The Chosen One

Copyright StarWarsA friend called me the other day and shared her concerns about being chosen to be the health-care and financial power of attorney for her mother.  She had heard me speak on the topic and the challenges associated with the choice.  Having to make critical decisions under overwhelmingly emotional circumstances can be trying for even the strongest of souls.

As I’ve shared in presentations and posts, choosing a POA (and making sure it’s the right person for the job) is imperative. (See FYI about POA).  However; being named as the “chosen one” has its challenges as well.

Here are just a few:

  • You may question why you were picked
  • Others think they would have been a better choice and question why you were picked (
  • Knowing when to step in to help someone in making difficult health-care decisions
  • Having the strength to make the decisions that they would want IN SPITE OF your emotions and/or the emotions of other family members.
  • Having the courage to make difficult decisions IN SPITE OF the criticism of those around you.

Sounds daunting but have heart there is hope.

Here are some steps that you can encourage the person who has deemed you the “chosen one” to take once they’ve made their decision

  • Have a very direct and serious conversation about what they want/don’t want in certain situations.  Use the “what if” blog as a starting point.
  • Ask them to write down in DETAIL what they would or would not want done if certain situations were to arise (helpful tool – 5 wishes)
  • Confirm that their decision to choose you as POA and their detailed wishes are written down (DON’T ASSUME). Make sure to get a copy of the paperwork for your files, and be informed as to the location of the original copy.
  • Encourage them to share their decision, as well as their wishes with other family members so that everyone understands that this was their decision and isn’t about “favorites”. It’s strictly about who will be able to administer care directives in the fashion requested by the assignee.

you-are-the-chosen-one-pl-ffffffImportant point!!**Just because someone asks you to be their power-of-attorney does not mean you have to say “yes”.  This is a VERY important appointment and should not be entered into lightly.  You must be willing and able to follow their wishes IN SPITE OF your own thoughts, feelings or emotional connection.  If you do not think you can do that, you should be honest with them and graciously decline and share your reasons.

 

 

(Picture Copyright: Obi-Wan Kenobi/Star Wars, Mr T/Meme generator.net)

 

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Logan – A Caregiver’s Story

Copyright 20th Century Fox

Copyright Marvel/20th Century Fox

I will admit that I am a HUGE Marvel geek.  My friend Anne Marie and I attend opening night of all Marvel/DC Comic movies (I persuaded my husband to create a Super Hero bathroom in our Master Bedroom using Marvel and DC Comic movie posters).  Therefore, when I saw the preview for Logan (Wolverine/X-Men), I pre-ordered tickets and eagerly awaited opening night.

Early on in the movie, though the primary storyline is about the girl Laura, Logan’s daughter, the underlying narrative is one of the caregiving relationship between Logan and Professor Charles Xavier.

*At this point I want to assure my fellow Marvelites (not sure if that’s a word, if not, it should be), that I will not reveal any key movie spoilers, only my perception of the relationship between Logan and Professor Charles Xavier.

Professor Charles Xavier has always been a father figure to the mutants and Logan, for me, epitomized a type of prodigal son, whom Charles always welcomed back into the family fold.  Now in his advanced age, Charles is in need of care by someone who not only understands that his mind and body are frail and failing, but that the challenges of caring for an elderly loved one become more complex when that person is a mutant.

You may be wondering: OK Sue, you saw a movie and the characters cared for each other- What does this have to do with me?  Thanks for asking (I said to myself) – I’ll tell you.

The eldercare dynamics encountered by Logan and Charles, along with Logan’s normal capricious temperament (and a multi-generational movie twist), paradoxically embodied the challenges, frustration and chaos experienced by the majority of family caregivers throughout their caregiving journey.

Caregiving is a complex, nonetheless, there are things you can do to make the load a little lighter.

