Thursday

Is It Another 'Senior Moment' Or Is It Alzheimers?

Using Our Brains

By Kate McGahan LMSW

How often we are reminded that schools teach reading, writing and arithmetic, but not the lessons of the pure applications of life. They don’t teach us how to love, only that we love. They don’t teach us how to remember, just that we remember.

As we age, everything we have ever been creates an evolving identity of who we are, complete with our memories of the past, our place in the present and our hopes for the future. When we lose our connection to our past due to significant memory loss, we lose sight of everything we are. Our memory is essential to our growth as a person, as a family member and as a productive member of society.

“Uh oh,” we think “am I losing my mind? Is it Alzheimer’s?” when we forget a name or maybe a face. We prematurely experience what is called a “senior moment” or we become the butt of an old age joke. We remove the cold morning coffee from the microwave, forgotten in our mad rush to locate our keys. Where do we draw the line between mere forgetfulness and the problems that are the result of Alzheimer’s and other such disorders?

Every passing second of our lives we are receiving and transmitting information. The satisfied look of our golf partner, the disapproval of our boss, the ray of sunshine streaming through the window or a bird on the wing...the blare of the muffler that needs replacing, the roar of the alarm clock or the sweet sound of a symphony...the smell of your father’s aftershave or the feel of silk pajamas against your skin. Every sight, sound, smell, touch and taste is recorded in our phenomenal record-keeping center called the brain.




Every single experience has the potential of causing a physical neurological change in our brain. To this we owe the great success of music, art and aromatherapy to name a few. Every single message received by our senses goes through an intricate system of procedures. When we learn something or experience something, that “something” enters into a process that will file it according to what we will need it for. In other words, every experience will enter the brain, which will then decide if it should go to the short term memory, the long term memory, some storage area in between (a “recycle bin” of sorts, to be retrieved if necessary) or if it will be expelled as nonessential information.

It is our natural state to sort and file. A healthy brain does this flawlessly. Problems related to memory loss are not a natural state that comes with aging. It is said that we have 90 or so billion neurons and that with age they decrease in number. Neurons are naturally depleted with age by possibly a billion or so... hardly enough to affect our lifestyle.

What gets in the way? No matter what our age, we are affected by stress and anxiety, lack of sleep, malnutrition, overwork, hormonal changes and more. Exposure to influences such as drugs, alcohol, electromagnetic fields, medical illness and traumatic events can dramatically affect our memory storage and retrieval system.

Other than avoiding exposure to such things, what do we do to keep our memories on track?

1) The old standbys of eating right, getting enough sleep and exercise and trying to decrease stress is a good start.

2) Take some time to discover the growing industry of memory “wellness”. Hundreds of books, websites, school programs and courses are designed to help people to learn ways to adapt, compensate for and prevent forgetfulness. An array of alternative medicine remedies such as ginko biloba, vitamin E, lecithin and vitamin B12 are being professed as playing a part in winning the memory loss game.

3) Everything you experience, to a greater or lesser degree, creates a physical change in the brain. If you have had a negative experience in the past, don’t hang onto it -- because it will continue to affect you in negative ways.

4) Be sure you are doing the work you love and that you surround yourself with people who are supportive and nurturing rather than those who are critical or judgmental. You will absorb whatever others have to offer you – positive or negative.





5) Surround yourself with an aesthetically pleasing environment. Colors, sounds, textures, light can all have an impact on your sense of well being.

6) “Use it!” Don’t just play the memory games and take memory classes. It’s the things that you learn that you incorporate into your “being” that have the most profound affect on your memory. It’s looking at life in a whole new way, or looking at yourself with a new attitude. It’s having that internal light bulb go on that say’s ‘Wow, I never thought of it that way before.’ It’s the things that encourage you to take off the old shoe in exchange for new ways of doing and perceiving. It’s living in the moment. The positive experiences that stretch your creativity, your passions and your feelings will create an atmosphere in your brain conducive to optimal memory and cognitive health.

