Caring for someone who is injured, frail, or ill can be physically and emotionally exhausting.

In fact, caregivers can become become “burned out” when they don’t get the help they need, or if they try to do more than they are able. They may experience fatigue, stress, anxiety, and depression.

Some symptoms of caregiver burnout include:

• withdrawal from family or friends
• changes in appetite or weight
• feeling hopeless or irritable
• increased use of alcohol or other substances
• decreased work performance
• negligence of responsibilities
• emotional and physical exhaustion

Respite care is short-term, temporary time off for family caregivers from someone who is injured, frail or ill, and it is one way to address caregiver burnout. It can be provided a variety of ways to ensure that the caregiver gets the time off they need, and the recipient of care gets the care and services they need.

Respite care can occur in the home as well as outside the home.

In its simplest form, respite care can be provided for someone by friends or volunteers staying with the care recipient in the home so the caregiver can leave the home and have some time off.

From my personal experience, this in one of the most valuable things you can do to support someone in a caregiver. A concrete offer to come relieve the caregiver at a specific time goes a long way to support them. When my mother was ill, one of her friends came every Monday and Wednesday afternoon so my dad could get out of the house and do the things he needed to do, even if he didn’t have specific plans.

Some faith communities as well as local aging resources may have programs that can provide volunteers to be a companion to someone, take care of meal preparation etc. to give the caregiver some time off.

Respite care can also occur in an Adult Day Care setting. These centers provide care and companionship for seniors who need assistance or supervision during the day so caregivers can go to work or handle personal business while knowing their relative is well cared for and safe. Adult daycares can provide socialization and recreation as well as therapeutic services in some situations.

Respite care outside the home can also be provided by some nursing homes as well as hospice facilities for a day, a weekend or while the caregiver is on vacation.

The cost of respite care varies with the services provided. While it is not usually covered by Medicare, some long-term care insurance policies will cover a portion and there are some federal and state programs available.

Mick Jagger turned 65 a few days ago. That’s right, the Rolling Stones rock and roll legend is officially eligible to retire.

But apparently he has no plans to do so. According to the U.S. News and World Report blog “Planning to Retire,” the Rolling Stones and Universal Music Group signed a long-term deal just last week. So the beat goes on.

And why should Mick retire? Not only are he and his bandmates still able to pack a house, they grossed nearly $558 million on their last tour in 2007.

Most of us aren’t anywhere near being in that financial position, of course. With gas and food prices on the rise, and healthcare costs continuing their climb, many retirees are either returning to work or cutting back to make ends meet, according to a recent MSNBC story that finds seniors “perhaps the hardest-hit victims of the slumping economy.”

An increasing number of older workers are delaying retirement or re-evaluating plans to retire. According to an AARP survey in May, nearly one in five people ages 55 to 64 and about one in four ages 45 to 54 said they planned to delay retirement due to the economic downturn.

An uncertain economy has also spurred some retirees to return to the labor force, fearing they’ll outlive their savings, according to “Shaky Economy Puts Retirement Plans on Hold.” Nearly one of four adults ages 65 to 74 was in the workforce, and those numbers continue to grow. In 2000, the Bureau of Labor Statistics recorded just 19 percent of workers in that age group.

But never mind about “older” workers in their 60s and 70s. How about workers in their 80s? My own mother, who is nearing that age group, just left a position in fundraising in June, will take a short break for the summer, and then will start looking for a new job this fall.

Mom would be perfectly happy to stop working. She has plenty of other things to fill her days. But living on a fixed income — even when keeping expenses down — is tough, and unexpected (and uncovered) medical bills led her to hit the pavement again.

Are your parents continuing to work, deep into traditional retirement age? If so, why? I welcome your stories on this new generation of older workers.

– Lori Woehrle

Seniors’ numbers are growing, but doctors trained in geriatrics are not.

Note: Melissa Evans, a staff writer for the Daily Breeze website, is writing an ocassional series about how the Baby Boomers will affect the Los Angeles region as they age. And while her article focuses locally, the issues certainly are much wider.

With about 70 million Americans set to reach retirement age over the next 20 years, plenty of doctors who specialize in aging will be needed, Evans writes.

But experts see a shortage in the making. Nationwide, there are only 7,100 doctors certified in geriatrics - one for every 2,500 Americans over 70, Evans reports. The Institute of Medicine estimates the country will need an additional 30,000 doctors trained in the field to meet the needs of the aging baby boomer population.

Getting there will be tough. According to a recent report by the Public Policy Institute, an independent research association, just three of the nation’s 145 medical schools have a full-time program in geriatrics, Evans reports. Less than 3 percent of all medical students take even one course in this specialty, according to the report.

