The holidays can be a difficult time if a loved one has moved into a senior living facility, or if Alzheimer’s or dementia blocks recognition of family members. Adult children who have not been able to visit an aging parent for several months may notice subtle or drastic changes in their parent’s ability to manage living independently. As if the stress of untangling Christmas lights and waiting in retail store lines wasn’t enough, this extra layer of tension also wraps itself around families during the busy holiday season.

There are a number of things to keep in mind if you are in the “Sandwich Generation” and juggling the many responsibilities that come with this phase of life. Holiday visits with senior family members can still be meaningful, enjoyable, and pleasant –- for both the senior and their extended family -– and all should contribute to making it so.

I’m reminded of the well-known anthem from Fiddler on the Roof, “Tradition,” where Tevye, the patriarch and lead character, sings of the sacred role that traditions play in keeping the community together. The same goes for families today. If there is a tradition that has been longstanding in your home, continue practicing it.

One of our favorite holiday traditions came from my grandparents’ home country of Norway. Every Christmas Eve, we would eat ris grod (Norwegian for rice pudding). Before Grandma dished up the tasty treat, she mixed a nut into the serving bowl. If you were lucky enough to receive the nut in your bowl, you were awarded a marzipan pig. After we left my grandparent’s home, my parents would always allow us to open one gift: a new pair of pajamas to wear that night. Both of these traditions are simple and can be practiced anywhere, and although my Grandpa is currently suffering from Alzheimer’s, I am sure we will still eat ris grod on Christmas Eve.

Perhaps your mother is in a nursing home, but she has always left cookies and milk for Santa. If so, bring a plate of cookies and a glass of milk to her room in the facility. Maybe your grandfather just lost his wife of 50 years. Talk with him about how he is feeling; you may want to create a new tradition together if the grief is still overwhelming.

Other tips:

• A recently posted article on CNN.com offers insights on visiting family members with Alzheimer’s or dementia who may not recognize their loved ones. Regardless of whether or not there is visible recognition, it is absolutely crucial to visit your loved one. In many cases, your loved one may recognize you, but they are unable to recall your name because of the disease’s effects on memory and cognitive function. Perhaps they have lost the ability to speak but are still able to express their emotions non-verbally. Ultimately, it is important to remember that whether or not your loved one recognizes you, they are likely to notice if you are not there. As hard as it may be for you to see them without the ease and closeness you were once accustomed to, your visit will help maintain some sense of normalcy while their own world turns upside down as a result of the disease.

• Ten practical tips for keeping seniors happy during the holidays include reminiscing, planning ahead, and monitoring medications and alcohol. If a loved one lost a spouse within the year, it is important to be sensitive to the signs of depression and offer support for the family member –- respect their need to grieve the loss while providing many opportunities to connect with those who will lift their spirits.

• If it’s been awhile since you last visited your great aunt, keep an eye out for the telltale signs of Alzheimer’s or dementia. All too often, the signs and symptoms are present long before a family member (or the afflicted individual) notices or takes the next step towards diagnosis. Memory loss is not the only sign of dementia –- be aware of personality changes, mood swings, or problems with language.

Most important: Keep things simple, straightforward, and special, and cherish the time spent with family regardless of how different things may be. You may end up creating a new tradition that will be enjoyed for years to come.

- Michelle Seitzer

Last month, the MetLife Mature Market Institute released their 2008 survey of nursing home and assisted living costs. As to be expected, rates increased since last year’s publication. The national average rate for an assisted living facility increased by 2.1% since 2007, bringing the monthly fees from $2,961 to $3,031 and the annual cost from $35,628 to $36,372.

A new feature of the 2008 report is the grouping of assisted living communities based on the number of services included in the base rate, which can vary greatly by community and thereby dramatically effect the overall cost of long-term care.

Most assisted living facilities are regulated at the state level; therefore, when crossing state lines, no two assisted living facilities operate equally. Even the basic definition of assisted living, a care setting that currently more than 900,000 Americans call home, varies greatly from state to state, which also contributes to the variances in costs. However, most assisted living communities advertise “a home-like setting” with assistance provided as needed, as opposed the 24-7 care provided in nursing homes.

