1. Do your homework. Get to know your clients and their needs, so you can better understand what to communicate to these adults and how.

2. Realize that your marketing needs to “capture the spirit” of the viewers, readers or users by featuring real people, with real stories. How would your clients react to your offerings if they captured their spirit? Ask your clients to share their successes online and to encourage others to share theirs.

3. Create a community feeling among your clients from the start. For example, host gatherings in your juice bar or dining area after classes. Program support groups, and invite them to get involved with your center or community. You’ll know you’ve achieved that community feeling when your clients express a sense of ownership about your business. Pride is priceless.

4. Demonstrate that you’re an advocate for your clients. Engage in community events that support mature women or men—from the Red Hat Society, to raising funds for breast or prostate cancer, to hosting postmenopausal education workshops.

5. Create a debate in your community around your offerings.

6. Use your website as an interactive marketing tool for storytelling, and not just as an online brochure. (Seventy percent of adults ages 50–64 use the Internet, as do 82% of those 30–49, and 33% of those over 65, according to a 2006 Pew Internet and American Life Project study.)

7. Be pro-age! Promote “affirmative and hope-driven” attitudes toward aging.

This complete and insightful perspective addresses just about every facet of life that this devastating disease takes hold of and the changes that a caregiver can expect to see in their loved one.  From the early signs of Alzheimer’s, to the importance of maintaining a simple routine, to day-to-day tasks like using a telephone this book is a invaluable companion.

For more information or to order your own copy please visit the author’s site:
http://www.stayingafloatbook.com/

A link to the author’s column in the Tampa Tribune

One particularly helpful feature is their Ask an Expert column.  Dr. Vivian Argento, a trained geriatrician at Bridgeport Hospital in Bridgeport, Connecticut answers caregiver questions on a broad range of topics, from Alzheimer’s medications to tax deductions for caregiving.  Dr. Argento’s responses are clear and compassionate and can help to take some of the guesswork out of eldercare.  Find her column here.

Although there are always different techniques for approaching this conversation, there does seem to be one common opinion: the time to do it is now.  “Everyone over the age of 18 should have a health care proxy form filled out and should be discussing what they would want done with a person that would be making decisions for them in the event that they are not able to make these decisions for themselves,” said Fern Wasserman, Founder of New York Legal Nurse Consultants. New York Legal Nurse Consultants helps facilitate conversations between the individual filling out their health care proxy form and the people who will need to carry out these wishes in the event this person is unable to make their wishes known.

Colleen Reynolds, President of Edge Communications and former admissions and marketing coordinator of a skilled nursing facility in Fort Myers, Fla., also emphasizes that time is of the essence. “I’d suggest that the Healthcare POA/Surrogate be discussed well in advance of needing it. A DNR should be gently discussed, but discussed again when the decision is imminent,” she said. “I watched so many people struggle with this decision and family members who wished desperately that loved ones asked for a DNR after they had been resuscitated and then left to suffer brain damage and broken ribs.”

In Reynolds’s work, she had to have these conversations with patients who did not have any advance directives on file.  “Because the conversations didn’t happen earlier, it was often left up to me to talk to someone who was admitted, if they were not declared legally incompetent, to see if they wanted to be resuscitated in the event of heart failure. Strangers should not have to do this.”

Diane Carbo, RN and founder of Aging Home Health Care, agrees. “Individuals that feel uncomfortable discussing end of life issues do not realize they are giving control over the end of their life to strangers, the health care professionals and the medical delivery system,” she explained. “I want a say, I want everyone to know that quality of life is more important to me than how long I am on this earth.  I want to be the one to have a say in my health care, right up to the end of my life.”

Carbo made her wishes clear to her sons to ensure that if something were to happen everyone would be on the same page. “As an RN I have always found opportunities to talk about end of life issues since my sons were young. The death of a pet, a grandparent or even a sports figure were opportunities in my household that end of life issues were addressed.”