Lessons from Logan (both constructive and adverse)

  • Show up – even when you don’t want to because the burdens feel so overwhelming
  • Accept support from others – this was a difficult proposition for Logan as well as countless family caregivers, however, Logan employed another mutant to assist in the care of the professor.
  • Even in the midst of frustration and overwhelming feelings of dejection, do your best to be respectful of those in your care as well as those who are helping you (even if they don’t do things exactly how you would do them)

Most importantly TAKE CARE OF YOURSELF!

This was the greatest challenging for Logan and EVERY caregiver I have ever met (myself included –see Fundamental Rule of Caregiving).  It’s easy to get overwhelmed when caring for a loved one and not only put self-care on the back burner, but develop unhealthy habits.  If you don’t engage in self-care, both physically and emotionally (ex: making time to exercise and seek an outlet for frustrations, whether through a formal caregiving support group or with a trusted friend – challenges associated with caregiving can have a negative effect on your health and makes you less effective in the care of others.

logan-trailer-breakdown-11

Copyright Marvel/20th Century Fox

Make self-care a priority, exercise, read a book, go see a movie (Logan is now playing in theaters – Official Trailer).

 

 

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FYI about POA

Medical Power of Attorney (POA) is something each of us, no matter our age, should have.poa Frequently, people grant POA to their spouse, children or siblings. POA goes into effect only if you are not able to make competent decisions. Not when the POA doesn’t like or agree with the decisions you are making.

*It is crucial to choose someone you trust and discuss what you do and don’t want done in certain circumstances (i.e. removing life support).  Confirm they are willing to following YOUR wishes in spite of their feelings at the time the decisions have to be made. When someone has been granted the POA for another, they have an ethical responsibility to act in good faith on behalf of the person.

FAQ

What is a Medical POA?

It is a document, signed by a competent adult, i.e., “principal,” designating a person that the principal trusts to make health care decisions on the principal’s behalf should the principal be unable to make such decisions. The individual chosen to act on the principal’s behalf is referred to as an “agent.”

What happens if I do not have a Durable Power of Attorney for Health Care?

If you do not have a Durable Power of Attorney for Health Care and are physically or mentally unable to tell your doctors what you want, the following people, in order of priority, are legally authorized to make your health care decisions for you:

  1. Your court-appointed guardian or conservator;
  2. Your spouse or domestic partner;
  3. Your adult child;
  4. Your adult sibling;
  5. A close friend; or
  6. Your nearest living relative.

When does the POA have the right to make health care decisions on my behalf?

A POA can make health care decisions for you only if your attending physician certifies in writing that you are incompetent, some states may require 2 physician certifications. The physician must file the certification in your medical record. Usually the POA authority will take over in situations where you suffer from advanced dementia, permanent disability or experience a dramatic mental decline.

The process to appoint your POA should be done before competency is questionable. As long as you can make decisions for yourself, there is no need for a power of attorney.

Can the agent make a health care decision if I object?

No. Treatment may not be given to or withheld from you if you object. This is true whether or not you are deemed incompetent.

What health care decision-making power does the POA grant to an agent?

The POA can make arrangements for doctor visits, treatments, medications, tests and surgeries if needed. It also gives the agent the power to make decisions about life support.

However, an agent cannot consent to:

  • Commitment to a mental institution
  • Convulsive treatment
  • Psychosurgery,
  • Abortion, and
  • Neglect of comfort care.

In the POA document itself, you may limit the agent’s decision-making authority. The POA agent can be changed at any time by simply tearing up the old form and filling out a new one. Many states do not require a lawyer or notary to update the forms so check what the requirements are in your state.

**This post is meant to share basic information about POA laws in order to get you to think pro-actively about potential future care needs and those whom you would want in charge of your care.  Laws vary from state to state, so it is important that you consult with an attorney near you on the scope and range that a medical power of attorney contract has for you.

References: Texas Medical Association & AgingCare.com

 

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Strategic Caregiving

plannowheader“I wish I had met you when…,” I hear some variation of this phrase weekly (sometimes daily) from people I meet through networking and personal events.  The statement derives from people who have experienced the chaos associated with caring for an elderly loved one with little to no idea what resources were available to assist them or the person they were caring for.

