When you have aging parents or family members, sometimes you find yourself thrust rather suddenly into a world of taxes, insurance and benefits involved with their care.

In my case, I had a rather general notion of how some of these things worked, but it wasn’t until I had to face it head long when my mother became ill that I really understood how some of these things worked. Since I still have my father and my mother-in-law to care for and I guess I’ll need it someday, too, I thought I’d try to find out what the current candidates for President are proposing for Social Security.

But, what I’ve found is that even as Democrats and Republicans prepare to gather in this election year, there hasn’t been much said about Social Security and its reform has been a political issue for over 30 years.

It’s curious because the Social Security program is set to pay out more than it receives in just a few years and something needs to be done, since for many older Americans, Social Security is their only income.

Earlier this summer, presumptive Democratic presidential candidate Barack Obama called for a Social Security payroll tax on incomes above $250,000 a year. Currently, the tax is only on the first $102,000 of a worker’s income, which includes the salary of most Americans.

Though the plan has been criticized for a lack of detail, he cited that it was unfair for middle class citizens to pay tax on their entire income while the very wealthy only pay tax on a small percentage of their income.

John McCain, the presumptive Republican nominee, doesn’t support raising payroll taxes as a fix for Social Security. He agrees that the current system is unsustainable, and he supports supplementing the current Social Security system with personal accounts that would either permit employees to make contributions above the current payroll tax rate or a mandatory diversion of some of the current contributions to private accounts (”carve out” accounts).

But he has also been quoted that “everything is on the table” to be discussed as a solution, and this could include a tax increase.

Perhaps as the race heats up, we’ll hear more about it, people need to know in order to make an informed decision as Social Security issues are paramount to so many people’s lives.

A healthy sex life can continue well into the 70s and 80s, and apparently that’s on people’s minds all over the country.

More than three-quarters of American men aged 75 to 85 and half of women that age are still interested in sex, a survey of the elderly by University of Chicago researchers found.

“It’s not age per se; that when you get to 80 it’s all over with,” said sociologist Edward Laumann, who led the study of 3,000 American men and women aged 57 to 85 who lived at home, not in nursing homes.

Sexual dysfunction is not an inevitable part of aging, but it is strongly related to a number of factors, such as mental and physical health, demographics and lifetime experiences, many of which are interrelated, according to the study.

STD History a Factor

The study, funded by the National Institutes of Health, found that a history of sexually transmitted disease also has an impact on sexual health later in life. People who had an STD are also more likely to have had sexual experiences over their lifetimes that included more risks and multiple sex partners.

“Having had an STD roughly quadruples a woman’s odds of reporting sexual pain and triples her lubrication problems,” said Laumann, the George Herbert Mead Distinguished Service Professor of Sociology at the University, and lead author of the paper, “Sexual Dysfunction Among Older Adults: Prevalence and Risk Factors from a Nationally Representative U.S. Probability Sample of Men and Women 57 to 85 Years of Age,” published in the current issue of the Journal of Sexual Medicine.

Men are more than five times as likely to report sex as non-pleasurable if they have previously had an STD.

Laumann was joined in writing the paper by University researcher Aniruddha Das, and Linda Waite, the Lucy Flower Professor in Sociology at the University.

The study showed that women may be more likely than men to experience sexual dysfunction because of health issues. The most common problem for men is erectile dysfunction, a problem that increases with age.

“The results point to a need for physicians who are treating older adults experiencing sexual problems to take into account their physical health and also consider their mental health and their satisfaction with their intimate relationship in making any assessment,” Laumann said.

The study is based on interviews with a national sample of 1,550 women and 1,455 men, ages 57 to 85, who were part of the 2005-2006 National Social Life, Health and Aging Project, a nationally representative survey of community-dwelling older U.S. adults. The survey collected data on social life, sexuality, health, and a broad range of biological measures.

Okay, so maybe all the news about aging isn’t bad.

– Lori Woehrle

Like many communities, my neighborhood in Washington, D.C., has an active neighborhood listserv. Neighbors post questions — “where can I find a good plumber?” — announcements, provide (very) local news updates — “the traffic light at Morrison St. has been repaired” — discussion about zoning issues, etc.