There are various experts and websites that offer their knowledge to help make these decisions go smoothly. Five Wishes is a common guide that people use to provide their doctors and loved ones a more clear picture on their decisions, with 14 million copies in circulation according to their website, that separates the end of life options into five “wishes” the patient can then elaborate on. It is written in plain English that most people would be able to understand, and is legally recognized in 42 states. For residents of the remaining eight, they can use this as a way to clearly outline their wishes for their healthcare proxy to advise their doctors.

Some may wish to request the assistance of a health care professional, an elder advocate or an elder care attorney to help move the conversation along.  Wasserman is an RN who helps families discuss this subject.  She offers her services nation-wide, doing some appointments over the phone or via Skype. She meets with clients at least three times, first to help them determine their wishes and understand what the common medical procedures they may need at a time when they are not able to make decisions for themselves are, then to establish which of these procedures they would be comfortable with on paper and discuss them with the family and health care agent. She gives the family advice on how to advocate for the patient if medical professionals are trying to step in to prevent these advanced care wishes from being followed.  While caregivers can have these conversations themselves, Wasserman said, having the assistance of an insider in the medical field can provide the person filling out their advance directives an understanding of the choices they are being asked to make. “I’m the difference between Turbo Tax and an accountant,” she said. Wasserman utilizes her years in nursing and her inside knowledge of health care to assist her clients to make educated decisions about advance care and end of life critical care choices.

“The original purpose was for only a certain demographic of patients to undergo CPR. It does not cure cancer, if one did not walk before the resuscitative efforts this will not change.  CPR merely gets the heart circulating again,” Wasserman explained. “When circulation stops, all the parts of the body stop working and the organs start to die.  Only time can tell how much damage was done to the person.  Each person is different.”

Joanne Fanizza, Attorney at Law, of The Law Offices of Joanne Fanizza, which lists elder law among their specialties, assists people in writing documents relating to end of life care.  At her Florida practice, she uses one document that covers the living will, health care proxy, and the medical power of attorney, which she calls the “super living will.”

Florida is a perfect example of why people need to do their research about their state’s rules and precedents on actually following the orders.  “The DNR is a separate document that has to be executed with special formalities, including the color of the paper,” Fanizza said.  “Health care providers prefer not to abide it; even if a client has one, they often will not follow it because they’re afraid of liability if the person dies and they didn’t revive them.”

Fanizza also practices in New York, where health care professionals recognize the DNR more than in Florida.  The state also established a default health care proxy law that became effective in June, “which designates a hierarchy of individuals who would make medical decisions for someone who cannot, either temporarily or permanently,” said Fanizza. “It is admirable that New York would establish such a law, but I tell my clients:  ‘Don’t let the state decide who will make your decisions for you!’”

Once it is time to discuss end-of-life care wishes, it is advantageous to remain calm about the subject matter, in order to reassure everyone involved that it is a normal thing to discuss – which, considering the number of people who have advanced directives, is perfectly normal.

“In spite of the subject matter, I kept the conversation casual and light, and it seemed to work,” says Robin Barr, President and Product Inventor at Cold Sores Begone.  At a family get-together, she shared a heartbreaking story about a family that became bitterly estranged only because a family member had not prepared end-of-life documents prior to passing. “I said because I loved them, I took steps to protect them from that situation, had already met with an estate attorney, and gave each a copy of my medical power of attorney and end-of-life documents. I expressed my hope that each would love me enough to do the same. I provided the analogy that it’s no different than what we already do to prepare for emergencies - keeping supplies in the event of an earthquake, pre-identifying what we would grab in a fire, and being aware of where the shut off valves are in the house.”

“This is a very very hard question for most people to answer. In my dad’s case, he said, ‘If they think that CPR will allow me to survive, I want them to do it. If they don’t just let me go,’” Reynolds said, emphasizing that medical professionals would not be able to make that decision in a crisis situation.  Adult children must explain that they are not saying death is immediately imminent, but that if they are growing weaker, they need to make their wishes known in case of emergency.  “These words spoken confidently with a lot of love and concern takes the burden of this decision off the dying patient and allows them to ask for a DNR issue and die peacefully,” Reynolds said.