Exactly how many standard services are included in the base rate also varies, and, as they age in place, many assisted living consumers will need several supplemental services. These additional services are often charged “a la carte” and can dramatically alter the grand total on the monthly bill.

There is yet another dimension to the already complicated base rate breakdown: charges for assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). ADLs (bathing, dressing, toileting) and IADLs (medication management) can also drastically alter a consumer’s monthly charge, and each community has their own formula for how they calculate these charges.

Finally, if your loved one needs the specialized services offered in an Alzheimer’s wing (provided by 52% of the assisted living facilities surveyed in the report), be prepared to pay. The average base rate for Alzheimer’s and dementia care is $4,267 monthly and $51,204 annually, according to the report’s findings.

Assisted living is an actively evolving market. Baby boomers are aging, state regulations are changing, communities are adapting to provide more specialized services — and we all know that the current economy is unstable, to say the least. All of these factors will impact the bottom line and therefore impact the consumer’s ability to afford this category of care both now and in the future.

Cost analysis aside, choosing the right long-term care setting for a loved one is not an easy task. Just as a prospective home buyer must weigh all the options, pros and cons (hidden costs, taxes, maintenance, etc.), prospective assisted living consumers must do the same. Ask yourself: What is most important to you? For some, aesthetics may be more important than the staff-to-resident ratio. For others who may have more complex care needs, the staff-to-resident ratio will likely be a higher priority than whether there are manicured lawns and walking paths.

Regardless of how you assess your priorities in choosing an assisted living facility to call home, you must choose wisely. Though the data fluctuates by state, the report clearly indicates that life in assisted living communities, regardless of where they are located and how many ancillary services they provide, is expensive.

Be a smart shopper: Weigh all the potential future care needs (the base rate plus the cost of a la carte services), tour many facilities, spend time talking to the staff, eat a meal in the dining room, visit the facility on a weekend or in the evening (most facilities are well-staffed during the day, but a good quality indicator is how well-staffed they are during off-peak hours), do the research, read all the fine print, and ask lots of questions. Your final decision will significantly impact your finances and your family member, and this decision must not be rushed or taken lightly.

Find out more about assisted living options.

- Michelle Seitzer

Elder Cottage Housing Opportunities (ECHO) presents a way for seniors to live near family, but not actually live in the same house with them.

An ECHO unit is a separate, small manufactured home that is in the side or back yard of a single family home, often that of adult children. ECHO units allows older adults to get support as needed, while still remaining independent in their own homes, and giving adult children the privacy they may desire.

These units are constructed with special needs in mind and usually include such features as wheelchair access and easy navigation as well as safety features such as elevated toilets and grab bars in the restroom.

Elder cottages are installed by contractors with a building permit and require proper space on a lot as well as access to water, sewer and electricity. It may be difficult to navigate zoning laws to get them approved. Zoning departments and neighborhood associations may feel that these units detract from the look and the quality of the neighborhood.

These units are temporary and can be removed when it is no longer needed and may even be resold to another family with the need for this type of housing.

Before proceeding with an ECHO housing unit there are some things to consider for both the senior and the property owner:

1. Is there adequate space and accessibility for the unit?
2. Do your zoning laws allow for this type of housing?
3. Is independent living realistic for the senior?
4. Can you provide the care that the senior will need?
5. Is the cost of the unit and care financially feasible?

If an ECHO unit is for you and your family, it can be a great way to help someone maintain their independence while being safely near family and friends.

Find out more about Elder Cottages. Or, for information on more traditional care options, explore eight reasons why home care may be the best choice for your loved one.

While it’s known that many seniors have to make sacrifices to survive, it turns out that some seniors are even commiting crimes to survive.

Crime by the elderly is on the rise in Japan:

Over one-fifth of Japan’s population of 128 million is now aged 65 and over, and the figure is expected to double by midcentury.

In 2007, the number of elderly caught committing crimes other than traffic violations totaled 48,605, twice that of five years earlier. Thefts such as shoplifting were the most common offenses.

According to the article, factors ranging from lower income and loneliness to an unstable living environment are some of the reasons behind these crimes. It’s even speculated that some of the crimes are committed intentionally in order that they may go to jail and have food and a place to sleep as well as health care.

