Seniors are at risk of not having their daily nutritional needs met. This can be a result of many factors such as decreased mobility, medication interactions or side effects, cognitive deficits, isolation, climate barriers and mental health issues.

What are some easy tips that seniors and their caregivers (or concerned family members) can due to minimize the risks of poor senior nutrition?

Make sure that your loved one is eating from each of the four food groups at least three times a day. For example:

Group 1 – Fruits and Vegetables contain natural disease fighting ingredients and can aide in healthy digestion. Try eating some that are dark green, red, orange and yellow such as spinach, oranges, bell peppers, etc.

Group 2 – Grains contain fiber which can aide in digestion. Remember to increase fiber slowly and to increase fluids at the same time. Eat some whole wheat pasta and breads, oatmeal (porridge), etc. Consult a physician if you have any concerns or any digestive problems.

Group 3 – Milk and Milk Alternatives help to prevent osteoporosis and aide in bone development. Additionally, this group gives us vitamin D, which may be less available in the winter months. You can eat milk, cheese or yogurt.

Group 4 – Meat and Meat Alternatives provide us with protein, vitamins and minerals. Enjoy some fish, poultry, lentils, chickpeas, nuts and seeds.

If a senior is not able to shop or to prepare balanced meals, you can try these tips:

• Make a little extra dinner at your house a few nights a week and put one portion in a re-heatable
container with instructions on how to re-heat the meal. Leave this in your loved one’s freezer or refrigerator;

• Invite your loved one over for one meal a week at your house;

• Look into community resources, such as Meals on Wheels, to provide one to three meals a week;

• Hire a neighbor, friend, or home care agency to prepare two-four meals a week at your loved one’s home;

• Hire a teenager in the area to have one meal an evening with your loved one. This is good for social interaction for your loved one and provides the teenager with a “job” that has lifelong learning potential;

• Call your loved one’s friends and ask them to invite your loved one to dinner or lunch once a week.

Never forget how important fluid is to our body since it is made up mostly of water. Without enough water, our body has more difficulty digesting food, transporting medication, and circulating blood to aide in healthy bone and muscle development and maintenance. In the winter time, we can become more dehydrated due to being indoors with heating systems. Add soup to your meal and drink lots of water, fruit juices (100%pure), milk, and herbal teas.

Sometimes seniors are not as active as the general population. This reduction in activity can contribute to a reduced appetite. Even light and consistent exercise such as walking, yoga, stretching and chair aerobics can stimulate one’s appetite. If you find that motivation is lacking, perhaps joining an exercise group or moving into a retirement residence where group exercise activities are organized could help. Exercise also releases chemicals in our brain that help with improving one’s mood and cognitive functioning.

Written by:Sarah Blunden, Registered Dietitian, Certified Diabetes Educator, McGill University Bachelor in Human Nutrition 2003; Stephanie Erickson, MSW, PSW, LCSW

Let me start by saying that I am a firm believer and advocate of the public system in Montreal, and in Quebec at large. I feel that the public is entitled to receive services and support from the system into which they have been paying. Unfortunately, the growing demands of the senior population are too much for the public system to support. Families are turning to private social workers more and more to fill these gaps in service.

Private social workers can offer a variety of services for seniors and their families. For example, Erickson Resource Group can complete psychosocial assessments for mandate homologations and private curatorships throughout greater Montreal and its surrounding communities. We can also complete these same psychosocial assessments for a public curatorship if a private or public facility requires this service. (http://ericksonresource.com/senior-services/)

Many hospitals and local community agency social workers are not able to provide psychosocial evaluations for mandate homologation and private curatorships because they are overstretched with the critical needs of the population. With public waiting lists for social services ranging from 3 months to eight months, Erickson Resource Group can become a family’s “safety net” during, through and after the acquisition of public services.

Erickson Resource Group private social workers can act as a liaison between the public and private systems, guiding families through the relocation or placement process, the accessing of public or private home care, and care management and/or coordination of private and public health services. In addition, Erickson Resource Group is a complete resource center for seniors and their families. We are available to advise seniors and their families as to how the public system and private system can collaborate together.

Erickson Resource Group has a team of private occupational therapists, private nurses, private dietitians and private recreation therapists to provide professional evaluations and treatment plans for seniors and their families. (http://ericksonresource.com/about-you/ ) If a senior or family requires an advocate to help them navigate the public system or to work with public and/or private health care professionals, an Erickson Resource Group team member can act as this advocate.

We are in no way attempting to replace the public system. Our intention is to supplement services when a family needs it and when the family is able to afford it. If the senior or family need help NOW, we can be there NOW. We do not have waiting lists. Call us at 514-795-7377 for further information.