Discussing end of life care at another shift in life can make it easier. A simple “we have to do this so the Assisted Living Facility knows what to do in case we are not immediately available” can act as a useful icebreaker. Always remind the patient that their advance directives can be changed at any time – as often as they change their mind!

Readers: Have you had this conversation with a loved one? How did you approach the topic? Was it well received? Do you have tips for other readers who haven’t talked about their loved ones wishes yet? Tell us in the comments!

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RetireLife announces free discount prescription card in partnership with Honest Discounts

RetireLife is pleased to offer ScriptSaveRx, a free discount prescription card that saves card bearers 10 to 60 percent off most brand name and generic prescription medications, accepted at over 60,000 pharmacies nationwide.

The ScriptSaveRx card is great for those who fall in the “coverage gap,” need prescriptions not covered by their health insurance, and those without any insurance coverage! Since there are no age or income restrictions or qualifications, the card can be used by people who would simply like a little extra cash in their back pocket.

The Centers for Disease Control and Prevention estimate that 43.6 million Americans were without health insurance in 2008.  Couple this with the fact that $216.7 billion was spent on prescription drugs in 2006, according to The Henry J. Kaiser Family Foundation, Americans can certainly benefit from saving 10 to 60 percent off their prescriptions!

“Offering the ScriptSaveRx prescription discount card provides us with yet another opportunity to help the aging population and their families, who are often responsible for a majority of out-of-pocket prescription costs,” said Megan Shea, founder and CEO of RetireLife, whose website features over 194,000 listings of eldercare services nationwide. “We are very excited about partnering with Honest Discounts to expand the benefits we can offer our users.”

“There is a lot of discussion today about Americans’ difficulties in affording healthcare.  We at HonestD wanted to do more than just talk, we wanted to make a difference,” said Chris Jacobs, Chief Card Giver at Honest Discounts (HonestD).  “That’s why we developed the HonestD Prescription Drug Program, and through our partnership with RetireLife, we can bring it to even more people.  It is a classic ‘actions speak louder than words’ scenario, and now HonestD and RetireLife will be able to speak louder than ever.”

Obtaining the ScriptSaveRx prescription discount card is as easy as going to the ScriptSaveRx page, printing out the card, and saving money right at the pharmacy counter.  Don’t forget to print a copy for your family and friends!

Save 10 to 65 percent off all brand and generic prescription medications

• No activation necessary
• Never expires
• No age or income restrictions or qualifications

Valid at over 60,000 pharmacies nationwide, including:

Target, Rite Aid, CVS, Walgreens, Walmart, and many more.

The ScriptSaveRx card can be used an unlimited number of times, on multiple prescriptions – at no cost to you.

RetireLife’s discount prescription card is offered in partnership with Honest Discounts, a subsidiary of IAB Associates, a 501(c) 3 non-profit organization  (501(c) 6 status pending) established in 1982.

Pharmacy discounts are Not Insurance, and are Not Intended as a Substitute for Insurance.  The discount is only available at participating pharmacies.

About RetireLife

RetireLife [www.retirelife.net] is the nation’s leading online eldercare planning resource – with over 194,000 aging services providers available free for caregivers and adult children of aging parents to find local providers that best fit their needs – from assisted living, to in home health care, elder law attorneys, adult day health programs, companion care, transition and move management services, geriatric care managers, and more.

About Honest Discounts

Honest D (Honest Discounts), located in Boston, MA, is a marketing line of IAB, in Arlington, TX. IAB was established in 1982 and is a 501 (c) 3 non-profit organization. [501 (c) 6 status pending]

Since 2008, the healthcare debate has raged feverishly throughout the United States. The interests of each side have been loudly voiced and strongly heard. Instead of venting about the problems from each end, we at HonestD created a solution. Our answer is the HonestD Prescription Card Program, which allows anyone to save 10 – 60% on all generic or brand name prescriptions not covered by their health insurance. The card is accepted at over 60,000 pharmacies across the country. Our new platform integrates partnerships with non-profits, communities, and small businesses, allowing everyone to join in on the effort to provide affordable healthcare at no cost. The Card Program is the first of many, so stay tuned for more benefits that are currently working their way through the pipeline.

