Hospice Care

Dear Linda:
       As a result of multiple strokes, my 92-year-old father is in a long-term care facility suffering with various challenges. He's beginning to lose weight, sleep more, and talk less. When he does talk, it's clear that he's suffering with uncontrolled pain and depression. Should I be considering Hospice care?
Sadie in Fort Worth

Dear Sadie:

       The symptoms you describe are sometimes indicators of the beginning of the end, but no one has a crystal ball, and doctors will be the first to say so. All the family can do is ensure that their loved one's health and comfort is optimum.

       Hospice is an excellent program that is under-utilized and often called so late in the process that many beneficial services go unused. Though the purpose of Hospice is to provide compassionate support and extraordinary care for people in the final phase of a terminal disease, the program's goal is to enhance the quality of life regardless of its duration.

       Subscribing to a holistic approach, a Hospice team includes a medical director, physician, nurse, certified nurse assistants (CNAs), social worker, spiritual care coordinator, therapists and counselors. Volunteers provide companionship and emotional support to the patient and respite services for the patient's caregiver, including shopping, errands, childcare, and light meals.

       Begin with discussing your dad's condition with his doctor, who must certify to Hospice that he is no longer thriving or that his disease is terminal. Ask your physician to recommend the best Hospice provider or call the National Hospice Organization at 800-658-8898 or visit www.nhpco.org for valuable information and recommendations.

       Once a patient has been examined, records reviewed and medications evaluated, a care plan is developed. Then Hospice will provide all necessary equipment, supplies and medicines, whether the patient is at home or in a facility, and the cost is covered by Medicare, Medicaid or private insurance.

       The final phase of the journey need not be feared. With help and support, the last moments in our loved one's life can be peaceful and uplifting.

Giving Advice--Helpful or Hurtful

I’m struggling with knowing when to advise others or to keep my mouth closed. I know the best course of action is to wait until being asked before giving advice, but my dilemma with that wisdom, and I do believe it is wisdom, is what to do when the person making a mistake is unaware that they are doing so. Do I let them experience the consequences of their bad choices or try to help them avoid the inevitable pain?

The first difficulty with giving advice is presuming that we always know the best way…assuming there really is such a thing. If we realize that there are many paths to the right end, then we will take greater care in how we offer our solutions.

The second problem is that we don’t really know all the details of another person’s experience, so we should consider giving advice a great risk. If we don’t take great care, we can harm more than help.

And the third issue to consider is that the person may just want a listening ear and sympathy that comforts. Advice offered to a person in pain can be viewed as condescending and judgmental rather than helpful. We must also know that a person who is in pain can’t really hear what we’re saying anyway. You might have a chance at making an impact if you listen carefully to them first.

Author Uzi Weingarten has determined three simple steps for handling giving advice that I like very much:

1. Listen first. While this rule is true for all good communication, it is doubly true when we wish to give advice. Issues are often more complex than they initially appear. By first listening, we open a space for the speaker to more fully describe the situation and for us to more fully understand it. What is the point of offering advice based on partial information?

In addition, when we listen first, it makes it more likely that the other will then listen to what we have to say. In the words of Dr. Marshall Rosenberg, one needs “connection before correction.” It is empathic listening that establishes the connection.

2. Ask permission. Unsolicited advice is a major cause of grief among friends and family members. It can be experienced as unwelcome intrusion into personal business. It might also be seen disrespectful, as implying that a person is incapable of caring for himself and resolving his own issues.

Asking if our advice is desired shows respect for others and prevents resentments. Here is one way to do this: “As I listen to you, there are some ideas coming up for me that you might find useful. Would you like to hear them?” It is very important to ask that question without attachment, from a place that both “yes” and “no” are equally acceptable responses.

3. Offer without insisting. It is worth keeping in mind that even after we have listened, we can never know with certainty what is best for another person. There is so much that we are not aware of. So we should offer our insights, experiences and ideas, with the attitude that our advice is another point of view, and then we must trust the listener’s inner wisdom to discern what is right for him or her.”

Perhaps the most important thing for us to remember is that people need validation far more than correction, empathy more than solutions, and though I understand this all too well intellectually, emotionally I still feel the need to help. It is the way I show my love, and it is very much my personality to solve problems. So…I too must keep asking myself if, barring criminal acts, is there really anything that can’t be corrected with time?

If we shower the person we hope to help with love and sympathy, perhaps they will then be willing and more able to hear what can only be a suggestion that you have that may or may not be right for them.

That's my best advice on the subject. See...I just can't help myself!

Be Thankful for Friends

We will soon celebrate the Thanksgiving holiday. Besides turkey, all the fixings and my son's favorite chocolate mousse cake for dessert, my family has a tradition before eating. We pray and then share what we're most grateful for.