I rely on it for leads on babysitters, and to keep up with news like whether the hours at the local library branch are changing.

Today’s post was different, however. It was from a neighbor of a 90-year-old gentleman who lives alone, and it was a important reminder about how we need to watch out for our neighbors, especially the vulnerable.

“As many of us do in this neighborhood, we keep an eye on one of our elderly neighbors. This evening he came to us to tell us of a story that is probably all too common, just not reported, as they are embarrassed about it, or not sure that it really could happen to them,” wrote the listserv poster.

“This week he had some workman clean up his garden, and he paid them and all was good. Then yesterday or today one of the workers came and knocked on his door and demanded payment for the work he did.

“Our neighbor told him he had contracted with the company to do the work, and the guy said, ‘yeah but I did the work, now I need to be paid.’ Thankfully our neighbor chose not to pay this guy.

“The workman got our neighbor out of his home, and would not let him back in until he agreed to pay him, which our neighbor did not. Our neighbor said, ‘I think I will call the police’ (which sadly he did not) and the workman got angry, punched him in the face, and left without anything.

“This incident has gotten him so upset that he has come to stay with us, as he is afraid to be in his own home alone,” the listserv poster wrote.

The listserv poster reminded all of us — and I’m passing this on to you — to watch out for your vulnerable neighbors, including those who are elderly, as they can be easy marks for this kind of bullying.

— Lori Woehrle

An update: The DC police, who also participate on the listserv, stepped in and are now on the lookout for the workman.

Respite care — temporary care designed primarily for an overworked at-home caregiver that has been covered in previous posts for this blog — was the subject of a front-page article in the August 19 New York Times.

The story profiles several families in serious need of time to relax and rejuvinate before they could fully re-engage with full-time caring for an elderly relative with Alzheimer’s disease or or another form of dementia.

The article notes common characteristics of many caregivers — being tired and stressed, not having free time, trading duties with a spouse to always have somone at home — coupled with feeling guilty about the idea of needing time away from caregiving.

“In an aging population, nine million people take care of someone with Alzheimer¹s or another form of dementia, and for many it is a responsibility without a break,” the article says.

“But as health professionals and the federal government have recognized the strain on these family members, including higher rates of depression, hypertension, diabetes, sleep disorder, heart disease and death, a growing number of facilities now offer short-term respite stays. In its simplest form, respite might be a home aide a few hours a week or use of an adult day care service. To caregivers at the end of their rope, real respite means a short time away, what for anyone else would be called a vacation,” the Times reports.

If you’re feeling overwhelmed with caregiving, the article may help you see that you’re not alone, and that there are some ideas out there for you to consider.

As a separate matter, the article notes that Congress passed the Lifespan Respite Act in 2006 to provide support for respite programs, but so far it has not appropriated any money to finance the act.

Perhaps advocating for financing this much-needed program should become a 2008 goal for caregiver or senior groups.

– Lori Woehrle

With cold weather around the corner, there is usually an increase in fires and fire-related injuries. In particular, fires can be a hazard for the elderly.

Older people are more at risk for fire death and injuries since they may be less able to act and make decisions quickly due to the aging process or medications. Also, many older people live alone and don’t have help to react to fire emergencies.

Some fire accidents that affect older people:

• Cooking - cooking accidents can occur if a senior can’t read the stove markings and turns the heat up too high, or if food is left unattended
• Smoking - unsafe smoking (e.g., smoking in bed) habits can cause death or serious injury from fire
• Heating - heating equipment such as space heaters can be a hazard to seniors. Many seniors live on a limited income and they may attempt to save money on the electric bill by using space heaters or the stove to heat the house. Space heaters can cause fires if they are too close to other objects or loose clothing, or they tip over.
• Faulty wiring - many seniors live in older homes with older wiring that can cause problems.