“America’s Most Promising Startups” – BusinessWeek “Frustrated that the aging services industry was “so fragmented and so localized,” she launched a free consumer information site called RetireLife to address the problem last May, the same month she completed her MBA at Babson College. By early February, it had grown into the most comprehensive Web site on the topic in Massachusetts, with some 5,800 listings of residences and professionals across the state. Now she has gone national, increasing total listings to more than 194,000.”

“10 Hot Startups” - Entrepreneur “The Census bureau estimates that the number of people age 65-plus will shoot from 40.2 million in 2010 to 88.5 million in 2050, and some estimates put the eldercare market at nearly $200 billion. At 26, Meagan Shea isn’t anywhere near that demographic, but she’s serving it well with RetireLife.net, which helps aging adults and their caregiver children more easily find care solutions.”

“Hottest Startups of 2010″ - Helium.com “RetireLife.net is a business geared toward the senior section of society and their caregivers. Meagan Shea developed the idea of a central database to help caregivers find services, such as medical, and care facilities for elderly relatives. It is based in Charlestown, Massachusetts.”

“10 Hot Startups with Future Potential” – MSNBC “Shea came up with the idea after going through the onerous process of relocating an aging relative across the country, trying to find appropriate medical and care facilities and services. It inspired her to make an online information and content center for caregivers of aging relatives. RetireLife.net was one of 15 of 42 businesses selected for development by Shea’s business school peers as she was finishing her MBA at Babson College.”

“Young people create services for boomers and seniors” – AARP Global Network “This website focuses on helping adult children finding care-taking solutions for their aging parents.  Founded by 26-year-old Meagan Shea, RetireLife.net was one of 15 businesses that was chosen for development by her MBA colleagues at Babson College”

“Monster and Eons Founder Jeff Taylor Starts Incubator as Protest to Startups Fleeing Boston” Xconomy “I moved into this incubator to surround myself with other startups and to get a new set of blood to bounce ideas off of,” said RetireLife founder Megan Shea, who previously worked out of Babson College’s incubator space. Shea’s website, which launched to a Massachusetts audience last May and opened last month as a national elderly care directory, targets the same baby boomer group as Taylor’s businesses.”

“Family pride brings joy to holiday season,” Bay State Banner “Local entrepreneur Megan Shea said caregivers should speak to visiting relatives in advance so they’re prepared for the changes they’ll see. “It’s really hard for family members who are out of the area to understand the stage at which their loved ones are until they actually see it for themselves,” she said.”

“MBA Teams Compete For Cash,” SanDiego.com “Shea launched the site as a result of her four years caring for aged grandparents. The experience, she says, was frustrated because information and resources for the elderly is “so fragmented and localized.” No longer.”

My mom had been diagnosed with Alzheimer’s Disease seven years before my stepfather passed away suddenly. She had already been started on Aricept, a drug used to help alleviate some confusion in those with Alzheimer’s, but I hadn’t fully grasped the severity of her dementia and how much my step-father had cared – and covered up – for her until his passing five years ago.

As we stood at the hospital, Mom had no idea why she was there or what had happened to her husband, although I had told her repeatedly. The doctor would ask her questions and she would turn to me for the answers. She repeatedly asked me, just seconds apart, “Why are we here?” and “What’s a seizure?” when I told her how her husband had died.

My first task in taking charge of her care was to get a baseline on her medical condition, so I took her to her neurologist. She reconfirmed the Alzheimer’s diagnosis and suggested that I take her to a geriatric institute where she would receive the appropriate medical and psychological care. After she was evaluated by a full panel of medical experts, I received a written prescription stating my mother needed “24 hour assistance with medications, cooking meals, eating on a regular basis, daily hygiene, and observation for falls.” I was encouraged to seek Power of Attorney (POA) and move her to a safe environment. Convinced I was doing the right thing, I obtained the necessary medical signatures and paperwork so I could legally make medical and financial decisions for her.