While society can be conflicted about elderly crime, (i.e. should their circumstances dictate the punishment or should they be held to the same standards as their younger counterparts?) it’s clear that correctional facilities must make changes to accommodate the increased elderly population.

Much like any aging group of people, elderly prisoners needs include safety concerns as well as medical and mental health issues.

Examples of safety needs are grab bars by showers and toilets, non-skid surfaces on floors, adequate lighting and doorways and thresholds to accommodate wheelchairs and walkers.

Many aging inmates require skilled medical and nursing care for both acute and chronic illnesses and some facilities choose to provide this care in special elderly wards, though most prisons weren’t built for these special needs.

Though the practicality of detaining elderly, infirm prisoners is hotly debated in some circles, special housing can protect vulnerable elderly prisoners from the general prison population, which can be mentally and physically stessful, and address their needs to help preserve their human dignity.

A visit to the emergency room can be stressful for anyone, especially a senior. They may often be alone in the ER or hesitant to speak up about a problem and they may also have multiple doctors and medications, sometimes making treatment difficult.

In order to get the best ER care and a safe visit, here are some tips:

Prepare for a visit - It is vital for a patient to have pertinent medical information on hand, including medications and dosages, as well as a health history including illnesses, injuries, past surgeries and allergies. Make a list and keep it in your wallet. If you have elderly relatives or friends, keep their information at hand and update it frequently.

So many times I’ve cared for patients in an urgent situation (I was an ER nurse) and needed this information only to be told, “My doctor has all that.” While that may indeed be true, it’s not something the ER should stop and look up in some situations and some places don’t have prompt access to that type of information.

Don’t go alone - When possible, bring someone along to the visit. It is vital that the patient be able to understand and express what happened during the visit as well as the plan for follow-up care. This is most effectively done when the patient has someone with them in the ER, no one should go to the ER alone. A family member or friend can help give the medical history if someone is too sick to take notes or ask questions. You can then also be sure that discharge instructions are followed.

Understand the ER process -Emergency rooms are crowded, and you will likely have to wait a long time, particularly for non-urgent visits. Even when the waiting room looks empty, remember that patients come to the ER by ambulance and helicopter and the patient load in the ER may not always be apparent.

However, if there is a problem or question about someone’s physical condition, the triage nurse is the one who sees patients upon arrival, often in the reception area. Be sure to communicate any problems or changes to that nurse, or ask to see the charge nurse.

Communicate - An ER visit is (usually) a temporary encounter and all parties have to be able to understand what transpired and how to proceed with health care afterward during follow-up. The parties that must communicate include the patient, the hospital, and the patient’s regular physician. Any time one party is left out or doesn’t understand, then the patient’s health could be at risk.

During the visit, ask questions and don’t hold anything back, doctors need to know what the patient is experiencing in order to treat them. When applicable, the patient should be able to state in his or her own words what happened, what the treatment was and the plan for follow-up.

Also, be sure to let the patient’s own physician know what happened, especially if he or she is not on the staff of the hospital and collect pertinent results from the ER before discharge if needed.

Meet Michelle Seitzer, a new blogger for SeniorsForLiving.com.

I’ve had a thing for senior citizens since I was a young girl. Having close relationships with my grandparents certainly contributed to my keen affection for the greatest generation. But I always felt comfortable around elders. I wasn’t frightened when our Brownies troop visited the nursing home to sing Christmas songs or give out cookies. And every time a commercial featuring a senior flashed across the TV, I took notice and made sure to comment on how cute or spunky the star of the advertisement was.

During my first year of college, new students were required to fulfill 20 hours of community service. There was no question where I wanted to serve. I spent those 20 hours assisting the activity director of a nursing home in the suburbs of Philadelphia, and was completely fascinated by the people I met there. Now, I must also mention that since a young age, I loved stories. Loved reading them, loved writing them, loved hearing them. I was a bit too shy to tell them, but I loved creating them just the same. The people in that nursing home were full of interesting stories; many of them were great characters for future stories I hoped to write. I seemed to have found my niche.

So, after the professor signed off on my volunteer hours, I continued visiting these great characters. I woke up early on Saturday mornings to play trivia games with them. I helped the activity director set up for holiday parties. After classes, I visited some of the residents with whom I had developed a special bond. When graduation came into view, the administrator of the facility called me into her office. The activity director had resigned, and as everyone in the facility knew, I was graduating. To the chagrin of many of my classmates who were sending out resumes and going on interviews, I was offered the job before I even got the cap and gown. Things just fell into place.