Fire safety tips for seniors:

• Use alarms - make sure all smoke and carbon monoxide detectors are installed and maintained properly
• Plan an escape route - make sure the exits can accommodate walkers or wheelchair safely
• Examine home for safety hazards - check for such things as overloaded electrical outlets, objects too close to, or on top of heaters, blocked escape routes
• Education - remind a senior (especially those who live alone) of such tips as don’t wear loose clothing such as billowy sleeves when cooking, never throw water on a grease fire, never smoke in bed and never leave food unattended when cooking.

Smoke detectors, batteries, and fire extinguishers make good gifts for anyone, especially a older person. However, consider that the recipient may live on their own and have no way to get up high to change the batteries, or, they might not know how to operate a fire extinguisher, so you might want to add maintenance and instruction about how to use these tools to the list.

If you’re starting to become concerned about your loved one living alone, it may be time to consider assisted living, or — as a start — a home care aide. Read more about senior housing and senior care options here.

Though it’s still warm outside in many places, fall is right around the corner.

The change of season also means some chores to get ready for cooler weather and busier schedules. Even though we all have our own homes to care for, if you have parents who are getting older, some fall cleaning chores can be difficult.

However, sometimes, older parents or relatives don’t know what they need help with, or, are hesitant to ask for help doing things that are useful, but, not always critical. Offering to do specific chores might make it easier for older people to accept assistance.

Here are some ideas for chores that might need addressing before everyone leaves the lazy days of summer behind and gets involved with their back to school schedules:

1. Clean and repair any outdoor furniture to prepare for cold weather storage.
2. Weed garden areas and replace any plants weary from the summer sun.
3. Clean or replace air filters on heating and air conditioning units.
4. Check, and, replace light bulbs as needed, don’t forget the outside lights.
5. Inventory and clean out the pantry and refrigerator, and, offer to go shopping to re-stock.

Even though there may be many chores to do, offering to do a specific task may enable someone to open up and ask for the assistance they might need.

However, as Lori points out, it’s imperative that the senior be aware of and willing to accept the assistance before anyone goes in to help with anything.

Whenever I start thinking about long-term care insurance, my immediate next thought is: “Don’t I have something else I need to be doing this afternoon?”

Long-term care insurance is still a pretty non-standard insurance product, so there are a huge number of variations from one policy to another.

Fortunately, the folks at Medicare.org (a private organization, not part of the federal government) have provided a roadmap for comparing policies.

They recommend that once you’ve got a short list of insurance companies, you take a look at a specific list of policy benefits so that you can start to compare the offerings. Start by asking each company for a sample policy.

“Each sample should include an Outline of Coverage section at the beginning of the policy,” according to Medicare.org. “This section briefly summarizes the policy’s benefits and highlights the major features. After you read this section, read through the entire policy to make sure you understand all of the provisions.”

Here are some key items to look for:

• Waiting period: This is the period of time that must pass before the insurance company will begin to pay benefits. It can be anywhere from 0 to 365 days. You’ll be asked to select a waiting period–the shorter the period, the more the policy will cost.
• Duration of benefits (known as the benefit period): You’ll also be asked to select a benefit period (e.g., two years or a lifetime)–the longer the period, the more costly the policy. Watch out for caps placed on the total lifetime benefits you can receive if the policy lets you carry over unused daily benefits beyond the scheduled benefit period.
• Nursing home and home health-care daily benefit: This is the amount of coverage you select as your daily benefit limit (e.g., $50, $200).
• Cost-of-living rider: This feature provides protection against loss of purchasing power due to inflation. It increases your coverage every year to keep pace with inflation (either based on the Consumer Price Index or at a fixed percentage rate).
• Range of care: A policy may provide coverage for different levels of care, such as skilled, intermediate, and/or custodial. A good policy should cover all levels of care.
• Pre-existing conditions: A waiting period (e.g., six months) may be imposed before you can receive coverage for any pre-existing conditions you might have.
• Other exclusions: Some policies may not cover certain medical conditions (e.g., Alzheimer’s or Parkinson’s disease). Others may specify that you have to be in certain types of facilities.
• Premium increases: Some policies may have a level premium for the period that the policy is in effect. In other cases, the premium may increase during the policy period.
• Waiver of premium: Most policies waive your premium after you’ve received benefits for a certain number of days, but sometimes only if you’re receiving care in certain types of facilities.
• Guaranteed renewability: Most policies give you the option to renew the policy and maintain your coverage, despite any changes in your health.
• Grace period: Most policies give you a grace period if you’re late with a premium payment (usually 30 days). This means that the policy will remain in effect during that period.
• Restoration of benefits: This is a feature that restores your benefits if you recover from your condition and do not require care for a consecutive period (e.g., 180 or 365 days).
• Return of premium: You may be entitled to a return of premiums paid (or a nonforfeiture of benefits or a continuation of benefits for a limited period of time) if you cancel your policy after paying premiums for a number of years.
• Prior hospitalization: Some policies require a hospital stay before you can qualify for benefits under the policy. This requirement is less common than it used to be, and you should probably avoid policies that include this provision.