Thankfully, my mother and stepfather already had their wills and POAs completed. My sister and I were co-executors and POAs, so my first priority was getting her finances in order so I could make necessary arrangements and outstanding payments. As exhausting as it was to hunt down all her accounts and deal with the banks to consolidate them, my hardest job was yet to come – moving her out of her house.

Even before she was diagnosed with Alzheimer’s, my mother had always made it very clear that she did not ever want to move out of her house. When my siblings or I suggested that she move into an assisted living apartment to make things easier for her to manage, she angrily and unequivocally refused – although, I found out later, she would require much more assistance than just assisted living. She reasoned that we didn’t want to be burdened with her, and why couldn’t one of her children move in with her. I explained that we all were married and had families of our own, and suggested that perhaps we could hire some in-home help. She angrily stated that she didn’t need any help. She even tried to strike my sister.

After several failed attempts at trying to convince her to move, including interventions with two different doctors, I realized there was no “reasoning” with someone who had Alzheimer’s. She firmly believed she could take care of herself – and that she was still driving, even though she hadn’t driven for more than 10 years!

My next step was to find out what my legal options were. First, I contacted an elder-care attorney. After reviewing her POA and will, the attorney told me in no uncertain terms that if my mother did not want to move, her documents provided no legal allowance for me to move her against her will. Any doctor’s orders and recommendations that I had stating she was unsafe alone at home meant nothing. I was floored. How could this be when it was clearly a dangerous situation?

Next, I searched websites, contacted the Alzheimer’s Association, the county department of aging, and an elder-care attorney website. ‘Surely someone else has been in this predicament,’ I thought. I was told to contact the county department of aging and have her evaluated for being “a danger to herself or others.” But this would only allow the county to step in for extreme cases of neglect or endangerment, and it wouldn’t guarantee that I would have any control of where she was sent.

I also learned that I could go through the legal process of having my mother declared incompetent and have the court appoint a guardian who may or may not be a family member. This process, I was told, was lengthy, extremely expensive, time consuming, and very stressful for the elderly person because they are questioned at great length in court. Given my mother’s extreme anger when asked about moving, and her financial situation, this was not a viable option.

I resigned myself to the fact that my mother was going to remain in her house alone until I somehow found a way to move her. Then I arranged for 24-hour live-in help with various home-based caregiver agencies. I went through three different people in nine months until I relented that it was not going to work. Mom was mercilessly suspicious of them and couldn’t understand why they wouldn’t leave.

I then arranged for drop-in help, which worked better for my mother, although it still meant she spent far too much time unsupervised, which had me constantly worried. I unplugged her stove, disconnected her car battery, and kept her medications in a carefully labeled, weekly pillbox. I called her multiple times a day and stopped by at least once daily. I gave neighbors my phone number and had them keep an eye on her when she was outside. Despite all this, she would call me repeatedly, asking where her husband was, why her stove didn’t work, where her car keys were, and who was stealing things when she couldn’t find certain items. She would forget to take her medication, despite reminder calls from me and numerous strategically-placed notes. She began to eat erratically and strangely (ice cream for breakfast!) or she sometimes didn’t eat at all. She often locked herself out of the house while doing yard work or getting the mail. A watchful neighbor would call me and I would rush over. Months before, my siblings had abandoned her primary care to me, and it was becoming exhausting. I couldn’t go on like that, and I was quickly running out of options.

Despite knowing I couldn’t move her, I began researching and visiting dementia care facilities. When I spoke to them of my dilemma, they told me, “no one comes here willingly,” which surprisingly provided some comfort. Then one facility offered some helpful insight: often a fall or another injury will necessitate a hospital stay followed by time in a rehab facility. After rehab, I could move my mom into the dementia care facility as part of her continuing recovery, instead of returning her back home. No, they could not restrain her and hold her against her will, but their locked doors (to prevent wandering) would stop her from leaving the building alone, and they could redirect her attempts to leave. The only caveat was whether there would be an available bed at my chosen facility when the accident occurred.

