Dr. Shady Salib isn’t the sort of physician who sugarcoats the truth. “Becoming a caregiver suddenly can be very stressful,” says Salib, a touted internist and the chief of staff at Palm Beach Gardens Medical Center.
Easing his patients’ families through the caregiving process is part of his daily routine, but he felt altogether unprepared when he learned his mother, a retired physician in her 70s, had fallen and fractured her leg during a visit to his sister’s home in Houston.
“I freaked out and panicked,” he admits. He also remembers how his mind flooded with questions: How would his mother get up and down the stairs? Would he need to take time off from work?
According to AARP and the National Alliance for Caregiving, approximately 43.5 million Americans have served as unpaid caregivers to a family member in the past 12 months. With the nation’s elderly on the rise, so will be the need for affordable and accessible elder services and quality caregiving.
In “The Silver Tsunami,” a recent study spearheaded by Broward’s Community Foundation, Jewish Federation and United Way, the region will witness its greatest population shift, from ages 55-64 to 60-74, in the next five to 10 years.
“Broward is a growing community and the aging population is the biggest part of that growth,” says Sheri Brown, vice president of grants and initiatives at the Community Foundation of Broward. “The study’s important because, when we look at how our systems are currently designed, we find that it’s not equipped to handle this massive growth of older people.”
While the system requires tweaking, family caregivers already have many resources at their disposal, including the Aging and Disability Resource Center in Broward and Palm Beach counties, and the Area Agency on Aging, whose office locations are listed on the State of Florida’s Department of Elder Affairs website.
BEGIN WITH A CHAT
Unlike most journeys, caregiving doesn’t have a set starting point. Aging experts recommend talking to a loved one about their desires and expectations, which will help you determine your next steps. There’s always the possibility an older adult won’t want to divulge personal details or admit they need help, especially from children. Try discussing one area of concern, such as estate planning or gathering important paperwork. If you encounter resistance, ask their doctor or lawyer to run interference.
BUILD AN ESTATE PLAN
Your parents should have an estate plan, if they don’t already have one. This will outline how their assets are to be preserved, managed and distributed when they’ve passed away. Assets are typically transferred through a will, a trust or both. Lou Lehr, partner emeritus at Saul Ewing Arnstein & Lehr in West Palm Beach, recommends having both, but the trust being the operative document.
“A trust can be used to avoid probate, a will cannot,” he says. Trusts can also reduce estate taxes and safeguard the inheritance from a beneficiary’s creditors. Trusts laws can be complicated and vary from state to state, so hiring an estate-planning lawyer to prepare them properly is a safe bet. A power of attorney agent or an estate trustee should also be appointed.
Advance care planning is deciding and documenting, in an advance directive for example, the type of medical care a loved one would want if they became sick or incapacitated. A health care proxy can be assigned to make medical treatment decisions on the elder’s behalf. Be familiar with any health conditions your loved one has, and had, as well as what their insurance pays and what it doesn’t.
CONSIDER LONG-TERM CARE INSURANCE
The cost of elder care, especially if someone requires roundthe-clock assistance, can cause sticker shock. Depending on the policy purchased, long-term care insurance can pay part of the cost of care received at home, in assisted living residences or nursing homes, and other specialized services.
HOME IS WHERE THE HELP IS
Families often struggle over the best living situation for their parents. Three options to consider include in-home care agencies, nursing homes and assisted living communities. Nursing homes can be costlier than assisted living communities because they typically provide more intensive levels of care while elder care costs associated with in-home care can easily surpass assisted living expenses.
For local Patti Unruh, her parents, John and Patricia Atwater, didn’t want to become an encumbrance to their six children. “They would say, ‘We want to be able to take care of ourselves so that we’re never a burden on anybody,’” Unruh says. After her father, a former FBI agent and WWII fighter pilot, died and her mother suffered a stroke that affected her vision, Unruh started looking for a retirement community with continuum care.
With some coaxing from Unruh and her siblings, Enid and Jeff Atwater, the family matriarch agreed to stay in an independent living community at La Posada in Palm Beach Gardens, but on a trial basis. After six weeks, she was hooked. “Our mother was always very physically active,” Unruh says. “Here, she had a place to go, everybody knew her name and she could be busy all day long.”