How do the policies you’re considering stack up against each other? Which benefits and features mean the most to you? How much can you customize each policy to your needs? These are very important questions. Knowing how to evaluate LTCI coverage in light of your own needs is the key to comparing and weeding out policies. Your final list of policies should include only ones that can offer exactly what you’re looking for.

– Lori Woehrle

If you’re communicating with someone with dementia, here are tips from the Family Caregiver Alliance for making that a better experience.

“We aren’t born knowing how to communicate with a person with dementia—but we can learn,” says the FCA. “Improving your communication skills will help make caregiving less stressful and will likely improve the quality of your relationship with your loved one. Good communication skills will also enhance your ability to handle the difficult behavior you may encounter as you care for a person with a dementing illness.”

1. Set a positive mood for interaction. Your attitude and body language communicate your feelings and thoughts stronger than your words. Set a positive mood by speaking to your loved one in a pleasant and respectful manner. Use facial expressions, tone of voice and physical touch to help convey your message and show your feelings of affection.
2. Get the person’s attention. Limit distractions and noise—turn off the radio or TV, close the curtains or shut the door, or move to quieter surroundings. Before speaking, make sure you have her attention; address her by name, identify yourself by name and relation, and use nonverbal cues and touch to help keep her focused. If she is seated, get down to her level and maintain eye contact.
3. State your message clearly. Use simple words and sentences. Speak slowly, distinctly and in a reassuring tone. Refrain from raising your voice higher or louder; instead, pitch your voice lower. If she doesn’t understand the first time, use the same wording to repeat your message or question. If she still doesn’t understand, wait a few minutes and rephrase the question. Use the names of people and places instead of pronouns or abbreviations.
4. Ask simple, answerable questions. Ask one question at a time; those with yes or no answers work best. Refrain from asking open-ended questions or giving too many choices. For example, ask, “Would you like to wear your white shirt or your blue shirt?” Better still, show her the choices—visual prompts and cues also help clarify your question and can guide her response.
5. Listen with your ears, eyes and heart. Be patient in waiting for your loved one’s reply. If she is struggling for an answer, it’s okay to suggest words. Watch for nonverbal cues and body language, and respond appropriately. Always strive to listen for the meaning and feelings that underlie the words.
6. Break down activities into a series of steps. This makes many tasks much more manageable. You can encourage your loved one to do what he can, gently remind him of steps he tends to forget, and assist with steps he’s no longer able to accomplish on his own. Using visual cues, such as showing him with your hand where to place the dinner plate, can be very helpful.
7. When the going gets tough, distract and redirect. When your loved one becomes upset, try changing the subject or the environment. For example, ask him for help or suggest going for a walk. It is important to connect with the person on a feeling level, before you redirect. You might say, “I see you’re feeling sad—I’m sorry you’re upset. Let’s go get something to eat.”
8. Respond with affection and reassurance. People with dementia often feel confused, anxious and unsure of themselves. Further, they often get reality confused and may recall things that never really occurred. Avoid trying to convince them they are wrong. Stay focused on the feelings they are demonstrating (which are real) and respond with verbal and physical expressions of comfort, support and reassurance. Sometimes holding hands, touching, hugging and praise will get the person to respond when all else fails.
9. Remember the good old days. Remembering the past is often a soothing and affirming activity. Many people with dementia may not remember what happened 45 minutes ago, but they can clearly recall their lives 45 years earlier. Therefore, avoid asking questions that rely on short-term memory, such as asking the person what they had for lunch. Instead, try asking general questions about the person’s distant past—this information is more likely to be retained.
10. Maintain your sense of humor. Use humor whenever possible, though not at the person’s expense. People with dementia tend to retain their social skills and are usually delighted to laugh along with you.