To learn about Erickson Resource Group’s services: http://ericksonresource.com/senior-services/

To learn about Erickson Resource Group’s team: http://ericksonresource.com/about-you/

I hear it from both sides. Some seniors telling me that they try to have discussions with their children regarding aging and planning for their future, such as living wills, mandates in the case of incapacity, funerals, illness, housing, etc., but their children don’t want to think about such unpleasant things. I also receive many phone calls from adult children, asking for advice on how to approach these same discussions with their parents who refuse to discuss their own aging process. As a result, these adult children don’t know how to help their parents, if they do need help in the future. I am also witness to both of these generations sitting across the table from one another in silence, avoiding direct conversations about these difficult topics, or fighting amongst one another as decisions are needed to determine medical and health care (non)interventions.

Example: An 84 year old widow has a mild stroke and is hospitalized. His 3 adult children arrive at the hospital to see their father. The physician informs the family that although their father has survived, he has moderate cognitive deficits (Dementia), as well as mild-paralyzation on his right side. He can return home, but only with full time care. The alternative is relocation to a full care facility. Two of the three children opt for relocation, but the other child insists that she can care for her father herself at his home. None of the children know the father’s financial resources, nor do they know what type of care he would prefer. You see, this man never signed a Power of Attorney (Mandate in the case of Incapacity) and he has always been secretive about his finances. What will happen to this man as his children battle it out? How will his children manage his finances now?

This is not the case for all families. Many families do address these difficult topics directly, honestly and realistically. No matter what the unique family situation is, it is not easy to broach these very personal and often scary topics. After all, who wants to imagine ourselves or our parents as old, invalid, or incapacitated?

It has been my experience that without these premeditated and purposeful conversations, families will experience health crises to a much greater degree than those families that communicate openly BEFORE a crisis, as shown in the example above. Planning and communication amongst families is a gift that benefits every member of the family.

Below are some tips to begin these difficult discussions:

1. Use the media: Find a story on the television, in a magazine, on the radio, in the newspaper, or on the internet. Ask your parent (or child) to view this media. You can either look at the media together, or separately. A week or so after you have this shared experience, ask your parent (or child) for their feelings about the media. Wait to see if the discussion about the “objective” media leads to a discussion about the family situation.

2. External tool: Use an external tool, such as the Erickson Resource Group “Organizing Affairs” toolkit. Complete it and then share it with your parent/adult child. Ask them if they have any questions. Encourage them to discuss its contents with you. Encourage them to begin to discuss their plans for aging as well.

3. Personal examples: If you have a friend or another family member that experienced an acute health crisis recently, share this story with your parent/adult child. Discuss the ways in which this friend’s preparation, or lack of preparation, impacted the family’s coping and overall functioning. Wait and see if your parent/adult child offers to discuss your own family situation.

4. Include outsiders: Try to involve a social worker, financial advisor, notary or attorney who can share their unbiased experience as to what the negative consequences are of not planning. Perhaps this third party can open the doors of communication within your own family.

5. Ask meaningful questions: Create discussions that enable your parent/adult child to look at their life and the meaning that it has to them. This life review cultivates the relationships within the family, which can help to increase trust and open the doors for communication. Ask questions like, “What has been your most meaningful experience? What are you most proud of? Tell me about the day I was born? What is it like to watch me be a parent?

6. Hear their story: Silence is an undervalued communication tool. Do not forget to hear your parent/adult child’s story. If we interrupt or interpret what your parent/adult child is saying, it can create communication barriers. Make sure to listen and then ask follow up questions to be sure you understand fully what was said.

7. Be conscious of terminology: The words we use to communicate give us insight into how somebody processes information. Do they use the word death? Die? Deceased? Passed on? Went with God? Respect that terminology and the distance it may or may not create for that person and that topic. Allow your parent/adult child to protect him/herself with language.

8. Take your time: If your family is not used to discussing difficult topics openly and directly, things cannot change overnight. Bite off small pieces of the aforementioned tips and let things marinate within each member of the family. Follow up every few months until you are satisfied with the depth of conversation.

9. Remember your history: All families have their unique communication styles, personal history, cultural influences, generational influences, gender influences, role expectations, etc. Work with what you have. A square peg will not fit in a round hole.

10. Be honest: Being dishonest will not get your family to a “non-crisis” mode. In fact, if we are not clear about our choices, more confusion and family dysfunction will ensue.

11. Legal, legal, legal: Discussions are fantastic, and absolutely help with facilitating and following through on your wishes. However, it is necessary to complete the legal paperwork to ensure that your wishes are met. You can always, at the minimum, just inform your parent/adult child that the paperwork is complete, and to contact the notary/attorney who assisted you in the case of an emergency.

Written by, Stephanie Erickson, MSW, PSW, LCSW

What is a Mandate in the Case of Incapacity?

This is a, “document in which a person, known as a mandatory, while in full possession of his faculties, appoints another person, known as the mandatary, to see to his protection or administer his property or both at once, in the event that illness or an accident deprives him of his faculties, either temporarily or permanently.” http://www.curateur.gouv.qc.ca/cura/publications/mandatE.pdfpermanently.

What is the homologation of a Mandate in the Case of Incapacity mean?