But doctors-in-training have little incentive to specialize in geriatrics. One 2007 compensation survey finds that geriatric physicians make an average of $177,392 a year, compared with $193,162 for a general internist.

In addition to making less money, these doctors tend to have to work longer hours, Evans writes.

Fortunately, not all of the country’s medical students are deterred, and you can read her article to learn about some of the most dedicated.

– Lori Woehrle

I’m an only child, and both my mother and my grandmother were only children. My father’s brothers are/were significantly older, and therefore their children, my cousins, are a lot older than I am, and I don’t know them, so I don’t have a lot of extended family.

It doesn’t bother me, but people have a lot of questions and misconceptions about being an only child, and I’ve learned to address them.

Though it was largely theoretical to me for most of my life, I knew I’d have the sole responsibility of taking care of parents as they aged. It became very real when my mother was diagnosed with and lost a long battle to cancer 2 years ago this week.

I have a full-time job and three young children of my own, so there were times that dealing with my mother’s illness was brutal. My boss doesn’t call me the “Sandwich Generation Poster Child” for nothing.

Only children know that this time is coming. We hesitate to move far from home because the burden will be on us, yet we try not to let it consume us. Often, we are launched into the caregiver role suddenly, and you just do it, leaving all those, “I wonder what it will be likes” behind.

While it can be lonely in that there’s no sibling to mull over decisions with, and there’s very little relief for you, there’s also a certain freedom in being the one responsble for things such as health care and housing choices.

I have seen the families of my friends torn apart when mom or dad became ill and the siblings couldn’t agree on how best to care for them. It can be brutal as adults slip back into family roles that were long thought to be left behind in childhood.

The fact is though, that even with the most supportive of spouse and children, only children are often alone in caring for aging parents and must rely on outside help and though it’s hard for people like me, it’s a good idea to reach out to the kindness of friends, no one can do it alone and you don’t have to.

I live in Washington, D.C. But I’m spending a long weekend — very long, Friday to Tuesday — with my sister and her husband in Atlanta.

I love visiting my sister. I grew up in a family of two girls and four boys, so Helen and I have a special bond. Because we live so far apart, we see each other only once or twice a year. One fun part about this trip is it is all relaxation and visit time. Usually when I’m here, it’s because I have a business trip to Atlanta and I take an extra day for a visit. (Nice, but I can always feel the clock ticking when I’ve got work looking over my shoulder.)

The best part of this trip is that I’ve brought my eight-year-old daughter along. Helen is her godmother, and she has a special bond with my daughter, too.

My daughter is the center of attention in this house, and that’s a nice thing for a kid who (1) has two working parents who are always racing from one thing to the next; and (2) has a brother who also needs attention. So it is good for her to be at center stage for a few days.

Seeing my daughter playing and joking with my brother-in-law, and talking earnestly or teasing with my sister, reminds me how vitally important these couple of days are. A time for family connection. No big plans for the day — maybe we’ll take a hike at a nearby park or perhaps spend a couple of hours splashing in the neighborhood pool.

Make time for family, especially folks you don’t see often enough. I know my daughter will always remember this trip to see Aunt Helen and Uncle Frank. She’ll remind me (long after I’ve forgotten) about the fact that Aunt Helen sometimes finds geckos on her back deck, and about Aunt Helen’s glorious chocolate chip cookies.

I can see the future coming, and it’s going to be a lovely memory that makes me smile. And it’s happening now.

– Lori Woehrle

We often hear about how important it is to be familiar with your aging parents’ (or other family members’) finances, but it is often easier said than done to summarize and organize these matters.

It’s a tough thing to talk about because many people were raised to believe that money matters are an intensely personal and private matter. But, the fact is that any of us could be called upon at any time to be in charge of or assist with the finances of someone else. Remember, the 40/70 rule is a good indicator of when it’s time to talk about it, but the earlier the better when you can.

Always consult your legal or financial adviser, but some of the issues to consider:

• Assets – Make a list of checking and savings accounts and investments such as 401(k) accounts, stocks, certificates of deposit and life insurance polices. Also include other assets such as residential and commercial real estate.

• Income – How much money comes in to your parents and from where? Are there pensions or Social Security benefits?

• Other valuables and documents – Do your parents have safe deposit boxes? Where are they? Where are the keys? Whose names are on the signature cards? Where are their important documents stored? What about valuables such as jewelry, antiques and collectibles? Where are their birth certificates and their Social Security and driver’s license numbers?