I felt that this solution was somewhat deceitful, and that there was no way I could do that to my mother. But I also realized that I had no other choice. Inside I knew this was how it was going to happen. So I bided my time until my mother would fall and hurt herself. It just didn’t seem like the humane way to deal with the situation!

I didn’t have to wait long. Two months later, Mom fell down the stairs and broke her shoulder. Luckily, it occurred when drop-in help was there and could call 911. Later, I thought, ‘What if my mother had been alone? How long would she have lay there before any type of help arrived?’

My mother was taken to the emergency room, x-rayed and treated for her broken arm. After three days in the hospital being treated for pain management, she spent about a month at a nursing home for rehabilitation. This gave me time to revisit my top two dementia care facilities and see if there were openings. I was very lucky and my first choice had a room available. The staff came to the nursing home and did an evaluation and determined Mom was a good candidate. I then moved her furnishings and other items to the facility. After her discharge from the nursing home, I drove her straight to “her new home” and explained that she would finish her rehab there. Although she didn’t like it, I was able to leave her, knowing she was safe and well cared for.

On my subsequent visits, she always had the same question: “When can I go home?” This always surprised me, because even with the dementia, she knew she wasn’t at home. When asked, however, she couldn’t tell me where home was, but she knew she wasn’t where she wanted to be.

It’s been four and a half years, and my mother still asks when she is going home. She continues to pack up all her clothes daily, because she believes “my husband is coming to take me home.” Although I am sad that she still won’t settle in to her lovely room, I am content in knowing that she is in the best place for her.

The Leonard Florence Center for Living was founded by the Chelsea Jewish Foundation, and is one of 89 Green Houses across the country.  AARP is currently lobbying for legislation to ease access to money to construct smaller nursing homes and assisted living facilities.

Readers: Are you or a loved one living in a “Green Home”?  What aspects of this type of living environment solidified your decision?  Are there drawbacks that you were not expecting?  Tell us in the comments!

“A second move is emotionally trying on the family and the resident, particularly if the resident has Alzheimer’s Disease. They may be facing behavioral problems down the road,” said Andrea Donovan, Senior Housing Placement Consultant and founder of Andrea Donovan Senior Living Advisors. “Will the community be able to accommodate the resident’s change in level of care, or will it involve a move to another community? Not all nursing homes are equipped to handle the later stages of the disease, particularly if a person develops unacceptable behaviors.” Donovan recalled one situation where she had placed a client with Alzheimer’s in an Assisted Living Facility with a “memory unit,” only to have to move them to a facility with a specific Alzheimer’s special care unit, which requires more specific training to become licensed, after the resident began slapping other residents.

Mitch Feigenberg once faced a situation that many adult children run into: what to do when one parent needs more extensive care than their spouse? One way to handle this would be choosing a facility that allows residents to transition between different levels of care while staying in the same building or on the same campus.

Feigenberg’s father, who was afflicted with dementia, needed to transition into assisted living at a time when his mother felt she could stay at home. “My mom moved into independent living in the same facility out of her sense of duty as a wife,” Feigenberg said. “The question, in our case, was more about what my wife, sister and I thought would be in his and their best interest. Knowing that the facility had all levels of care (independent, assisted, memory care, skilled nursing) reduced our stress level about the inevitable transitions that were to come.”

When touring a facility, make sure to meet with the person who would be helping you through any possible future transitions, advises Dr. Robert F. Bornstein, Professor of Psychology at the Derner Institute of Advanced Psychological Studies at Adelphi University and co-author of When Someone You Love Needs Nursing Home, Assisted Living, or In-Home Care: The Complete Guide. “They should be able to explain the process, the steps involved, which skilled care facilities (nursing homes) they work with most frequently, and what sorts of problems they encounter during transitions,” he explained. “Then you may want to speak with representatives of the nursing homes which work most closely with the facility, and ask about their experience as residents transition to them.”

What do you think? Are there other questions that should be considered when choosing an assisted living facility? If you or a loved one have already moved, do you look back and wish you had asked other questions? Let us know in the comments!