It is the legal procedure in which a person’s incapacity is proven by a Court of Law, and the designated mandatary is given the legal authority to act on the mandator’s behalf. Without this legal procedure, the document “as is” does not allow legally for the mandatary to use the authority entrusted to them by the Mandator.

When is it time to homologate a Mandate in the Case of Incapacity?

If your mother, father, spouse, partner, friend, or relative designated you to make decisions for their health care, medical treatment, housing situation, management of their finances, or for any other reason should they not be able to make decisions for themselves, it is recommended that you homologate a Mandate as soon as the mandatary (person who signed the document) is deemed incapacitated. As a mandatary (person named to manage the personal or financial affairs of another), you must have the complete legal authority to make all decisions (personally, medically, and financially) for your loved one. A homologated mandate is the legal step required to ensure that you can manage all aspects of your loved ones’ life without complications.

What are the steps involved to homologate a mandate?

Medical assessment:
A physician (M.D.) must complete a medical form (Report of the Director General – 2A) that outlines the person’s diagnosis and mental capacities. If you do not have a physician who can do this, Erickson Resource Group can refer you to someone.

Psychosocial assessment:
The CLSC social worker or a social worker in private practice can complete the psychosocial assessment for a mandate homologation. Often, the wait at the CLSC is between 5-8 months. Check with your local CLSC to assess the wait times. Erickson Resource Group can complete the psychosocial evaluation and report within 10 business days. An expedited service is available for urgent cases. Please phone Erickson Resource Group to learn more about the specific steps and fees involved in this process.

Both of these reports are given to a notary or an attorney for filing with the court. Please contact your notary or attorney for further information regarding the specific legal steps and fees involved. If you do not know a notary or attorney who specializes in this area of practice, please contact Erickson Resource Group and we can refer you to a notary.

What could happen if the Mandate is not homologated?

What if you need to sell you loved ones’ home but they are no longer competent to sign the necessary documents? What if you need to make changes to your loved one’s pension? Change an address? Change an investment account? None of this can be done without a homologated mandate. You may have been acting on the mandator’s behalf without a homologated mandate and have not had complications. However, if you are questioned by a financial or governmental institution and the Mandate is not homologated, financial accounts could be “frozen” until such time that the Mandate has been homologated. This could create delays of up to 6 months for family members.

What is a protective regime?

If someone did not take the steps to sign a Mandate in the Case of Incapacity, and it is felt that they require protection or assistance, someone can apply to the government to represent this person in financial and personal matters. There are different levels of protective regime. Please refer to the following link on the government website to learn more. http://www.curateur.gouv.qc.ca/cura/en/majeur/inaptitude/protection/index.html

What are the steps to apply for a private curatorship or private tutorship?

Medical assessment:
A MD must complete a medical form (Report of the Director General – 2A) that outlines the person’s diagnosis and mental capacities. If you do not have a physician to do this, Erickson Resource Group can refer you to someone.

Psychosocial assessment:
The CLSC social worker or a social worker in private practice can complete the psychosocial assessment for a private or public curatorship. Often, the wait at the CLSC is between 5-8 months. Check with your local CLSC to assess the wait times. Erickson Resource Group can complete the psychosocial evaluation and report within 10 business days. An expedited service is available for urgent cases. Please contact Erickson Resource Group to learn more about the specific steps and fees involved in this process.

Both of these reports are given to a notary or attorney for filing with the court. In addition, there is a “family council” that is facilitated by your notary or attorney. Please contact your notary or attorney for further information regarding the specific legal steps and fees involved. If you do not know a notary or attorney who specializes in this area of practice, please contact Erickson Resource Group and we can refer you to a notary.

What could happen if I do not become a private curator or tutor on behalf of my loved one?

What if you need to sell you loved ones’ home but they are no longer competent to sign the necessary documents? What if you need to make changes to your loved one’s pension? Change an address? Change an investment account? None of this can be done without an established protective regime. If this step is not taken until a crisis occurs, the family will experience long time delays and accounts can be frozen in the interim.

Who can help me navigate this process?

Erickson Resource Group can provide the psychosocial assessment for either a homologation of a mandate or for an application for protective regime on a private basis. You may also contact l’Ordre Professionnel des Travailleurs Sociaux du Québec for more information. We also have referrals to many notaries and/or attorneys who can assist you with the legal process. You may also consult the Chambre des Notaries for more information. Erickson Resource Group can refer you to a physician who can assist with the assessment and completion for the required medical form on a private basis. Erickson Resource Group can provide you with guidance and support throughout this process.

How long does this process take?

Erickson Resource Group can complete the psychosocial assessment required within 10 business days after meeting with the client and family. Generally, a ERG social worker can meet with the client and family within a week of receiving the request. An expedited service is also available. If you choose to go with a public agency (CLSC, CHSLD, etc.), there could be delays for up to 6 months. Contact your local government agency for an estimated time frame. ERG provides services in both English and French.

The medical report can also be completed on a private basis and ERG can assist you in connecting with a physician. If you choose to go with a public agency (CLSC, CHSLD, etc.), there could be delays for up to 6 months. Contact your local government agency for an estimated time frame. You can also request that the client’s family doctor complete the required form. ERG can assist you in facilitating this process.

