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.

As a family caregiver, you have probably thought a lot about your loved one’s safety. Perhaps you have even purchased a wearable call button for medical emergencies.

But what if something happens to you? For instance, a car accident on the freeway? Or a trip-and-fall incident in a parking lot? How will emergency responders know that someone is depending on you for their health and safety?

A caregiver wallet card or bracelet provides a solution. A wallet card is something you can make at home. It can include more information than a bracelet. But it must be with you at the time of the critical incident. (Did you bring your wallet with you on your walk this morning?) An ID bracelet or necklace, on the other hand, can be worn all the time.

Information to include. At a minimum, your ID should state: “I am a caregiver. ICE, call [name, phone number].” “ICE” is short for “in case of emergency.” The idea is that this ID includes the name and phone number of an alternate caregiver who can step in. Of course, let your alternate know they are your backup and may get a call.

A more complete ID provides additional information:

• I, [your name], care for my [mother/father/aunt/spouse, etc.],
• [name of person you care for].
• Please call [name of alternative caregiver] at [phone number] to take care of him/her.

You might also identify your relative’s most critical medical need. For instance, specifying if they are an insulin-dependent diabetic, or have dementia, or are wheelchair bound.

Ideally, your relative might wear a similar ID bracelet or have a wallet card. This one would list their name and immediate medical needs. It would also list you as the first contact and an alternate if there is room.

Are you prepared if something happened to you?
Your support is critical to your loved one’s well-being. We can help. As the San Francisco experts in family caregiving, we at Compassionate Community Care have thought of all the potential problems and contingencies. You don’t have to do this alone. Give us a call at (415) 921-5038.

If the person you care for has generally good balance and needs just minimal support for getting around, a rollator (walker with wheels and brakes) might be preferable to a standard walker. Rollators enable a more normal, fluid stride. The features to consider start with size, weight, and foldability. If the rollator will be used outside the house, it must fit in the trunk of the car or behind the passenger seat. Is it light enough for your relative to lift themselves? Does it fold easily and to a workable size?

Another issue is the number of wheels and wheel size. The three-wheeled models are narrower and more maneuverable. This makes them ideal for indoors. Outdoors, wheel size is important. Small wheels don’t handle uneven paving very well (e.g., a sidewalk buckled by tree roots). A rollator with four large, fat wheels is less likely to abruptly halt or tip over.

Brakes are another concern. Will your loved one be walking up or down hills (even across the slope of driveways)? Most braking systems involve a hand grip that pushes a wedge into the tire, producing a quick stop. For downhill slopes, you want a larger brake that compresses a large part of the wheel and allows for a more gradual slow down.

Accessories are an important part of rollators. Does your relative need a seat, for instance? If so, is the seat for short rests, or would your loved one sit in the walker for a few hours at a time? If the latter, look for a seat with good cushioning. Other accessories often revolve around using the walker to carry items. Would a simple bag or a basket do? Is a cup holder needed? Or a tray for transporting a plate or bowl from the microwave to the dining table?

Some people get two rollators:

• For home. A three-wheeler with 6″ tires, wedge brakes, a hard seat (or no seat), and desired accessories. It can be heavier (20–24 pounds). Size and flexibility don’t matter.
• For outdoor uses. A three- or four-wheeler. Lightweight for lifting (13–15 pounds) and collapsible to fit easily into the car. Most important, you want large tires (8–10″) for safe walking on uneven surfaces. Wide tires and compression brakes reduce the chance of tipping or having the rollator go too quickly down a slope or driveway. A cushy seat may be the most essential accessory.

Consult with a Care Manager to find a physical therapist who can fit the rollator to your loved one’s size, weight, and needs.

Are you concerned about a loved one’s mobility?
As the San Francisco experts in family caregiving, we at Compassionate Community Care notice that a rollator can open up new options that are too difficult with just a standard walker. For these and other eldercare tips, give us a call at (415) 921-5038. You don’t have to do this alone.

The ability to handle one’s own financial affairs is critical to adult independence. Low vision challenges this freedom.

Fortunately, most banks are prepared to assist clients, whether banking online or in person. Online, your loved one can adjust the bank’s website for large print. Plus, many banks provide instructions on how to use a screen reader. Banks can also issue large-print checks and monthly statements in large print, braille, or audio versions. Some banks now have audio-accessible ATMs (and braille keyboards). By inserting a headphone jack, the ATM switches to audio mode. Consider a check template (like a stencil) for your relative, indicating where to write the date, payee, dollar amount, and signature.

To support your relative in storing and spending cash, look for a “low-vision wallet” with multiple compartments that facilitate storage by denomination. Folding bills will help your relative quickly identify what’s in their wallet. Keep ones flat. Fold fives in half to make something of a square. Fold tens in half lengthwise to make a skinny rectangle. Fold twenties twice to make a rectangle one-fourth the size of a normal bill.