I took some time and thought about what else I had to be thankful for besides my family. I have a home that is lovely and a comfort to live in and share with others. I have work that I love and is a way to give back, and I have the physical health and financial security enough to allow me to live a full life. That's a lot to have, and I am truly grateful.

The most important thing to have though, as we grow older, is friends. As many of you have experienced: husbands come and go, children leave and forge their own lives, and even the most fulfilling work meets only some needs, but friends....ah, they can be the mainstay of our lives.

My oldest and very best friend of 42 years has been one of the most important constants in my life. Though she does not live close by, we talk weekly for several hours. She is the one person who knows all—the  good, the bad and the ugly, and she loves me anyway, and the reverse is true.

We have a relationship that allows telling each other the hard truth when it's been necessary, sharing in each others hardships, and earnestly cheering on the successes. It's a rare gift to have a friend such as this. Most of us can count on only one hand how often that type of relationship comes into our lives, and I am grateful to be one of them.

I am also grateful for my other girlfriends. Some I relate to often and others I see periodically, but all offer help, wisdom and laughter whenever I need it. As we grow older, it is critical to have a circle of friends on whom we can depend for these things, but, also as we grow older, having that becomes more and more difficult.

Friends we made when our kids had common activities often disappear when the activity stops. Friends move to other areas. Some of my very best friends live all over the country now, and sometimes friends are only that for a certain season in our life, and, for various reasons, the relationship stops, as sad as that can often be.

Forging and maintaining new relationships takes time and work, and often we don't have that time or the energy to do what it takes, especially when isolation is so much easier. This is dangerous thinking though especially as we grow older. It leads to fear, loneliness and depression. 

What should you do about it? 

Become a joiner: Bible study at church, the rotary if you've worked, the toastmasters group if you like speaking and listening to others, a book club if you like to read, or a social or dance group.

Don't stop learning: take classes at the college (they're often free to the older generations), learn a new craft, or take lessons in something you've always wanted to try. They say now that avoiding dementia and Alzheimer’s is as a result of learning new things. That’s what keeps the brain younger.

Make sure you have some fun: start a card group, a dinner club that forces your friends to gather regularly, and have movie parties. Don't watch your new video alone. Ask friends over, make some popcorn, and share the tears or laughter.

It doesn't take a lot of time to organize these moments, and maybe you'll be the only one of your friends who will. Don't worry about that. The dividends to you will be too great to wonder why you're the social director in your life. 

 

Ageism in the Workplace

Dear Linda:
 
My mother is 58, has worked at her company for 18 years, and had been promoted regularly throughout her tenure. Lately, promotions to which she was entitled were given to younger workers, often less qualified. We think it’s ageism. What are our options? 

Joan’s son

Dear Son:
 
Ageism is a bias against someone because of their age. If that bias impacts how an employee is treated, the employer has broken the law. The Age Discrimination in Employment Act (ADEA) protects applicants and employees who are 40-70 years old from employment discrimination based on age with respect to hiring, firing, promotion, layoff, compensation, benefits, job assignments, training, terms, and conditions. The ADEA applies to employers with 20 or more employees, to employment agencies and labor organizations, and to the federal government.
      
Despite the law, however, ageism has increased from 6-to-8% for workers overall, and from 11-to-16%  for workers 65 years and older according to the National Social and Quality of Employment Survey. Because firms are 40% more likely to interview younger applicants, 63% of senior applicants said they’d hide their age and 18% said they’d have plastic surgery before applying.
     
In the past two years, the U.S. Equal Employment Opportunity Commission (EEOC) has received more than 20,000 complaints of ageism. That number will grow dramatically as Americans, 65 and older, double in population to 70 million over the next three decades, and those over 85 (the fastest growing segment of the population) will surge from 4-19 million.
      
Though millions of dollars have been paid in settlements, attorneys say discrimination is difficult to prove. Only 1/7 of the cases have benefited the complainant thus far.
      
The International Longevity Center (ILC), administrated by Dr. Robert N. Butler, who coined the term ageism in 1968, is publishing a detailed study in February, 2006. Visit www.ilcusa.org or call 212-288-1468 for information.
      
Read The Older Job Hunter’s Guerilla Handbook by Gunthar Manusson for how to combat ageism, and contact the EEOC at 800-669-4000 to report cases.