The legal petitioning of the Court cannot occur until both the psychosocial assessment and the medical report are completed and given to the notary or attorney. Once the notary or attorney has these documents, they can petition the Court. Depending on the notary/attorney and the Court delays, the process can take as little as 4 weeks and up to 6 months. There are additional steps required for the opening of a private curatorship or private tutorship.

For more information, contact Stephanie Erickson at Erickson Resource Group at (514) 795-7377.

written by: Stephanie Erickson, MSW, PSW, LCSW

If you have aging parents, you are most likely concerned about their physical, emotional and cognitive health.  As your parents get older, they will have medical appointment after medical appointment with a variety of medical professionals including doctors, nurses, social workers, physiotherapists, etc.  Your parents may have difficulty remembering the details of each of these appointments, as one specialist blends into another.

It is important for you to keep track of the dates and times of the appointments in order to remind and follow up with your parents.  However, this is not the only information you need to monitor.  The following list contains suggestions on how to record the essential details of your parents’ health so in case of an emergency or hospitalization, you have their full medical history available.

1. Buy a journal or make an excel spreadsheet that records all of the names, addresses, phone numbers and areas of specialty of each of your parents’ physicians and other health care professionals with whom they have contact.
2. Include the diagnosis or problem treated by each of these health professionals, as well as the medication(s) prescribed (dose, times of day, etc.)
3. Document the emergency procedure to contact each of these physicians in a time of crisis as well as their normal office/clinic hours.
4. Encourage your parents to sign a Consent to Release Information with each professional so you have the legal authority to exchange information.  (See our website for a free form).
5. Ask your parents to bring a list of questions and concerns to each appointment and to document the answers.  Include your questions on this list. 
6. Document the pharmacy name and location for each medication prescribed so you can discuss any medication concerns or interactions with the pharmacist.  Make sure your parents sign a Consent to Release Information at each pharmacy.
7. If possible, use only one pharmacy for all of your parents’ prescriptions for better monitoring by a pharmacist of possible drug interations.
8. Make a list of all medical diagnosis, medications, surgical history, current treatment regimes, and treating physicians and ask your parents to keep this list in his or her wallet or purse in the case of an emergency.  Place a copy of this form on the refrigerator and near each phone in their home.
9. Encourage your parents to draft a Mandate, Power of Attorney and/or Living Will so they will be ensured you can act on their behalf  if necessary.

The above information is the basic information needed to assist your parents with their overall health.  It is equally important to organize all of their personal and financial affairs to ensure that you can provide comprehensive support in all aspects of their life when the time approaches. 

For more information or for organizing tools, documents and tips for medical, financial and personal affairs, see our website e-store.

Written by: Stephanie Erickson, MSW, PSW, LCSW 

As our parents age, it becomes harder and harder to feel secure that they are safe and healthy in their home.  This becomes even more difficult if we do not live nearby and are unable to “pop in” to make sure they are okay.  We are left to rely on their self-report of their situation. 

If our parents have memory problems, we wonder if they are accurately reporting what is happening.  We may also believe that they are minimizing their struggles for fear that they will be forced out of their home.  Even if our parents live in senior’s community, assisted residence or full care facility, we still worry if they are getting all the care and attention they need.

There are some things we can do from a distance to increase our full understanding of their situation, to improve the communication we have with them, and to manage the risks inherent in long distance (and close distance) caregiving.  All of these suggestions can be done via the internet and phone.

1. Ask your parent to sign a consent to release information from all of their health care providers so that you can gather collateral information about their functioning.  Get a list of the names and phone numbers of these individuals.
2. Encourage your parent to complete a power of attorney at all of their financial institutions so you can monitor their management of money.  Make sure to tell them that you do not plan on taking over; you just want to oversee to ensure they are not being taken advantage of by another and if they have questions, you can assist them. 
3. Encourage your parent to draft a Mandate/Living Will/Durable Power of Attorney for Health Care so you have the legal authority to make decisions and manage their finances if they become unable to do so.
4. Ask your parent to list all of their utility providers, their mortgage carrier, car insurance, etc. and account numbers and to give these facilities authorization to share information with you so if they are confused about their accounts, you can assist them.  (See our website for a complete list). 
5. Arrange for automatic bill pay where applicable.
6. Ask your parents for the location of all important documents (power of attorney, birth certificate, deeds, etc.). 
7. Obtain LifeLine, Medic Alert, or another type of safety system so that your parent can access help if he/she falls or has another emergency.
8. Obtain a list of individuals nearby who could stop by your parents’ home if you have an immediate concern (neighbor, friend, relative, etc.)
9. Obtain a complete and updated list of all medications, prescribed and over-the-counter.
10. During a visit to your parents, conduct a home safety assessment and make all necessary modifications to the home.  (See our website for a complete list of areas to observe).
11. Prepare a list of private and community agencies that are available to make visits to your parents for future or immediate reference.
12. If your parent is at a facility, get the names, phone numbers, and emails of at least two professional staff members (nurse, social worker, etc.) and make contact with them periodically to foster an on-going relationship.
13. If you can afford it, arrange for a monthly visit from a social worker or nurse to monitor your parents’ safety and report back to you.  The money spent will be worth the peace of mind and may prevent major crises.
14. Begin a journal of all of the above information, as well as on-going updates about your impressions of their functioning, including specific examples (i.e., my mom called me again to ask about her phone bill; I noticed she has lost weight since our last visit, etc.). 
15. Monitor the following when you visit: Physical appearance and hygiene, medication administration habits, ambulation risks and falls, home cleanliness and organization, food acquisition and preparation, driving, memory loss, ability to express thoughts, social interaction or isolation, judgment, decision-making, etc.)