REALITY CHECK: At some point, we have either been, will be or know someone who is the caregiver of an elderly relative. Depending on our life expectancy, we will also become an elderly person in need of care and resources.

So, what happens when caregivers have to make decisions with no preconceived notion about available resources or are making decisions in reaction to a crisis? All decisions made from the point of the “incident”, the fall, hospitalization, _____ (you fill in the blank), are done in REACTION to the situation.

Without a proactive plan in place, these very important, potentially life altering decisions will be based primarily on the emotional response to the event or the direction given by a medical professional (often one who is meeting your loved one for the first time).  Regrettably, reactionary decisions can have unexpected consequences that may be in direct opposition of the person wishes.

I realize that in our busy world, if something isn’t happening to us this instant, then we aren’t going to seek out information and resources concerning the “what if’s” in life.   Unfortunately, in the case of elder care, lack of a “what if” strategy can lead to uninformed decision-making when a crisis strikes.

The good news is it doesn’t have to be that way.  There are preparations that can be made TODAY for the “what if’s” in life.

Ask yourself and those you love these pro-active “what if” questions and begin the effective process towards preemptive crisis management:

  • If I cannot make health care decisions for myself, who would I want to make those decisions? (See FYI about POA)
  • What guidelines would I want my POA to follow in determining what care was given? (i.e., nutrition, resuscitation, end of life comfort/care. See 5 Wishes or ask your local hospital if they have copies of POA/Living Will forms)
  • What if I could no longer manage my finances, who would I trust to manage them for me?
  • What if I can no longer care for myself in my home?
  • What if I needed long-term nursing care, would I want that in home or in a facility?
  • Do I have enough money to cover the cost of long-term care? (Long-term Care Insurance?)
  • What if I need short-term rehabilitation, where would I want to go for that care?
  • What do I need to have in place to make sure that if one of my “what if’s” happened my family would know what I wanted done?
  • What if _____ (Fill in the Blank)

I know that asking these questions can be awkward, however; if and when the crisis strikes, you’ll be glad you did.

 

 

 

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God’s Plan for Family Caregivers

If I’m being honest, as a Christian, Ephesians 6:2-3 (NIV) exhorts us: “‘Honor your father god-has-a-planand mother’”—which is the first commandment with a promise— “‘that it may go well with you and that you may enjoy long life on the earth.’”, has always caused me a bit of anxiety.

I mean, that is quite a promise, RIGHT?! We all want to enjoy long life on the earth. However, what happens when the commitment to honor our parent’s triggers feelings of guilty or sets us up to make decisions based on self-reproach or lack of information and resources, instead of the best care options for our love ones? Or what if we feel we have to choose between doing what’s best for our aging parents or our young children?

The Bible is very clear about the promise.  Nevertheless, we need to be clear about what honoring truly means.

In truth, caring for an elderly parent can be both challenging and rewarding. It can be the greatest blessing and the most painful ordeal you may ever experience. The good news is that there are more options and resources available today to help us care for aging parents—to assist us in truly honoring our parents—than at any other time in history. Many mistakenly think the only way to honor their parents is to move them in their home, however, often the best way to honor them is to find the right independent/assisted living community or skilled nursing facility, supporting independence while affording them opportunities for social interaction with others experiencing similar changes and losses in their lives, as well as trained professionals to care for increasing care needs.

If our parents need care, then we are expected to help. Unfortunately, most decisions to move mom or dad in with us are made during an emergency situation lacking the understanding of how the move will affect not only our relationship with our parent, but our spouse, children and siblings as well.