Dementia

Dear Linda:
       My mother repeats stories, gets lost in familiar places, forgets to eat and bathe, and is often disoriented. I don’t know if she has dementia or Alzheimer’s. Can you explain the difference?
Confused Daughter


Dear Daughter:

       The classic symptoms of dementia include the ones you’ve identified and also impaired judgment, behavioral problems, mood swings, and difficulty with language and abstract thinking. Caused by changes in brain function in those over 65 years old, dementia (nerve cell mutation or destruction) affects a person’s ability to do Activities of Daily Living (ADL’s).

       The two most common types of dementia are Multi-infarct (vascular dementia caused by stroke) and Alzheimer’s (progressive disease destroying communication pathways). Neither condition is curable. Of those with vascular dementia, about half also have Alzheimer’s disease. Several drugs are effective in slowing symptoms of Alzheimer’s disease and in reducing associated anxiety, depression or problems with sleeping. With Multi-infarct dementia patients, physicians often prescribe medication to control blood pressure and prevent new strokes.

       Dementia is caused by many conditions. Some are treatable: high fever and dehydration, poor nutrition and vitamin deficiency, head trauma, medication reactions, and problems with thyroid gland. Seek diagnosis and treatment options.

       Emotional problems can be mistaken for dementia. Seniors face the loss of work, family and friends, and physical wellness. Adapting to these changes and resulting emotions—anger, sadness, loneliness, worry and boredom—can result in being confused and forgetful. These problems can be eased by supportive friends and family, a professional counselor, and appropriate medication.

       A physician can conduct a thorough physical examination (blood and urine tests), can assess medical history, prescription use and diet, and may recommend a neurological and/OR psychiatric evaluation. A CT scan may be ordered to rule out a curable disease and identify brain changes.

       Delay disease onset by keeping the mind sharp. Keep working or volunteer after retirement, stay involved in stimulating interests, maintain physical fitness and a positive attitude.

       Visit www.dementia.com and contact the the Alzheimer’s Association at 800-272-3900 or www.alz.org for more information and critical support services. 

65 Ways to Save Money

General Finances:

1.    Have a budget, review it often and live within it – www.spannet.com / www.credit.com

2.    Use a credit card with no annual fee to make all your purchases. It allows you to contest a charge, to track your spending, and to enroll in program that will credit you with airline mileage or refund money back to you. But you must  pay the bill off fully each month to avoid interest charges.  I was so emphatic about this rule that one of my children thought it was a law.

3.   Do not have more than two credit cards as it impacts your credit standing when you keep opening accounts, and having many cards allows for paying off one account with the another one--the most common way people get into terrible trouble. 

4.   Budget a certain percentage from every paycheck to be automatically deposited into a savings account. When a paycheck is automatically deposited, and bills are paid automatically from your account, and savings are automatically withdrawn before you have access to it, you will be less likely to spend money in a way that is impulsive, foolish or extravagant.

5.    If your full time job does not allow for saving, get a temporary or seasonal job to build a savings account and put every dime in the savings account.  

6.    Bank extra paychecks or pay down your mortgage. Even two paychecks a year pays down a mortgage significantly. If you can, refinance your 30 year mortgage to a 15 year one. When you pay off your mortgage, you will think you've gotten rich.

7.    Find a bank right for you and avoid all fees. If you have banked with them for a long time, call in to have the fees removed.

8.    Pay all bills on time and avoid late fees. Pay bills on-line to save postage and shipping.

9.    Save money by paying annually for things rather than monthly as they usually include service charges.  (Example:  Paying annually for insurance saves rather than paying monthly).

10. Have a special fund into which you save monthly for big ticket items like property taxes if you do not have a mortgage, holiday shopping, college and weddings. If you have money earmarked, you will be less likely to spend it on something else and you will be better prepared and less likely to charge what you can't afford.

Shopping:

11.   Set a certain dollar amount weekly for your shopping needs (groceries and toiletries) and  don’t exceed that amount. Include just a little for impulse buying so you won't feel you are  denying yourself constantly, but be wise about how much and don't spend more.

12.   Always ask the services clerks if there are any deals on the items you are purchasing.

13.   Be kind to sales/service associates as they will tell you about discounts and deals.

14.   Avoid shopping without purpose. Hobby or window shopping fosters impulse buying.

15.   Buy generic instead of brand names. Check the labels to see if they are the same products. If  you do not care for the generic product, return it to the store.

16.   You will save money if you buy in bulk. Go in with others to buy in larger quantity.

17.   Buy holiday and birthday gives all year around and when things are on sale. I would even wrap early to minimize the number of things to do at the time of the holiday. Keep a careful list of what you intend to buy and indicate when you bought it, so you will not overbuy.

18.   Use Coupons and go to the store on double coupon day.  Use only the coupons you need.

19.   Visit www.grocerygame.com  as it tracks sales with coupons for you. If you "join" grocery    stores online, they will send you the featured sales for that week.