To identify American bills, the Bureau of Engraving and Printing—the division in charge of printing money—created a free app, “EyeNote®” It scans bills and speaks the dollar value. Or when set in privacy mode, it pulses the value with vibrations or beeps. (One dollar is one pulse, two dollars is two pulses, five is three, ten is four, twenty is five ….)

When receiving money at the bank, have your loved one ask for bills all in one denomination, such as all tens. Or ask the teller to count them out in denominations (all the twenties together, all the tens together, all the fives …). This helps for storing and then folding appropriately when at home.

Are you concerned about a loved one with low vision?
As the San Francisco experts in family caregiving, we at Compassionate Community Care understand how important it is for visually impaired adults to maintain control of their money. There are support services, apps, and devices to help. Give us a call at (415) 921-5038. You don’t have to do this alone.

Has your loved one ever flatly rejected your perfectly sensible solution to their problem?

Though your idea may seem like the obvious route to take, it’s not so simple when you’re caring for an older adult. Your relative has had a lifetime of making decisions on their own. They usually want to continue doing so.

If you are having trouble agreeing, start with one simple principle:

Take your eye off the goal. Focus on the process instead.

We all want to be treated like people rather than like a project in need of completion. Much as you are concerned about the urgency of change, ask yourself if it’s really worth jeopardizing the trust and long-term communication you share with your relative.

• Involve the person you care for in decision making (assuming they do not have dementia). Do what you can to suggest a range of options so your loved one retains as much control as possible.
• Resist the allure of efficiency. Think in terms of teamwork. Coach yourself that the winning game plan is to go slow and steady. Sure, you could pick out an assisted living facility in a week. But without your relative’s buy-in, you likely won’t get cooperation for the move-in! Embrace compromise. Even if the pace seems too slow and the solutions are not ideal, it’s still progress.
• Honor their feelings. Aging involves so many losses. Acknowledge these losses during a private conversation. “Gosh, Dad, I can tell this is hard to swallow. What can we do to make it easier?” Your goal isn’t to become your parent’s therapist. But sometimes a demonstration of empathy is just what’s needed to melt resistance.
• Give it time. Make your suggestion and if you get resistance, let it rest for a while. Hammering on your points could easily prompt your loved one to become more entrenched. Let the idea percolate. After some time and reflection, your relative may find ways to make the idea their own.

If it truly is an emergency. It’s hard to watch parents struggling. We want to short circuit their distress or immediately reduce their exposure to hazards. But what seems urgent to us may not be to them. (And unless they are legally deemed incompetent, they have the right to make unwise decisions.) The threat to your relationship because you steamrolled an idea cannot be underestimated. If you truly think an urgent change is needed, get a second opinion from a professional. A physician. A Care Manager. Someone with training and experience in eldercare. They can give you an objective sense of how quickly action needs to be taken.

Are you worried about an aging parent?
We can help! As the San Francisco experts in family caregiving, we at Compassionate Community Care have a lot of experience working with families that are in the same situation: Kids see a definite problem and the older adult does not. Give us a call at (415) 921-5038. You don’t have to do this alone.

Don’t you just somehow feel better when you laugh? It turns out, that’s not just fantasy.

Laughter has physical and emotional health benefits.

Studies show that laughter can

• support the heart. If we’re laughing, we’re not stressing. The stress hormones make chronic inflammation worse and threaten the heart. Laughter stimulates your heart and lungs in good ways, bringing oxygen and reducing the stress response.
• relax muscles. Good, deep breathing is part of laughing. It stimulates oxygen flow to the muscles and triggers muscle relaxation.
• lessen pain. The body’s natural pain-relieving hormones, the endorphins, are released when we laugh.
• boost immunity. Laughter helps combat infections and other diseases by releasing neuropeptides that help fight stress and potentially more-serious illnesses.
• ease mood. Laughter is emotionally distracting. It can interrupt the blues or anxiety and cast everything in a new light.
• increase self-esteem. It’s easy as a caregiver to feel at the mercy of many forces and to feel like you can’t do enough. Laughter helps counteract feelings of low self-worth.

Want more laughter in your life?

• Read children’s books. They are often silly (Amelia Bedelia, anyone?). Ask a librarian for recommendations. The illustrations alone may bring a chuckle.
• Look for humorous gift cards at the store. Maybe even buy one to put on your refrigerator. In a couple of weeks, send it to a friend, and give yourself a new one!
• Play with a pet. If you don’t have a pet, find out if there’s a dog park nearby and go watch. Dogs are naturally joyful.
• Spend time with funny people. Some people have a knack for finding the humor in things. Laughter is contagious. You may even learn to laugh more at yourself!
• Choose comedy. When you’re selecting a movie to watch or a screensaver for your computer, look for something funny. Consider humorous podcasts. Visit joke websites or buy a joke book to add some humor to your conversations with others.
• Make silly happen at home. Dress your toast with raisin eyes and jelly mouth. Wear goofy socks. Play a game with friends.