Once I joined the staff, I gained a much more detailed perspective of how senior living facilities operate. While there were many positives –- a handful of hard-working staff, several kind family members who visited often, and a number of committed volunteers -– I soon began to see the darker side of things. Staff shortages, family members who never came around, volunteers who didn’t show up, poor care, lack of ethics in the way the business was run, and to me — most striking of all — the devastating effects of Alzheimer’s disease. These observations pushed me to seek the next step. What could I do to make a difference and transform these negatives into positives? How could senior care and services be tailored more specifically to meet the complex needs of those with Alzheimer’s? I wanted to fix what was broken, and it seemed that systemic change was needed.

Flash forward a few years and a few more experiences in other senior living facilities, and I’m doing just that. I’m working with the Alzheimer’s Association as the Public Policy Coordinator for the state of Pennsylvania. In this role, I have been able to work with state-level policymakers and agency officials on some of the very issues I confronted during my years in the senior living world. Most recently, I was able to provide input on assisted living legislation and subsequent regulations, specifically addressing Alzheimer’s services in that care setting.

I also understand these issues from a very personal angle. My grandfather is currently struggling with Alzheimer’s and is being cared for at home by my grandmother and my immediate family. I have learned so much during the past few months about the challenges families face in providing at-home care for a loved one.

I look forward to sharing more of my experiences and insights –- whether positive, negative, or indifferent –- from all angles of the senior living world in this blog, while exploring new questions and hearing from you on topics of interest pertaining to older adults and their caregivers.

-Michelle Seitzer

Flu season is underway and it’s important to make sure you, and, the elder in your life, and anyone who is high risk gets a flu (and pneumonia) shot as recommended by a physician.

The symptoms of flu in older adults are much the same as in other age groups and may include: fever, headache, fatigue, general aches and pains, chest discomfort, cough and sore throat.

Seniors are particularly susceptible to respiratory flu complications such as pneumonia since they may have a reduced cough and gag reflex as well as weakened immune systems which makes it harder to fight the illness. Additionally, dehydration is a risk for the elderly as well as the possibility of other conditions such as asthma or heart disease worsening.

Despite the fact that there’s been some controversy about flu vaccine for the elderly, it’s been recently suggested that a high dose flu vaccine is beneficial to the elderly:

A high dose of seasonal flu vaccine gives an added boost to the immune system of people aged 65 and older and provides them with better protection, according to a U.S. study that included nearly 4,000 people.

The flu can be a very serious illness and it’s important to remember that anyone exposed to it can get it, not just those at high risk such as the elderly, young children and people with chronic illnesses. Though the best times to get vaccinated are October and November, remember it’s never too late to do it.

There are some myths about the flu and it’s especially important to remember that the flu is more than a “bad cold” and that you cannot get the flu from vaccine since it is not a live virus and that common-sense infection-control measures like avoiding other sick people and frequent hand washing are still important in flu prevention.

Hospice is a philosphy of care rather than a place (though there can be hospice residences) and that care can be provided in a variety of settings.

One place that isn’t commonly thought of for hospice care is in a nursing home.

Nursing homes usually have the image of skilled nursing care or rehabilitation rather than actively supporting the dying process. Though some people argue that it’s a duplication of services, nursing home patients can receive hospice care.

Nursing home staff can be stretched thin and since a hospice patient requires even more care than a typical nursing home patient. Though many nursing homes believe their staff can fill this role, it makes sense for a specially trained team to enhance and complement the nursing home to improve end of life care.

The hospice team is more than one trained person. The team includes doctors, nurses, social workers, spiritual counselors, home health aides, bereavement counselors and volunteers. They help patients live out their final days with dignity and with as much physical comfort as possible.

Hospice care in the nursing home also reduces end-of-life hospitalizations which can be both stressful and costly and negatively affect a person’s remaining quality of life.

Medicare has a hospice benefit for those eligible for Medicare Part A (Hospital Insurance), but it is important for beneficiaries to look closely at the benefits when someone is in a nursing home bed that is already covered by Medicare.