With the exception of Tip Number 9, the others sound like excellent tips for communicating with children, too. Or for that matter, for communicating with just about anyone.

– Lori Woehrle

One of the hardest decisions an adult with aging parents has to face is, “When is it time for a parent to stop driving?”

While I’m not in favor of mandating that everyone cease driving after a certain age, the reality is that the changes that come with aging, rather than the age itself, can possibly impair driving skills, and it’s important to assure the safety of everyone involved.

Some of the physical changes that affect driving ability include slower reflexes and reaction time, night vision changes, limited physical mobility such as difficulty turning head or raising arms, fatigue, and, increased risk of medication side effects.

It’s a difficult subject for both the driver and the family, but, here’s a sample of the help available out there:

• Warning Signs - when to stop driving from AARP
• Driving Safely While Aging Gracefully - From the United States Government’s National Highway Traffic Safety Administration, this site addresses the aging driver directly
• When to Put the Brakes on Elderly Drivers - a checklist from Aging Parents and Eldercare
• Driving Us Crazy - a interesting Time article about elderly drivers
• Patient Resources for the Older Driver - from the American Medical Association
• AAA Self Rating for the OlderDriver
• In the United States, your local Area Agency On Aging - may have resources to help with older drivers issues and community transportation.
• Also, in the United States, your local unit of National Association of State Units on Aging may be able to help.
• United States Driver’s License Renewal Procedures for Older Drivers

The National Center on Senior Transportation addresses the transportation options for seniors and might be helpful as well.

Many people are aware of their limitations, and, voluntarily stop driving, I hope I will be one of them, someday. However, I can’t imagine what it would be like to have to give up your independence in this way.

Families, health care providers and communities are the most valuable resources for insuring the safety and satisfaction of everyone concerned, when it becomes time for driving retirement.

I enjoy a column in The Washington Post entitled “Family Almanac.” It’s written by Marguerite Kelly, who has a smart and sensible approach to raising children, managing the teenage years, and adapting to changing roles within a family.

Today’s column, What to Overlook, and Not, With an Aging, Anxious Mom, is a different story, however.

In it, a daughter complains that her agoraphobic mother of 78 is losing interest in her own grandchildren. The daughter writes that her mother makes excuses for not seeing the grandchildren, such as that her home is “too messy for visitors.”

Kelly encourages the daughter (and her sister) to hire a housekeeping service to clean their mother’s house while she is out running errands with one of them. “Although she probably will explode when she sees what the cleaners have done, don’t take her complaints personally,” writes Kelly. “In her heart, she’ll be relieved and may even want them to come back in a few months.”

No, no, and double no.

This approach takes all the control away from the mother, and gives her every reason in the world to distrust her own daughters. It disrespects the mother.

Just two days ago I overheard a lunchroom conversation at the office in which an adult granddaughter bragged about how she “cleaned” her 80-year-old grandmother’s apartment while the grandmother was in the hospital for a few days. She threw away “old” copies of National Geographic magazines, for example, because she “knew” her grandmother would never read them.

But from the grandmother’s point of view, whose to say she’ll never read them? Perhaps she was storing them for a purpose. Even if the magazines have no purpose at all, it should be the grandmother’s decision to throw them away.

Don’t toss out a person’s dignity along with the “trash.” If you think your elder needs help with organizing and cleaning out their living space, work with them to make it happen rather than go behind their back. As Aretha sings, it’s a matter of respect.

– Lori Woehrle