20.   Always shop with a list and don’t deviate. Try to avoid processed foods (all those items on the shelves in the interior of the grocery store. They are the most expensive items in the store and the least healthy for you. You can buy all the fresh, natural foods you need just by shopping the perimeter of the store.

21.   Don’t’ shop when hungry. Impulse buying rises exponentially when you do and you make

       less wise food choice.

22.   Always do research and price check.  www.pricegrabber.com researches the product and price

       checks for you.

23.   Appliances – buy efficiency vs. price.

24.   Buy scratch and dent items when available.  They sell at a discount.

25.   Avoid disposable items (i.e. paper plates, forks, cups etc.).  Use and wash instead.

26.   Limit dry cleaning.  Buy things that don’t need dry cleaning.

27.   Grow your own vegetables and spices if you can.

28.   Invest in a water purifier instead of buying bottled water.

29.   Take snacks don’t use vending machines. 

30.  Prepare your lunch for work or school. The savings are tremendous and you can ensure healthier fare for less money.

31.   Before making any major purchase, wait for best times of the year to buy the product. The item will be on sale and you will have saved a great deal of money.

32.   Never order drinks when eating out.  Order water with lemon and you can put sweetener in it  for lemonade. Make sure they bring the lemon on the side. They are the dirtiest food in a restaurant, so clean off before putting in your glass.

33.   Go to matinee movies instead of evening.  Watch for promotions at the movies example:  dollar night.  Watch for free events sponsored by your town like concerts and openings.

34.   Don’t cook huge portions for meals unless you want left overs.  www.leftoverchef.com gives you ideas on  how to use your left overs.

35.  Get into the habit of going o the library not only to borrow books instead of buying but also for music and movie CDs. The children's offerings at the library are great. Make a weekly event of it. Attend story time, return read books they've selected and take out new selections. You and your child will get into the habit of using that resource and reading more.

Utilities:

36.   Never leave heat or cooling items running. Unplug whatever you can. If it is plugged in, it is draining electricity.

37.   Don’t over dry clothes.

38.   Shut off dripping faucets.

39.   Place a brick in the toilet bowl.  It makes it not use so much water when flushing.

40.   Run appliances in the evening, like the oven and dishwasher, so it doesn’t heat up the house. 

41.   Avoid the rinse hold option on the dishwasher. Open the door and avoid dry cycle.

42.   Change hot water thermostat to a lower temp.

43.   Check with the Utility company to see if they can conduct an energy audit on your home.

44.   Use caulking and weather stripping around the windows and doors to close air gaps.

45.   Use blinds or curtains to hold in/out air.

46.   Use compact flourescent lights instead of regular bulbs.  They are more energy efficient.

47.   To check the door gasket on the refrigerator, put a dollar bill in the door and close it.  If it is  easy to pull out, it is time to change the gasket.

48.   Ask your utility companies for average billing.  It makes the bill the same each month instead of high/low.

49.  Shred newspapers and magazines and use them in flower beds and pots.  Put them under the potting soil.  It holds the water on the plants longer and serves as mulch.

50.   Get on a cell phone plan that is good and disconnect the home phone.

51.   Bundles services when your able, and negotiate periodically with your company to achieve the best programs for the least amount of money.

52.  Negotiate for big ticket items like cars, appliances and furniture, but don't forget to try even at local stores. Ask for a discount or sale price. Be sure you've done your research about the price of an item. Know what it cost the company and add on a fair profit margin. If you go too low, they won't consider your offer, but if it is reasonable, they will be likely to agree.

Transportation

53.   Car pool or use public transportation or a bike when you can.

54.   Conserve gas by combining errands.

55.   Keep car well maintained and keep tires inflated.

56.   Vacation off season.  It’s less crowded and cheaper.

Health & Education

57.   Check with local community for free vaccines or hearing tests.

58.  If you do not have medical insurance, visit free clinics in your area.

59.   Take advantage of employment benefit offers. Check and see what your coverage dictates for procedures and vaccines. They may have reduced the cost of a vaccine you have avoided because you thought it was too expensive.

60.  Use tuition reimbursement offers.

Miscellaneous

61.   Become a product tester; you get free products.  (i.e. diapers)

62.   Don’t throw out items, sell them (ebay, garage sale)

63.  Never spend change.  Save it in a jar and then cash it in. Look for machines that don’t charge

       to cash in or take to sales clerk.

64.  Keep a gift closet. When someone gives you something nice that you can't use, regift.

65.  Keep your receipts and return items that are sub standard, break too soon or spoil too quickly

       including to the grocery or club store.