For further information and more detailed toolkits that outline each of the above areas in more detail, please refer to our website. http://www.ericksonresource.com/estore/

Written by: Stephanie Erickson, MSW, PSW, LCSW

It is very scary to know that our parents are living alone in their home as they begin to lose physical and cognitive functioning.  We want to respect their decision to remain autonomous at home for as long as possible so we search for ways to make this happen.  The following is a complete list of all of the areas in your home that present a danger to your parent or loved one, outlines the factors that increase risk and offers concrete suggestions to reduce the identified risks.

Emergency Preparation:

1. Get the name of neighbor/friend/relative and phone number to contact in the case of an emergency and you are not able to get to your loved one’s home.
2. Post your name and phone number next to every phone AND give this information to AT LEAST one neighbor/friend.
3. Obtain the name of a community member, social worker, other professional to contact in the case of an emergency and/or regular updates.
4. Give an extra key to a neighbor or friend, have an extra key for yourself, and hide one outside the home (if you feel comfortable) so someone can gain access to the home in an emergency.
5. Register with Medic-Alert or LifeLine and get a bracelet for your parent so he/she can access help if there is a fall.  See our website under Resources for a link.
6. Make sure all legal documents (power of attorney, mandates in the case of incapacity, etc. are updated and complete).

Risk Factors for a Fall:

1. Over 75 years old
2. Living alone
3. Housebound
4. Use of cane/walker
5. Previous falls
6. Acute illness, chronic conditions, tremors (neurological disorders)
7. Multiple medications
8. Cognitive impairment
9. Vision and hearing problems
10. Difficulty sitting/standing from a chair/bed
11. Foot problems
12. Alcohol/drug use
13. Poor nutrition
14. Balance/equilibrium problems

Bathroom Safety:

1. Install grab bars in the bathtub or shower and by the toilet
2. Use rubber mats in the bathtub or shower
3. Use a shower chair or bench
4. Take up floor mats when the bathtub or shower is not in use
5. Install a raised toilet seat
6. Remove tub and install a shower with a minimal step-up
7. Place a chair in shower stall
8. Use a telephone shower head

Kitchen Safety:

1. Use automatic tea pot
2. Remove rugs without a non-stick service
3. Place frequently used pots and pans at waist level to minimize bending and stretching
4. Use a microwave to reduce use of oven/stove
5. Disconnect stove/oven fuses if there are memory impairments and it has been left turned on in the past

Outdoor Safety:

1. Repair cracked sidewalks
2. Install handrails on stairs and steps or install a ramp
3. Trim shrubbery along the pathway to the home
4. Install adequate lighting by doorways and along walkways leading to doors

Living Space Safety:

1. Remove throw rugs, or tape down to secure
2. Secure carpet edges
3. Avoid visually distracting patterns on flooring/carpets
4. Mark transitions from carpet to flooring with a different color paint/stripe
5. Remove low furniture and chairs that are too low to get up/down
6. Remove objects on the floor
7. Reduce clutter
8. Remove cords and wires on the floor
9. Avoid floor wax or use nonskid wax
10. Ensure the telephone can be reach while laying on the floor

Stair Safety:

1. Install hand rails on both sides of staircases at elbow height
2. Make sure an adult can wrap their hand completely around the handrail
3. Attach them securely to walls or posts
4. Secure carpet on treads of stairs
5. Install light switches at the top/bottom of stairways
6. Do not reduce lighting in stairways; in fact, increase the lighting
7. Do not place rugs at the top/bottom of stairs
8. Leave one hand free to hold the handrail when carrying objects
9. Check lighting for adequate illumination at night, especially in the pathway to the bathroom and on stairs

General safety:

1. Wear shoes or slippers that fit properly and have a non-slip sole
2. Remove reading glasses when walking up/down stairs
3. Install a telephone on every level of the home, especially in the bedroom, kitchen, and bathroom
4. Install a bathroom on each floor
5. Understand side-effects of medications, such as dizziness
6. Avoid alcohol
7. Avoid carrying large or heavy objects, such as laundry baskets
8. Get up slowly from a sitting or laying position; sit on the side of the bed before rising
9. Wear clothing with an elastic waistband for easy removal

For further information, please contact Erickson Resource Group at www.ericksonresource.com

By: Stephanie Erickson, MSW, PSW, LCSW

You get a message from your employee stating that he cannot make it into the office.  His mother is in the hospital after falling in her home.