• Insurance – How much and what types of medical, life and long-term care insurance do your parents have? What do their policies cover? Do they have supplemental insurance? How are the payments made – you need to know this to prevent coverage termination due to a payment lapse.

• Wills – Do your parents have wills? Who have your parents named as executors, trustees and powers of attorney, and do you know how to contact them? If your parents don’t have wills, urge them to work with an attorney and create them so they can avoid potentially huge tax consequences.

It’s also very important to contact each pertinent institution to find out what their requirements are for acting on someone else’s behalf should you be in a position to act as a power of attorney or other legal representative. With various privacy laws, you may not be able to get the information you need if there isn’t proper documentation.

Even if you can’t relate to needing this type of information about your parents because they are young and in good health, it’s still a good idea to broach the subject with them from a “what if there was an emergency?” approach.

Perhaps it is information they could prepare and store in a safe deposit box or with a lawyer if the discussion is deemed too awkward.

Additionally, do you have this type of information on hand for your own finances? In an emergency or under stress, this type of important information may be too difficult to remember.

One of your fist steps into the world of the Sandwich Generation may be having to hire in-home assistance or care for your aging parent or relative when activities of daily living become a struggle.

In addition to navigating the world of payors, you may find yourself having to hire someone to come into your parent’s home in order to provide care whether it be long term or temporary.

Often, home care falls into three categories: Nursing/nursing assistants, home care aides, and, “personal attendants,” sometime referred to as custodial or companion care.

It can get complicated, but, whether or not insurance pays for this help mainly depends upon the patient having a “skilled care need,” i.e. something that only a licensed person (nurse or certified nursing assistant) can perform, or, their needs fall into “activities of daily living” such as eating or bathing that a certified home health aide can perform.

Companion care, tips for hiring in-home care:

1. Have a job description - a list of specific duties that are expected in the position lets the candidate make an informed decision and cuts down on misunderstandings later in the process. Be sure to include a schedule and hours needed.

2. Prepare a list of interview questions - If you are hiring independently, or if the agency lets you interview the prospective caregiver before committing, then you must be prepared with interview questions. Consider screening applicants over the phone and take notes.

Ask such questions as: Where have you worked before? What were your duties? Why did you choose this type of work? What attracted you to this job?

Ask for two work references and a personal reference. Always check them and find out information such as dates of employment, quality of work performed, reasons for leaving, attitude, absences, lateness, honesty and drug or alcohol use. Are they eligible for rehire?

Be sure to notice the reference’s attitude. Are they enthusiastic? Guarded?

3. Consider legal and financial issues - If you are hiring independently, then you must research legal issues such as withholding taxes and insurance coverage. If you’re using an agency, be sure to find out if insurance covers any of the services and the method of payment to the agency.

4. Prepare a written agreement - When you are ready to hire, draw up and sign an agreement with the chosen candidate.

To find independent workers, ask local senior centers, churches or senior organizations for referrals. Also check the classified ads in a newspaper.

You can locate home care companies in the phone book, get referrals from your doctor, hospital or social worker or consult online resources to find workers through an agency.

Most mothers (80%) and grandmothers (74%) say they would rather spend time with family than receive a gift on Mother’s Day. Speaking as a mother myself, and knowing my own mother and step-mother (and mother-in-law), this does not surprise me.

Here are some ideas that I found on a site for an e-mail type product—Presto—that allows the sender to send e-mail, but the receiver to simply receive a printout of the message. Ideal for folks who don’t want a computer, but want to hear from you (or your children) once in a while.

In this digital age, e-mail is probably the communications method of choice for many, but there are others that do not have Internet access or simply choose not to be online. A family communication survey conducted by Harris Interactive® on behalf of Presto Services, Inc. found that about three out of four mothers (76%) and more than half of grandmothers (60%) agreed that advancements in technology, such as cell phones and e-mail, sometimes leave the older generations feeling left out.

In fact, when asked why they prefer not to use the latest technology, such as e-mail, to communicate with family members, about 8 out of 10 mothers (77%) and grandmothers (79%) said they prefer other means of communication, such as regular mail and phone. This could cause a greater communication gap between generations, as grandkids seem to be constantly logging onto MySpace or sending text messages to their pals.

Although 61% of grandmothers said they would like to be in touch with their grandchildren more regularly, recent trends suggest that today’s youth has become embedded in the digital lifestyle and the chances of them picking up the phone or writing a letter to grandma are unlikely.