In a June 13, 2000 TIME magazine article, George Johnson writes in regard to memory loss: “(Research has shown that) canaries create a new batch of neurons every time they learn a song, then slough them off when it’s time to change tunes.” Don’t be afraid to change your tune once in awhile; it may be just what you need.

7) Don’t worry about your forgetfulness unless it begins to impact your patterns of routine, your behavior or your overall functioning. Not being able to find your keys is one thing. Not being able to find your car, well, that may not be quite so bad either. Not being able to find your way home is another story.


8) If you feel that memory loss is impacting your life or the life of someone you care about, don’t hesitate to seek medical advice. Many people procrastinate because they “don’t want to know” that they have a cognitive disorder. The fact is there are 100 or more reversible conditions that could cause memory loss. The sooner you find out, the sooner you can realistically get back on track.

In the meantime, you can join the rest of us who question ourselves from time to time. Just don’t let it prevent you from allowing your brain to grow from the experience of living life fully.

...And if you can say “Wow, I never knew that” somewhere during the course of this article, my goal today has been accomplished.




Wednesday

A Final Gift

I suppose I have another book to write one of these days -- after I finish the one after the one after the one I am writing now. I worked many years doing hospice counseling and I could tell you some stories about the final hours and moments of life. One in particular I am thinking about.

She was younger -- late 50's. Loving husband. Devoted teenage kids. She had been battling breast cancer for 15 years. She was determined to the win the battle, but she was losing. The day she decided to go on hospice was the day she decided she would take no more treatments. She was tired. She only wanted comfort care. 

As her social worker, it was one of my goals to help her to find the peace in that decision. She was terrified of dying. With the support of the hospice team, she was able to come to terms with it as the end of her life on earth loomed closer and closer. 

I didn't know it would be my last visit, but it was. I entered her bedroom and she was in bed, surrounded by a dozen people who loved her. She was slipping in and out of consciousness. At one point she had her eyes closed, but her expression looked as if she was listening to someone who was teaching her something she had never known before. She was obviously amazed. Her forehead would frown and then raise in wonder and amazement. Over and over again.   

Then all of a sudden she went quiet. We all looked intently at her. We watched for her breath to come. It did. She slowly opened her heavy eyes, looking around the perimeter of her bed at each and every face that was looking back at her. No one said a word. 

"I am loved and protected," she said earnestly, dreamily. "Don't worry about me. I am in safe hands." She closed her eyes and she was gone. 

Gone From Our Sight. 

Click here to view our "Gone From Your Sight" video 


Sunday

When Someone You Love Is Dying

In my years as care manager and hospice social worker I have met a surprising number of people who have had Near Death Experiences. Some have "seen the light", one saw no light at all but floated in the darkest darkness in the most comfortable and blissful state he had ever experienced. One in his late 50's, continues to rage that he had to return to his earthly existence. Ever since his revival he has had an explosive temper. They blame it on his brain injury. He blames it on having to leave the State of Heaven.

It is surprising to me that not all of these people had faith in a higher power or a belief in an Afterlife.

Death can be a frightening thing. As one dying client said anxiously, "I've never done this before." The first time doing anything is always scary. Try to rest assured that throughout the process of life through death, you will be Taken Care Of.

Have faith that even though you may be an Earthly Caregiver for someone you love, there is Something Greater ready to take over when your loved one leaves.

There is a reason we typically enter this world crying and leave this world smiling.

Faith, Dear Ones.



Tuesday

What you need to know about Medicaid Eligibility

What You Need to Know About Medicaid Eligibility

By Kate McGahan

(Remember laws can vary from State to State and from year to year! Be sure to
check with an informed attorney, geriatric care manager or Medicaid or other informed human service representative to see how Medicaid rules apply to your individual situation.)