Tips to Help Family Caregivers:

  • Take care of yourself FIRST. When we are well rested and cared for we actually have more energy to assist those around us. (See Self-Care )
  • Don’t try to be everything to everyone. REALITY CHECK: you will become overwhelmed by trying to meet everyone’s needs.
  • Learn how to say “no,” This can be a challenge for those of us feeling called to help others, however; overloading your “to-do” list is really no help to anyone.
  • Pray about request instead of instantly responding “yes”.  Give them a time-line in which you will get back to them.
  • Let go of any guilt you associate with saying “no” to a request. Guilt is self-induced and self-destructive. (See Let Go of Guilt)
  • Ask for help! You would be amazed at how many people want to help but don’t know how because you are not allowing them in. (See Avoiding Burnout  )

Most importantly give your burdens, struggles and care needs of your loved one over to God! He is always waiting for us to ask for His help, His guidance and His peace. He has already put in place a plan to care for your elderly family member. His plan might include trained professionals either in the home or in a facility caring for them which would allow you to enjoy the time you have with them instead of feeling the overwhelming burden of taking on their care.

live-long-and-prosper(Sorry, the Star Trek geek in me couldn’t resist)

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Surprise – Mom got old!

It still amazes me how many people I have met over my 25+ year career that seemed genuinely surprised that their parent had gotten old.  Especially since the alternative to getting old would be death (not trying to be crass, it’s just the truth).  The reality is that barring an untimely death our family members, as well as ourselves, will all eventually be old.

When I speak to people about being pro-actively prepared for this approaching season of life share many will say that they are prepared.  When I ask for an example of their “preparedness” 99/100 times their example is their pre-paid funeral, to which my responses is “That’s great for when you’re dead, what do you have planned before that?”

While it is very helpful to have your funeral pre-paid, there are many other pro-active steps that can be taken to help ourselves as well as our family members before that.  I refer to this as preparation for “What if”.

Ask the following questions of your elderly loved ones (as well as yourself) and then encourage them to start gathering information on the local programs, facilities and care options available in order to empower them to make pro-active decisions about their care.

What if…

  • You needed to go for rehab due to a stroke or other major health issue, where would you want to go?
  • You were no longer able to safely live in your home where would you want to live?
  • You were unable to make decisions about your care would you want the procedures/options of care:
    • Resuscitation. Restarts the heart when it has stopped beating.
    • Mechanical ventilation. Takes over your breathing if you’re unable to do so.
    • Nutritional and hydration assistance. Supplies the body with nutrients and fluids intravenously or via a tube in the stomach.
    • Dialysis. Removes waste from your blood and manages fluid levels if your kidneys no longer function.

Write down the answers and then share them with all the family members.  When everyone is aware of the persons’ wishes ahead of time it makes it less problematic for the family if ever faced with making those types of difficult decisions. These are just a few examples of care related questions.  Having a place to start the conversation can help families share much needed information about individual preferences and help not only to create a practical plan for the future but empower pro-active personal decision making.

About the Author:

Sue Salach has worked in the geriatric healthcare field for 25 years and has a Master’s Degree in Gerontology (the study of aging).  Sue employs her comprehensive experience and enthusiasm to assist corporations in creating innovative programs to reach out to employee caregivers in the workplace. She is a National Speaker and the author of two books, Along Comes Grandpa, a caregiving resource guide and If I Walked In Her Shoes  a caregiving novel. Follow me @SueSalach on Twitter.

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Fear vs. Fact

TheWorkingCaregiver

fear-picWhen a loved one gets a life altering diagnosis it can be scary.  Distressing questions rush through one’s mind such as: will they survive, what are the options, do we need a second opinion, what will their be like now that they are facing _________?   These types of thoughts are normal and can help to evaluate the situation and search for solutions.

However; the longer one fixates on the situation the more likely it is that fabricated stories (usually of the horror kind) begin to develop about what “could happen”.  Along with that, well-meaning friends, after hearing the diagnosis, will share an experience they, or someone they know, went through in a “similar” situation.

Unfortunately, these stories are frequently the worst-case-scenario that happened to their friend’s, cousin’s mother and, not only does the reality of that specific situation get lost through interpretation (think of the game “telephone” – what was…

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