Technology is not the only barrier when it comes to family communication. As families move farther apart, it becomes increasingly difficult for loved ones to communicate on a regular basis, causing many to lose touch and miss out on cherished family moments. According to the study, 8 out of 10 mothers (81%) and grandmothers (79%) wish they could share more everyday moments with family members they do not see often, and 65% of mothers and 71% of grandmothers agree that their relationships with their children or grandchildren would grow if they shared in each other’s lives by staying in touch more often.

“Communication is the key to a healthy relationship, especially for families that want to maintain that special bond,” said Donna Erickson, family expert and host of PBS’ Donna’s Day. “If a family member is not online, there are plenty of methods that can be used to keep in touch and share special, everyday moments.” Erickson recommends the following tips to stay in touch with technology-shy family members.

• SEND A POST CARD each month to share the latest news. A post card is much more fun than a letter and the pictures create a great visual to bring the note to life.
• PICK UP THE PHONE at least once a week. Even if there is nothing new to share, making a quick call helps to stay connected.
• MAKE TIME FOR A VISIT, especially for those that live nearby. If distance plays a role, make a concerted effort to plan a monthly or even yearly visit.
• TOOLS FOR THE TECH-SHY make regular communication easier. Products like the Presto Service and HP Printing Mailbox and Jitterbug cell phones are perfect for grandma, grandpa or Aunt Betty.

The Presto Service and HP Printing Mailbox lets users receive e-mail and digital photo attachments without a computer. Tech-savvy family and friends can continue to use the convenience of their own e-mail accounts, while grandma, grandpa or Aunt Betty can receive family updates and photos everyday. Presto is available at most major electronics stores and online.

I do not have direct experience with the Presto Service, but it sounds like it could be great. Has anyone out there tried it?

—Lori Woehrle

Doctors across the country are breathing a sign of relief this morning, and if you or your loved ones are among the 44 million Americans who rely on Medicare for access to health care, you should be too.

The U.S. Senate late yesterday (July 9) agreed to recind a 10 percent cut in fees that Medicare pays doctors. The cut went into effect on July 1, but the government has agreed to pay doctors the their full fees retroactively to that date.  The U.S. House overwhelmingly voted against the cut on June 24, meaning that legislatively, the fight over reducing doctors’ fees is over.

The Senate decision is considered a victory for Sen. Edward M. Kennedy (D-Mass.), who returned to Capitol Hill just for this vote from his home in Massachusetts — where he is recovering from June 2 brain surgery to remove a life-threatening tumor. Senate leaders tried to push the bill through without out the Medicare champion in June, but that effort failed.

“I return to the Senate today to keep a promise to our senior citizens – and that’s to protect Medicare,” Kennedy said.  “Win, lose or draw, I wanted to be here.  I wasn’t going to take the chance that my vote could make the difference.”

More and more often, people are opting to stay in their own homes as they age.

Known as “aging in place,” seniors grow older without having to leave their homes and communities. They adapt their surroundings to their needs and they utilize products and services to help them as their circumstances change.

Not only are they are connected to their homes and their neighborhoods and want to remain there, sometimes other senior living options are limited and can be very expensive. Remaining in their own homes helps seniors feel more independent and secure.

But what happens when a senior’s family lives far away? Adult children and grandchildren become long distance caregivers.

They must navigate an array of providers, services and payors, often without seeing or meeting them. It’s important for the family to have a plan in place to care for their loved one when they can’t be nearby.

Some things to consider:

Plan ahead and discuss legal and financial issues before they are needed.

Consult senior care services and networks or the Area Agency on Aging or the Department of Human Services Eldercare Locator to get involved with their network of services.

Make sure that your loved one’s neighbors, doctors, church members etc. know how to reach you and that they know the situation, especially if a senior is living alone. Keep a copy of their local phone book to use to contact resources in their town.

Consider a geriatric care manager to act as an advocate and to help facilitate elder care. Use caution though as there are no licensing requirements for this emerging profession.

If there is a primary caregiver, identify ways in which the long distance family can help. Long distance caregivers can provide emotional support, financial support, speak with health care providers, or handle some financial issues.

Make a physical visit to the home to assess for any hazards and view the actual living situation. Plan your visits so that any appointments or errands can be taken care of during this time. But, also remember to actually visit with your loved one.

Arrange for the senior to keep in touch with family through e-mail, a cell phone or other methods.

Organize a plan of care, make sure everyone in the family knows the plan, and communicate regularly such as through a conference call.

Often, care giving isn’t easy for anyone, whether giving or receiving the care. Sometimes, it’s hard to feel like you’re doing enough, especially when you live far from your loved one, but your efforts are important.