You notice that your employee seems to be spending excessive phone time speaking to her mother.  It seems her mother calls her daily needing help or guidance with even small matters.

Your employee just put in a request to take 3 weeks off to help his father find a home for his mother whose Alzheimer’s is getting worse.

Does this sound familiar?  How do you think caregiving issues are impacting the productivity of your company and the morale of your employees?  Do you even know?

Most employers are aware that some of their employees are what are referred to as “working caregivers,” that is, employees who have the responsibility of assisting their parents, or another loved one, with financial, health and personal matters.  These tasks can take just a few hours a week, or a few hours a day.

Most likely, there are more employees dealing with their aging parents’ needs than you are aware of.  Many suffer with their dual responsibilities of work and family in silence, afraid that there jobs will be at risk.

Even more employees are part of the “sandwich generation,” those individuals providing care for aging parents AND children simultaneously.  This matters to employers because business is directly impacted by the issues working caregivers face.

As our population ages, the negative fiscal impact on businesses will continue to grow as the baby boomers fall ill and the workforce is faced with the responsibility of caring for them and working for you.

Here are some clear facts about the impact of working caregivers on business:

• 87% of employed caregivers made telephone calls for caregiving responsibilities from work¹
• 64% arrived late or left early²
• 70% took time off²
• 20% reduced their hours¹
• 16% quit their jobs¹
• 13% retired early¹
• 56% developed health or stress problems that affected work productivity¹
• An estimated 46%-59% of caregivers are clinically depressed³
• 41% took time at work to discuss caregiving issues with colleagues²

(¹Advantage 50Plus magazine, ²LifeCare® Inc. February 2008, ³Family Caregiver Alliance 2000)

When employees are at work physically, but spending company time (and resources) researching placement facilities on-line, phoning financial institutions to assist their parents in making payments, or speaking with social workers to arrange for help in their parents’ home, this is “presenteeism.”

 “Researchers say that presenteeism—the problem of workers’ being on the job but, because of illness or other medical conditions, not fully functioning—can cut individual productivity by one-third or more. In fact, presenteeism appears to be a much costlier problem than its productivity-reducing counterpart, absenteeism. And, unlike absenteeism, presenteeism isn’t always apparent” (2004 Harvard Business School Publishing Corporation).

Here are other staggering statistics regarding the financial cost to businesses due to working caregivers:

• The estimated cost to employers for full-time employees with intense caregiving responsibilities is $17.1 billion.
• The average cost per employee for those with intense caregiving responsibilities is $2,441.
• The total estimated cost to employers for all full-time, employed caregivers is $33.6 billion.
• The average cost per employee for all full-time, employed caregivers is $2,110

(The MetLife Caregiver Cost Study: Productivity Losses to U.S. Business, July 2006, MetLife Mature Market Institute and National Alliance for Caregiving)

Research shows that those who used an Elder Care Program experienced dramatic changes in their ability to manage work and caregiving. 

• Presenteeism improved overtime for users of the Geriatric Care Management Program
• Users of this program were less likely to report deterioration in their health over time
• Users of this program were less likely to report negative impacts on their work performance (LifeCare® Inc. February 2008)

The demographics of the population are shifting dramatically.  In Canada:

• The number of seniors has more than doubled in the past 25 years¹ (Health Canada, July 2004)
• The proportion of Canadian seniors will grow from 17% in 2001 to 28.5% in 2031 (Conference Board of Canada 2001)
• Recent changes in the health care system have put further pressure on families (shorter hospital stays and more outpatient treatment) ¹

In the United States:

• In 2015, 78 million baby boomers will begin to turn 65
• The United States population aged 65 and over is expected to double in size within the next 25 years.
• By 2030, almost 1 out of every 5 Americans — some 72 million people — will be 65 years or older.
• The age group 85 and older is now the fastest growing segment of the U.S. population

(National Alliance for Caregiving, 2004, National Institutes of Health, 2006)

These population shifts will directly impact our workforce.  “With the aging Baby Boomers and the natural growth of the “sandwich generation”, it’s equally obvious the caregiving phenomenon is here to stay.”  (Family Caregiver Magazine Spring 2004)

Generally, EAP programs give out names and numbers of a local resource when an employee calls.  These are not prevention programs, nor programs that provide a step by step guide to managing the problem.  Companies like Erickson Resource Group can help. Erickson Resource Group provides information, resources and a wide range of comprehensive and simple tools to assist employees and employers in managing the many issues faced by caregivers, preventatively and reactively.

It’s not enough for businesses to sit and wait for the caregiving phenomenon to impact the bottom line.  Being proactive in providing your employees with knowledge, insight and practical tools to address their current and future caregiving needs will assist in reducing the negative impact this issue will have on your company.