Continuing care retirement communities, like La Posada and MorseLife Health System, a five-star, 50-acre senior living community in West Palm Beach, are “one-stop shops” offering independent and assisted living options as well as memory care and skilled nursing. They also feature a range of amenities, like wellness and fitness programs and a busy social calendar.
MorseLife President and CEO Keith Myers says due diligence and research are keys to finding quality senior living. “Once you’ve researched the facility, go see it and ‘kick the tires.’ Ask residents if they like living there and why they like it.”
Keep in mind many assisted living facilities and nursing homes have waiting lists, and it may take years to snag a spot.
STARING IS CARING: LOOK FOR THE EARLY SIGNS OF DEMENTIA
In 2018, more than 540,000 Floridians 65-years and older were diagnosed with Alzheimer’s disease, the most common type of dementia. Dr. Salib says looking for signs of early dementia can lead to a quicker diagnosis and treatment. After noticing two of his patients, both in their 80s and active, appeared unkempt and kept forgetting their medications, he reached out to their daughter. They discussed dementia and the warning signs.
“I also asked if she or another family member could come with them to every visit,” he says. Over the next year, the couple’s blood pressure and sugars improved, and their confidence returned. “We slowed down the progression of the disease just by getting the caregiver involved and educated.”
CONSIDER PROFESSIONAL CAREGIVING ASSISTANCE
Depending on the family caregiver’s schedule, or where they reside, hiring a professional may be necessary. Home care agencies, like Right at Home in Lake Worth and Palm Beach Gardens, offer a compendium of cost-effective services, ranging from housekeeping and running errands to performing memory and motion exercises. Employing an independent caregiver is another option. Be sure to conduct a complete background check and ask them to sign an independent caregiver agreement with a start date, schedule and responsibilities to avoid any issues later on. For a sample agreement, Paying for Senior Care (payingforseniorcare.com) is a useful resource.
GET IT TOGETHER
Store your loved one’s health records, medical history and personal information in a binder or in a digital document storage system you can access easily. This may include a list of medications and copies of lab results, clinical notes, hospital discharge summaries and advance directives. Also keep social security numbers, birth dates and important contacts close by. “I’d update the information every six months and had a file on my phone so I could send it to my family if they needed it,” Salib says.
“There are so many support systems that we, as doctors, can provide caregivers to help them be involved and not overwhelmed and burned out.”
– Dr. Shady Salib
THERE’S TECHNOLOGY FOR THAT
No one will ever forget Life Alert’s famous catchphrase, “Help, I’ve fallen and I can’t get up!” The National Council on Aging reports an elder adult dies every 19 minutes from a fall. Products with motion sensors can detect movement in the home so if someone hasn’t moved in awhile, possibly due to a fall or home health emergency, it will send a signal to your phone.
Smartphone apps can be a caregiver’s best friend. Care.com makes it easy to source excellent caregivers. CareZone stores health information, like medications, medical files and important contacts, tracks refills and doctor’s appointments, and assigns tasks to helpers to squelch caregiver burnout. GoodRX compares prescription drug prices and finds coupons at area drugstores.
TAKE CARE OF YOURSELF
The role of a caregiver can feel taxing and lead to burnout. Lessen anxiety by carving out time for the activities you enjoy. Sign up for a respite service, like South Florida Institute on Aging RELIEF for Caregivers and Senior Companion programs, which sends over a trained volunteer to shoulder some of the caregiving responsibilities for a few hours. Supplement healthy practices by joining a support group and speak with your physician. Salib says, “There are so many support systems that we, as doctors, can provide caregivers to help them be involved and not overwhelmed and burned out.”
BENEFITS FOR CAREGIVERS
Balancing a full-time or parttime job with caregiving responsibilities can lead to reduced work productivity, tardiness and even time off. The Family Caregiver Alliance states that 70 percent of these caregivers suffer from work-related difficulties as a result of their dual roles. Peter Kaldes, president and CEO of South Florida Institute on Aging (SoFIA) in Wilton Manors, recommends learning if your company has an employee assistance program. These employer-sponsored programs are free, confidential and available to employees (and sometimes their families). They range from counseling to legal assistance. If not, you may want to talk with your employer about telecommuting, flexible hours, job sharing or rearranging your schedule to help reduce stress. You can learn more about these work benefits, community resources for caregivers, the economics of aging and more at SoFIA’s “Aging in South Florida Symposium” at Nova Southeastern University on June 21.