Or just plain start laughing. Whether you’re laughing at someone’s joke or laughing for no reason at all, your body responds the same. Some people enjoy going to “laughter yoga” sessions where the point is to laugh in a group. It’s contagious!

Laughter is good medicine. And it’s free!

Are things getting too serious at your house?
Consider injecting more humor in your life. As the San Francisco experts in family caregiving, we at Compassionate Community Care know how big the stakes are when caring for an ailing family member. Still, laughter can ease the stress and doesn’t take away from your vigilance. It’s just one more tool in your toolkit to help you avoid burnout and continue the important work you do for as long as you are needed to do it. You don’t have to do this alone. Give us a call at (415) 921-5038.

When your loved one is hospitalized, getting word of discharge “soon” can be heartening: Yay! Improvement! And it also can be distressing. Many aspects of care may drop into your hands. Mobility, incontinence, wound care, oxygen…. And you may not have the needed help lined up.

Good news: There are options. Tell the doctor and the hospital discharge planner immediately of your concerns. According to Medicare regulations, they are required to work with whoever is the “family caregiver” to come up with a safe and appropriate plan.

The hospital may pressure you. (They get paid a fixed fee, so the earlier the discharge, the more money they make.) Your relative may pressure you, too. Ask the hospital for the reasoning behind the discharge plan. Stand your ground for a wise decision about timing and aftercare. If this seems daunting, consider the advocacy services of a Care Manager.

There is also a formal appeal process for discharge decisions, but timing is crucial.

• Upon admission, your relative should receive an “Important Message from Medicare.” Keep this paper. It lists the agency that handles discharge appeals. If you don’t receive this document, ask for it.
• Also upon admission, ask the case manager (aka, discharge planner) how long your relative will likely be staying and if they are officially “an inpatient” or just there for “observation.” The appeal process is only for patients who have been formally admitted.
• As soon as you have safety concerns about the discharge, alert the doctor and discharge planner.
• If the hospital persists with its discharge timetable, contact the reviewing agency immediately and ask for a “fast appeal.” You can ask for a fast appeal up to the day of discharge.

A review usually takes twenty-four to forty-eight hours. Medicare will continue to pay for your loved one’s hospital stay during the review (although the deductible and usual copays still apply).

Worried about potential after-hospital duties?
Give us a call at (415) 921-5038. As the San Francisco experts in family caregiving, we at Compassionate Community Care can help guide you through the process to figure out the best timing and combination of support services. You don’t have to do this alone.

Chronic inflammation occurs when the immune system doesn’t shut down properly. Instead, it attacks the body. This can last for months, even years. It’s like a persistent internal war. It puts the body under tremendous stress. There is growing evidence that chronic inflammation is involved with a number of problems common in aging. These include heart disease, some cancers, Alzheimer’s, and Parkinson’s. Also, bowel disorders, lung disorders, diabetes, depression, and several autoimmune conditions.

Most people don’t feel the symptoms of chronic inflammation directly. Instead, they discover it’s there when they delve into other health concerns, such as possible arthritis or unexplained weight gain or loss. Addressing chronic inflammation can ease the stress on the body and help slow the development of serious conditions.

Signs and symptoms. Because chronic inflammation can affect many body systems, you might want to talk with the doctor if your loved one is experiencing any of the following. (Yes, it’s a dauntingly broad list! But any combination of symptoms will help the doctor determine next steps):

• Joint or muscle pain and stiffness
• Fatigue and muscle weakness
• Gastrointestinal issues (diarrhea or constipation)
• Unexplained weight gain or loss
• Persistent infections
• Skin rashes
• Dry or gritty eyes
• Balance issues, especially when walking
• Insulin resistance (also known as “prediabetes” or “metabolic sy­­ndrome”)
• Depression, anxiety, or other mood disorders
• Brain fog

Getting tested. There is no one test for chronic inflammation. But there are a few blood tests that can indicate the level of generalized inflammation. C-reactive protein, sedimentation rate, and fibrinogen are the most common. Talk with the doctor. They may want to also order other tests to zero in on the particular system that appears to be under attack.

Are you concerned about chronic inflammation?
If the person you care for has any of these symptoms—and especially any of the associated conditions—talk with the doctor. As the San Francisco experts in family caregiving, we at Compassionate Community Care encourage you to be proactive. The earlier inflammation is tamed, the better for your loved one’s health. If you need a patient advocate, we can help. You don’t have to do this alone! Give us a call at (415) 921-5038.