This approach to employee benefits should be adopted throughout workplaces in terms of working caregivers.  Better informed and prepared working caregivers will be under less stress and be able to manage their work and life responsibilities more effectively.

The advantages of elder care training are numerous and include:

• Increase employee’s awareness of their current or future role of caregiving
• Increase employee productivity
• Decrease the number of employee absences
• Increase employee morale and concentration at work
• Equip employees with life-work balance skills
• Increase management’s ability to prepare and respond to employee work-life crises
• Meet company’s mission of being empathic to work-life balance and responsive to social trends
• Be progressive and innovative in employee training

“Demographics are critically important for business.  They probably won’t alter a company’s financial results from one financial quarter to the next.  But the management of a business that fails to pay attention to demographics for five years may wake up to find itself in a different business than it thought it was in – or not in business at all”  (David K. Foot, Boom, Bust & Echo, 1996).

Contact Erickson Resource Group for more information on how you can offer this value added benefit for your employees at www.ericksonresource.com

by: Stephanie Erickson, MSW, PSW, LCSW 

Every time you visit your parents, you notice that they are having more and more difficulty keeping the house clean.  They seem to be losing weight, and when you look in the refrigerator, you can see why. Clearly their nutritional needs are not being met.  You suggest they bring in private help a few days a week to help with the shopping, cooking and cleaning, but they will not even consider it.

Does this sound like your parents?

As a geriatric social worker, the question I get asked most often is, “Do you have any suggestions of how I can get someone in the home to help my parents?  They just won’t agree to help.”  Boy!  Do I wish I had a cookie cutter answer! 

In reality, there are so many different personality characteristics and past experiences that impact one’s openness and willingness to acknowledge deficits and accept help.  I cannot give you the guaranteed solution.

Below are some basic suggestions to assist you in introducing home care assistance.

1. Lower your own expectations.  It is not realistic to expect that individuals who have been managing their own life from A to Z are going to welcome others taking over.  Understand that things will not change overnight.
2. Acknowledge their fear.  Most seniors feel that once they accept help, even in the most minimal way, it is the “beginning of the end” for them.   This is scary and they want to prolong this first step for as long as possible.
3. Introduce the topic slowly. Start by asking your parents some open ended questions, such as, “Tell me how you’re managing the housekeeping?”  Not, “Can you do the housekeeping?” – which will draw a quick “yes” and an abrupt end to the discussion.
4. Start with housekeeping.  This is usually the least threatening type of help and the one most appreciated.  If your parent already has a housekeeper, how about suggesting that “large” chores are done by someone else, i.e., washing windows, and that you know of someone who is available and good.
5. Give the gift of help.  Instead of presenting help as a “need”, give your parent a gift for the holidays, a birthday or anniversary.  You can frame it that your spouse/friend gave you the same thing (i.e., housekeeper for 3 months), and you found it so incredible, you wanted to share the joy.  You may find that they are relieved once the assistance begins.
6. Qualifications.  Make sure that the housekeeper is a qualified nurse’s aide (attendant, caregiver) and able to assist with personal care (bathing, dressing, etc.), even though this service will not be introduced at this time.  Professionals will understand and expect that their introduction into the home may be about “housekeeping” for a period of time.  At least you know that this person has additional skills if needed in the future.
7. Introducing housecleaning.  Ask your parent what tasks in which they could use help.  DO NOT decide for them.  Suggest large tasks such as window washing, floors, toilets…this may feel less threatening than imaging a stranger washing their clothes.  Once the housekeeper is there, she can offer additional tasks gently and at your parents’ pace.
8. Building on existing housekeeping. When there is already a housekeeper in the home, ask if this person is available and willing to provide more help.  If they are, perhaps they could take some basic nurse’s aide courses to learn about assistance with transfers and bathing.  If not, this housekeeper could suggest a “friend” (the aide you find) to provide cleaning when she is out of town or busy.
9. Introducing groceries and cooking.  Suggest the housekeeper start to phone your parents prior to her visit to state that she is running to the grocery store on the way to their house and would your parents like her to pick up a few things (milk, coffee, bread).  Presented in this fashion, it will not feel like your parents are in “need”, but are benefitting from a convenience.
   1. Slowly, this person can ask if they would like her to “run to the store” quickly at the end of her day.  Soon, she can suggest she bring them along to do the shopping themselves.
   2. One day, this person can show up with a bag of groceries, stating they have a “surprise” and cook a meal WITH your parents (if they want).  By this time, there should be a nice rapport and relationship, so this would be a fun activity to do as “friends.”  Again, this is not a “need”. 
   3. Over time, this could build into a weekly/daily activity.
10. Introducing medication assistance.  Once this person is in the home, they can ask to assist your parents with minor organization, such as placing their medication and other supplies in one location.  Then, this person will have access to their medication and can slowly begin to monitor the medication to ensure it is being taken properly.
11. It costs too much!  When/if your parents resist due to finances, there are a few ways to proceed. 
    1. You can pay yourself, if you have the money. 
    2. You can sit down with your parents and review their finances to reassure them that they have the funds.  Look into tax write off’s for home health support.
    3. If you have a banking power of attorney, you can make the payments directly so your parents do not have to see the bill.
    4. You can find low cost support through a community agency.
    5. You can arrange with the provider/aide that services rendered more often are at a reduced rate, making it more affordable to your parents.
    6. IF you have discussed “assisted living” environments in the past, you can compare costs.
    7. Be honest! You can talk about the risks that are currently in the home.  Are your parents willing to end up hospitalized and then placed in a facility?  Or, would they rather spend some money up front?  Not eating well is a risk that can lead to hospitalization and subsequently a medical evaluation that finds the person incapable of living autonomously.
    8. You can look at existing insurance policies to assess if there are funds available, or if the policy can be “cashed out” and used towards help.
12. Following up.  When you ask your parents how this “housekeeping” is going, again, use open ended questions to encourage their verbalization of the benefits.  For example, “What did she do today?”  (Oh, how nice!)  “Are there ways she’s helping you that you didn’t expect?” (Oh, how nice).  If your parents do not want to “fess up” to all the things this person is doing, do not push it.  Does it really matter?  As long as they are getting what they need, you can find out from the aide/caregiver what she is doing straight from her!
13. Discuss your concerns lovingly.  When you were a child, your parents encouraged you to make healthy and appropriate decisions.  You are honoring them by behaving in the same way, making good decisions for their health and safety.  Share this with them.
14. Be honest.  Your parents will know if you are trying to “trick” them and this never works.  If you’re introducing someone through the existing housekeeper, make sure that the new person and the existing housekeeper meet ahead of time so when she is introduced to your parents, you can honestly say they know each other.  Or, if you give the gift of help, make sure you DO use it prior to honestly share what your experience was like.  Dishonesty will always backfire.