There are strict guidelines for Medicaid eligibility and the rules vary from state to state. If your income, resources and expenses fall within the Medicaid guidelines, you will be eligible for Medicaid assistance. A very important aspect of the Medicaid process is the determination of your ongoing medical and health care expenses as they relate to your income level. After all, the reason you are applying for Medicaid is because your medical expenses outweigh your ability to pay for them.

You will need to verify the extent of your medical expenses as well as account for your income and assets. If your income is too high, you may be eligible if your medical bills, when subtracted from your income, bring you below the eligibility levels needed to qualify. The process of subtracting your medical bills from your income to become eligible for Medicaid is called a "spend down".

If you have excess resources, you must also "spend down" to qualify for Medicaid.
Usually assets include anything that can be converted to cash such as real estate,
automobiles, IRAs, stocks, bonds, and bank checking and savings accounts. If your
countable resources are over allowable limits, you can spend them down to the
required level and then become eligible for Medicaid. You can reduce your cash resources by paying off the mortgage, buying a new car, making home improvements, prepaying taxes and utilities, or paying family members to provide you with home care and other services. This is a good time to prepay your burial expenses in the form of an Irrevocable Trust Agreement. You might also cash in a savings account and pay
off the mortgage or to make a home improvement. Always keep a complete record of disbursements; Medicaid may ask you to prove how you spent it.

If you need Medicaid assistance and you reside in your home or apartment, Medicaid will set up a budget for you based on your income and medical expenses. There are laws that protect you so that you should always be able to live within the budget that is designed for you. If your income is greater than Medicaid allows you to have to qualify, you can "spend down" your excess income on your medical care needs to "buy in" to the Medicaid program.

If you require care in a nursing home or residential care facility, Medicaid will set up a budget for you that will indicate the amount of your monthly income which will go towards paying your cost of care at the facility. Medicaid makes allowances for you to keep enough of your income to continue to pay your health insurance premiums
and provide you with a monthly personal allowance for special expenses such as
cable TV, hairdresser services and the newspaper. The remainder of your income is paid to the facility towards the monthly bill. Medicaid is then billed for the rest of your cost of care. Under certain circumstances, you may be able to keep your home as well as a home maintenance allowance if your doctor believes that you will be able to return home within 6 months. This means that Medicaid will allow you to continue to pay your home maintenance costs during your stay at the facility.

Many people are afraid that they will lose their home in the Medicaid process. Your
home can be protected for you so long as you reside there or have the potential to
return there after a period of rehabilitation in a residential care facility. If your
spouse, minor, blind or disabled child is living in the home or if an adult child, sibling or other relative was living with you for an extended period prior to application for Medicaid and has established residency at that address, your home may also be
exempt from consideration.

Your spouse is the only person whose income and assets are deemed to be available to you if you require long term care. For purposes of determining eligibility, your combined assets are totaled and then divided equally between you and your spouse.

Part of the Medicare Catastrophic Coverage Act of 1989 brought about the "spousal
impoverishment rule" which protects the rights of your healthy spouse. The rule
requires that the income and assets of the "at home spouse/community spouse" must
be taken into account when determining the eligibility of the spouse applying for
Medicaid. Your spouse can keep his or her own income and usually some portion of
your income to go towards maintaining his or her standard of living. This amount is
determined upon the state's limits and your spouse's needs.

Your spouse who remains at home can keep the home, car, personal belongings, half
of the assets up to a set amount (usually around $75,000+). Your spouse has appeal
rights if he or she believes that the resource allowance is so low it will cause a
hardship. Some states have a "Spousal Refusal" law which gives your spouse the
right to refuse to pay towards your cost of care.

If you have extensive health care needs, regardless of income, you may be eligible for what is known as a Medicaid waiver. This is a concept where certain regulations
regarding income are waived to allow eligibility for Medicaid to take place to
specifically cover those health care needs. Because the application process is a
complicated one, it is a good idea to contact an attorney, geriatric care manager or
agency adviser to help you with the process. Be sure to seek the advice of a professional familiar with Medicaid eligibility, the limitations of transfers and the right to retain income and assets. If there is a charge associated with the services and you have to spend down your resources to qualify, this is a smart way to do it. You may save a lot more in the process.

