We at Compassionate Community Care can walk beside you with education and support for those areas that feel daunting. Give us a call at (415) 921-5038.

Inflammation is the way the immune system attacks bacteria, viruses, and any perceived foreign agent in the body. It’s crucial when we need it! Think of inflammation as sending soldiers onto a battlefield. You need to fight the invaders, but also clean up afterward so life can get back to normal. As we age, our body’s ability to shut down an attack gets compromised. We don’t fight the battle as well. That means the inflammation doesn’t resolve. The body has not cleared out dead cells and other debris from the fight so new tissue can be rebuilt. Without resolution, the immune response keeps going. It’s harder for other cells to return to normal function.

To reduce chronic inflammation. The first step is to quit activities that provoke inflammatory response. Smoking and alcohol consumption, for instance, create unnecessary threats. Stress reduction techniques such as yoga or mindfulness contribute to health because they reduce the signals that the body is under attack. Weight loss is often recommended because fat cells produce cytokines, some of the warrior cells of inflammation.

Actions to support resolution (the cleanup)

• At least moderate activity 30 minutes a day, five days a week, helps flush the system and enhances DNA repair.
• Seven to eight hours of sleep a night gives the brain the down time it needs to tidy up and remove dead cells and the byproducts of inflammation.

Anti-inflammatory diet. While dietary changes may not eliminate chronic inflammation by themselves, they do support a healthy, resilient immune system.

• Avoid these foods. They tend to promote an inflammatory response. Trans fats. Fried foods. Sugary drinks or foods. White bread and pastries. Cured meats with nitrates (deli meats, hot dogs). All highly processed foods.
• Eat lots of these foods. They help get rid of dead cells and debris. Whole grains. High-fiber vegetables such as kale, spinach, and broccoli. Legumes such as beans and lentils. Anti-oxidant fruits such as blueberries, strawberries, and cherries. Fatty fish such as salmon and sardines. Nuts and seeds. Good fats from olives, olive oil, and avocados.

The Mediterranean diet and the DASH diet are examples of dietary practices that help reduce inflammation.

Are you concerned about chronic inflammation?
If your loved one has signs of or conditions linked to chronic inflammation (cancer, heart disease, dementia, diabetes, arthritis, autoimmune diseases), it’s wise to consider lifestyle changes. As the San Francisco experts in family caregiving, we at Compassionate Community Care know that isn’t easy. Give us a call at (415) 921-5038.

While older adults make up roughly 17% of the population, they constitute 22% of deaths by suicide. There are many reasons older adults might lean toward death: Poor health, chronic pain, loss of a spouse, loneliness, departure from working life, loss of independence, cognitive impairment. 

Warning signs. Any mention of wanting to die should be taken seriously. Also watch for depression. Withdrawal from social activities. Expressions of hopelessness (“Why bother?”) or worthlessness (“I’m just a burden”). Increased use of alcohol or drugs. Poor self-care and hygiene. Giving away belongings. Hurriedly changing a will or trust.

What you can do

• Ask if they are considering suicide. Asking will not prompt them to act. By asking, you demonstrate that they matter. Talk with them. Acknowledge their emotional pain. Find out more about their issues.
• Keep them safe. Ask if they have a plan. Do they have a timetable? Do they have access to their planned method? The more detailed the plan, the more likely they are to act. Ask them to promise you they won’t do anything for 24 hours.
• Be present. Gently ask how you might help. If you can ask them in person, great. If not, video conferencing and phone calls let them know they aren’t alone. Don’t promise things you cannot do.
• Assemble support. You can text or call the 24-hour Suicide & Crisis Lifeline at 988 to get advice. Also, help your relative identify others they can reach out to (a friend, counselor or faith leader, or the 988 Lifeline). The Suicide & Crisis Lifeline does not automatically send out first responders. They assess the urgency of the situation and work to diffuse the pain.
• Follow up. Call your loved one the next day to see how they are doing. Implement the suggestions of the 988 professionals. Encourage your relative to get professional support.

Are you worried about an older adult?
Let us support you. As the San Francisco experts in family caregiving, we at Compassionate Community Care understand how scary the prospect of suicide can be. You don’t have to do this alone. Give us a call at (415) 921-5038.

The original idea of “assisted living” was to give generally healthy elders a social option to offset the isolation of living alone. They were not intended to be medical facilities.

But things have changed in the 40 years since inception! Now, 41% of residents have dementia or moderate-to-severe cognitive impairment. One out of ten has a serious mental illness. More than half are 85 or older.

Assisted living communities are also experiencing staff shortages and high turnover. With a needier population, employees need far more specialized training than they did in the past. For dementia care, certainly. Also for infection control, as came to light during the pandemic. And end-of-life care. It’s hard to know which communities have adequately trained staff. 

Choosing an assisted living facility. If an assisted living facility seems like a good fit for your relative, your next step may be a Google search for available options. Placement agencies will offer “free” referrals. These agencies receive a fee from the facilities for bringing in a new client. They may only show you those that provide the highest fee. For objective recommendations, hire a Care Manager. They will assess your relative and give you suggestions based on the support your loved one requires and the facilities best suited to meet those needs. Also the ones with the lowest staff turnover and those that fit your budget.

When you tour a facility, be sure to talk to the frontline staff. Ask how long they’ve worked there and what they like about their jobs. Also ask about staff training offered through the facility. Look for clues in their body language that suggest their level of comfort about speaking freely.

Recognize that this may not be your relative’s last move. The median stay is 22 months. About 60% of residents leave to go to nursing homes. Others move in with family or move to a different facility.

Considering an assisted living community for your loved one?
Give us a call at (415) 921-5038. As the San Francisco experts in family caregiving, we at Compassionate Community Care understand what’s important to families. We know the local facilities very well—which ones have the best reputation and which have staffing problems.

We all need hope. It motivates us to get up in the morning and get going on the day. It makes our burdens less tiring. It’s even been documented to reduce anxiety and depression while improving health and quality of life.

Hope is not a blind conviction that everything will be okay.

Hope involves a process (often internal, unconscious). Hope requires having a goal, having options for achieving the goal (pathways), and believing in one’s ability to take meaningful action.

Hope is generally possible, but it may not be everything you want.

Hope for a cure in a cancer situation, for example, is a natural desire. But it’s not a hope you can make come true. Instead, convert it to something you can affect, such as having hope to make the treatment as easy as possible. Does your loved one have a hard time with chemo? Here you do have many options:

• Learn about the side effects.
• Be ready with remedies for nausea.
• Pick the best time of day for treatment.
• Find the easiest transportation there and back.
• Simplify daily activities and be patient if your relative struggles with the fog of “chemo brain.”

If you find yourself losing hope, examine what you are hoping for. Is it something you can influence? If not, revise your hope to something more within your ability to change. And if everything seems outside your reach—which happens often in caregiving—then make sure there is some other part of your life where you can achieve a desired goal. Make a plan and follow it so you can feel that at least one area of your life is under your control.

Does hope feel elusive?
You are not alone. As the San Francisco experts in family caregiving, we at Compassionate Community Care know how important hope is for keeping your spirits up. How tiring it can be when you feel hope fading. Let us help you bring realistic hope into your life. Give us a call at (415) 921-5038.