For more information or to obtain toolkits to assist in the organization or management of your loved one’s personal, health and financial affairs, visit my website at www.ericksonresource.com or contact me directly at stephanie@ericksonresource.com

Parenting my parents: Where do I start?

 written by: Stephanie Erickson, MSW, LCSW

When we were young children, we looked to our parents to tell us right from wrong, to make decisions for us and to protect us.  As we became a young adult, our relationship to our parents became different.  We still turned to our parents, but more for guidance and support.  Never did we imagine or expect that one day we would be the parent to our parent.  When did it happen?  When was the shift?  Now we are the ones in the “worry seat.” 

As a geriatric social worker, I get calls from adult children expressing concern about their parents and looking for guidance.  My clients say things to me like:

 “I’m so worried about my mom living alone.  She keeps falling.” 

“Last time I was at my dad’s house, he asked me to look at some of his mail and I saw that he hasn’t paid the electricity in three months.”

“I’ve tried to talk to my parents about getting someone into the home to help them but they just won’t discuss it.”

Where do you start?

1. First, take a detailed inventory of all of the areas that you have observed to be of concern.  Use the following categories:
   • Memory (short term, long term, immediate)
   • Orientation problems (time, day, year, people, location)
   • Judgment and decision making
   • Safety concerns (isolation, driving, medication errors, leaving the stove on, etc.)
   • Ambulation (falls, assisted devices)
   • Hygiene
   • Appetite and meal preparation
   • Medication issues
   • Existing relationships and contact with others
   • Financial management
2. Locate an existing power of attorney to ensure your parents’ assets and personal affairs are protected.  If not, consult an attorney or notary and a financial advisor immediately and encourage your parent to draft these documents.
3. Contact your local community agency and share your “inventory” with your contact.  Ask about community services available to meet the identified needs.  What are the processes for finding an assisted living or full nursing care environment?  What are the costs?
4. Is your parent a veteran?  Contact the Veteran’s Affairs office to assess what services are available and what your parent can benefit from.
5. Do a search on line to access your provincial, state or federal government website.  You may have government sponsored programs or funding available to assist you.
6. You can also hire a private geriatric social worker to conduct a complete psychosocial evaluation and assist you in accessing appropriate resources.  If you do not live in the same city as your parent, this is a great resource to have.  Do a search on-line to locate a local referral.  Or, ask a community agency for a referral to a private social worker.  The local hospital social workers may also have a referral.
7. In terms of supportive services, depending on if your parent is autonomous, semi-autonomous or dependent, there are different services available.  You can look at home care support, a retirement community, assisted living, board and care, or a full care nursing facility.  You can find these resources with a search on-line, or a private, community or hospital social worker can provide referrals.

Once you have an idea of what your parent needs and what is available, you can begin to discuss or continue your discussions, sharing your concerns with your parent. I find that with most of my clients, this is the most difficult area.  See my article in next quarter’s newsletter in which initiating difficult topics with our parents will be discussed. 

If you have further questions or are interested in tools to help you assess and organize your parent’s affairs, feel free to contact me directly.

Written by, Stephanie Erickson, MSW, LCSW

www.ericksonresource.com

stephanie@ericksonresource.com