Boomers Need To Plan

By Kate McGahan MSW

They are called The Baby Boomers; The Sandwich Generation. They are the largest segment of our population and they were born between the years of 1946 and 1964. They have become the driving force of the marketplace and an issue of increasing magnitude for our society as a whole.

Greater longevity, lower mortality and diverse lifestyles are causing giant shifts in the demographics of our society. Some of us will spend as many years in retirement as we spent in our career. Some of us may spend as many years caring for our aging parents as we spent raising our children. Many of us will have the overwhelming task of caring for our children and our parents simultaneously.

Government has created new laws and has redefined the healthcare system in countless ways in an attempt to keep Social Security, Medicare, Medicaid and the taxpayers intact. Corporations now offer benefits such as Family Medical Leave and employee assistance programs which specifically address eldercare issues. Individually tailored work programs and pension plans offer increased flexibility to workers. More and more companies offer Long Term Care insurance as an employee benefit.

The year 2011 is the year the first born Baby Boomer will reach retirement age. Our government anticipates its approach, our employers are addressing the potential effects it will have on workers, and our communities are building the momentum to equip society with the programs that will help meet the needs of an aging population. Aging is inevitable. It is not something we like to think about, but loss or disability is certain to be an issue for each and every one of us. What have you done on a personal level to prepare for your aging and that of your family?

Creating and implementing a personal long term care plan is essential. It is not unlike creating and implementing a business plan. It has to do with identifying areas of need and weakness, creating a strategic action plan to meet those needs and deciding how to finance the whole operation. It is about hoping for the best and planning for the worst. People who see themselves as having an element of control always feel more secure and therefore are more resilient when changes take place. The primary purpose of the long term care plan is to ensure that an element of control always exists, no matter what happens. It is a planning tool as well as a communication tool.

Maslow's Hierarchy

There are six basic elderplanning areas that should be addressed in your long term care plan.
Medical: Preserving your health and wellness comes first and foremost. Be sure to have a trusted physician and a solid health insurance plan that meets your specific needs and preferences. Be accountable for learning and understanding the issues at hand so that you can take an active role in your own medical care.

Psychiatric: Have a plan for coping with the possibility of mental health issues such as clinical depression or substance abuse and addictions. Address competency and treatment issues and develop an awareness of support and treatment programs available to you. Take care of your ongoing emotional health as a preventive measure.

Physical: Be aware of options related to home safety, accessibility and residential and retirement living. Home safety is crucial to preserving ongoing independence. Accessibility experts can help to modify existing homes to accommodate disabilities. Creative residential options such as continuing care communities and special needs programs are regularly being developed to meet the needs of those who cannot or who choose not to stay home.

Legal & Financial: Legal and financial independence results from your ability to create a realistic plan related to your retirement goals and your preferences regarding medical treatment and long term care. This involves choreographing investments, your insurance portfolio, taxes, trusts, and your estate to work together to meet your projected retirement needs.

Social: This encompasses your hobbies, diversional pursuits and areas of passion and productivity. It is about connecting with others: family, friends, neighbors and community. It is about preserving individuality, complete with cultural and ethnic traditions. It is about learning and growing, no matter what age you happen to be.

Spiritual: This addresses the ongoing development of your understanding of what is important in life. This is the area where faith, hope and charity reside. It is where knowledge and forgiveness take place in the depths of your heart.

Involve a team of professionals to help you implement your long term care plan. This team should consist of a physician, an attorney, a financial planner and a geriatric care manager who can help you to pull the entire plan together. Your advisers will become an important part of the foundation that will help you to feel more secure and confident in facing the days and years ahead.